International Foundation for Asthma and COPD in the UAE

I would like to welcome you all to this Website site International Foundation for Asthma and COPD in the UAE

Let me introduce myself.

My name is Pieter Engelhardt

Age 50 years old

Nationality Dutch

E-mail address:pietertje197550@gmail.com

Mobile phone number and WhatsApp number: +971 56 633 0524

Homepage:

https://sites.google.com/view/freewillyorcaswimmingschooluae/homepage

Facebook :

The best International Academy Institute Free willy orca swimming school

when I was a baby I suffered from asthma and now I am 50 years old and I still suffer from it.

I have created this website and facebook profile for everyone in the UAE, so that we can connect with each other and talk about the situation in the UAE, about the asthma and COPD in our daily life.

There are many people in the UAE who do not want to understand and they laugh in your face and they have no respect for the fellow human being who suffers a lot from their asthma and COPD.

Because you tell them that the air conditioning is too cold in the room and that we have too many problems with our asthma and COPD every day and night

I also created a Facebook site International Foundation for Asthma and COPD in the UAE

i can create a program for everyone who has asthma and COPD and that together we can enjoy life better.

I am a swimming instructor myself and have more than 30 years of experience in swimming and sports

I am a Dutch-European and have more than 44 years of experience with the Rescue Brigade and rescue team

and lifeguard because I have been with the Rescue Brigade in the Netherlands since I was 5 years old.

I am a Dutch-European since I was 10 years old, I started studying,

for a swimming instructor until I was 20 years old.

I am a Dutch-European and have more than 30 years of experience

with baby's Swimming.

I have more than 30 years of experience in international professional swimming training and international professional swimming teacher and international professional training for water paranoia and trauma to the water that makes them unable to shower or even go to the pool and international professional stress manager and international professional medical massage for everyone and international professional lifeguard training and international professional paramedical training and international professional aqua gymnastics and international professional swimming therapy and international professional therapy for asthma, copd and disabled children and adults and international professional baby courses and international professional water polo and teaching children in preparation for international swimming competitions and international professional Olympic swimming training and much more......

I speak four languages (English, Dutch and German and Tagalog very well).

I also have Dubai Lifeguard certification and Emergency first aid, defibrillation and CPR (hands only CPR) * swimming training *swimming teacher * first Survival technique is the basic technique for all swimming techniques in the world, including in the United Arab Emirates. * Olympic swimmer training ( these swimming techniques Freestyle, Butterfly, Backstroke, Breaststroke, Front crawl, Back crawl, Medley, these are for the Olympic swimmer and international swimming competitions. * international professional training for water paranoia * Water polo training * water therapy * aqua gymnastics * baby courses * Also give Medical massage to everyone * and international professional stress manager * lifeguard training * paramedical training (Emergency first aid, defibrillation and CPR (hands only CPR) * therapy for asthama, copd and disabled children and adults with disabilities and Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability, Very severe intellectual disability and that intellectual disability more often also has a psychiatric disorder

For example asthma, copd and psychoses, schizophrenia, obsessive-compulsive disorder, ADHD, depression, epilepsy diabetes and movement problems autism, trauma and intellectual disability,

'intellectual disability' or mentally handicapped

I see that every time the fake swimming instructor in United Arab Emirates especially in Abu Dhabi

that they make video or photo of your children in the swimming pool especially of the girl and

I see that the fake swimming instructor do every time to make video and photo and that is 100% not allowed.

I have a lot of contact with America FBI to stop this to make

video or photo of children and especially video or photo of the girl.

That making video and photo is not allowed in the swimming pool by all the fake swimming instructor.

Because there are international rules that it is not allowed to make

video and photo of children and especially girls.

If a fake swimming instructor tells you that they show video or photo

to your children or if they swim well is 100% lies.

These fake swimming instructors sell the video or photo of your children

on the black market where they earn a lot of money.

Especially video or photo of the girl the fake swimming instructor earns

a lot of money on the black market and that is 100%.

Please Call Abu Dhabi Police 999

And tell that fake swimming instructor illegally make video and photo

of children and girls in the swimming pool.

Do not go the lifeguard because they get money from the fake swimming instructor

to make video and photo of the children and especially girls.

Because the lifeguard earn too little money with their work, because of the fake

swimming instructor the lifeguard have a little more money because of that video and photo making.

Here are the Code of Conduct for the Swimming Industry.

Version November 2021

The interaction between swimming pool employees and visitors

and swimming students cannot be regulated in detail.

Certainly not when physical contact is necessary in the form of instruction,

correction or assistance (think of visitors with a disability) or to prevent drowning

or another unsafe situation or is necessary for maintaining order and safety.

Nevertheless, it is advisable to establish principles and rules of conduct on

the basis of which the boundary between permitted and undesirable behaviour

of swimming pool employees in specific situations can be determined.

The aim of this is to protect all persons involved and

to promote public confidence in the swimming industry.

The National Swimming Safety Council (hereinafter referred to as ‘NRZ’) and stakeholders

from the swimming industry (hereinafter referred to as ‘the swimming industry’) have entered

into consultations with the aim of realising a code of conduct with the above-mentioned purpose.

To this end, NRZ and the swimming sector have drawn up the

‘Code of Conduct for the Swimming Sector’ and the ‘Principles of Professional Practice in General’

(hereinafter jointly referred to as: ‘the code of conduct’), which contain rules of conduct.

These rules of conduct are intended as a guideline for correct behaviour by swimming pool employees.

The various examples of undesirable behaviour mentioned

in the code of conduct are therefore not exhaustive or static.

A number of terms mentioned in the code of conduct

are defined below.

In 2021, the Code of Conduct for the Swimming Sector was updated by NRZ, in collaboration

with various sector parties, based on the most recent developments.

In addition, the Code of Conduct for the Swimming Sector was supplemented with the section

‘The swimming pool employee in contact with colleagues’.

Swimming pool employee

In the code of conduct, the term ‘swimming pool employee’ is understood to mean:

a natural person who, regardless of the legal status of the working relationship

(civil servant, employee, seconded employee, self-employed person, temporary worker, volunteer, intern, student, etc.), performs work in the:

● executive framework, for example in the position of swimming pool employee or swimming instructor;

● facility framework, for example in the position of canteen employee,

maintenance employee, counter employee;

● management framework;

● administrative framework;

● supervisory framework, for example in the position of delegated diploma swimming.

Visitor

The term ‘visitor’ is understood to mean: any (natural) person, other than

a swimming pool employee, who visits the swimming pool.

Swimming student

The term ‘swimming student’ is understood to mean: any visitor who

receives swimming lessons from a swimming pool employee.

Logbook

The term ‘logbook’ means: a register, written or digital, in which the swimming pool

employee can record the events mentioned in the code of conduct

General principles of professional practice

A swimming pool employee

1. strives to practice the profession as well as possible and in doing so takes into account

the views and positions of the professional group as laid down in the code of conduct;

is constantly aware of the exemplary function when practicing the profession;

2. takes personal responsibility for practicing the profession within the limits of swimming

education and within the applicable regulations of the swimming pool where the work is performed;

3. observes the limits of professional expertise; in the event of the nature and scope of

problems that exceed expertise, the swimming pool employee is obliged to call in other experts;

for example in the event of suspected abuse and mistreatment (in the home situation);

4. is responsible for the further development of professionalism; also in the area of social interaction

and correct communication with visitors, parent(s)/guardian(s) and children;

5. performs the work as a member of a team, in a collegial responsibility;

6. maintains professional contacts with colleagues within the swimming pool

and with the swimming pool management;

7. communicates correctly with colleagues and management in words, gestures,

in writing and via social media or other electronic means;

8. ensures that colleagues adhere to the code of conduct. Where appropriate,

addresses colleagues about undesirable forms of conduct;

9. informs the manager in the event of undesirable forms of conduct or

disregard of the code of conduct by a colleague;

10. refrains from behaviour and statements that discredit the employer,

colleagues or visitors, also when using social media, and is an example to others;

11. can provide a certificate of good conduct (VOG);

12. addresses the employer, colleagues, visitors or parent(s)/guardian(s) in appropriate cases

about undesirable forms of conduct, such as making and sharing images without permission

B. The swimming pool employee in contact with visitors

1. provides an environment and atmosphere in which the visitors of the swimming pool, including

swimming students, children and parent(s)/guardian(s), feel safe; by being visible,

supervising and consistently monitoring compliance with the regulations, house rules,

code of conduct and other internal agreements and enforcing the rules;

2. has the duty to protect visitors against (power) abuse, (sexual) intimidation and

other undesirable forms of conduct within the swimming pool.

The employee is vigilant and alert to signs of transgressive behavior and takes action if necessary;

3. realizes at all times that certain situations and/or actions can be experienced by

the visitor as (sexual) intimidation, or can lead to accusations of undesirable behavior.

The employee acts in accordance with established regulations, house rules, code of conduct

and other internal agreements so that it is easy to explain the actions and

there is insight into the actions and the motives;

4. avoids 1-on-1 situations with visitors in a closed space, unless this is necessary from a safety

and/or health perspective, such as in the event that first aid must be provided, life-saving actions

must be performed or the swimming pool must be evacuated due to calamities.

Such a situation is always recorded in the logbook and reported to the manager;

5. only enters a changing room, shower room, sauna or similar space where a visitor is

after obtaining prior permission from the visitor and will then justify entering the

changing room/shower room to the manager.

If it is nevertheless necessary for reasons of safety and health of the visitor to enter this space, such as in

the cases mentioned in Article 4, the swimming pool employee will announce this clearly and with reasons.

Such a situation is always recorded in the logbook and reported to the manager.

The visitor is granted as much privacy as possible;

6. only has physical contact with the visitor if this is functional and/or necessary,

for example for educational reasons or for reasons of the visitor's safety or health,

for example when first aid must be provided or life-saving actions must be performed.

Does not touch the visitor in such a way that the visitor and/or the employee themselves

can reasonably expect this contact to be sexual, aggressive or intimidating;

7. behaves hospitably and respectfully. Respects the visitor and refrains from treating

the visitor in a way that affects the visitor's dignity.

Therefore, refrains from any form of intimidation, namely: humiliating, threatening, coercing,

swearing, ignoring, bullying, sexual intimidation, discrimination on the grounds of gender, race,

(philosophical) belief, sexual preference, disability or for any other reason;

8. shows involvement with the visitor, but always maintains and maintains

a professional distance in contacts with the visitor;

9. does not penetrate further into the (private) life of the visitor than is necessary for the performance of

the function; this also applies to contacts via social media or other electronic means of communication;

10. clearly indicates the boundary if a visitor insists on intimacy; this also applies if intimacy is

insisted on via social media or other electronic means of communication.

The rules for dealing with 'visitors' in general have been set out above.

The following describes specific additional rules with regard to swimming students

and their parent(s)/guardian(s).

These two groups are primarily visitors to the swimming pool, but

unlike regular visitors, swimming students have social contact with their

swimming instructor during swimming lessons.

There is direct contact between swimming student and swimming instructor within

a dependency situation.

Also in the contact with their parent(s)/guardian(s) there is such a relationship of

dependency between swimming instructor and parent(s)/guardian(s),

whereby the swimming instructor has professional

predominance by virtue of the profession.

The above also applies in appropriate cases to

pool employees other than swimming instructors.

