Severe asthma: Managing daily reliance on quick-relief medications
May 5, 2022
Under-diagnosis and under-treatment of asthma can lead to sleep disruption, daytime fatigue, and reduced quality of life.
In a world where the threat of chronic non-communicable diseases (NCDs) is widespread, asthma may be perceived as a common and relatively unthreatening condition. Few, however, are aware of the consequences of living with uncontrolled and undertreated asthma, or worse still, having severe asthma which is the most devastating form of the disease. With approximately two million Malaysians living with asthma, and 90% of these patients classified as having uncontrolled cases, the risk of them suffering poor health outcomes and reduced life expectancy is high.
Every year, the number of Malaysian lives lost to asthma-related complications reaches thousands, hitting close to 1,700 deaths in 2014. This may seem a small number compared to other causes of death in the country, but it is important to note that asthma-related deaths are largely preventable. Hence, every effort should be made to improve health outcomes and reduce mortality due to asthma. Furthermore, asthma can severely affect the quality of life for those with this condition, especially if it is under-diagnosed and under-treated. Frequent sleep interruption can be common, leading to daytime tiredness and lethargy. These in turn cause poor performance and absenteeism in school or at the workplace, besides increasing the risk of accidents. The economic impact resulting from asthma can be significant given the loss of work productivity and income, in addition to increased healthcare costs for treatment or hospitalization. Asthma severity: Mild, moderate, and severe classifications To treat and manage asthma effectively, accurate classification is an important first step. Asthma is classified in three levels of severity – mild, moderate, and severe asthma. The levels of severity are typically assessed by how well the patient’s asthma is controlled, as well as the types and dosage of medication a patient needs to get his or her asthma under control. There is still very little awareness among the public that asthma exists in different levels of severity, whereby each level requires a different treatment approach. Severe asthma patients in particular require special attention as they are more likely to experience multiple asthma attacks, despite proper use of medications such as inhalers, due to the factors causing their asthma. In Asian countries, the prevalence of severe asthma is substantial and is estimated to be up to 10% of the total adult asthma population. Patients with severe asthma are not only challenged by their daily symptoms and interrupted sleep but they also experience limitations in their daily activities. They are also burdened with the need for daily and long-term use of quick-relief medicines such as multiple inhalers and oral corticosteroids (OCS). OCS treatment, in fact, can be paradoxical as long-term exposure to OCS can lead to multiple health risks such as type 2 diabetes, osteoporosis, heart disease and weight gain. This awareness gap might have led to suboptimal management in many asthma cases which itself is a significant barrier in improving patient outcomes. We also find that many asthma patients lack adequate motivation to get their condition under control. Meanwhile, there are some patients who may use asthma as an excuse not to engage in physical activities like exercising, or to avoid going to school or work. Despite the prevalence of patient apathy, it remains critical to empower people with asthma so that they can be more actively involved in the management of their conditions. Patients must be guided to thoroughly understand the signs and symptoms of asthma to help them identify when to seek medical attention. Early and proper treatment, regular follow-ups, and compliance to treatment are among the key aspects in proper asthma care. Gaps in patient care While low awareness levels and poor adherence to medical advice are common challenges in treating various types of chronic NCDs, asthma patients are further challenged by barriers in getting the right diagnosis and treatment. We have seen advances in asthma diagnostic technologies and facilities, but such facilities are still not evenly distributed across the country. It is still a challenge to ensure all patients have equitable access to the much-needed comprehensive diagnosis. Beyond diagnosis, access to the latest recommended therapies is an area that requires further improvements, especially when it comes to severe asthma patients. For patients living outside urban centers, physical distance and cost can present further barriers to receiving sufficient medical care. For example, when patients suspected of severe asthma are referred to a specialist for further diagnosis and assessment, having to travel for medical examinations and care increases the likelihood that the patients will miss their appointments. Addressing severe asthma To improve severe asthma care in Malaysia, the PRECISION Severe Asthma Working Group are developing an essential framework to elevate the diagnosis, management and tertiary referral of severe asthma patients across the whole country. In addition, they are working on a local expert consensus to guide the establishment of severe asthma clinics to provide dedicated and quality care to these patients. Patients who have been referred to us include those who are on long-term OCS; those who had emergency hospital visits and ICU admission due to asthma; as well as those who used three or more reliever inhalers in the last one year. Patients with these profiles are urged to proactively seek advice from their primary care doctors to get a treatment review and if necessary, a referral for further assessment from a respiratory physician. |
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