1. Please define asthma and how is it the same/similar/different/unique from other respiratory problems.
Asthma is an inflammatory airway disease characterized by wheezing, shortness of breath, cough, and chest tightness.
It is a chronic condition usually seen from childhood or with a history of past childhood asthma/allergy including allergic rhinitis which makes it different from a common acute bronchitis. It could be triggered due to viral infections, allergens at work or home like house dust mites, pollens, smoking, exercise, and stress. It can be intermittent, seasonal, or perennial.
2. What are the complications of asthma? Are these terrifying and fatal? Please explain.
Asthma can worsen due to certain exposures or infections (bacterial/viral) which can lead to a decrease in oxygen levels in the body and increasing carbon dioxide levels thereby causing respiratory failure or death hence no exacerbation or worsening of asthma should be taken lightly and treated in accordance with the pulmonologist.
Another complication or long-term problem that I would like to stress is the possibility of permanent airway damage due to asthma not being treated. This will lead to persistent breathing difficulty which cannot be easily controlled with inhalers. Hence the right treatment at the right time will prevent long-term damage to airways.
3. Based on the 2011 World Asthma Day theme "You Can Control Your Asthma," decided upon by the Global Initiative for Asthma (GINA), is asthma controllable? If so, how?
Yes, it is controllable. I would like to stress again that it is not '"curable “but "controllable”. Optimum control can be defined in a simple manner as minimal daytime and nocturnal symptoms with the ability to perform any physical activity without many limitations. Inhaled corticosteroids are the mainstay of treatment to achieve control. If the asthma is well controlled on an assessment by a regular follow-up every 1-3 months, inhaler therapy can be stepped down from a ‘daily regimen ᾿ to even an ‘as and when needed' regime᾿. However, symptoms can resurface at any time, and stepping up off treatment may be required.
4. What are the challenges still around since 2011 or since 12 years back regarding asthma still being a problem? Why do these challenges persist?
There are multiple challenges in treating asthma as it is a chronic condition. This mainly includes access to specialists, cost of medications/tests, eliminating the myths associated, compliance to medications, and regular follow-ups.
5. Based on the 2021 World Asthma Day theme of "Uncovering Asthma Misconceptions" by GINA, what are the asthma misconceptions? How did these misconceptions come about? How do you address these misconceptions as an immunologist or allergist?
There are many misconceptions or ''myths'' about asthma. I would like to highlight a few as underlined below:
MYTH: Inhalers can be addictive.
FACT: Inhaled corticosteroids are not habit-forming/addictive.
Corticosteroids used in inhalers are a copy of the steroids that are normally produced in our bodies. Regular use of these medications does not cause addiction and is often needed to bring down airway inflammation and achieve asthma control.
MYTH: Inhalers are ‘strong medications’ and are the last resort for the treatment of asthma.
FACT: Inhaled corticosteroids are the first and the best medication to control symptoms with steroid doses in micrograms.
Corticosteroids in inhalers are in microgram doses as compared to tablets/ syrup which are in grams. Moreover, as they are inhaled, they provide rapid relief of symptoms and a reduction in airway inflammation needed to achieve control.
MYTH: Physical activity/ sports should be limited if you have asthma.
FACT: Well-controlled asthma allows you to lead a normal, healthy life – including regular exercise.
As mentioned earlier, well-controlled asthma enables us to perform any physical activity with ease. If you have any difficulty in performing a physical activity it means that your asthma is not in control. In fact, regular exercise prevents obesity, makes your heart and lung stronger, and improves your immune system. Obesity makes asthma control difficult.
MYTH: Inhaled steroids cause weight gain, increased blood sugars, growth stunting in children and other side effects as seen in oral steroids.
FACT: Inhaled steroids reach our lungs only in minimal amounts with no systemic side effects.
As mentioned previously, inhaled corticosteroids are available in microgram doses. On inhalation, only ῀ 20% of this dose will reach our airways and lungs with the systemic absorption and in turn side effects being almost nil.
With regard to stunting of growth in children, studies have shown that a very minuscule percentage of children with asthma on regular inhaled steroids have 1 to 1.2 cm less height than their normal percentile in the long term. But, it should be remembered that if asthma is uncontrolled then the reduction in height can be much more.
6. Based on the 2022 World Asthma Day theme of "Closing Gaps in Asthma Care" by GINA, how can governments, health authorities, and the entire health system including families close the gaps in asthma care? Your suggestions, please.
Government can help in this aspect by providing equal access across wealthy and poorer communities to specialist evaluation and treatment support which at times can be a costly affair especially in the case of uncontrolled asthma which may require regular follow-up and medications.
Health authorities can play a great role by proper education to the people regarding asthma and by appropriate and timely referrals by the general physicians for evaluation and treatment of asthma.
Families can support the patient with asthma by helping them prepare a self-action plan in conjunction with the pulmonologist thereby helping them monitor their symptoms and see for any worsening of asthma and take appropriate steps based on the self-action plan.
Families who know about asthma can identify other family members/ friends who require diagnosis and treatment of asthma.
These can probably help in closing the gaps in asthma care.
7. The 2023 World Asthma Day theme is "Asthma Care For All" as decided upon by GINA. Please share your thoughts and expertise on this.
GINA, a global initiative of asthma has this theme to encourage healthcare leaders to ensure the availability of and access to effective, quality-assured medications. This is mainly in low- and middle-income countries where the burden of asthma morbidity and mortality is more.
I would like to share a few perspectives. In the last report given by the world health organization in 2022, asthma affected an estimated 262 million people in 2019 and caused 455 000 deaths. This number would just be ' the tip of the iceberg ’as there are people who do not have access to appropriate facilities to evaluate or treat asthma. So, the aim of every country should be to provide access to these facilities in addition to access to quality medications thereby helping to reduce the morbidity and mortality due to asthma.
Secondly, I would like to emphasize that educating the people and the health care providers on asthma thereby promoting timely referrals/ self-referrals for evaluation and treatment of asthma is of utmost importance.
8. Please provide a profile of your asthma patients in the last three years. Are there more women asthma patients than men or men asthma patients than women?
Based on my experience profile of 7 years, I would say I have seen more women asthma patients than men. I have not seen many patients with severe asthma, I would say only 2- 3 percent had uncontrolled/severe asthma while most of the patients did respond to treatment.
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