C. The swimming pool employee in contact with swimming students

1. respects the swimming student in look, word, gesture and does not make video recordings,

unless swimming students and/or their parent(s)/guardian(s) themselves request the making

of video recordings and in that case in such a way that the swimming student's dignity is not affected;

2. does not abuse in any way the power and dependency relationship that results

from the profession; both during work and outside of work and in

any form of communication (for example social media);

3. refrains from any form of intimidation, namely: humiliating, threatening, coercing,

swearing, ignoring, bullying, sexual intimidation, discrimination on the basis of gender, race,

belief, sexual preference, disability or for any other reason; children are addressed by their name

and certainly not on their external characteristics or specific behavior;

4. ensures social safety during lessons, especially for the less gifted swimming students; unnecessary

comparison situations and situations that accentuate the physical appearance are avoided;

5. ensures that necessary physical contact is functional and cannot be misunderstood.

Functional contact such as technique, posture and breathing corrections are preceded as much as possible

by an announcement of the contact and are accompanied by an explanation of the reason for the contact.

D. The swimming pool employee in contact with parent(s)/guardian(s)

1. respects the parent(s)/guardian(s) in look, word and gesture;

2. deals correctly with the dominance resulting from the profession in contact with parent(s)/guardian(s);

3. provides honest and relevant information about the progress/performance and (movement)

behaviour to parent(s)/guardian(s) with regard to the swimming student;

4. is visible during the lesson situation.

If the situation requires a 1-on-1 setting, this will be in the presence

or direct visibility of the parent(s)/guardian(s) if possible.

If this is not possible, the employee will discuss this with the manager

and ask the parent(s)/guardian(s) for permission.

The pool employee will also report such a situation in the logbook;

5. realizes that certain instructional actions can be misunderstood by the parent(s)/guardian(s)

and can lead to accusations of (sexual) intimidation; is therefore always prepared to account for

the pedagogical approach followed/the method of instruction to the parent(s)/guardian(s) and manager.

The use of a pedagogical approach that is not applied as standard will be reported by the

pool employee in the logbook and to the parent(s)/guardian(s).

E. The swimming pool employee in contact with colleagues

1. refrains from any form of intimidation, namely: humiliating, threatening, coercing,

swearing, ignoring, bullying, sexual harassment, discrimination on the basis of gender,

race, belief, sexual preference, disability or for any other reason;

2. does not abuse in any way the power and dependency relationship that results from the profession;

both during work and outside of work and in any form of communication (for example social media);

3. enters a changing room, shower room or similar space, where a colleague is,

only after expressly obtaining permission from the colleague;

4. clearly indicates the boundary if a colleague insists on intimacy in any form or at any time;

this also applies if intimacy is insisted on via social media or other electronic means of communication;

5. respects the colleague in look, word, gesture and does not make video recordings,

unless the colleague himself requests the making of video recordings

and in that case in such a way that the colleague's dignity is not affected.

Disclaimer

The authors of the Code of Conduct for the Swimming Industry are not responsible

for the implementation and supervision of compliance.

They accept no liability for any violation of the Code of Conduct for the Swimming Industry by

swimming pools and/or swimming pool employees as referred to in the

Code of Conduct for the Swimming Industry.

National Council for Swimming Safety

This table shows in 1 year time how drowning is in UAE , Abu Dhabi

This is only because of the fake swimming training in UAE.

That people drown in the swimming pool and the water park and the sea

Because these fake swimming training are just lifeguard and not a swimming teacher.

According to the World Health Organization (WHO) at least 236,000 people die from drowning every year. It is one of the ten most common causes of death in people between the ages of 1 and 24.

The fake swimming training in UAE gives you and children wrong swimming lessons it gives you and children these swimming techniques, freestyle, butterfly, backstroke, breaststroke, front crawl, back crawl, medley, these are only meant for the Olympic swimmer and international swimming competitions.

the Survival Technique is the basis for all swimming techniques,

The survival technique can only be learned from me, because there is no other swimming training in the United Arab Emirates that can do this Survival Technique,

The, right Swimming schools are Europe and America and California and Los Angeles because they are the right swimming schools in the world.

These people from these countries, Europe and America and California, and Los Angeles, know how real swimming lessons should be.

All in UAE need the right swimming certificate and that ABC this swimming certificate can only be given by

Europe and America and California and Los Angeles because they are the right swimming schools in the world.

With this swimming certificate ABC you and children know how real swimming is.

Everything you want to know about exercising with asthma

If you have asthma and shortness of breath and tightness of the chest make you less inclined to exercise?

Good news: exercising is good for you, even if you have asthma.

Do you also get so happy from exercising?

It is no surprise that exercising is good for you.

Being active makes you a fitter and happier version of yourself and is good for your health.

But what if that health gets in the way of exercising?

If you have asthma, for example, and shortness of breath

and tightness of the chest make you less inclined to exercise?

Good news: exercising is good for you, even if you have asthma.

Exercising helps to improve your lung function and reduce your asthma symptoms.

We will tell you everything about exercising with asthma.

We explain what asthma is exactly, why exercising is good if you have asthma and which sports are suitable. Because asthma is not a reason not to exercise, but rather to exercise.

With our handy tips for exercising with asthma, you can get started right away.

What is asthma?

1. Why is exercise good if you have asthma?

2. Which sports can you do with asthma?

3. Tips for exercising with asthma

What is asthma?

Asthma is a chronic, or long-term inflammation of the tubes in your lungs.

Do you not suffer from asthma?

Then the tubes in the lungs are wide, so that you can breathe in and out without problems.

Do you suffer from asthma?

Then your lungs are oversensitive and contract when certain stimuli are detected,

causing the tubes to become narrower.

This reduces the airflow to your lungs and you get problems breathing.

What do you suffer from if you have asthma?

Shortness of breath, coughing, wheezing and fatigue are well-known complaints for asthma patients.

These complaints are caused by allergens such as pollen, pets and dust mites.

And smoke, cold, polluted air and even stress can also worsen your asthma symptoms.

Asthma is a disease that cannot be cured.

The treatment of asthma is aimed at making the periods without complaints as long as possible

and keeping the condition of the airways as good as possible.

You do this with the help of medication, such as inhalers and anti-inflammatories.

Just as important are lifestyle changes, such as quitting smoking,

avoiding certain circumstances that aggravate your complaints and of course exercising.

Why is exercising good if you have asthma?

Exercising is good for you, especially if you have asthma.

Being active means an improvement in your condition and a number of important benefits.

Easier breathing - Exercising ensures a greater lung capacity and strong respiratory muscles.

This makes it easier for you to breathe, even during exercise.

Weight loss - About half of people with asthma are overweight.

This excess weight puts a strain on your respiratory system.

Exercising helps you to lose weight in a healthy way,

which in turn has a positive effect on your respiratory system.

Improved recovery capacity - By exercising regularly,

you improve the recovery capacity of your airways.

This can make an asthma attack less severe and shorter.

Increase resistance – Exercise improves your immune system.

Your body uses that immune system to protect you against pathogens.

This makes you less susceptible to an asthma attack and you are therefore literally

and figuratively stronger in your shoes.

Do you have a serious form of asthma or are you wondering how to start exercising with asthma?

Then don't start alone, but choose to work on your condition together with a sports doctor or physiotherapist. This way you can be sure that you are exercising in a safe and responsible way with asthma.

2. Which sports can you do with asthma?

Are you convinced of the benefits of exercising with asthma?

Then you are probably curious about which sports are best for you with asthma.

Sports that improve endurance are particularly good for you, such as walking, jogging, cycling and swimming.

Walking – Do you want to do some exercise, but at a leisurely pace?

Then walking is the ideal sport for you.

Walking at a leisurely pace improves your condition.

Do you opt for Nordic Walking, or walking with poles?

Then you also walk upright, which opens your chest and makes breathing even more pleasant.

Jogging – Jogging is walking at a fast pace or running at a leisurely pace.

Jogging, like walking, improves your fitness without having to exert yourself too much.

Cycling – Cycling in the fresh air is good for you.

Cycling ventilates your airways.

During a bike ride, you breathe more intensely and clean your lungs in this way.

Swimming – The high humidity and pleasant temperature make swimming an

ideal sport for many asthma patients.

Whichever sport you choose, build it up slowly.

This way you prevent asthma attacks and annoying injuries.

All beginnings are difficult, even when you start exercising with asthma.

Remember that perseverance wins.

Once you have been doing it for a few weeks

and experience positive effects on your body, you will know what you are doing it for.

We give you 5 useful tips for exercising with asthma.

3. Tips for exercising with asthma

1. Always make sure you have medication with you for an unexpected attack.

Especially if you do intensive sports in cold and dry air, you are more likely to have an attack.

2. Tell your sports buddy(ies) or trainer that you have asthma and what they should do if you have an attack.

If something happens, they will not be scared, but they can take action.

3. Always listen to your body.

Do you feel an attack coming on?

Then take a break

4. Sometimes things go well and sometimes they do not go so well.

This applies to athletes without asthma as well as to you.

Accept that and do not force yourself if you feel that you have no energy.

5. Choose a sport that you like. Sports are a lot easier if you enjoy them.

Can't figure out which sport that is?

A physiotherapist or sports doctor can help you choose the sport that suits you and your asthma.

Exercising is good for you, especially if you have asthma.

The chronic disease is an inflammation of the tubes in your lungs, which causes you to suffer

from tightness in the chest, shortness of breath and coughing.

Exercising with asthma improves your condition.

This makes it easier to breathe and improves your resistance.

Choose sports such as walking, jogging and swimming if you are going to exercise

with asthma and build up your activities gradually.

Always take your medication with you when you go to exercise

and inform your training partner(s) about your asthma.

Accept that exercising with asthma does not always go well and listen to your body.

You can also perform top-notch with asthma.

Well-known athletes such as Chris Froome, Erben Wennemars and Marleen Veldhuizen

prove with their many medals that anything is possible.

Asthma is not a reason not to exercise, but rather a reason to exercise.

I hope you have lots of fun exercising!

Exercise is important to stay healthy.

The advice is to exercise moderately intensively for at least 2.5 hours per week.

Think of cycling or walking, for example.

Do this spread over several days.

But what if you have asthma?

Is exercising healthy with asthma?

And what do you take into account when you exercise?

Benefits of exercising with asthma

Exercise is especially important with asthma.

Regular exercise or movement strengthens the respiratory muscles and increases lung capacity.

This means you become less short of breath.

In addition, you also train the oxygen absorption of the muscles.

You feel better and get tired less quickly.

The importance of warming up and cooling down for asthma

If you have exercise-induced asthma, it may sound strange that exercising is healthy for you.

Exercising can then cause shortness of breath.

But if you do it sensibly, you will also benefit from the aforementioned advantages.

Start exercising with a gentle, good warm-up and build up the effort.

You can also use bronchodilator medication beforehand to prevent shortness of breath.

This medication can also resolve the shortness of breath during exercise.

Do not stop abruptly after exercising, but do a good cool down,

in which you gradually reduce the effort.

Your heart rate and breathing will slowly return to normal in this way.

"Especially with asthma, you should

stay in the best possible condition"

Be careful with certain sports with asthma

The choice of a sport is very personal.

Choose something you like and that is not too heavy for you in terms of breathing strain.

With some sports, there is a greater chance of coming into contact

with stimuli that can trigger an asthma attack.

Below are a number of examples:

All outdoor sports.

Do you also have hay fever?

In the seasons when certain grasses or trees bloom, there may be a lot of pollen in the air.

Take into account additional stimuli that can trigger an attack.

Winter sports.

The transition from warm to cold or vice versa can be a stimulus

that triggers an asthma attack for some people.

