Dubai: Delayed asthma treatment or poor adherence to management protocol of the condition can prove fatal, doctors say.
The recent incident of a Dubai-based Canadian expatriate slipping into coma following a severe asthma attack and finally breathing her last has raised concerns among residents.
According to Dr Bassam Mahboub, secretary of the Emirates Allergy and respiratory society, the prevalence of asthma in the UAE is eight per cent in the adult population and 12 to 13 per cent among children. The incidence is high among children because of their weaker immune system that are susceptible to manifesting allergies triggered by environmental triggers.
What is Asthma?
Dr Mahboub explained: “Asthma is a chronic inflammation of the airways that is caused by irritation in the presence of dust, smoke, chemicals, certain food additives and environmental triggers. Also, gastro oesophagal reflux, commonly called acid reflux, can also trigger asthma.”
8%prevalence of asthma among adults in the UAE
However, not all types of cough and wheezing can be diagnosed as asthma, said Dr Jasem Abdou, consultant, respiratory and sleep medicine at Health Point Abu Dhabi. He explained: “Diagnosis of asthma is conducted on a clinical basis where a history of the patient’s complains and the pattern of symptoms are analysed. We conduct an airway reversibility and pulmonary function test to ascertain a clear diagnosis.”
Since allergy of any kind is the trigger, asthma is attributed to partly genetic and partly environmental factors. “People with low immune resistance are likely to react to environmental triggers such as dust mites, sand storms, cold, bacterial infections, humidity and other such variables. People susceptible genetically need to take care to eliminate these triggers,” said Dr Abdou.
What happens during an asthma attack?
During an asthma attack, a patient experiences a heightened allergic reaction to one of the triggers. This results in instant inflammation of the airways which produce extra mucous to counter the attack and cause the bronchial tubes to go into spasm. The spasms cause oxygen supply to the body to be cut off considerably resulting in a patient wheezing and struggling to breathe.
According to the treatment guidelines issued by the Global Initiative for Asthma management strategy, 2019, mild cases need to be treated by inhaled cortico steroids. In such cases, use of an inhaler with cortico steroids eases the airways. In moderate attacks, patients requires anti histamine injection and nebulisation. In severe cases the patient must be hospitalised immediately and intravenous cortico steroids administered along with injectable anti histamines to release the spasms and restore oxygen supply to the body and brain. Patients must therefore, keep their first aid revival kit always ready and waste no time in reaching hospital if they sense the slightest trouble in breathing during an attack.
How intense is your condition?
It is important therefore for patients to know when the attack is mild, moderate or severe, observe and maintain a diary and keep their doctor in the loop. Asthma is said to be mild when the individual suffers an episode once a year which can be treated with inhalers with cortico steroids and broncho dialators.
The condition is moderately risky when a person suffers more than two episodes a year and night time disruption of sleep due to wheezing. In such cases, the patient might be advised to take anti histamine tablets, note down symptoms and colour of phlegm and inform his GP. In cases of severe asthma if a patient experiences severe breathlessness and wheezing many times a year, experiences nighttime disruption of sleeping pattern he or she is said to have poor control over the condition and might require long term treatment and even hospitalisation in times of such episodes.
Dr Abdou added: “Approximately 5-10 per cent of the asthmatic population suffers from severe asthma while 90 per cent of patients can be managed with oral or injectable medicines.”
Providing details on the modern protocols for treatment of severe cases, Dr Mahboub said: “In the past, we could only treat patients with corticosteroids. However, new biological treatment is based on immunotherapy. We use a chemical molecule which is extracted from the allergen to attack the antibodies that cause the reaction in the patient.
One of the challenges in case of treatment is the attitude of the patient. If the patient does not diligently record the frequency of breathlessness, wheezing, couging etc and alert his GP and if the patient is not compliant to adhering to the medicine regimen then the chances of relapse or recurrence of asthma is very high.
Ten-step asthma management programme:
- Track your symptoms and keep record to be discussed with your doctor
- Adjust medication according to the recurrence and severity of episodes
- Be regular and consistent with your medication and visits to clinics. Non-compliance to medication and treatment results in relapse.
- Keep quick relief inhalers handy.
- Create a quick asthma action plan with your doctor which lists in order of priority what needs to be done in case of a mild to severe episode. Educate your care giver or family member who can assist you during an attack.
- Educate your care-giver or family member who can assist you during an attack.
- Keep your GP in loop and do not waste precious time in case the inhaler is not working effectively during an episode. Do not waste time trying to manage a severe attack, rush the patient to emergency immediately. Do not wait for broncho-spasms to occur that will restrict airways and cut of oxygen supply to the brain. This can be fatal.
- Try and keep all allergy triggers away from your environment. This would require the home to be dust free, avoidance of strong or pungent smells, chemically processed foods, strong house paints etc
- Keep abreast of latest immunotherapy protocols that can play an important part in keeping your antibodies really low to avoid regular flareups.
- In complementary medicines doctors agree that light yoga exercises (both physical and breath-based can help in keeping wheezing and coughing under control and can strengthen your respiratory system.