 Hello, greetings on the occasion of the word Asthma Day. I am Dr. Satyanarayana Mysore, interventional pulmonologist and sleep medicine specialist. Since the year 1998, we have been having the annual event of word Asthma Day. At each year, this is a theme to celebrate and work on the goals of the theme. This year, the theme of the word Asthma Day is stop. And when we mean what we mean by stop is S stands for symptom evaluation. What are the subjective complaints that patients come with? One has to pay meticulous attention to what the patient is complaining of and their symptoms. The second is to test response, give medications. Suppose there is cough, suppose there is breathlessness, tightness in the chest. These things need to be addressed and O stands for observation. So, have a follow up with the patient, observe and assess how they are fearing well in the progress of control of Asthma. The last one is the P and the P stands for proceed to adjust the treatment. I would like to share with you all on two important aspects. One is the aspect of the myths, the do's and don'ts of Asthma. And secondly, the newer developments in Asthma. There is a reason why I would like to share the myths. Every day, if I see about 20 asthmatics in my clinic, I find that in majority of patients, there are a set of firm beliefs. These beliefs may be based from the internet search or beliefs that have been shared to them by their well-wishers, friends or relatives. There has to be a rational understanding of these things for a proper control of Asthma. The number one myth that we see is, doctor, can my Asthma be cured? Is there a permanent cure that you can provide? Asthma is a chronic disease. Symptoms may be there at times. Symptoms may not be there at all times. So lack of symptoms does not mean that there is no asthma. Usually children who develop asthma at a very young age outgrow the symptoms but not the disease. So by the ages of 18 to 24, we may see that the symptoms are to the bare minimum. And that may mislead about then why should I use the medication anymore? That is a myth that is very firmly there in the community. The second one and the largest one is that inhalers. I don't want to use inhaler. I think I will get addicted to it. I may have to use it for lifelong or long term. Now we have to understand the firm difference between a tablet and an inhaler. A tablet has to be taken. It's usually much more bigger dose than what the drug is delivered through an inhaler. It goes to the stomach, gets into blood circulation, visits all the other organs which it does not have to, then comes to the lung. In case of an inhaler, it is 100th of the oral medication. Very tiny, mini dose that is mixed with a whiff of pressurized air and that is what you take directly into your lung. Side effects whatever are minimal and negligible. When you put the risk versus the benefit, I think most doctors would recommend inhalers, rota healers and other forms of treatment once the diagnosis is confirmed. Spirometry or lung function test is widely available. We at Manipal do have further improved diagnostic skill sets. We do have cardiopulmonary exercise testing. When a normal lung function does not confirm or refute the diagnosis of asthma, when the clinical symptoms are not that consistent, but you do have a fear that yes, there could be a little bit of asthma that is not obvious, we can do what is known as cardiopulmonary exercise testing, asthma protocol. And that can show that the airway gets tightened, the airway smooth muscles get into spasm. So this is the range of improved diagnostics. Every patient of asthma is recommended to have a spirometry done or a lung function test done to confirm the diagnosis. And on the follow, it needs to be measured to see how well the disease is controlled. Myth number three is an extra emphasis on diet. People tend to associate food as warm, cold, hot and then impose self-imposed restrictions on dietary products which may not be recommended or necessary in most of the cases. These are some of the myths that I wanted to share with you all. Coming to the other important aspect, newer treatments in asthma. Asthma has four different severities and treatment response based on the treatment response. The medications are added or subtracted, brought to a minimal. Lack of symptoms, as I earlier said, does not mean absence of disease. A small dose of inhaled medication may be required to prevent what we call as airway remodeling. So to keep the airway free from inflammation and permanent changes or long-standing changes, a little bit of medication may be required. So medications can be broadly put into two categories. Preventors, that is, those medications which prevent asthma, relievers, those that relieve the symptoms. Relievers on their own is not advised as per the current GNA guidelines which is global initiative for asthma control. Coming to the newer modalities of treatment, we at Manipal, we are passionate to bring the best to our patients and we do have a center established for biologics. Till date in our country, we had criteria for using which patients should receive these new drugs called biologics. They are costly. Just because they are costly, that doesn't mean they are the best. It has to be considered only after medical evaluation, risk and benefits and the cost is all clearly discussed with the patient in question. Now we had this drug called omelizumab and we do have it, but then exciting newer molecules are coming into India. We will be looking forward to having a drug called nipolizumab. We also are looking towards a drug called vendralizumab and these drugs may turn out to be game changers. As far as interventions for asthma, the most important intervention in asthma is basically very very simple tool. Every time the patient comes to me, I would suggest that the inhaler technique is changed and checked. If the technique is ineffective, if there is problems with synchronizing the hand to mouth coordination, the drug is not delivered to the lung and the asthma control remains poor. So this is a low cost initiative that everyone involved in treatment of asthma should do. Manipal has trained respiratory nurses in the outpatient areas who are well trained to check and assess the correct inhaler technique. Coming to the newer devices, we have what we call as bronchial thermoplasty. Bronchial thermoplasty is a tool in which bronchoscopy or a camera is inserted into the lung and once you assess the smooth muscles of the lung, you use thermal heat to thin the smooth muscles. Therefore the airway muscle cannot get into replicated spasm. However, this is not offered to every patient upfront. This kind of intervention remains the last resort in establishing a firm control. Doing bronchial thermoplasty does not mean freedom from drugs. Patients do need to be on drugs, but may be at a very minimal dosage. All in all, I am glad that I have had this opportunity to share with you all about the common mix in asthma, the theme for the 2019 word asthma and thirdly the newer developments and devices. Let us all work towards, you know, increasing the asthma awareness, making the treatment accessible and in tune with the Manipal philosophy, let us make the asthma care affordable as well, but not compromising on what the latest that we have to offer to you all. Thank you.