Managing Asthma

Managing Asthma.

What is Asthma?

Asthma is a persistent and recurring inflammatory disease of the airway, which can affect males, females, children, adults, and people of all races. A distinguishing characteristic, trait or feature of Asthma is that it is a physical condition which causes inflammation of the airways, meaning it becomes swollen and plugged with mucus, especially as a reaction to environmental irritants.

 It causes the symptoms below:

Shortness of breath

Tightness in the chest

Coughing

Wheezing

A creative analogy for a vivid description is to have people completely close their nostrils and then breath for the next 5-10 minutes through a straw. The reality, however, is that this is like what happens with an Asthma attack except it lasts hours and days with terrible consequences.

 Asthma How common?

Asthma is a burdensome disease, and exact figures are hard to come by in countries like Nigeria and indeed the African Continent. Recent studies suggest an Asthma prevalence of 14-18% in Nigeria which means about 30-35 million Nigerians suffer from it. I will assume that at least 20 Million Nigerians, which represents about 10% of the population suffer from Asthma, given the trends elsewhere but that remains cold comfort. One pertinent fact is that every Nigerian knows someone or people who suffer from the disease. In 2017, nearly 12,000 Nigerians died from Asthma according to WHO.  Studies done on patients with Asthma and how well the disease was managed showed disturbing trends and lack of adherence to established guidelines. Some of my colleagues and I examined some of the studies done on patients with Asthma and the management of the disease; we found disturbing outcomes. 

 Diagnosis

Your doctor can confirm the diagnosis of Asthma by requesting a Lung function test (called spirometry) which should be available with a Lung specialist. The physician, based on the symptoms and findings on examination, can decide to treat for Asthma if this test is not available. The physician may also choose to run some blood tests and allergy tests depending on unique characteristics that may be tied to the individual.

 Treatment

The treatment of Asthma should be undertaken with your physician or specialist chest physician. Taking advice and medication from the local chemist, unproven herbal remedies or faith healers is inherently detrimental to your health. Asthma is ongoing and causes relentless damage to the airway, which demands your attention and that of your physician.

 The standard therapy of Asthma is the use of inhaled corticosteroid daily. Inhaled steroids help to keep the inflammation that Asthma causes in check and therefore should be used every day as a controller medication. Some examples of these include Beclomethasone (Becotide/Becloforte), Pulmicort and Fluticasone inhalers.

The popular Ventolin (blue) puffer is a bronchodilator which works to expand the cavity of the airway when they are used during asthma attacks. They are used during acute attacks of Asthma or just before sufferers engage in sporting activities which have been known to cause symptoms. One Ventolin puffer should last for a year if the inhaled steroid well controls Asthma. 

Your physician may decide to add another group of medication called Long-Acting Beta Agonist (LABA) like (Salmeterol) Serevent or Formoterol if the target of control is not met with the use of the inhaled corticosteroid. For convenience, these agents are often combined with inhaled steroid in the same device and marketed for instance as Seretide, Symbicort, Zenhale etc. 

The inhalers come in mostly two types of devices, the metered dose inhalers which are cheaper but are more effective when used with a spacer device (aero chamber) and the more expensive dry powder inhaler which is slightly more effective in dry delivery.

The use of spacer devices improves the delivery of the medication in the puffers, and I have attached a short video link here that should help educate you on the proper use of Asthma puffers.

Do inhalers damage the lungs over time?

No, puffers are safe. The biggest problem with inhaled corticosteroids (ICS) is oral thrush, which causes creamy white lesions on inner cheeks and tongues. The easy way around it is to use the steroid first in the morning and then brush the mouth and then repeat the process in the evening before going to sleep.

Leukotriene receptor antagonists, called LTRAs for short, are a class of oral medication that is non-steroid like Montelukast that your physician may choose to add if Asthma is uncontrolled with inhaled corticosteroids and or Long-Acting Beta Agonists (LABA).

There are still other agents and Biologics that are at the disposal of the physicians and specialists for the more severe Asthma. The use of oral steroids like prednisolone in Asthma care is usually after an acute flare-up for 7-10 days and in severe Asthma. It is NOT ideally to be used every day as a treatment for Asthma as they do lead to several issues like weight gain, high sugar, raised blood pressure, Osteoporosis etc. unless at the discretion of the specialist.

For the avoidance of identified triggers of Asthma such as dust, pollen, cockroaches, viral infections, animals and so on, the use of an Asthma Action plan such as you can find here helps you to be in control.

 https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653 also gives additional information concerning Asthma.

 Motunrayo Adetola MD is an Assistant Professor at the University of Saskatchewan, and a Family Medicine practitioner in Canada.