Sports in the cold, such as skating and skiing, increase the chance of an attack.

Try to keep breathing through your nose while exercising.

This humidifies and warms the air you breathe in, which means you irritate your lungs less.

A good warm-up and cool-down help your body get used to the temperature differences.

Swimming.

The water in some swimming pools contains a lot of chlorine.

If you are sensitive to this, look for a swimming pool with no or less chlorine.

Take the bronchodilator with you

Despite all the preparatory measures, you can still become short of breath.

In that case, it is good to have your bronchodilator medication with you.

For example, a spare in a locker at your sports location.

Bronchodilators come in 2 variants: powder inhalers and metered dose aerosols.

If you use a metered dose aerosol, it is important for it to work properly that you

also have the corresponding spacer with you.

If necessary, you can inhale the bronchodilator medication before exercising.

Are you a top athlete?

Then keep in mind that some inhalation medication

is on the doping list for some sports.

Tell your sports buddies about your asthma

Bystanders can be very shocked by someone having an asthma attack and often do not know what to do.

Tell your friends that you have asthma and explain that they should not panic.

Tell them where you keep your medication and ask them to take you to a quiet environment during an attack.

9 reasons why swimming is good for body and mind!

Swimming is not only fun, it is also excellent for your health.

And that goes much further than just improving your fitness.

Benefit 1: Swimming boosts your health and mood

Swimming has a relaxing effect.

This is because the water makes you feel lighter and gives your heart peace.

Relaxing swimming reduces stress and depression.

Swimming is also a cardiovascular workout and such workouts improve your

mood and increase your self-confidence.

This is because you produce more of the hormone serotonin while swimming.

The effort of swimming gives you more energy than it costs you.

Immediately after exercising, you have more energy available than a few hours earlier,

when you came home tired from work.

All of the above things ensure that swimming boosts your physical and mental health.

Benefit 2: Swimming improves your sleep pattern

Your general health also depends on your night's sleep.

Because during the night,

your mind and body recover and rejuvenate.

So sleeping well is important and exercising properly will help you with that.

Because during (heavy) exercise, hormones are released that give you a better night's sleep afterwards.

Benefit 3: Swimming keeps blood pressure low

Since the water in a swimming pool exerts more pressure than air outside the water,

the water ensures that the blood flows back to your heart more easily.

As a result, your heart has to work 10 to 15% less hard!

Benefit 4: Burn 500 calories per hour

Swimming (not floating ;-)) burns about the same number of calories as running at 10 km/h.

With half an hour of swimming, you easily burn 300 kcal.

Benefit 5: Reduces the impact on the joints

Swimming is a low-impact sport.

By that we mean that swimming is good for your muscles, tendons and joints.

In the water you weigh 90% less and you therefore spare your body much more!

That is also the reason why injured athletes often start working on their fitness again in the pool.

Benefit 6: Strengthens the muscles

In addition to a fat-burning fitness training, swimming is

also a resistance or strength training.

You get that resistance from the water itself.

Because water works harder against you than air.

Swimming also builds muscle mass.

If you also alternate the different strokes, you also train the muscles in different ways.

Swimming helps you develop a balanced body and is the ideal full-body workout.

Benefit 7: Reduces the risk of cardiovascular disease

Swimming, like other forms of cardiovascular exercise, lowers your blood pressure

and your cholesterol level and thus reduces the risk of developing cardiovascular disease.

To do this, you need to swim at least three times a week for 30 minutes

or otherwise increase your heart rate.

Benefit 8: Strengthens the capacity of the lungs

Asthma patients are often advised to swim, preferably in an indoor pool.

The warm and humid climate is better for the airways than the drier outdoor air and indoors

the amount of pollen in the air is also limited, which is so bad for hay fever and asthma patients.

But swimming also offers benefits to asthma patients in general. Swimming increases lung capacity

and improves breathing, things that asthma patients in particular benefit from.

If you exercise regularly, you will have a larger lung capacity.

This is not only reserved for swimmers, but applies to all sports.

For example, if you go swimming once a week, you will soon notice

that you will be less likely to get out of breath when walking up stairs, for example.

Benefit 9: Strengthens the bones

Weight-bearing sports such as running are known to increase your bone density.

Because your body has to carry more weight during these exercises, your bones become stronger.

For a long time, it was thought that swimming as a low-impact sport did not come with this advantage.

However, recent research shows that swimmers do have a lower bone density than runners

and strength athletes, but still a higher density than non-athletes.

Swimming therefore increases your bone density.

Swimming:

The high humidity in a swimming pool combined with the high temperature

makes it an ideal environment for most asthma sufferers.

The right medication and the right exercise can have a positive effect on asthma.

A very suitable exercise is swimming.

Swimming is a favorite activity for many children and adults with asthma

and has been linked to a number of health benefits, including improved physical

fitness and mental well-being.

Swimming is traditionally recommended for people with asthma

because the warm and humid environment is less challenging.

Tips for swimming with asthma

Do:

1. Use the 'nose' test.

If you notice a strong chemical odor after being in the pool

environment for more than three minutes, this could indicate an imbalance in

the pool chemicals or problems with the pool ventilation.

You should not stay in the water for too long and inform the pool management.

2. Always shower before entering the water to maintain good water conditions.

3. Keep your reliever inhaler to hand

4. Consider using your reliever inhaler (as prescribed) 10 minutes before your swim

5. Warm up and cool down properly to reduce the risk of exercise-induced asthma

6. Consult your GP if swimming seems to aggravate your asthma.

This may be a sign that your current treatment is not working.

Don’t:

1. Swim on days when you have asthma symptoms or if you have a cold

Participate in other aquatic activities with asthma

Open water swimming

Remember that the water temperature is likely to be colder, which can affect your asthma.

Wearing a well-fitting wetsuit can help.

Take your inhalers with you if you are swimming far from shore.

A waterproof wallet or bum bag can be useful.

Swimming abroad

Remember that different climates can affect your usual asthma control;

particularly changes in humidity, pollen levels or air quality.

You may need to adjust your inhaler use.

Discuss this with your GP or asthma nurse before travelling.

Take into account local hygiene standards for swimming pools as these can vary.

Asthma History, Current Situation, an Overview of Its Control History, Challenges, and Ongoing Management Programs: An Updated Review

Abstract

Asthma is a disease of the airways that is characterized by chronic inflammation and disordered airway function.

The purpose of writing the current review paper is to review the history, current situation, control history, challenges, and ongoing management programs of asthma.

Some official websites of known respiratory professional bodies were consulted for asthma guidelines,

and information from Google Scholar® and PubMed® was also consulted.

We reviewed around two hundred eight papers, and then, inclusion and exclusion criteria

were applied to prepare this manuscript.

Out of these papers, thirty papers, factsheets, and some official websites were used to prepare this manuscript.

Physicians should follow already existing asthma guidelines in order to manage asthma.

All prescribed medications should be continued.

The government should make and adopt more strategies to promote the rational use of anti-asthmatic drugs and healthcare facilities and also make plans to disseminate more awareness among people about the schemes and programs made for safeguarding people against this life-threatening disease.

We have done so much advancement to fight against this deadly disease,

and we still need time to make the globe asthma-free.

The number of people suffering from asthma is more than the number of people

suffering from HIV infection and tuberculosis.

Understanding the recommendations of professional bodies will assist in medical

decision-making in asthma management.

The individual needs of patients should be considered by healthcare professionals.

Graphical Abstract

Keywords: Asthma, Respiratory, Physicians, Healthcare professionals, Management, Anti-asthmatic drugs

Introduction

Asthma is one of the most ancient diseases of the airways, characterized

by chronic inflammation and disordered airway function.

Despite numerous advancements in the treatment and diagnosis of asthma, unfortunately,

a large population is still suffering, and worldwide it becomes one of the top infectious diseases.

Approximately 10% of children and 5% of adults are suffering from this disease.

A WHO key facts dated May 3, 2021, on asthma stated that approximately 262 million people are affected

by this life-threatening disease in 2019 and the number will be expected to hike in the future.

It is also characterized by some other symptoms like epithelial rupture, hypertrophy of airway smooth muscles, hypersecretion of mucous in lungs bronchial walls, wheezing, coughing, and dyspnea (Fig1).
Although there is no proper treatment available for asthma, it can be controlled

with proper management and help asthmatics to live in a better way.

The primary preventive measure taken by WHO (world health organization) for asthma and disease management is reducing tobacco smoke exposure, and the initiative MPOWER and Mtobacco cessation is enabling progress in this area of tobacco control.

Fig. 1.

Flowchart of asthma

The use of bronchodilators is the principal therapy used in asthma but a greater understanding of the chief role of inflammation in asthma has led to the conclusion of the use of anti-allergic or anti-inflammatory agents

for the management of asthma and is an internationally recognized strategy for its cure.

The ICS (Inhaled corticosteroids) can provide ideal disease control but not as monotherapy.

They need additional therapies such as SABA (Short-acting β2 agonists), LABA (Long-acting β2 agonists), LTRA (Leukotriene receptor antagonist therapy), and theophylline to achieve adequate control.

The primary aim of writing this review paper is to provide a brief understanding of asthma

by critically assessing articles related to asthma.

Material and Methods

We performed an electronic search to find out the existing literature on asthma.

Initially, the search was conducted on search engines like Google Scholar® and PubMed®

to gather updated information about asthma.

In addition, the search was conducted on the official websites of professional organizations such as GINA (Global initiative for asthma), WHO, MOHFW (Government of India-ministry of health and family welfare), and CDC (Centers for disease control and prevention) to get relevant guidelines for asthma control, anti-asthmatic drugs, challenges, prevention, and control management programs.

Approximately 10 months were completely used to compile data for this manuscript.

The key terms used during the search were “Asthma,” “history of asthma” “current situation of asthma,” “asthma control history,” “challenges in asthma,”

and “ongoing asthma management programs.”

Two hundred eight papers were screened, and then, inclusion

and exclusion criteria were applied to prepare this manuscript.

Out of these papers, thirty papers were used to prepare this manuscript.

The last search was conducted on October 30, 2021.

Inclusion and Exclusion Criteria

Resources that were targeted at healthcare professionals and articles with a thorough

understanding of asthma were included.

All those papers which do not have original data and studies targeting the general

public and patients were excluded.

History

Ancient History

For the very first-time, respiratory distress was recorded in China in 2600BC.

The evidence was found in the form of “noisy breathing.” Shen nong in 2700BC was the first person to taste ephedra which was popularly known as anti-asthmatic herbal medicine around 5000 years ago.

The ancient Egyptians in 3000–1200BC believed respiration was one of

the most crucial functions of the human body.

Greco-roman (1000BC–200AD), both believe that asthma was produced due to demonic possession.

Hippocrates was the first person who found that people suffering from asthma may have a hunch back.

He also tried to understand the correlation between environment and respiratory problems.

He also recommended ephedra along with red wine for the treatment of asthma.

Modern History

In the modern period, the understanding of the root cause of asthma began.

In Europe 1500s, tobacco was introduced for the treatment of asthma, expectorate mucus and induce coughing.

In 1579–1644, one of the chemists and physicians from Belgium Jean Baptiste Van Helmont said,

“asthma was developed in the pipes of the lungs.”

In (1633–1714), Bernardino Ramazzini found for the first-time exercise-induced asthma.

He also acknowledged the correlation between organic dust and asthma.

In the year 1873, Charles Blackley discovered the main cause of “hay asthma”

and found that pollen was related to it.

He rubbed pollen on different body parts to reproduce the symptoms.

