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Asthma is an inflammatory respiratory condition of the airways and affects about 262 million people globally. In South Africa, more than 20 % of children and 10 % to 15 % of adults have Asthma. For those living with the illness it can reduce quality of life in varying degrees, and it’s not uncommon to be hospitalised during an attack.

It is clear that fundamental changes are needed to reduce avoidable Asthma deaths, and the updated Global Initiative for Asthma (GINA) recommendations are expected to do just that.

Johannesburg-based GP, Dr Marlin McKay, shares what has to be done to achieve better control and explains the new treatment strategies that are being followed to reduce risks and attacks.

Asthma is described as a chronic respiratory inflammatory disease but what does that really mean?

Your airways carry air from your nose and mouth to your lungs. Asthma causes swelling of these airways – which become over-sensitive to certain environmental factors (allergens/triggers) that they normally wouldn’t react to.

When exposed to these triggers, the airway lining becomes inflamed and swollen and starts producing a sticky mucus or phlegm. The phlegm clogs up the already narrow airway, making it very difficult to breathe. If the swelling is not treated, over time the airway walls may thicken permanently, preventing them from working efficiently. Symptoms include a wheeze, shortness of breath, chest tightness and cough, which vary in intensity and over time.

What are the new developments in treating Asthma?

Asthma causes permanent inflammation of the airways. Reduce your inflammation and you reduce your risks. To illustrate how dangerous this inflammation can be for those who live with Asthma, a global study reports that excessive inflammation causes 176 million Asthma exacerbations (complications/incidents) annually.

For decades, asthmatic patients have been overusing their blue SABA symptom-reliever inhaler and underusing their anti-inflammatory maintenance medication. The problem is that SABA reliever pumps do not treat the underlying inflammation caused by Asthma.

Using the blue inhaler just three times a week masks the symptoms and actually increases the risk of Asthma attacks and death.

The paradigm shift in Asthma management is that we are moving away from these blue rescue inhalers and advising patients to avoid establishing patterns of reliance on SABA therapy early in the disease. This is in line with the new GINA Guidelines being followed globally.

So how should Asthma be treated now?

Understanding your specific Asthma symptoms is undeniably important for better managing your condition. Everyone is different and needs a unique plan. That said, regardless of your triggers or disease severity, you need to use a low dose inhaled corticosteroid (ICS)-formoterol therapy as needed as the preferred reliever therapy. This combination maintenance inhaler contains an anti-inflammatory agent which reduces inflammation.

Asthma can be classified as mild, moderate and severe? Do the GINA Guidelines apply to all classifications of disease severity?

Chronic control relies on anti-inflammatory maintenance and the GINA Guidelines apply whether you have mild, moderate or severe Asthma. The approach to treatment and management of Asthma is almost identical and reducing inflammation is at the heart of it. We need to adopt a zero tolerance of Asthma attacks approach to management of the illness.

Is it safe to say that if you have mild Asthma, you won’t have or are less likely to have an Asthma attack?

Mild Asthma doesn’t preclude you from having an Asthma attack. The risk is equally high regardless of disease severity, adherence to treatment, or level of control. This is significant because mild asthmatic patients are regarded as the silent majority of asthmatics. One could say labelling Asthma as “mild” is a misnomer because you are still equally at risk of attacks.

So you can land up in hospital with Asthma even when it’s been classified as “mild”?

You absolutely can! Mild Asthma is associated with a considerable risk of exacerbations, including severe and life-threatening forms. Around 22 % of patients with mild Asthma are reported to have severe exacerbations or are hospitalised.

A large placebo-controlled study found that 0.67 % of newly diagnosed mild Asthma patients experienced a life-threatening exacerbation within three years, despite their physician prescribing additional Asthma medications.

What final comments would you make on the subject of establishing control?

In individuals with Asthma, starting low dose inhaled corticosteroids (ICS) early leads to a larger improvement in lung function. It also provides a positive impact on quality of life and airway hyper-responsiveness. Studies have also found that regular low dose ICS also lowers the incidence of severe exacerbations, hospitalisations and death. Exercise-induced bronchoconstriction is also reduced.

None of this can be achieved if your Asthma treatment plan relies only on a SABA inhaler. If you are unsure if you are over-reliant on your reliever inhaler, take the “Reliever Over-Reliance Test”. and discuss your results with your doctor. Breathing should not be a battle. Take the test today and take control of your Asthma!