Medical Matters: Take a deep breath and keep your asthma under control

While asthma is recognised as a common condition, it is not generally regarded as a dangerous one. So when you hear of someone with asthma dying suddenly, it comes as quite a shock.

I was reminded of asthma's potential lethality recently when listening to a radio advertisement run by the Asthma Society of Ireland.

In it, a sweetly spoken young girl quietly informs us that one in five children and one in 10 adults in Ireland have the disease. But then, continuing her calm delivery, she says: "Every week, one person dies from an asthma attack."

The Republic has the fourth highest prevalence of asthma in the world. A survey by the Asthma Society showed 13 per cent of respondents reported they had the condition; this equates to almost 600,000 asthma sufferers in Ireland.

And despite its benign image, figures show about 20,000 people attend emergency departments because of asthma each year, with 5,000 requiring admission for an average hospital stay of three days.

Dr Stephen Lane, consultant respiratory physician at Tallaght hospital and a member of the Asthma Society's medical board, says: "The high levels of emergency department admissions, hospital bed days, and nebulisations are unnecessary.

“The existing situation where asthma patients’ symptoms worsen until they require nebulisation or hospital treatment, rather than being prevented by structured treatment in primary care, not only puts patients at risk but wastes much needed hospital resources.”

Stable asthma
With these figures as a backdrop, it is perhaps less surprising that asthma claims one life each week here.

Someone with stable asthma can usually control the disease using a combination of “preventer” and “reliever” inhalers. But during an asthma exacerbation, the patient may require drugs to be delivered by a nebuliser, an electronic device that delivers the medication in an aerosol mist for better delivery and absorption. And if this doesn’t quieten the attack, intravenous and subcutaneous injections of steroids and other drugs may be required.

If you need to be nebulised on a regular basis, this is a sign that your asthma is poorly controlled. It also means you are more likely to suffer a life-threatening attack in the future.

Other signs of poor control include coughing and shortness of breath occurring more than twice a week; being woken at night by symptoms more than once a week; experiencing some limits on your ability to carry out normal daily activities; and having to use additional reliever doses of inhaler on more than two days per week.

For the most effective asthma treatment, work out a treatment plan with your doctor. This involves routinely tracking symptoms and measuring how well your lungs are working.

The best way to track symptoms is to use an asthma diary. It allows you record whether you are short of breath or wheezing; note any sleep disturbance due to asthma symptoms; chest tightness; asthma symptoms during exercise; and any changes in the colour of your phlegm.

In addition, it facilitates a record of how many puffs of rescue inhaler you use as well as recording disruptions to work or school activities.

What’s the best way to measure how well your lungs are working? A gadget called a peak flow meter is a simple, hand-held, portable device; it measures how fast you can force air out of your lungs.

A sudden dip in these readings is a sign that your airways are tightening up. Doctors will give you step-by-step advice as to how to manage these initial deteriorations as part of your asthma treatment plan.

Five-step rule
Follow the five-step rule if you experience an acute asthma attack:
1. Take two puffs of reliever inhaler immediately.
2. Sit upright and stay calm.
3. Take slow steady breaths.
4. If there is no immediate improvement, take one puff of reliever inhaler every minute (up to 10 minutes).
5. Call 999 or 112 if symptoms do not improve after following steps one to four.

mhouston@irishtimes.com
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