6 May 2019, Mumbai, Maharashtra, India
Guide to an effective management of asthma
Call for an increased awareness and dialogue on asthma and adoption of the right treatment to improve patient outcomes
Call comes in light of the concern that up to 7 out of 10 patients in a region with asthma do not use inhalation therapy Less than a quarter (15%) of people with asthma in a region lack having an action plan in place
While pediatric asthma is on the rise, in the adult age group men clearly out-number women in having asthma.
With the aim to dispel myths and fears regarding asthma and encourage those affected by this condition to live a life without limits, with World Asthma Day, let’s eliminate the stigma around inhalation therapy and make it more socially acceptable and help foster further dialogue between patients and their physicians.
Asthma is a chronic (long term) disease usually characterized by airway inflammation and narrowing of the airways, which can vary over time. It is estimated that in at local doctors on a daily basis see an average of around 40 patients suffering from asthma/respiratory diseases. Out of these a majority are men (60%) with the pediatric asthma segment has seen a significant increase on a year on year basis (doctors reckon they see an estimated 25-30 new cases of children with asthma every month). On average until the date in 2018, there has seen a 5% increase in the number of people suffering from asthma as compared to last year. Meanwhile, the number of patients using inhalation therapy has increased in the last few years, an estimated 20% of asthmatics discontinue inhaler use largely during their pre-teen and teenage years.
The reasons for the prevalence of asthma can be attributed to air pollution to the increase in air particulate matters, smoking, incorrect treatment in children, seasonal variations causing viral infections such as common flu and largely ignorance amongst parents.
Speaking on the occasion of World Asthma Day, Dr. Sameer Garde, Chest Physician, Global Hospital said, “It is very significant to change the perception towards Asthma and Inhalation Therapy. While inhalation treatment can play a crucial role in reducing the impact of asthma on people’s lives, compliance is crucial. Inhaled medicines help to deliver the drugs directly to the lungs. But we need patients to adopt the treatment as they are prescribed in order to get the full benefit. Inhalation therapy works to control asthma by preventing & relieving symptoms and reducing flare-ups, but they will work if patients work in partnership with their GP and take them in the way they are prescribed.”
It is important to note that symptom-free is NOT asthma free. This remains one of the biggest challenges to the management of asthma when there is discontinuation of the medication once the symptoms have subsided. This can be majorly to save the cost of the medication. Unfortunately, this may result in the aggravation of the disease and chances are that symptoms may flare up anytime – this time with double impact. It is important to understand being symptom-free does not mean one is free of the disease. Always, consult a doctor before taken such steps. Asthma requires long-term treatment. Many patients once they feel better to stop taking their inhalers. This can be dangerous since discontinuing treatment means stopping the very thing that is keeping them fit and healthy. Patients should consult their doctor on each and everything that stops them from not continuing inhalers rather than taking a decision which can be dangerous.
According to Dr. Mukesh Sanklecha, Pediatrician, Bombay Hospital, “Ongoing education is of paramount importance in chronic diseases like asthma. This is precisely where #BerokZindagi will lead to “Winning against Asthma” and will enable patients to participate and have a more effective role in their own treatment, working together with doctors to achieve optimal inhaler use and disease control, thereby living life to the fullest. While encouraging an increased dialogue on the management of asthma, lets us mark World Asthma Day to directly resonate with our endeavor of enabling people with the condition to achieve more in their daily lives.”
There are many reasons why patients stop inhalers. These include unnecessary concerns about the cost of medication, side effects, myths about inhaler devices and social stigmas. There are also several psychological barriers which lead to inhibitions such as dissatisfaction with healthcare professionals, inappropriate expectations, anger about one’s condition, underestimation of the severity of the condition and casual attitude towards health. The need for an hour is to overcome barriers/ taboos and understand the importance of inhalation therapy and adhere to it. To be a winner against asthma, an effective treatment i.e. inhalation therapy is required. The treatment is available in India at a price as low as Rs.4 to Rs.6 per day which means that a year’s supply of medicine is less than the cost of 1 night’s stay at the hospital.
Inhaled corticosteroid therapy (ICT) is the cornerstone of asthma management. For the effectiveness and safety of any treatment modality, optimal drug delivery is crucial. In the case of ICT, the drug reaches the inflamed airways directly in small doses, limiting the potential side effects. In the case of oral medication, the drug dosage is many times higher than in ICT. This excess dosage then reaches other parts of the body too, where it is not required and increases the systemic side-effects.
Myths associated with the treatment needs to be busted. Inhaled corticosteroids have been recognized and widely accepted as the mainstay of asthma management. However, due to lack of awareness, many people remain reluctant to take the therapy. For many, the word ‘steroid’ conjures up the vision of building up muscles. Most often corticosteroids are confused with anabolic steroids.
For people suffering from asthma and COPD, corticosteroids can be lifesavers because they help prevent or reverse the process of inflammation in the airways while making them less sensitive to the triggers. Asthma patient adherence is a major health and economic challenges. Several studies report poor adherence towards asthma medication with measured rates of non-adherence ranging from 30 to 70 percent. Patients appreciate dose counters because they are convenient and improve safety by allowing them to identify the number of doses of medication left in their inhalers and to avoid running out of medicines when required.
The National Asthma Education and Prevention Program (NAEPP), in its updated guidelines, recommended the use of inhaled corticosteroid (ICS) therapy for mild, persistent asthma across all age groups, including children1. Inhaled corticosteroids have been found to bring about improvements in the quality of life of patients by helping reduce the frequency of asthma attacks, improving asthma control, reducing the requirement of oral steroids and by bringing down the frequency of ER visits and hospitalizations.
This year on World Asthma Day, as we celebrate the spirit of those winners – who have won their battle against asthma and taboos related to it. Awareness about the disease, acceptance towards it and adherence to the right therapy, all this can make one win against asthma. Today, we learn from them how they made it possible through inhalation therapy – a key to win against asthma, #BerokZindagi.
1. U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Full Report 2007 National Asthma Education and Prevention Program. Available at: www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf Accessed November 17, 2009.
2. WHO fact sheet N°206
3. L. COLICE, MD; HARTMUT DERENDORF, PHD; GAIL G. SHAPIRO, MD. Inhaled Corticosteroids: Is There an Ideal Therapy. Medscape
4. 2017 Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation