BY Dr. Sanjiva Wijesinha

ASTHMA CONTROL

A recent study conducted by Dr. Lakmali Amarasiri and colleagues at the University of Kelaniya found a high prevalence of asthma in Sri Lankan adults when compared to those in other countries. Many people who have typical symptoms such as recurrent wheezing, tightness of the chest and breathlessness deny suffering from asthma, and are not on medication.

In their representative study population of 1,872 people, researchers found that over 30 percent had asthma as judged by standard criteria with the presence of symptoms being higher in those over 45. What was worrying was that of those who showed symptoms, nearly 70 percent denied they had asthma and less than 40 percent were using medication for it.

This is serious… not only from the perspective of their health and the long-term lung damage they will suffer due to recurrent episodes of asthma; but also, owing to a loss of productive hours, and the burden of future chronic obstructive lung disease.

A simple acronym to help people manage their asthma better and reduce the burden of this disease is ‘CREATE’ – as given below:

Confirm the diagnosis and take the correct medication.

Review its use periodically.

Expiry dates are also to be reviewed.

Action plan for asthma to be developed.

Triggers are to be avoided.

Enthusiastically follow the guidelines.

While an occasional wheeze, cough or breathlessness can occur due to various causes, what is significant in experiencing these symptoms regularly? These are usually triggered by exposure to allergens such as pollen, animal fur, cold, smoke, emotions and so on.

If you experience recurrent symptoms, consult a good doctor who will listen to your story carefully, examine you and then arrange a simple test called ‘spirometry.’ This test can demonstrate whether you have sensitive airways, which react to certain stimuli by constricting and reducing airflow into your lungs.

While there are several medications available with varying degrees of efficacy, the best available today are inhalers or puffers. These are devices that deliver a dose of the medicine straight into your airways when you hold them to your lips and inhale the medication. Your doctor will decide, which of the various puffers available is best for you, based on your particular situation.

Merely having the proper inhaler is only half the solution – the other half entails using it correctly. I usually get my patients to show me how they use their inhalers… and I’m no longer surprised to find that they use them incorrectly!

Even though patients think that they are getting the correct dose of medication each time, they’re actually getting little or no medi­cation into their lungs if they use the inhaler incorrectly.

Keeping tabs on expiry dates is also essential. Always check the expiry date of the inhaler and don’t use it if it is past its ‘use by date’ – because it will not be of any use then.

An asthma action plan requires detailing what medicines should be used when you are well (preventers) and which ones must be utilised when symptoms supervene (relievers).

The plan should also indicate what action should be taken in the rare event that an asthma attack persists despite normal measures. Asthma action plan templates are available on the internet.

Understand what triggers an episode of asthma in you and take steps to minimise your exposure. Getting on top of asthma needs enthusiasm – from both patients and their doctors!