In the 1900s, selective beta-2 adrenoceptors agonists were used for asthma treatment.

In 1916, a physician and allergist named Francis Minot Rackemann reported

that not all asthma is related to allergies.

In 1920s, the deaths from asthma were related to airway structural changes and extensive inflammation but the information on why this happened and how it is responsible for bronchospasm was not known.

For some decades, the treatment of asthma was done as episodic exacerbations.

Kustner and Prausnitz in the year 1921 noticed that asthmatics suffer from

allergy symptoms due to indoor and outdoor irritants.

In 1960s–1970s, technological advancements led to the use of peak flow meters to

measure obstruction in airways and arterial blood gasses.

After the 1970s, inhaled corticosteroids were used for asthma cure.

In 1980s, a depth understanding of how an allergen exposure, affect the release of a chemical mediator

from mast cell which results in allergic asthmatic response.

Global Scenario

According to WHO information, asthma is included among (NCD) non-communicable diseases which is prevalent in children and adults.

Generally, the deaths related to this disease mostly occur in countries with the economy in creeping

and walking stage.

The top fifteen countries with the largest asthmatic patients are Myanmar, Kiribati, Laos, Sri Lanka, New Guinea, Mali, Nepal, Fiji, Lesotho, Indonesia, Solomon Island, Sierra Leone, Timor-Leste,

Philippines, and Vanuatu

(https://www.worldlifeexpectancy.com/cause-of-death/asthma/by-country/).

In 2010, according to the data provided by National Hospital Ambulatory Medical Care Survey,

approximately 1.3 million patients hospital visits were due to asthma.

In 2011–2012, the national survey for children’s health reported that around 3.4% of children have used emergency hospital visits due to this life-threatening disease.

Around 10.1 million physician office visits were reported for the year 2015. In 2017, around 43.12 million asthma cases were recorded whereas 272.68 asthma prevalence (prevalence 3.57%)

and 0.49 million deaths (mortality rate 0.006%).

More than 1.6 million asthmatic patient emergency visits were reported for the year 2018.

According to the 2019 data by WHO, this disease is considered one of the top ten deadliest diseases.

It cannot be completely cured but proper management with inhaled medications can help to control the disease and thereby help people to lead normal life .

Around 262 million people were affected by this deadly disease in 2019 which caused 461,000 deaths.

Globally, this disease is ranked 16th among the leading causes of years lived with a disability as well as 28th among the leading causes of burden of disease as calculated by DALY (disability-adjusted life years).

It is estimated that around 300 million people were suffering from asthma worldwide

and by 2025 around 100 million people were affected.

There is a huge geographical variation in asthma severity, prevalence, and mortality.

The prevalence is extremely high in high-income countries whereas the mortality

rate is high in low-middle-income countries.

As per the Lancet, the asthma statistics worldwide for 2020 reported that more than 339 million people were suffering from asthma and globally approx.

four million children develop asthma each year.

In North America, approx. 8% population has been diagnosed with asthma.

The estimated prevalence of severe asthma is 5–10% of the global asthma population.

It is more common in Puerto Rican Hispanic (13.3%) and Black (8.7%) than in white people (7.6%).

The mortality rate is higher in black 25.4 than in whites 8.8 per million annually.

The treatment options available for asthma are discussed as follows:

Bronchodilators or relievers act by quickly opening the airways and improving the rate of breathing.

They also remove mucous from the lungs.

As the airways get dilated, the mucous can be coughed with more ease.

These act by targeting the β-2 adrenergic receptors in the airways.

Activation of this receptor may relax the airway smooth muscles, thereby ensuring better airflow in the lungs

Furthermore, they also help in inhibiting the parasympathetic nervous system receptors from functioning.

As the parasympathetic nervous system increases the bronchial secretions and constriction in airways, inhibiting the nervous system should result in bronchodilation and lesser bronchial secretion (Fig.2).

Bronchodilators are subdivided into the following parts (Fig.3),

Inhaled rapid-acting β-2 agonists: Fenoterol (1), Salbutamol (2), Isoproterenol (3), Metaproterenol (4), Terbutaline (5), Albuterol (6), Glucocorticoids (systemic): Beclomethasone (7), Prednisone (8), Triamcinolone (9), Budesonide (10), Flunisonide (11), Anticholinergics: Tiotropium bromide (12), Ipratropium bromide (13), Atropine methonitrate (14), Oxitropium bromide (15), Xanthine derivatives: Caffeine (16), Theobromine (17), Theophylline (18), Aminophylline (19), Hydroxyethyl theophylline (20), Choline theophyllinate (21), Doxophylline (22), Deriphylline (23), Diprophylline (24), Theophylline ethanolate of piperazine (25), Oral SABA: Salbutamol (2), Terbutaline (5), Bitolterol (26), Fenoterol (27), Rimiterol (28), Levalbuterol (29), and Pirbuterol (30).

Fig. 2.

Mechanism of action of bronchodilators in asthma

Fig. 3.

Anti-asthmatic drugs used as bronchodilators

Anti-inflammatory agents reduce inflammation, swelling, and mucus production in the airways.

The most important anti-inflammatory treatments are given by inhalation.

Their mode of action is not completely understood, but they are likely to act in several

different ways to produce an anti-inflammatory effect.

The glucocorticoids act by inhibiting transcription factors that help in the regulation of pro-inflammatory mediators such as eosinophils, macrophages, dendritic cells, mast cells, and lymphocytes.

The steroids also act on mast cells and exert their anti-allergic action

by inhibiting the signaling pathways in mast cells.

Furthermore, they also reduce plasma exudation in the airways and inhibit mucus glycoprotein secretion (Fig.4).

Anti-inflammatory agents are further classified into (Fig.5),

Inhaled or systemic corticosteroids: Triamcinolone (31), Mometasone (32), Budesonide (33), Prednisolone (34), Hydrocortisone (35), Beclomethasone (36), Fluticasone (37), Ciclesonide (38), Flunisolide (39), prednisone (40), Methylprednisolone (41), LABA: Formoterol (42), Salmeterol (43), Anti-IgE: Omalizumab, Leukotriene antagonist: Zafirlukast (44), Montelukast (45), Pranlukast (46), Iralukast (47), Oral anti-allergic compounds: Tranilast (48), Mast cell stabilizer: Sodium cromoglycate (49), Nedocromil Sodium (50), and Ketotifen (51).

Fig. 4.

Mechanism of action of corticosteroids on airway inflammation, symptoms and airway hyper-responsiveness

Fig. 5

Anti-inflammatory drugs used for asthma

Indian Scenario

The Indians ayurveda believe that asthma results due to the imbalance between three doshas:

(a) pitta (bile),

(b) Kapha (phlegm),

A person stays healthy if these three humors were balanced.

The first book Ayurveda Materia medica from India ‘Charaka Samhita’

has a good clinical description of this life-threatening disease.

A recent study on respiratory symptoms and chronic bronchitis performed on 85,105 men and 84,470 women from eleven rural and twelve urban areas in India estimated the prevalence rate of asthma is 2.05% among those aged above 15 years with an estimated national burden causing 18 million asthmatics.

Despite enormous advancements in the treatment and management of this disease,

it becomes a major public health issue in India.

Asthma Control History

The Early Period of Asthma Control

In 1500BC, the inhalation of the smoke of herbs is recommended for use as

the treatment therapy for asthmatic patients in Egypt.

In ancient China around 5000 years ago, the treatment was done by using ma-huang (Ephedra sinica),

a type of Chinese herb which was later examined to have ephedrine (muscle relaxant),

and these agents work as bronchodilators [6].

For a prolonged period, bronchodilators were used as the first-line drugs for the management

of asthma which indicates contraction of airways as the chief pathology involved in the treatment.

In 1900, the avoidance of allergens was used as the foremost therapy for asthma.

The use of a pressurized metered-dose inhaler in the mid-1950 has been developed for

the administration of adrenaline and isoproterenol and was later used as a β2-adrenergic agonist.

Later salbutamol and terbutaline were introduced as SABA.

Recently, LABA is used as the principal drug incorporated into

the inhaled corticosteroids in Japanese guidelines for asthma.

Furthermore, LTRA and theophylline were used as the first-line drugs along

with LABA and inhaled corticosteroids.

The American thoracic society in the year 1962 describes asthma as a disease identified by the presence

of airway hyper-responsiveness as well as reversible airway constriction.

Moreover, chronic airway inflammation was finally found as the clinical etiology involved in

the pathogenesis of asthma and inhaled corticosteroids and the use of anti-inflammatory

drugs became the first-line therapy for asthmatic patients.

In the early twentieth century, inhalation and intravenous administration of

anticholinergic drugs were regarded as the principal therapy for asthma.

Current WHO-Aided Asthma Control Program

For the prevention and control of asthma, this disease has been incorporated in the WHO global action plan as well as the UN (United Nations) 2030 agenda for the sustainable development.

WHO has taken several actions to extend the diagnosis and treatment of this disease.

The PEN (package of essential non-communicable) disease intervention was developed by WHO to support people with non-communicable diseases with the help of UHC (universal health coverage).

The PEN includes rules for assessment, diagnosis, and management of asthma and (COPD) chronic obstructive pulmonary disease and includes modules on healthy lifestyles (Fig.6).

The primary preventive measure taken for asthma and disease management is reducing tobacco smoke exposure, and the initiative MPOWER and Mtobacco cessation is enabling progress in this area of tobacco control.

MPOWER is the WHO framework convention on tobacco control, and its guidelines were meant for countries working toward tobacco control.

These guidelines were introduced in the year 2008 to manage tobacco control at the country level.

Fig. 6.

Assessment of asthma as per WHO PEN

WHO Global Action Plan 2013–2020

The goal of this action plan is to reduce the number of morbidities, mortality, and disability due to NCD by using multisectoral cooperation and collaboration at distinct levels (national, regional, and global),

so that the population will remain at the highest standard of health

and productivity at all ages as well as those diseases will no longer act as a barrier to well-being.

As per the WHO, the total number of deaths due to NCD may increase to 55 million by 2030.

The scientific knowledge demonstrates that the prevalence of non-communicable diseases is greatly decreased if cost-effective preventive and curative action, as well as interventions for prevention and control of NCD which are already available, are implemented in a balanced and effective manner.

GINA Global Strategy for Asthma 2021

On Nov 1, 2021, the GINA published an executive summary of an updated evidence-based

summary for the treatment and prevention of asthma.

On Oct 18, 2021, the summary was published online.

The GINA science committee was developed in the year 2002 to review published research on asthma. This GINA report is updated every year and approx.

500,000 copies of GINA reports were downloaded each year by one hundred countries.

GINA report has been updated in the year 2020 with some modifications such as interim guidance about asthma and Covid-19, additional information for the new as well as existing therapies; additional documents have been added in supporting the use of ICS (Inhaled corticosteroid)—formoterol in mild asthma; assessment of symptom control and new data have been incorporated for the initial treatment of newly diagnosed asthma; information related to a maximum daily dose of ICS-Formoterol has been added; additional documents for the support of the use of ICS and addition of minimum and maximum doses of ICS have been incorporated in the treatment recommendation for asthma, and new additional information about the

management of asthma in children has also been added.

India Asthma Report

As per demographics, around 6% of children and 2% of adults were suffering from this disease.

A maximum number of people in India have no health insurance, and there is a big gap in

healthcare facilities for the poor and the rich people.

Most of the medications available in India (inhaled corticosteroids, combination inhalers,

and β-2 agonists) are too expensive compared to oral formulations.

