Keeping asthma under control
This long-term condition has no cure. The only way to deal with it is by using medication regularly.
BY: Eleanor Yap
Desmond Seng.
Fifty-four-year-old Desmond Seng had asthma since his early teens. However, he has not let his condition get the better of him. “When I was diagnosed with asthma, one of my main concerns was that it would stop me from doing the things I love including sports – running and swimming. Therefore, from the word go, it was hugely important for me to ensure that I controlled my asthma; I didn’t want it to affect my quality of life and to cause me to miss out on everything that my peers were doing.”
The director of a trading and logistics company shared that he had used a controller inhaler on a regular basis, which kept his asthma well controlled for the last 10 to 15 years. And if he felt an attack coming on, he would immediately see his doctor.
This however does not mean it was all smooth sailing for Seng. Recently, his asthma flared up and his doctor prescribed an additional stronger inhaler to work alongside with controller and reliever inhalers. He said: “This new inhaler has made a huge difference and I’m very pleased with the results; I am back to my active and healthy lifestyle. Nevertheless, I still carry my reliever inhaler with me to be on the safe side.”
Asthma on the rise
Seng is not alone. In Singapore, there are some five percent of adults who have asthma (this condition is more common in children) and it is considered one of the most chronic diseases. It is often under-diagnosed and under-treated, creating a substantial burden to individuals and families, and possibly restricting individuals’ activities for a lifetime. According to experts, patients locally underestimate their condition and the importance of asthma control to prevent an asthma attack, which could be fatal.
In addition to this, the asthma cases continue to rise and patients are not treating the condition properly. According to a local study done last year, the number of adult patients admitted to intensive care units (ICUs) with severe life-threatening asthma is on the rise, with an almost 30-percent annual increase in the last six years. The study further noted that a staggering 67 percent of these patients effectively had ‘untreated asthma’, risking their lives by relying on short-term use of rescue medications to relieve symptoms during a flare-up rather than regularly using controller medications.
Asthma is caused by long-term inflammation of the airways (breathing tubes) which makes the lungs narrowed and obstructed leading to difficulties in breathing. In asthma, exposure to trigger factors causes the lining of the airways to become inflamed (swollen), the muscles in the airway walls to contract and spasm, and production of thick mucus, which clogs up the airways. It is a long-term condition that has no cure. The only way to deal with asthma is to manage the condition like what Seng is doing.
Managing asthma
Dr Tan Tze Lee, a GP and a council member of The College of Family Physicians, Singapore, explained that there are two types of medications – reliever and controller medications. Reliever medications provide fast relief from asthma; however, they do not treat the underlying problem. On the other hand, controller medications act by providing long-term relief for the inflammatory process. The most effective controller medication is inhaled corticosteroids and it can be inhaled or taken orally (but not for a long-term basis), and should be used on a daily basis for long-term control.
An inhaler.
He also advised that it is important to learn the different things that can trigger your asthma symptoms and take steps to avoid them. These could include: Mould, pets, dust mites, tobacco smoke, outdoor air pollution and cockroach allergen.
Other tips he shared:
• Learn about your symptoms, so that you can recognise when your asthma is becoming less well controlled.
• See your GP regularly to review your symptoms as well as medication – meet at least once a year if you have mild to moderate asthma and more frequently if you have severe asthma.
• Follow a healthy diet and drink plenty of water.
• Engage in regular exercise. If you find that exercise triggers symptoms, use your reliever inhaler about 10 minutes before you start exercising and keep it close at hand at all times.
(** PHOTO CREDIT: Asthma inhaler, Jenny Rollo, stock.xchng)
30 years ago, I was a very bad asthmatic being considered for Methatrexate. I was terrified and then negotiated with the doctors that we first attempt to reduce my cortisone. I needed a peak flow meter, a home nebuliser. On hand extra cortisone, course of no less than 7 days broad-spectrum antibiotics and a large chart. Peak flows were done 2ce daily and recorded, nebulisations when done. If peak flow dropped, I used the reliever. If there was a productive yellow sputum, I took the course of cortisone and antibiotics, did more frequent peak flow checking. During this time, I learned to read my body like a book. These graphical record were kept on a continual basis. The pulmanologist checked these on a regular basis and realised what an effective tool this turned out to be for both doctors and patients. It took nearly three years to get off the oral cortisone. For the last 18 years, I have been leading a normal active live, BUT took my medications regularly, need the very occasional peak flow check, monitor my weight and BP as well as the guidelines Dr Tan listed.
This is the result of the team – doctor, patient, family as support but respecting this is the patient’s problem with which he has to deal. Implementing this educational strategy will ensure many more asthmatics will be leading normal lives. Wish I could have shared in greater detail but train the patients to take responsibility and lead a relatively normal life!!