World Asthma Day is observed every year on the first Tuesday of May. The day was conceived to spread awareness about the condition and make treatment options accessible.
Here we look at some common misconceptions about asthma that need to be dispelled:
‘Asthma is a childhood disease, and it doesn’t develop when one becomes an adult’
Although asthma usually develops in childhood, a considerable percentage of children ‘grow out’ of their asthma. However, it can recur once they become adults. The disease can present for the first time in adulthood. In fact, asthma can come on at any age, even after the age of 90.
‘I don’t get wheezing and, hence, I don’t think I have asthma’
Although wheezing is a classical symptom of asthma, it may not be appreciated by all patients. Sometimes, it is heard only with the aid of the doctor’s stethoscope. When an asthmatic patient gets a flare up, it is usually manifested by wheezing, but in extreme cases, the patient may have a ‘silent chest’.
A significant percentage of asthmatic patients have cough as their predominant symptom, and this is often referred to as ‘cough variant asthma’. They can be treated in the same manner as other asthmatics.
‘I need to avoid a long list of food items if I am diagnosed with asthma’
Only 2 to 4 per cent of adult asthmatics have their symptoms triggered by food. Hence, it is not a good practice to advise all asthmatics to avoid certain food items as a general rule.
However, in those with food-induced asthma, the more common culprits include dairy products, nuts, eggs, wheat, soya and shellfish. In most circumstances, the patient is likely to identify the trigger, and feel better off once the offending food item is avoided.
‘Asthmatic patients cannot do any exercises or take part in sporting activities'
The aim of asthma management is to ensure that the patient is able to lead a normal life. Famous sports personalities such as David Beckham and Novak Djokovic, who have asthma, have managed their condition with inhalers, and succeeded in their professional lives.
This is highly inspirational for anyone with the disease, who wants to engage in sports or even aim for major achievements.
Doctors usually advise the use of an inhaler half an hour before the sporting activity, or exercise is due to commence, and this helps prevent any flare up of symptoms.
Likewise, one of the asthma medications called montelukast, helps prevent exercise-induced asthma.
‘Inhalers should be avoided. Tablets are better than inhalers’
The modern inhalers for asthma have been developed after decades of research. They address the disease process of asthma by acting directly at the site, i.e. in the lungs, reducing the inflammatory process and dilating the narrowed airways.
Inhalers have been consistently shown to be better than tablets due to their direct action on the lungs and ‘bypassing’ the intestinal tract, as tablets need to be absorbed into the bloodstream, for them to travel to the lungs to have their action.
If a patient with a certain degree of severity of asthma needs a long-term inhaler, the medication will keep his asthma under control, but it is in no way addictive. If one decides to discontinue the inhaler, symptoms are likely to reappear.
‘Inhalers contain steroids. They cause more harm than good’
Not all inhalers contain steroids. But the current asthma inhalers do contain small quantities of steroids. A tiny fraction of the inhaled medication may make its way into the intestinal tract and get absorbed, but the side effects of the steroid absorbed from the intestinal tract are negligible.
However, the possible side effects are considerably less, and most often insignificant, when compared with oral steroids.
‘Nebulisers are better than inhalers’
Inhalers and nebulisers are different devices used for delivering asthma medications to the lungs. Patients with stable disease and those who are able to use their inhalers without any problems need not resort to using a nebuliser. The cost of inhalers is considerably less when compared with nebulised medications. When an asthmatic gets a flare up, it can prove to be difficult to use the inhalers effectively, and this is when nebulisers come into play most often.
Many elderly patients and those with physical problems affecting their hand coordination might find it difficult to use an inhaler, and for such patients, nebuliser would be a better choice. However, using a nebuliser at home, without a clear prescription from an appropriately qualified doctor, can possibly lead to untoward consequences.
The writer is a senior consultant, department of pulmonology, Apollo Adlux Hospital, Angamaly