WORDS MAK WEN YAO

On every first Tuesday of May, health advocacy groups and educators from around the globe celebrate World Asthma Day where they strive to improve awareness of the airway disease. As asthma continues to burden both the patients and the health system, it is high time for us to further understand what asthma really is, and what we can do to minimise its impact.

UNDERSTANDING WHAT ASTHMA REALLY IS

Asthma is a chronic condition where the airways become inflamed and stimulated to produce excessive sticky mucus. The bronchial tubes of an asthmatic patient, or the air passageway that connects the windpipe to the lungs, will become narrow as the muscles surrounding them constrict in response to the noxious external stimuli. As these tubes struggle to remain open, the patient’s ability to breathe also becomes compromised. 

An asthma attack is frequently described as having to struggle to draw a full breath, often accompanied by coughing, wheezing, and an overall tightness across the chest. When the airway becomes constricted and obstructed by thick mucus, the patient has to spend every ounce of energy just to draw in enough oxygen to make it to  the next breath. This could be a harrowing experience to patients and uninformed family members. Some patients say, “It’s like drowning in air.”

However, people with asthma may experience the disease in other ways. The condition is largely dependent upon the types of the trigger and other aggravating factors. A mild attack could last only minutes and resolve spontaneously without any treatment, while severe attacks could span hours and may require hospitalisation.

Asthma is a non-communicable disease that is common among children but can affect adults as well. According to the National Health and Morbidity Survey in 2011, more than 1-in-20 Malaysians self-reported that they suffered from asthma (6.4%). In addition, many patients or family members are not fully aware of the disease symptoms or the appropriate management of the condition. The head of the Ministry of Health’s Pulmonology Services, Dr Jamalul Azizi Abdul Rahaman, once said that out of 2 million patients with asthma, only 6% were well controlled. “There is low awareness of the disease, leading to poor compliance,” said Dr Jamalul Azizi.

COMMON CAUSES OF ASTHMA ATTACK

1. POLLUTION                        
2. PETS                         
3. DUST               
4. CHEMICALS                
5. MOLD

Although we have yet to completely understand the fundamental causes of asthma, we now know that the exposure to certain environmental particles or inhaled substances could cause an asthma attack.

Research has revealed a delicate interplay between the physical and psychological components of an asthmatic patient. Available scientific evidence points to a relationship between heightened emotional arousal, such as extreme anger or fear, and dyspnoea—difficulties in breathing—in asthmatic patients.

 Certain household medicines could trigger an attack as well. Aspirin and a group of painkillers known as the non-steroidal anti-inflammatory drugs (NSAIDs) may cause symptoms in certain patient populations. NSAIDs such as ibuprofen or naproxen are thought to increase the production of some pro-inflammatory chemicals in our body that can cause asthma attacks.

It is important to understand that asthma may not always manifest in the same way. Each individual may respond differently even if they were exposed to the same aggravating factor. It would be essential to understand how the body reacts when exposed to a potential allergen and take the appropriate steps as recommended by the doctor.

ASTHMA TREATMENT AND CARE

While there is currently no cure for asthma, the condition can be well controlled if managed appropriately. Advances in medical care allow asthma medicine to be directly administered into the lungs,thus bypassing many unwanted side effects associated with systemic treatment method. The inhaler is, by far, the most extensively used option, but certain patients may have to use a nebuliser (a machine that helps one breathe in the medicine as a mist through a mask or a mouthpiece) or depend on oral medicine as an add-on treatment to the inhaler.

The array of treatment options and medical devices can be confusing. It is important to discuss any treatment option with your doctor and pharmacist in order to gain the best benefits and avoid any asthma emergency.

There are generally two types of asthma treatment:

1. The quick reliever

• functions as the rescue medicine to rapidly relax muscles around the airway during an asthma attack.
• relieves symptoms of breathlessness and helps the patients to regain control of their breathing.

For example, short-acting beta- agonists.

2. Long-term controller medicine

•  functions to prevent asthma attacks.
• reduces inflammation of the airway, making it less likely for allergens to trigger an attack.
• may be given in a combination of inhaled and oral medicine.

For example, long- acting beta-agonists that relax the airway muscles and corticosteroids that reduce airway inflammation and swelling.

USEFUL TIPS

Are you using your inhaler properly?

1. Always shake the inhaler canister before use. This action will mix the active drug well with the propellant to deliver the right dose into the lungs.
2. Your lips should form a tight seal around the inhaler to ensure the dose reaches its target.
3. Time your breathing appropriately while using the inhaler. Breathe out completely and take a deep breath while pressing the canister.
4. Hold your breath for around 10 seconds with your lips closed and then breathe out slowly after a puff is delivered to allow for the medicine to exert its effect.
5. If your doctor prescribed a second puff, wait for about 1 minute. Then, repeat the steps 1-4. HT

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