- Daytime wheeze < 2 /day
- Need reliever < 2 /week
- No limit on activity
- No night symptoms or wheeze on waking
- Daytime symptoms > 3 /week
- Need reliever > 2 / :week
- Limitation of activity
- Night symptoms or on waking
Factors in involved in suboptimal asthma outcomes are :
- Inhaler technique – a feview with your doctor is always worthwhile even if you are an experienced user
- Medication timing (up to 50% of asthmatics do not take there preventer as prescribed)
- C-o morbidities like allergies, sinusitis, nasal polyps reflux and obesity are common aggravating conditions
Chronic asthmatics on preventer medication should have regular eye checks every 1-2 years to minimize the risk of early cataract formation and bone density test every 2 years to minimize the risk of osteoporosis in those on long term preventer medication
If your asthma is not optimally controlled see your doctor to maximize your capacity to breath.
Gestational diabetes occurs in 0ver 8% of pregnancies and is associated increased risk in pregnancy including large babies , obstructed or prolonged labour, premature births and maternal hypertension. Oral glucose tolerance testing is often requested for high risk patients , the obese, those with previous gestational diabetes, older maternal age , family history of diabetes and ethnicities from Asia , the middle east , subcontinent , Hispanic or Pacific backgrounds.
Risk factors that can be modified include
- reduction of weight for the obese consuming a nutritious diet tht does lead to excessive weight gain and minimizing excessive post meal blood glucose levels.
- Exercise – hose women who are physically active before or during pregnancy have a lower risk of developing gestation l diabetes – possibly 20% less risk
Breast feeding appears to improve subsequent outcomes for mothers who have gestational diabetes or tending to develop postpartum type 2 diabetes.
This problem often presents as frequency of urination or frequent episode of needing to pass urine at night , or a sense of urgency to void sometimes accompanied by incontinence .involves the use of anticholinergic medications and third line referral to a urologist for consideration of any surgical factors that might be corrected , interventions or consideration of newer therapies like botox.
Diabetes and urinary infection should be excluded . Urodynamic studies or cystoscopy may be required to exclude rarer causes.
Bladder training and pelvic floor exercises whilst avoiding caffeine and treating constipation are the first phase of treatment . Subsequent treatment