Do you know what it takes to gain control over asthma? The 2024 Asthma Awareness theme “Asthma Education Empowers” underlines the importance of patient education.

@TheKnowHow

Everyone has heard of asthma, but how much do you know about?

Understanding Asthma triggers and symptoms is key.

Asthma is caused by inflammation and muscle tightening around the airways, which makes breathing a challenge. Symptoms like coughing, wheezing, shortness of breath, and chest tightness may indicate an asthma attack. Depending on the trigger, these attacks can vary in frequency, from intermittent to seasonal, or even persist throughout the year.

The severity of asthma is defined by the frequency of asthmatic attacks: Asthma is called “mild”, when symptoms occur at least twice a week, but not every day. “Moderate asthma” is defined by daily attacks. For “severe asthma”, symptoms strike multiple times each day.

Asthma: a common disease and preventable health threat

Asthma is one of the most common chronic noncommunicable diseases, affecting over 260 million people and accounting for over 450.000 deaths globally each year, the majority of which are preventable. In the UAE, asthma affects one out of every seven residents, with rates more than five times higher than in North America! More than that, over two thirds of asthma patients in the Middle East suffer from uncontrolled asthma — with negative long-term effect on lung function.

Asthma medication is all about teamwork!

In asthma treatment, two types of medications need to be differentiated: Medicines that relieve asthma symptoms quickly are called quick-relief or rescue medicines. They are called “reliever” and are abbreviated “SABA” for “Short-Acting Beta2-Agonist”. Breathing them through a handheld inhaler or nebulizer ensures to get the right amount of medicine into the airways.

Long-term control medications target inflammation, swelling, and mucus, which cause symptoms and damage to the airways and lung. These are referred to as “controller” or maintenance medications. Even when there are no symptoms, the disease remains active, and treatment is critical: If asthma is not treated on a long-term basis, asthmatic attacks can become more common, and physical fitness and quality of life may suffer.

Controllers can include inhalative corticosteroids and Long-Acting Beta2-Agonists (“LABA”), among others. To minimize inflammation, they should be taken permanently on a daily basis. In severe asthma, these medications may not suffice. In severe cases, traditional medications may not suffice. That’s where “Biologics” come in — innovative treatments designed to target the underlying causes of asthma.

The primary goal of asthma management is to achieve optimal asthma control while minimizing ongoing airway deterioration and lowering the risk of asthma exacerbations and mortality.

Unmasking Asthma Misconceptions — What is well-controlled asthma?

Patients frequently assume they have their asthma under control when their reliever medicine is effective during an asthma episode. However, in this premise, they are fatally mistaken.

A well-controlled asthma is defined by the absence of bothersome breathing problems during the day and night, as well as the requirement for little or no reliever medicine (no more than two puffs of SABA per week). Patients may live a normal, productive, and active lifestyle. The absence of asthmatic episodes indicates that the underlying inflammation is under control, which is critical for maintaining optimal lung function.

On the contrary, daytime symptoms or the use of relievers more than twice a week, nighttime awakenings, or limitations in activity all indicate only partial control. If a patient has all the issues above, their asthma is deemed uncontrolled.

Middle east patients out of control

Although asthma care has improved over the years, the level of asthma control is not considered to be optimal in many nations. Over two thirds of asthma patients in the Middle East suffer from uncontrolled asthma. Why?

For decades, the standard therapy for mild asthma had been as-needed SABA for symptomatic relief. The rapid alleviation following inhalation is one reason behind patients’ over-reliance on SABAs. They believe, subjectively, that their asthma would be under control. Over-the-counter purchase of SABAs and refilling of old prescription without consultation with physicians are further factors. In contrast to the high SABA use, the prescription of inhaled corticosteroids (ICS) or other controllers is underrepresented in the Middle East.

But because SABAs don’t have anti-inflammatory capabilities, this one-sided treatment has worse long-term effects. It increases the risk of asthma exacerbations, and death in comparison to the outcome when the right dosage of ICS and other Controllers are taken. Inadequate insurance coverage for asthma therapy with more expensive controllers and non-adherence to recommended medications — only 25% of patient population reported using their prescribed controllers regularly — adds to the problem. Poorly controlled asthma leads to more exacerbations and visits to the emergency department. According to regional studies, up to half of asthma patients in the UAE attend an emergency care facility at least once a year. Because of the severe situation, emergency doctors also one-sided rely on Reliefer medicine.

Get asthma under control!

The present issue in the Middle East is that patients do not consistently see a pulmonologist, specialists educated of the current treatment guidelines. Yet, asthma is a lifelong condition, and having a specialized doctor by your side is invaluable.

To effectively treat asthma patients, professionals have developed schemes for children, adolescents, and adults that include several therapy stages, known as Asthma Stage Therapy. Treatment is gradually enhanced with the administration of additional different asthma medication or a higher dose. Individual patients’ therapy levels are regularly assessed and altered in accordance with the philosophy “Reduce, if possible, intensify, if necessary.” This requires, on the one hand, regular checks with the treating physician, but also that asthma patients monitor their own health status and document any complaints that occur.

Empowering and encouraging asthma patients to self-management is crucial to keep asthma under control. Asthma education includes:

• Understanding asthma and breathing.
• Knowing asthma symptoms and keeping track of them.
• Improving communication skills with healthcare providers.
• Learning about asthma medicines and taking them correctly.
• Making changes in life to prevent asthma problems.
• Following good health habits like quitting smoking, managing stress, and exercising to stay active.
• Knowing what to do when symptoms aggravate.

Empowering and encouraging asthma patients to self-management is crucial to keep asthma under control.

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