Asthma attacks can be life threatening, says expert


Dr Shashiraj Eswarappa

Muscat: Uncontrolled asthma can affect both the patient and his or her family, according to Dr Shashiraj Eswarappa, consultant in internal medicine, KIMS Oman Hospital.
Asthma attacks can be life threatening. It is a chronic disease, and should be taken more seriously.  During winter, it can be more common.

Statistics show that there are over 235 million asthma sufferers worldwide. Even people in advanced countries are affected by asthma. It is estimated that eight to nine per cent of the population in the USA suffers from asthma.

There were 1,131 deaths from asthma in the UK and 3,388 deaths in the USA in 2009. Most of these asthma related deaths are preventable. Gulf countries have one of the highest levels of emergency room visits, hospitalisations and number of days missed from work/school. There is an urgent need to address the misconceptions about the disease and its management.

''Asthma is an inflammatory disorder which causes swelling and narrowing of airways in the lungs obstructing smooth flow of air in and out of the lungs. Inflammation also makes the airways more sensitive to the external factors or 'triggers' such as dust mite, pollen from flowering plants, pet dander, tobacco smoke, cockroaches, cosmetics, weather changes and environmental pollution.

"The inflammation and hypersensitivity of airways usually persist for many days to months,'' emphasised Dr Eswarappa, MBBS, MD, MRCP (UK).

Patients with asthma experience cough, breathlessness, tightness in the chest, and noisy breathing (wheezing). Asthma symptoms and acute episodes can last for a long time. Even when asthma is under control, the hypersensitivity of the airways can persist and cause acute attacks of asthma anytime when exposed to triggers.

Asthma is caused by interaction of multiple factors such as genetic factors and environmental factors. Children whose parents have asthma are at increased risk of suffering from asthma. Genetically susceptible persons may develop symptoms of asthma on exposure triggers. Allergic asthma is the most common type of asthma and is triggered by exposure to allergens. There are other types of asthma which are less common and are triggered by exercise, aspirin, acid reflux disease, etc.

Asthma can occur in people of any age including infants. Most often asthma symptoms begin during childhood. Asthma in older adults is sometimes difficult to distinguish from heart failure and smoking related bronchitis. Doctor may ask for some special tests to rule out these possibilities.

''Asthma is not curable but can be controlled. Avoiding potential allergens or triggers like dust and smoke is very helpful. Allergy tests such as skin prick tests and blood tests are available to identify the likely allergen. Allergy shots may be considered if a particular allergen is identified. Allergy shots are often given regularly for a period of three to five years. Most often patients are allergic to many allergens and allergy shots may not be practical in such situations,'' says Dr Eswarappa.

Two types of medicines — relievers and controllers — are available to treat asthma. Relievers, also known as quick relief medications or bronchodilators, temporarily open up narrowed airways giving relief to patients quickly. Those who require relievers frequently should consult a specialist.

Controllers are anti-inflammatory medications and are given for prolonged period to control inflammation and hypersensitivity of the airways. Steroids and other medicines are used for this purpose. Both relievers and controllers are available in inhaled, tablet, syrup and injectable forms.

There are some misconceptions and problems in controlling asthma effectively.
First among them is the fear and concerns about steroids. Patients and their parents should understand the inflammatory nature of the disease and the need to use anti-inflammatory medications such as steroids for a prolonged period of time. Persistent inflammation is responsible for unrelenting asthma symptoms and frequent acute attacks.

Second factor is the stigma attached to the inhaler devices. Fact of the matter is these devices have revolutionised the management of asthma as they use a small dose of medicine which is delivered directly to the inflamed airways. Treatment can be continued for a prolonged period for this chronic disease with minimal or negligible side effects.
Third factor is excessive use of relievers without consulting specialists. Frequent use of relievers points to unresolved inflammation and the necessity to use controller medications.
The last issue is incorrect use of inhaler devices. Patients should learn the proper technique of using inhalers for effective control of asthma, Dr Eswarappa added.

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