Opinion

ASTHMA: It Isn’t Easy, Being Wheezy!

Breathing is some­thing most of us take for granted. However, not everyone is as fortunate. Take five-year-old Jesse for example that narrates, “When I have my asthma attack, I feel
29 Jul 2017 11:06
ASTHMA: It Isn’t Easy, Being Wheezy!

Breathing is some­thing most of us take for granted. However, not everyone is as fortunate.

Take five-year-old Jesse for example that narrates, “When I have my asthma attack, I feel like a fish with no wa­ter.” Ask any general practitioner and they will agree that asthma is one of the most com­mon presentations in general practice.

In my experience, nu­merous patients refuse to accept the diagnosis and in many instances will say – “I only get wheezy when I have a cold” or state that “I’ve grown out of my asth­ma and am symptom free “, when in reality they are coughing fre­quently or getting short of breath and wheezy.

According to World Health Organisation (WHO) estimates, 235 million people suffer from asthma world­wide.

To put this figure in perspective, it is the total combined pop­ulation of Australia, New Zealand, Canada, United Kingdom, France, Singapore and Malaysia!

Asthma is the most common chronic disease among chil­dren. Asthma is not just a public health problem for high-in­come countries: it occurs in all countries regardless of level of development. Sadly, over 80 per cent of asthma deaths oc­cur in low and lower-middle income countries including Fiji.

In 2014, Fiji ranked number eight out of 172 countries in the world with regards to mortality rate from asthma with 21.85 per 100,000 population.

There were about 128 deaths from asthma in Fiji in 2014. (WHO, 2014)

It is known that asthma is under-diagnosed and under-treated throughout the world creating a substantial bur­den to individuals and families and possibly restricting individuals’ activities for a lifetime.

Acute asthma attack

An acute asthma attack can be classified as mild/moder­ate, severe or life threatening. It is important to recognise the signs and symptoms early and to start first aid before it is too severe.

Mild/Moderate

  • Minor difficulty breathing
  • Able to talk in full sentences
  • Able to walk/move around
  • May have a wheeze or a cough

 

Start First aid if the above happens

Severe

  • Obvious difficulty in breathing
  • Unable to speak a full sentence in one breath
  • Tugging in of the skin between ribs or the base of the neck
  • May have wheeze or cough
  • Reliever medication not lasting as long as usual

 

If the above happens call the ambulance on 911 and com­mence asthma first aid

Life threatening

  • Gasping for breath
  • Unable to speak 1 -2 words per breath
  • Confused or exhausted
  • Turning blue
  • Collapsing
  • May no longer have wheeze or cough
  • May not respond to reliever medication

 

If the above happens, call 911 and commence asthma first aid

Asthma First Aid (Adapted from Asthma Australia website)

  1. Sit the person upright
  • Be calm and reassuring
  • Do not leave the person alone

 

  1. Give 4 puffs of blue/grey reliever puffer- ventolin or salbutamol
  • Shake puffer
  • Put 1 puff through spacer
  • Take 4 breaths from the spacer
  • Repeat until 4 puffs have been taken

 

So don’t forget – 1 puff 4 breaths

  1. Wait for 4 minutes
  • If there is no improvement then give 4 more puffs of reliever medication

 

  1. If there is still no improvement call the ambulance and continue give 4 puffs every 4 minutes

Managing Asthma

Although asthma cannot be cured, appropriate manage­ment can control the disease and enable people to enjoy good quality of life.

A common myth is that most children will outgrow asthma. Some children do outgrow their asthma, however many do not, especially those with severe symptoms.

Short-term medications are used to relieve symptoms. These are called reliever medications.

The above inhalers ventolin and asmol contain salbutamol and are called reliever medications. They provide quick re­lief from asthma symptoms. Reliever medications start to work within minutes and the effects last for up to 4 hours. They relax the muscle around the outside of the airway and help open it up.

All people with asthma must have a reliever medication so that they can use it whenever they have symptoms.

However, if you find that you need to use the reliever medi­cation more than twice a week (other than prior to exercise) then you need to consult with your doctor as your asthma may not be well controlled and there may be a need for pre­venter medication.

Possible side effects include increased heart rate and trem­or of the hands, which are short-lived and occur when in­creased doses are required during an acute asthma attack.

People with persistent symptoms must take preventer medi­cation daily to control the underlying inflammation, reduce swelling and prevent symptoms and exacerbations.

The above inhalers becotide and flixotide are inhaled ster­oid medications. Possible side effects include a sore throat, hoarse voice, or oral thrush.

These side effects may be reduced by using a spacer and rinsing your mouth after using the inhaler. There are other combination inhalers that are also used.

Other Acute Medications

These medications are used for treating a sudden or severe asthma flare-up.

It is a corticosteroid liquid or tablet that is taking for a short time 3-7 days to reduce inflammation. With short courses on­going side effects are unlikely. Longer term or frequent use can lead to side effects such as thinning of skin and growth issues in children.

A spacer is a plastic container with a mouthpiece at one end and a hole for the asthma inhaler at the other. The medica­tion is fired from the puffer into the spacer and is then in­haled. By using a spacer it is easier to take the medication and it also ensures that more of the medication is delivered into the lungs. It is recommended that all children use spac­ers with their reliever and preventer medication.

Adults are recommended to use their spacer with their pre­venter medication and with or without the spacer for their reliever medication.

Many studies have shown that using a spacer with your re­liever medication in an asthma flare-up is as effective as or even better than using a nebulizer and its faster and easier and there may be fewer side effects.

We can see that asthma is a chronic disease that cannot be cured but can be managed with commitment from the patient and family and regular visits with your doctor.

Wise words by 17-year- old patient named Sydney, “one step at a time, inhaler in hand I will fulfill my dreams and live life to the fullest”.

Till we meet next week, keep calm and breathe!

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