Asthmatics should be proactive in managing their condition and not merely think they can live with it, writes Nadia Badarudin
WHEEZING, coughing, shortness of breath and chest tightness — symptoms experienced by some 300 million people around the globe suffering from asthma, a chronic lung disease for which there has been no cure as yet.
The American Academy of Allergy Asthma and Immunology states that asthma cases have risen substantially in the last 40 years, and with a projected additional 100 million asthmatics worldwide by 2025.
Asthmatics usually find their lives adversely impacted by recurrent attacks that cause fatigue and sleeplessness leading to school and work absenteeism, and limiting participation in sports and recreational activities.
Despite it being one of the most common chronic diseases, asthma remains under-diagnosed and under-treated.
According to a local study in 2012 — The Role Of Health Counselling In Relation To MDI Usage For Rural Adult Asthmatic Patients In Hulu Selangor by K. Selvam — prevalence of asthma in Malaysia is estimated between 10 and 13 per cent of the population, affecting approximately 3.25 million people, in which the majority are under-treated.
WHAT IS ASTHMA?
According to the MSD Global Asthma Fact Sheet, asthma is an underlying inflammation of the bronchial tubes (the airways leading to and from the lungs) which increase sensitivity to certain airborne substances. Once irritated, the sensitivity can trigger the narrowing of the airways and reduces the flow of air in and out of the lungs, resulting in an asthma attack.
Institute of Respiratory Medicine director Datuk Dr Abdul Razak Muttalif says asthma, which has become more common in urban areas, is triggered by various factors including genetics, outdoor and indoor allergens, as well as the environment.
“Besides genetic predisposition, the onset of asthma can be caused by allergens such as pollen, moulds, dust mites, animal dander or insects like cockroaches, as well as automobile emissions, toxic chemicals, viral infections, haze or changes in weather.
“Stress, anxiety, strenuous exercise and even laughter can trigger asthma attack.”
“There are also indications of exacerbations in a smoking environment. Studies show that smoking can influence the effectiveness of an asthma therapy and cause difficulty in controlling the disease,” he says, adding that males have a higher risk of asthma during their childhood but after adolescence, the risk is higher in females.
He adds that there are also cases of patients mistakenly thinking that their symptoms are merely allergic rhinitis (resdung in Malay).
“There is a close link between asthma and allergic rhinitis. About 80 per cent of asthmatics have concomitant rhinitis. Thus, it is important that if someone has ‘resdung’ and feels breathless, he or she should check for asthma,” he says.
Medications prescribed for asthmatics fall into two categories — long-term control, and quick relief or “rescue” medications.
Inhaled corticosteroids are the preferred medicine for long-term control of asthma, while short-acting beta2-agonists are one of the options for quick relief.
In serious conditions, oral and intravenous corticosteroids may be required for acute asthma flare-ups or for severe symptoms. However, these can cause serious side-effects if used long-term.
“Although the awareness on asthma is high, and there are advances made in the asthma treatment in recent years, many patients have yet to manage or control the disease well,” says associate professor Dr Roslina Abdul Manap, Universiti Kebangsaan Malaysia Medical Centre consultant respiratory physician and head of respiratory medicine unit.
Dr Roslina says, according to the Asthma Insight and Management in Europe and Canada (EUCAN AIM) 2010 survey, most patients believe their asthma is under control, when in fact, it is not. “One in five patients was found to have needed acute care for asthma over the course of a year, with 6.7 per cent of the patients requiring hospitalisation.
“Approximately 41 per cent of patients needed a quick relief of an inhaler at least once a week. These figures underscore the need for proper treatment,” she says.
She adds: “The survey found that sudden, severe episodes were considered far worse by patients than day-to-day asthma symptoms.
“These symptoms can be so severe that more than half of respondents stopped exercising as a result, while more than a quarter left work or school, and almost 10 per cent had to enter intensive care.”
TOO POLITE TO DISCUSS
Dr Roslina says the Global Initiative for Asthma (GINA) Control Classification is a guideline that determines whether a patient’s asthma condition is under control or otherwise. GINA works with health care professionals and public health officials around the world to reduce asthma prevalence, morbidity and mortality.
The guideline defines a patient’s “controlled”, “partly controlled” and “uncontrolled” asthma based on five characteristics: daytime symptoms, limitations of activities, nocturnal symptoms/awakening, need for reliever treatment and lung function.