According to the data compiled from 1990 to 2005, the mortality rate in India decreased mainly in areas

where healthcare facilities were better (urban areas and prosperous states).

It was documented that Rajasthan and Uttar Pradesh have the highest mortality rate.

The Rajasthan government had provided free access to medicines to all the asthmatic patients of the state at government hospitals since 2011 and around 15,000 pharmacies had been opened by the state government across the state along with a free supply of metered-dose inhalers, nebulizer solutions,

and dry powder inhaler capsules to asthmatic patients.

In 2018, the Indian government planned to provide health insurance at no

cost to 100 million low-income families, to cover their treatment costs.

Ongoing Challenges in Asthma Therapy

The problem of asthma is a global burden affecting more than 300 million people and causing around 2,50,000 deaths per year. Despite several effective treatments available, the control

of this disease in the population remains inadequate.

The advancement in treatments for children is lesser as compared to the adults due to the varying immunopathology, respiratory pathology, need for a child, parent education, and communication barrier.

As most of the asthma research work was performed on adult asthma, thus this seems to be one

of the principal barriers to managing the therapy childhood asthma.

The data on LABA use for the treatment of asthma in adults are widely available

while the data available for LABA use in children are limited.

Since then, several studies have been conducted to complete the gap for LABA use in children and adolescents resulting in several regulatory approvals for LABA inhalers, and inhaled corticosteroids such as fluticasone + salmeterol, budesonide + formoterol have been approved as maintenance treatment

for children and adolescents in the USA and Europe.

Asthma management in children is a complex process due to variability in asthma severity, control,

and difficulty in measuring lung function as well as airway inflammation.

The primary challenge in the management of pediatric asthma is treating the symptoms of asthma rather than treating the root cause, i.e., inflammation, and switching to controller therapy when the problem worsens.

The prevalence of childhood asthma increased in the 1980s–1990s, and the rate kept on increasing over the past decade; it seems to be one of the greatest global economic burdens in terms of direct and indirect costs.

Furthermore, the healthcare providers, as well as patients, are dealing with several types of challenges

such as challenges in diagnosis, treatment, and follow-up challenges.

As poor healthcare facilities are provided in rural areas, poverty, lack of awareness, and the high price

of anti-asthmatic drugs are some of the routinely faced challenges of patients.

The diagnosis of asthma seems to be challenging work, both in terms of underdiagnosis and overdiagnosis.

The underdiagnosis of asthma is familiar and was documented in epidemiological as

well as clinical studies while the data on overdiagnosis are new.

Physicians are entirely dependent on asthma guidelines for the diagnosis and management of this disease.

The NIH (National Institute of health) released latest updates to the national guidelines meant

for the diagnosis, management, and treatment of asthma.

The guidelines were made to upgrade patient care and to support decision-making

about asthma management in a clinical setting.

In India, the national rural health mission (NRHM) was implemented to improve primary healthcare facilities in rural areas, to improve the health status and quality of life of people living in rural areas, and to prevent

and control communicable and non-communicable diseases.

The diagnosis of asthma is a difficult process because for some reasons:

(a) The signs and symptoms might not show during routine analysis,

(b) unavailability of the standard diagnostic test—in clinical practice, spirometry

and peak expiratory flow assessment are done to check the signs and symptoms, and

Some of the other treatment options which might help in improving asthma management and control are switching from relievers SABA to LABA along with a combination of inhaled corticosteroids as per the recommendation of GINA to make sure that the person with asthma receives an

inhaled corticosteroid to get symptomatic relief whenever possible.

Ongoing Asthma Management Programs

The problem of asthma is prevalent among children and elderly people.

In UK 1 in 14 adults are affected by this alarming condition.

The national public health agency of the USA, i.e.,

CDC has made a self-management education (SME) program “Breathe well, live well” that helps

those people with prevailing health conditions to feel better.

The SME program helps people to strategize and develop the skills and confidence to tackle ongoing health conditions efficiently and help in dealing with the following conditions:

cope with symptoms, communicate with doctors, manage fatigue, handle stress,

manage medication, eat healthy, reduce depression, and be active.

These strategies can help the patients to make good decisions about health and makes them feel better.

The 2020 focused updates to the asthma management guidelines were published for

the diagnosis and management of asthma.

These guidelines help the clinician integrate the new recommendation into clinical care.

These are meant for individual patient management.

The Alameda County public health department (ACPHD) enabled community health services asthma start programs that help families of children with asthma by providing in-home case management studies.

They provide education, support, and assistance in developing an action plan to address the needs of families where the child has asthma thereby helping in regulating it.

The services provided by them is as follows:

(a) education to families about the disease, several types of triggers, prevention of attacks, treatments, etc.,

(b) collaborating with daycare providers and schools to make sure asthma medication is accessible to every child, and moreover, supplying asthma-related education to all the school staff as well as daycare providers,

(d) remote home inspections to find the triggers and causes of asthma.

Results and Discussion

Generally, the recommendations from different professional bodies suggest that physicians should follow the already existing guidelines for the proper management of this disease.

The key points are as follows: bronchodilators were considered a principal therapy for the treatment of asthma in early times, but after the advent of inhaled corticosteroids, the therapeutic history gets drastically changed.

The use of bronchodilators is the principal therapy used in asthma but a greater understanding of the chief role of inflammation in the pathogenesis of asthma has led to the conclusion of the use of anti-allergic or anti-inflammatory agents for the management of asthma.

The ICS can provide ideal disease control but not as monotherapy.

They need additional therapies such as SABA, LABA, LTRA, and theophylline to achieve adequate control.
It is very much clear from the above discussion that we have done so much advancement to fight against this deadly disease and we still need time to make the globe asthma-free.

The number of people suffering from asthma is more than the number of people suffering from HIV infection and tuberculosis.

Conclusion

Understanding the recommendations of professional bodies will assist in medical decision-making in asthma management.

Healthcare professionals should consider the individual needs of patients. In conclusion, the main problem in the management of this disease is improper use of healthcare facilities, lack of knowledge about anti-asthmatic drugs, poverty, and the cost of drugs.

The government should make and adopt more strategies to promote the rational use of anti-asthmatic drugs and make plans to spread more awareness among people about the schemes and programs made for safeguarding people against this life-threatening disease.

Acknowledgements

The authors are thankful to the Honorable Vice-Chancellor, Banasthali Vidyapith, Banasthali, Rajasthan, for providing essential facilities.

Authors Contribution

Nitin Gupta contributed to Conception and design of study, Swati Pant contributed to literature collection and Anandi Kapri contributed to Drafting the manuscript and Sumitra Nain & Sarvesh Paliwal contributed to Overall supervision.

Funding

There was no funding provided for the preparation of the manuscript.

Declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Footnotes

Significance Statement:This review paper aims to spread awareness among the general public about the scenario of Asthma. The physicians should prescribe bronchodilators and anti-inflammatory agents to manage asthma symptoms.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Asthma

Asthma is a disease of the smaller airways in the lungs that is particularly common in childhood.

Among school children, more than 1 in 10 children have asthma, but after puberty the symptoms often decrease and asthma also occurs less and less, although it is still seen in adulthood.

Asthma is a chronic inflammation of the airways, caused by allergic stimuli from outside, among other things. These stimuli can consist of common substances such as house dust mites, dog or cat hair, pollen from grasses or trees, etc. In addition, an asthma attack can be triggered by cigarette smoke, perfumes, cold air,

paint fumes or as a result of physical exertion.

During an 'asthma attack' the shortness of breath suddenly increases significantly.

And the victim suffers from shortness of breath, shortness of breath, sometimes wheezing or a tight feeling in the chest.

Between attacks the patient can be free of complaints, but sometimes mild shortness of breath,

coughing or reduced exercise tolerance persists.

The exact cause of asthma is unknown.

It is clear how an asthma attack occurs.

As a result of exposure to an allergenic stimulus, such as house dust mites, an inflammatory reaction occurs in the mucous membrane and the surrounding tissues of the smaller bronchioles

(the smaller branches of the airways).

This causes swelling of the mucous membranes, the smooth muscle cells in the wall of the bronchi contract (bronchoconstriction) and the production of mucus increases.

This reduces the patency of the bronchi.

This causes coughing and shortness of breath.

Symptoms and complaints

Untreated asthma causes alternating symptoms, there is a constant inflammation of the tissue which mainly causes (night-time) coughing, occasionally with an increase in shortness of breath.

Sometimes an asthma attack occurs as a result of exposure to an allergen, in which the shortness of breath suddenly increases, the victim starts coughing and a wheezing exhalation is often audible.

The wheezing is only audible when exhaling, this is therefore not stridor.

There is often shortness of breath with a somewhat tight feeling around the chest.

* Shortness of breath or shortness of breath

* Wheezing

* Tight feeling around the chest, a tight feeling in the throat

* Coughing, coughing up mucus

Status asthmaticus

A 'normal' asthma attack is usually not life-threatening.

In some (rare) cases, however, a reaction occurs so serious that a very serious asthma attack occurs, the so-called status asthmaticus, in which breathing is immediately threatened and rapid treatment is necessary.

This status asthmaticus often occurs in patients who have many attacks, continue to smoke despite advice to stop, and those who do not take their medication or take it incorrectly.

In the most serious cases, a patient can die from status asthmaticus.

Status asthmaticus is a serious asthma attack in which the victim is in respiratory distress.

He has great difficulty breathing and is no longer able to speak in full sentences.

There is great fear. Because exhalation is made much more difficult, wheezing is

often no longer audible and the sounds during exhalation may also be reduced.

Initially, the respiratory rate will be increased, but later it decreases as a result of exhaustion.

It then seems as if there is improvement, while the victim's condition has actually become (much) worse.

Status asthmaticus is a life-threatening condition for which 998 must be called immediately.

In case of an emergency, you can call the following numbers while anywhere in the UAE:

* 999 for Police

* 998 for Ambulance

* 997 for Fire Department (Civil Defence)

* 996 for Coastguard

* 995 for Find and Rescue

Action

Most victims with an asthma attack are familiar with the disease and are treated for it by their GP,

paediatrician or pulmonologist.

They have been prescribed medication to (preventively) inhibit the inflammatory response

(with anti-inflammatory hormones such as corticosteroids),

examples of which are Pulmicort, Qvar and Flixotide.

These medications are mainly given as maintenance medication,

they inhibit the inflammatory response and thus prevent an asthma attack from occurring.

In addition, people with asthma are given medication to counteract the narrowing of the airways (bronchoconstriction) as a result of contraction of the smooth muscles.

These medications can provide rapid relief during an asthma attack.

Examples of these are: Ventolin (fast-acting), Serevent and Bricanyl.

Ventolin in particular (also known as salbutamol) can provide rapid improvement

during an asthma attack because it is a fast-acting bronchodilator.

Sometimes these medications are also given as maintenance medication.

These medications are also available as combination medication,

in which an anti-inflammatory is combined with a bronchodilator.

These include: Symbicort, Seretide, Combivent or Ipramol and Foster.

In the case of an asthma attack, Ventolin is therefore the most effective because it works quickly.

Most other bronchodilators work less quickly, but for a longer period,

while Ventolin works for a relatively short period.

Ventolin can have mild headaches and palpitations as temporary side effects.

These are basically harmless and will disappear after a while.

First aid for a victim of an asthma attack consists of reassuring the victim, loosening tight clothing around the neck, having the victim sit in a position that he finds most comfortable

(often this is a half-sitting position or sitting at a table in a slightly

bent-over position, the so-called writing position)

and possibly having the victim take his own medication.

You can also help the victim take his medication, as long as he is still conscious.

Provide professional help if the asthma attack persists, the medication does not work,

the victim is unconscious or has not had an attack before.

In the case of status asthmaticus, the victim is placed in a half-sitting position and 998 is called as soon as possible. If there are any disturbances in the vital functions, they will be treated.

One can try to get the victim to take his medication, but often this is not or hardly possible.

Are there things that really should not be forgotten or are essential?

Then they can be mentioned again in a box:

Please note:

Remember that shortness of breath in adults can have multiple causes, even if the victim is known to have asthma! Also consider: allergic reaction, heart attack, collapsed lung, hyperventilation, airway obstruction.

The history of COPD

Abstract

The evolution of knowledge concerning COPD and its components--emphysema, chronic bronchitis, and asthmatic bronchitis--covers 200 years.

The stethoscope and spirometer became important early tools in diagnosis and assessment.

Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose.

Knowledge of the pathogenesis, course and prognosis, and new approaches to therapy have dramatically improved our understanding of this important clinical entity.

Smoking cessation improves the early course of disease.

Long-term oxygen improves the length and quality of life in selected patients with hypoxemia.

Surgery benefits a select few.

Today, COPD is a steadily growing global healthcare problem, with increasing morbidity and mortality.

Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.

Figures

Figure 1 Small respiratory bronchiole with surrounding alveolar attachments.

These alveolar attachments serve to tether small airways. Source: Petty T. 2002.

COPD in perspective. Chest, 121 Suppl:116S–120S.

Reproduced with permission from The American College of Chest Physicians

See this image and copyright information in PMC

Figure 2 A drawing describing the mechanisms of airflow obstruction due to the losss of elastic recoil and airway narrowing.

Source: Petty T. 2002.

COPD in perspective.

Chest, 121 Suppl:116S–120S.

Reproduced with permission from The American College of Chest Physicians

See this image and copyright information in PMC

Figure 3 The natural history of COPD.

Source: Petty T. 2002.

COPD in perspective.

Chest, 121 Suppl:116S–120S.

Reproduced with permission from The American College of Chest Physicians.

See this image and copyright information in PMC

Figure 4 Mean post-bronchodilator forced expiratory volume at 1 second (FEV1) for participants in the smoking intervention and placebo group who were sustained quitters (○) and continuing smokers (●).

The two curves diverge sharply after baseline.

Source: Anthonisen NR, Connett JE, Kiley JP. 1994.

Effects of smoking intervention and the use of an inhaled anticholinergic

bronchodilator on the rate of decline of FEV1.

American Medical Association.

COPD

COPD is a serious lung disease that used to be called chronic bronchitis or emphysema.

The term COPD is an abbreviation of the English term 'Chronic Obstructive Pulmonary Disease'.

In the Netherlands, COPD occurs in 20 out of every 1000 people (which amounts to 320,000 COPD patients).

In chronic bronchitis, the causes are often inflammatory processes in the small airways, the bronchioles.

This causes the mucous membranes to swell and more mucus to be produced, causing a partial obstruction (narrowing) of the airways.

In emphysema, the wall of the alveoli is damaged as a result of chronic inflammation.

The alveoli are connected to the small airways (bronchioles) in clusters.

In the inflammatory process, the thin walls of the alveoli are destroyed and larger air spaces are created

with less net gas exchange surface.

The bronchioles also lose their strength due to the damage and collapse during exhalation.

The most important risk factor for developing COPD is smoking, with smoking for a longer period

of time posing a greater risk.

In addition, COPD can occur as a result of long-term exposure to fine dust particles.

There also appears to be a hereditary component that increases the risk of developing COPD.

In the early stages of COPD, there is mainly an increase in mucus formation and coughing.

As the disease progresses, the structure of the lungs becomes increasingly damaged and ventilation (the amount of air in the lungs that is refreshed with each breath) decreases.

As a result, lung function decreases significantly and shortness of breath occurs more quickly, which means that the patient is increasingly less able to exert himself.

Symptoms and complaints

COPD mainly causes chronic shortness of breath, chronic (continuous) coughing, the well-known smoker's cough, and excessive mucus production. In some patients, the disease is mild, while in others it can rapidly worsen. Sometimes the patient becomes so short of breath that daily activities such as getting dressed and walking become almost impossible.

The disease can therefore be seriously disabling.

Diagnosis

COPD is diagnosed by means of a lung function test (spirometry) at a time when the patient is not experiencing an exacerbation.

COPD is present if the FEV1/FVC (maximum exhalation volume in 1 second divided by maximum tidal volume) is less than 70%.

This is also called the Tiffeneau index.

The severity of COPD is indicated in GOLD stages.

GOLD stands for Global initiative for chronic Obstructive Lung Disease.

GOLD I: FEV1 > 80% of predicted.

GOLD II: FEV1 50-80% of predicted.

GOLD III: FEV1 30-50% of predicted.

GOLD IV: FEV1 <30% of predicted.

In severe COPD, there is often an increased total lung volume, with a lot of air remaining in the lungs during exhalation, due to reduced (re)siliency of the lungs.

This causes a permanent inspiratory position with a barrel-shaped thorax.

The volume of air that is moved per breath can then be reduced.

Treatment

COPD cannot be cured.

The treatment is therefore aimed at reducing the symptoms and preventing deterioration.

The best medicine is to stop smoking - if the sufferer smokes.

As long as patients continue to smoke, the disease will worsen.

By stopping smoking, the accelerated deterioration of the lungs and lung function can be slowed down.

In addition, the symptoms can be alleviated: expectorants to facilitate coughing up mucus, bronchodilators that make the airways somewhat wider, antibiotics to combat infections and corticosteroids to prevent inflammation.

Supervised exercise can also provide relief for COPD patients.

That is why there are more and more fitness centres in the Netherlands that offer such facilities to COPD patients.

The importance of exercise therapy and other lifestyle interventions, such as guidance in quitting smoking and nutritional therapy, is increasingly being recognised.

Guidance in quitting smoking is the most effective treatment for COPD and can stop the progression of the disease. Exercise therapy, and in severe COPD also training of the respiratory muscles, are important for maintaining or improving the condition.

Nutritional therapy, in combination with exercise therapy, helps to break the downward spiral of energy deficiency and malnutrition.

First Aid for severe shortness of breath

Approach the victim using the ABCDE method

Warn 998

Have the victim sit in a position that he finds comfortable, such as a half-sitting position or writing position

If trained, be careful when administering oxygen!

In case of an emergency, you can call the following numbers while anywhere in the UAE:

* 999 for Police

* 998 for Ambulance

* 997 for Fire Department (Civil Defence)

* 996 for Coastguard

* 995 for Find and Rescue

How it all started...

1863

Davos consisted only of many meadows with a few farms.

Life in Davos and also in a large part of Graubunden was hard.

In the hope of a better future, people started to move away from the Davos area and surroundings.

They tried to build a life elsewhere and ended up mainly as mercenaries in European armies.

Some became very ill there.

They turned out to have tuberculosis.

This meant: constant weight loss, coughing, fatigue and fever, until death follows.

At that time, tuberculosis was the number 1 public disease together with the Plague.

The Plague was called the Black Death, tuberculosis the White Death.

Seriously ill, they returned home to Davos.

Thinking that they would die there.

But what happened when they arrived there?

Instead of dying, the tuberculosis patients actually recovered.

This was such a special story that it quickly went around.

The German doctor Herman Brehmer (1826-1899), is known as the discoverer of the “sanatoriums Frischluft Liegekur”, with cure prescriptions, use of the deck chair and the sputum bottle.

1865

The first guests arrive in Davos with the aim of being cured.

That led to 22 people coming to this place in Switzerland the following year, in 1866, because they hoped to find recovery or healing there.

Tuberculosis was hardly ever found in Davos at that time.

According to doctors, this is due to the cold, thin air and the number of sunny days in Davos.

1867

The Dutchman Jan Holsboer, comes to Davos.

The Dutchman Jan Holsboer is considered the founder of the Davos Spa, because he started building hotels in Davos, including the Curhaus (now Hotel Europ) and Pension Gelria.

1878

More than 800 people come to Davos every year for recovery and healing.

In addition to the fact that more and more people found their way to Davos to recover and get better, more and more people come to Davos for winter sports.

1886

The same Dutchman Jan Holsboer comes up with a ready-made plan for the construction of a narrow-gauge railway from Landquart to Davos.

1889

Another important factor in the development of Davos is the performance of the doctor Karl Turban (1856-1955).

In addition to rest, he also added discipline to the treatment of tuberculosis in order to achieve recovery.

In 1889 he co-founded the first real closed institution in Davos.

There, patients follow the treatment according to strict schedules.

His method proved successful and in a short time many hotels and guesthouses are converted into closed sanatoriums.

1890

Not long after, the train connection to Davos was a fact.

This accelerates developments.

An ever-increasing flow of foreigners comes to Davos.

1990 – 2021

Sponsored tour on a racing bike from the Netherlands to Davos

In 6 days, 950 kilometers of which 8300 meters of altitude on a racing bike from the Netherlands to Davos.

You have to want it and be able to do it, but then actually do it.

On Sunday, August 24, 1990, Professor Harm Tiddens, together with Professor Berent Prakken (Vice Dean UMCU) and Karoly Illy (Chairman of the Dutch Association for Pediatrics) and almost 30 fellow cyclists, rode from the Wilhelmina Children's Hospital in Utrecht to the Dutch Asthma Center Davos on a racing bike.

Freek de Jonge gave the starting signal for this sponsored tour.

Yvonne van Gennip supported this campaign by cycling along on the first day.

The cyclists took a total of 6 days.

This was part of a sponsored tour for a home care project for children with Cystic fibrosis.

At the time, more than 500,000 guilders were raised for these children. Quite an achievement with a fantastic final amount.

On Sunday 11 July 2021, this sponsored bike tour was held again.

Wytse van den Bosch took over the "Sponsor's baton" from his promoter Professor Harm Tiddens.

This time, 4 gentlemen (Fabian, Sjoerd, Tom and Wytse) left from the Erasmus MC Sophia Children's Hospital in Rotterdam with their racing bikes to the Dutch Asthma Centre Davos.

The same tour, almost the same number of kilometres and altitude metres in the same 6 days, and with exactly the same final destination in Davos in sight.

The sponsorship goal in 2021 was to raise as much money as possible for medical devices that should be able to improve the home monitoring of children with severe asthma.

Mission and vision

The NAD has been around for over 125 years and has a rich history of high mountain treatment.

Through our interdisciplinary treatment, the NAD helps the patient to regain quality of life and control over their life.

The way in which we do this is adapted to the patient's health profile.

Our care is therefore personal, tailor-made and interdisciplinary.

Through our knowledge and experience and because we take the time to carefully observe from the various disciplines, we are able to clarify why things go wrong.

And as experts, together with our partners, we achieve life-changing health outcomes for our patients.

In addition, the clean air in the mountain climate offers the opportunity to calm down the asthma and therefore the NAD has additional value compared to treatment at sea level.

Non-medicinal factors

We believe that every person has a goal, regardless of their physical and/or mental limitations.

We therefore believe in the autonomy of our patients. Treatment at the NAD mainly means paying attention

to non-medicinal factors.

Factors such as lifestyle and social interaction play a major role in a chronic disease and form a building block of the treatment.

In addition, our work consists of advising, providing information and coaching.

At the moment we do this for Dutch patients, but we could also offer this care to international patients.