Dr Roslina says: “Based on the guideline, asthma is classified as under control when the patient can avoid troublesome symptoms night and day, as well as serious attacks.”
“A controlled asthma also means that the patient can use little or no reliever medication, have near normal lung function and most importantly, he can have a productive and physically active life.”
She adds that learning about asthma and talking to the doctor are the two simple ways to manage the disease. “Unfortunately, patients, especially Asians, are too polite to discuss their condition with the doctors.”
“The majority of them share the perception that it’s okay to have asthma symptoms and think ‘I can live with it’.”
Some asthmatics quit exercising or playing their favourite sports just to avoid getting the attacks. “And such attitude and perception need to be changed. The patients have to realise that they can be proactive and control the disease,” she says.
LIVING WITH ASTHMA
Former nurse, Bibi Mohd Zain, 69, from Taman Melati, Setapak, has been living with asthma for 28 years. In the early years after diagnosis, having frequent episodes of attacks and being hospitalised had become part and parcel of Bibi’s life.
“The attacks would usually occur when I was under stress, and the episodes were like dreadful routines. And asthma did affect my daily activities back then,” she says.
Over the years, Bibi has learnt to adapt and deal with asthma, simply by understanding and managing the disease.
“I got tired of the various treatments and taking medicines that kept changing over the years. So, I took the initiative to understand asthma, as well as learn what I could do to prevent the symptoms. It’s all about taking control of the disease,” she explains.
Bibi says identifying the factors that can trigger her asthma is crucial in managing the disease. Among them cigarette smoke, strong smells and certain foods such as watermelon.
“I’ll also try to stay indoors if the weather is too cold or too hot, and try to stay calm and relaxed to avoid stress.
“It has not been easy, but it has worked over time. Precaution is also key, so, if I want to indulge in certain asthma-triggering foods or exercise, I’ll take the necessary preventive medicine prior to eating or exercising,” she says.
Bibi has become less dependent on her inhaler and has been exercising regularly after learning to control her asthma. She shares her asthma-controlling tips with her daughter, Rahayu Amiruddin, who is also asthmatic.
“My daughter was diagnosed with asthma when she was in primary school. I taught her how to take proactive measures, and now at 39, her lifestyle is not affected by the disease. She is in fact a fitness instructor, ” she says.
ASTHMATICS can lead normal lives if they learn to control their asthma. Here are the ways:
1. Take asthma medicines as prescribed by doctors.
2. Stay away from things that trigger your asthma attacks.
3. Go to the doctor two or three times a year for check-ups. Most importantly, go even when you feel fine and have no breathing problems.
4. Ask questions. Your doctor is your partner in controlling your asthma. Tell the doctor about any problems with your asthma medicines.
5. Know the signs if your asthma is getting worse and how to respond.
6. Keep a handy asthma medicine plan:
• Know what quick-relief medicines to take when you have an asthma attack.
• Help remember what preventive medicines to take every day.
• See if you should take asthma medicine just before sports or working hard.
7. Always carry your quick relief asthma medicine with you when you leave home.
8. Get help if you see any of these asthma danger signs:
• Your quick-relief medicine does not help for very long or, it does not help at all — breathing is still fast and hard.
• It is hard to talk.
• Lips or fingernails turn grey or blue.
• The nose opens wide when the person breathes.
• Skin is pulled in around the ribs and neck when the person breathes.
• The heartbeat or pulse is very fast.
• It is hard to walk.
Adapted from GINA Patient Guide 2007
• In the United States, asthma costs the country more than US$30 billion (RM94 billion) a year.
• In Europe, the total cost of asthma currently hovers at approximately £17.7 billion (RM86.8 billion) per year, with outpatient costs accounting for the highest proportion at approximately £3.8 billion (RM18.64 billion).
• In Malaysia, the direct cost of treating asthma is RM850 per year for adults, and RM577 per year for children (as of April 2013).
• According to the EUCAN AIM survey in 2010, patients surveyed experience almost a 40 per cent decrease in productivity on days when their asthma was at its worst compared with a typical day.
Source: MSD Global Asthma
Read more: Tackle and control asthma – Health – New Straits Times http://www.nst.com.my/life-times/health/tackle-and-control-asthma-1.302083#ixzz2WcWFytYU