Vision and ambition

The NAD has been around for 125 years and has already proven its importance for the treatment of severe asthma in practice.

This is evident from the stories of many patients with severe asthma as well as increasing scientific evidence that altitude treatment is effective in calming asthma.

Recurring reactions from patients about treatment at the NAD indicate that it has enabled them to regain control of their lives, to break the vicious circle, to regain control, to make choices and thus to experience quality of life again and to regain confidence to continue with their care providers in the Netherlands. As our mission also clearly indicates, the NAD definitely has something to offer people.

In order to shape this mission, we will focus on the following points in the coming 5 years:

* In 2030, the Dutch Asthma Centre Davos will be the leading treatment and expertise centre for patients who benefit from treatment in an alpine altitude climate.

* The NAD is committed to further research into the effect of treatment and identification of subgroups of patients who benefit most from the treatment.

We are convinced that more patients can benefit from high-altitude treatment.

Our aim is to reach these patients and give them the opportunity to receive the care they need.

* The NAD will adapt its care more to the current zeitgeist.

For example, we have the ambition to facilitate shorter admissions, especially for people who have been to Davos before.

In this way, we can also make care more efficient, which is also a responsibility of our center.

In addition, this also “saves” time for the patients.

* The NAD will continue our assessments in the coming years.

An assessment is a 1-week process.

* The NAD is developing a plan to enable short (3-4 weeks) admissions for children.

* The NAD will monitor people after admission by using e-health technology and possibly outpatient checks in the Netherlands. With all the current technological developments, it is easier to follow people remotely.

The NAD hopes to improve the retention of treatment results in this way.

In addition, we can collect data to improve our treatment and strengthen our story.

* The NAD is making progress in the field of sustainability.

The air in Davos is one of the cleanest in Europe.

The quality of the air is so high that overstimulated lungs can relax.

As NAD, we therefore realize how important it is to pay attention to the changing climate.

Clean air is our medicine, without side effects.

Ambition

As an organization, the NAD wants to be more prominent when it comes to asthma treatment.

In 2030, the Dutch Asthma Center Davos will be the leading treatment and expertise center for patients who benefit from the disadvantage in an alpine altitude climate.

This means that we are going to work to get a place in the training.

We also want to play a role in scientific research.

In addition, we will take stock of whether obtaining an official designation of “advanced asthma internship”

for the NVALT is feasible for us.

Since we are a small center, we will have to join a partner for this area of focus.

As that partner, we prefer an academic center.

The above principles also mean something for the internal organization.

We want to use the coming years to increase the pride of the organization.

We make a very important contribution to the lives of our patients.

We can be proud of that!

At the same time, it is our ambition to continue to develop ourselves.

Matters such as corporate culture, training and quality will be high on the agenda in the coming years.

Clinical pulmonary rehabilitation in the high mountains

Severe asthma

(Severe) asthma is a chronic disease.

It is very important to strive for the best possible asthma control.

This prevents exacerbations (lung attacks) and deterioration of lung function and thus strives for the highest possible quality of life.

With good treatment, in which, in addition to asthma, all other contributing factors are carefully mapped out and treated, severe asthma can also be brought under control.

For severe asthma, in addition to treatment with (inhalation) medication, there are various treatments that can be given in addition to the standard treatment.

One of these is high-altitude treatment

(Alpine Altitude Climate Therapy, AACT).

This is clinical pulmonary rehabilitation that takes place in the high mountains.

The NAD offers this unique form of pulmonary rehabilitation, in the middle of the high mountains in Davos, Switzerland.

This is one of the most important points that makes the care we provide so different from pulmonary rehabilitation that does not take place in the high mountains.

Pulmonary rehabilitation in general

Under the supervision of a multidisciplinary team with the pulmonologist as the person ultimately responsible, we work together with the patient to optimize the overall state of health.

Pulmonary rehabilitation can take place both on an outpatient and clinical basis.

If you are rehabilitating on an outpatient basis, you may visit the various disciplines such as a physiotherapist and a dietician one or more times a week (first line), or you may visit a rehabilitation institution in your area several times a week (second line).

With clinical pulmonary rehabilitation, you will stay in the rehabilitation institution during the treatment during the week; this rehabilitation can take place in a second-line or third-line rehabilitation center.

The treatment program is designed individually based on a so-called assessment.

The assessment is intended to clearly map out the problem by means of diagnostics and intake interviews with the various disciplines.

Based on the assessment, treatment goals are drawn up together with the patient, from which an individual treatment plan results.

There are 6 clinical pulmonary rehabilitation centres in the Netherlands:

* Beatrixoord Rehabilitation Centre, Haren

* Ciro Expertise Centre for Chronic Organ Failure, Horn

* Pulmonary rehabilitation RadboudUMC, Nijmegen

* Revant Centre Complex Longfalen, Breda

* Merem Medical Rehabilitation, Hilversum

* NAD (Dutch Asthma Centre Davos), Davos in Switzerland.

Who is clinical pulmonary rehabilitation in the high mountains intended for?

Clinical pulmonary rehabilitation in the high mountains is intended for people with severe and/or difficult to treat asthma.

To be eligible for clinical pulmonary rehabilitation in the high mountains, a referral from your pulmonologist is required.

We will assess this referral based on the criteria for pulmonary rehabilitation in the high mountains drawn up by the professional association (NVALT).

Clinical pulmonary rehabilitation in Davos

We only offer clinical pulmonary rehabilitation, where unlike other centres, patients also stay with us during the weekends.

The treatment is provided by a multidisciplinary team of experts in the medical, nursing, physiotherapy, movement and psychological fields.

We offer a tailor-made treatment, focused on your specific type of asthma (phenotype) and on the underlying ‘treatable traits’ (perpetuating factors).

To get an idea of what our healthcare professionals can do for you during a stay at the NAD, we invite you to watch the videos of the various disciplines.

We work efficiently and evaluate with you in the meantime how things are going with the set treatment goals.

The treatment duration is on average 8 weeks.

It is a long time away from home, which can sometimes be difficult, but at the same time it also offers the opportunity to reflect on your asthma and all the contributing factors without being distracted by your daily activities at home. Together with the treatment team, you will work on an asthma action plan, so that you can keep your asthma under control at home.

Our pulmonologists have expertise in working with new medications such as biologicals.

The often successful reduction of medication in the NAD can help to better characterize the asthma (phenotype).

This allows us to advise the pulmonologist in the Netherlands whether and for which biological you may be eligible if necessary.

Clinical pulmonary rehabilitation in the high mountains is intended for people with severe and/or difficult to treat asthma.

To be eligible for clinical pulmonary rehabilitation in the high mountains, a referral from your pulmonologist is required.

We will assess this referral based on the criteria for pulmonary rehabilitation in the high mountains drawn up by the professional association (NVALT).

Clinical pulmonary rehabilitation in high mountains is effective in patients with allergic and non-allergic asthma on:

Asthma control and quality of life

Upper airway- problems

Lung function

airway-inflammation

Oral steroids usage

Exercise tolerance

What makes NAD unique?

In addition to being the only pulmonary rehabilitation centre in Switzerland, there are a number of features that distinguish our rehabilitation centre from other lung centres.

We are the only specialised pulmonary rehabilitation centre with over 125 years of experience, which has focused exclusively on a specific target group for the past 30 years:

patients with severe asthma. NAD is located at an altitude of almost 1700 metres in the Swiss mountains.

The often ‘low-stimulus environment’ of this alpine climate has a particularly positive effect on the airways and asthma.

The low-stimulus alpine climate is characterised by drier air, less pollen, less house dust mites, less mould, less fine dust and air pollution.

In this environment, the airways and thus the asthma can come to rest, making it possible to effectively rehabilitate and build up condition.

These effects also make it possible to reduce medication (e.g. Prednisone), which has often not been possible in the Netherlands for a long time.

There is a proven scientific effect of high mountain treatment on asthma control, quality of life

and Prednisone reduction.

This effect lasts for a large proportion of people for a long time (12 months).

Both allergic and non-allergic asthma respond well to high mountain treatment.

In addition to the favourable effect on the airways, we also see a favourable effect on allergic eczema

and ENT complaints.

Even in the blood, where the cells that cause inflammation in the airways are activated, a change in inflammation patterns can be seen after high mountain treatment.

And not unimportant: high mountain treatment has no side effects!

The NAD

History of NAD

The Dutch Asthma Centre Davos is a Dutch specialised hospital for Dutch patients in the high mountains.

Our specialised hospital is the only one of the 6 Dutch asthma centres that focuses exclusively on patients with asthma.

The first observation of the favourable effect of the high mountain climate on asthma was made in Davos in 1879.

That was at a time when patients with tuberculosis sought recovery in Davos.

Among these patients were also patients with asthma, for which there was no medication at all at the time.

The asthma improved and patients felt less restricted.

Since then, patients with asthma have also been referred to Davos and many studies have been conducted.

These studies have demonstrated the beneficial effect on asthma control, on the sensitivity of the airways, on the severity of airway inflammation and on the use of Prednisolone in children and adults with asthma.

Clinical pulmonary rehabilitation in high mountains is effective in patients with allergic and non-allergic asthma on:

Asthma control and quality of life

uper airway- problems

Exercise tolerance

Lung function

airway-inflammation

Oral steroids usage

The high mountain environment of Davos

The high mountain environment (1686 meters above sea level) is characterized by low relative humidity with greatly reduced concentrations of house dust mites, pollen and mold spores.

Far away from the industrialized urban environment, much less air pollution is measured in Davos.

The mountain climate also offers high exposure to UV light with a possible immune-boosting effect.

The distance to the Netherlands also offers possible freedom from psychosocial stress.

What makes the NAD unique?

Apart from the fact that the NAD is the only pulmonary rehabilitation center in Switzerland, there are a number of characteristics that distinguish our rehabilitation center from other lung centers.

We are the only specialized pulmonary rehabilitation center with over 125 years of experience, which has focused exclusively on a specific target group for the past 30 years: patients with severe asthma.

The NAD is located at an altitude of almost 1700 meters in the Swiss mountains.

The so-called 'low-stimulus environment' of this alpine climate has a particularly positive effect on the airways and asthma.

The low-stimulus alpine climate is characterized by drier air, less pollen, no house dust mites, less mold, less fine dust and air pollution.

In this environment, the airways and thus the asthma can come to rest, making it possible to effectively rehabilitate and build up condition.

These effects also make it possible to reduce medication (e.g. Prednisone), which has often not been possible in the Netherlands for a long time.

There is a proven scientific effect of high mountain treatment on asthma control, quality of life and Prednisone reduction.

This effect lasts for a large number of people

for a long time (12 months).

Both allergic and non-allergic asthma respond well to high mountain treatment.

In addition to the beneficial effect on the airways, we also see a beneficial effect on allergic eczema and ENT complaints.

Even in the blood, where the cells that cause inflammation in the airways are activated, a change in inflammation patterns can be seen after high mountain treatment. And not unimportant:

high mountain treatment has no side effects!

Alpine Altitude Climate Treatment for severe and uncontrolled asthma: an EAACI position paper. Allergy 2022; 00:1-34

Medication history

Prednisolone has been on the market since 1955 and this medicine was also used for asthma.

This made it seem as if high mountains would also become unnecessary for patients with asthma.

However, this medicine has many side effects and it is very important for patients to be able to reduce or stop using it.

This works better in an optimal environment, such as high mountains.

Inhaled steroids were widely available from the eighties and now the asthma problem seemed to be solved for good.

But not for all patients! Even under treatment with maximum inhalation medication, some patients with severe asthma are unable to get their asthma sufficiently under control.

The new medicines (biologicals) that have come onto the market in recent years bring great relief to some patients with severe asthma.

In recent years, we have seen an increase in the number of patients in the NAD who have tried various biologicals with insufficient effect.

There are also patients who are not eligible for a biological.

For all these patients, pulmonary rehabilitation at altitude is a valuable treatment option.

Allergic / Non-allergic

In 1927, Storm van Leeuwen developed the hypothesis about the influence of “climate allergens” on patients with asthma.

Later it appeared that the house dust mite plays an important role in this.

In the dry mountain climate of Davos, the house dust mite can hardly survive. Compared to lower altitude areas, there is less house dust mite present in Davos.

In 1967, Kerrebijn and Zuidema showed that, during high mountain treatment, oral steroids could be reduced in 3 months in prednisolone-dependent children with asthma.

The hyperreactivity of the airways showed a steady improvement over 12 months.

In 2001, Grootendorst showed something new.

Allergic children, who were symptomatic despite high doses of inhaled steroids, respond favorably to treatment in the high mountains.

Improvements in inflammation were also found in adult patients, with severe or non-allergic asthma.

These improvements were seen in clinical and functional parameters.

In 2012, Rijssenbeek compared the effect of high-altitude treatment in non-allergic patients with the effect in allergic patients.

Both groups showed comparable improvements in asthma control and asthma-related quality of life, reduction of upper respiratory symptoms, improved lung function and exercise tolerance, and prednisolone use.

Almost half of the patients with a house dust mite allergy and a third of the non-allergic patients were able to completely stop the maintenance dose of prednisolone.

In the remaining patients, the dose could be significantly reduced.

Based on these results, we concluded that high-altitude treatment improves asthma control in both allergic and non-allergic patients.

Perspective

Perspective is our product.

That is different for everyone, but the effects of a NAD treatment are great in their apparent modesty for people with severe asthma.

Because there is more air, you literally get further and the world slowly becomes a little bigger, social isolation decreases and you can work on personal dreams.

Simply being able to do sports again, being there for your family or friends, helping with the household, having a cup of coffee or a meal with friends.

Air quality in Davos

Clean air

The air in Davos is breathtakingly fresh and pure.

Davos has a relatively clean and healthy air quality.

The combination of the altitude and the pure mountain air ensures that the air feels light.

It is a relief to breathe deeply and let the pure mountain air fill your lungs.

The climate of Davos contributes to the clarity of the air.

The city is known for its sunny days and clear blue skies.

During the winter months, temperatures can be quite cold.

This only adds to the freshness of the air.

The cold, clean mountain air feels revitalizing.

Air pollution in Davos is generally lower compared to many urban areas around the world.

This is largely due to the low population density, alpine climate and limited industrial activity in the area.

Davos has also taken several measures to improve air quality and reduce air pollution.

The city actively promotes the use of clean and sustainable energy sources, such as hydropower and solar power, to reduce the impact on the environment.

However, even in Davos, which generally has good air quality, there are factors that influence air pollution.

Seasonal biomass combustion, such as the use of wood stoves, and certain wind directions (Föhn) affect air quality.

However, to a lesser extent than in more urban and industrial areas.

The air in Davos contains a variety of allergens, including pollen from flowering plants, trees, and grasses.

As you move higher into the mountains, exposure levels to certain allergens may be lower.

This is because vegetation changes and climatic conditions are different.

Vegetation is often less dense and consists more of mosses, lichens, low grasses, shrubs, and conifers.

These produce fewer allergens compared to plants and trees at lower altitudes.

Some plants that are highly allergenic and produce large amounts of pollen, such as ragweed, are rare in Davos.

However, the precise exposure levels to allergens in mountainous areas are complex and depend on a number of factors, including altitude, vegetation types, and specific local conditions.

Reduced exposure to allergens can provide relief for people with allergic asthma and allergies, such as hay fever or allergic rhinitis.

However, individual sensitivity to allergens varies, and some people may still experience allergic reactions even at higher altitudes.

What is air quality?

The AQI (Air Quality Index) is a number used by the government to communicate how polluted the air currently is or how polluted it is expected to become.

At a higher AQI, a larger proportion of the population is likely to experience more serious adverse health effects.

The AQI is calculated using a model.

There are several websites with air quality forecasts such as https://aqicn.org/map/netherland/.

The AQI refers to different pollutants: PM10, PM2.5, NO2, SO2, O3.

What does air pollution consist of?

PM (Particulate Matter) stands for atmospheric particles.

These are microscopic solid or liquid substances

that float in the air.

Some particles are small enough to reach the deepest parts of the lung.

PM10 + PM2.5

PM10 are particles that have a diameter of less than 10 micrometers (about 1/7th the thickness of a human hair).

PM2.5 are fine particles with a diameter of 2.5 µm or less.

They are a mixture of materials that can contain smoke, soot, dust, salt, acids and metals.

PM10 is visible to the eye as smog.

PM10 is among the most harmful of all air pollutants.

The effects of PM10 and PM2.5 particles can be:

* Increase or worsen asthma attacks.

* Cause or worsen bronchitis and other lung diseases.

* Reduce the body's ability to fight infections.

NO2

Nitrogen dioxide.

This is a reddish-brown gas with a characteristic sharp, acrid odor and is a major air pollutant.

The main source of NO2 is the combustion of fossil fuels: coal, oil and gas.

NO2 is released during combustion at high temperatures, such as in a car engine.

It is used as an indicator of air pollution that comes directly from traffic.

The consequences of excessively high NO2 concentrations can be:

* Causing pneumonia and reducing immunity to lung infections.

* Causing problems such as wheezing, coughing, colds, flu and bronchitis.

SO2

Is a gas that is invisible and has an unpleasant, sharp odor.

The consequences of too many SO2 particles can be:

* Damage human airways and make breathing difficult.

* Exacerbating asthma in children, the elderly and people with asthma.

* Acid rain, which can damage vulnerable ecosystems.

This stands for Ozone.

This is a gas that occurs both high in the atmosphere and close to the earth's surface.

Ozone occurs naturally in the stratosphere and protects us from harmful UV light.

Close to the earth's surface, ozone is created from the reaction between nitrogen oxides and volatile organic compounds.

Ozone is therefore not directly emitted by, for example, road traffic or industry.

But it does contribute to smog formation.

The consequences of high O3 concentrations can be:

* Difficulty in deep and powerful breathing.

* Worsening shortness of breath and pain when breathing deeply.

* Painful or hoarse throat or causing coughing.

* Lung diseases such as asthma, emphysema and chronic bronchitis worsen.

* Increase the frequency of asthma attacks.

* Make lungs more vulnerable to infections.

* Cause life-threatening damage to the lungs, even when the symptoms have disappeared.

* Cause chronic obstructive pulmonary disease (COPD).

What is so clean about the air in Davos?

In general, the air quality in Davos is among the cleanest in the world. Patients who are rehabilitating at the NAD often immediately notice that the air in Davos is clean.

A current overview of the AQI, PM10, PM2.5, O3, NO2, SO2 in Davos can be found via the following link:

Switzerland air quality parameters

A current overview of the measured pollen concentrations can be found via this link: Pollen concentrations.

Together

With our knowledge and treatment

we create that perspective together.

125 years of the Dutch Asthma Centre Davos (NAD)!

This is how long our centre has existed this year and we are of course very proud of that.

What once started as a place where clear improvements occurred for people with TB, is now a specialised clinic for people with severe asthma.

The clinic had already noticed since the 1950s that people with asthma recovered very well at altitude and in the 1970s a separate building, the Eugenia House, was purchased to set up this asthma care; deliberately separate from the TB patients.

At that time, just as many people died from (severe) asthma as from TB and there was therefore a great need to do something about this.

Since then, a lot of knowledge has been gathered and the foundation has also been laid for the interdisciplinary approach that is still characteristic of the NAD.

Since the 1970s, there has also been a separation between the operation of the clinic and the patient association Netherlands-Davos (VND); they also play an important role in this history, then also in the exploitation, now still as advocates of asthma patients, a role that has proven to be very important in recent years.

Unfortunately, the last few years have mainly been dominated by the high costs and the associated research to demonstrate the added value.

Despite the many studies that clearly demonstrate a effect for these patients, the system for weighing evidence is not suitable for making statements for existing care that do justice to our care; a broader, complicated theme in care.

The fact that we have existed for 125 years, receive referrals from almost all hospitals, and see more and more patients who fail on the new medicines, at least indicates that there is still a great need for this care.

The uncertain times of the last few years, in which the existence of the NAD was really at stake, have resulted in a team that is there for each other, that understands that our care is unique and that is able to adapt to new circumstances time and again, together with our location our most valuable distinguishing feature.

In the coming years, the NAD will continue to invest in demonstrating the added value of our care, whether this is called value-based healthcare, value-driven care or appropriate care, this is in line with the vision of the NAD and it is therefore happy to make its results transparent to its environment.

The NAD knows better than anyone how important a healthy environment is and has therefore also designated the sustainability of its business operations as a spearhead for the coming years.

In addition, it will invest in digital solutions for its patients, strengthening existing collaborations and in scientific research.

In this way, the NAD hopes to be able to continue to play a permanent role for severe asthma patients and also to be able to have a different conversation with its stakeholders that is not only about costs but also about the outcomes that belong to those costs.

I have no choice but to express my gratitude to all the collaboration partners we deal with, the VND, the pulmonologists, the NVALT, the Dutch Lung Alliance and the health insurers.

Clinical pulmonary rehabilitation centre in the high mountains specialised in severe asthma

The Dutch Asthma Centre Davos is a Dutch specialised clinical pulmonary rehabilitation centre for Dutch patients in the high mountains of Switzerland.

Our specialised centre is the only one of the 6 Dutch pulmonary rehabilitation centres to focus exclusively

on patients with asthma.

Around 1950, medicines to treat tuberculosis become available.

The bed cure slowly disappears from view.

As a result, many sanatoriums in the Netherlands and in Davos close their doors.

The Dutch sanatorium reduces its admission capacity from 330 to 200 beds.

Beneficial effect of high mountain climate

The first observation of the beneficial effect of the high mountain climate on asthma was made in Davos as early as 1879.

That was at a time when patients with tuberculosis were seeking recovery in Davos.

Among these patients were also patients with asthma, for which there was no medication at all at the time.

The asthma improved and patients felt less restricted.

"The tulips also bloom for this Dutch Sanatorium in the high mountains, albeit sometimes under a thick layer of snow"

From the 1952 annual report

Beneficial effect on asthma control

Since then, patients with asthma have also been referred to Davos and many studies have been conducted.

These studies have demonstrated the beneficial effect on asthma control, on airway sensitivity, on the severity of airway inflammation and on the use of prednisolone in children and adults with asthma.

Around 1950, medicines to treat tuberculosis become available.

The bed cure slowly disappears from view.

As a result, many sanatoriums in the Netherlands and in Davos close their doors.

The Dutch Sanatorium reduces its admission capacity from 330 to 200 beds.

Much less air pollution in Davos

The high mountain environment (1686 meters above sea level) is characterized by low relative humidity with greatly reduced concentrations of house dust mites, pollen and mold spores.

Far away from the industrialized urban environment, much less air pollution is measured in Davos.

The mountain climate also offers high exposure to UV light with a possible immune-enhancing effect.

The distance to the Netherlands also offers possible freedom from psychosocial stress.

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