Surely modern medicine can do a better job for the 5.4 million people who have asthma – including 1.1 million children?
Each year there are around 77,000 admissions to hospital for asthma, each admission representing someone whose asthma isn’t under control.
In 2018 (the most recent data available), more than 1,400 people died from an asthma attack in the UK.
To my mind, every death is unnecessary.
Every case can and should be controlled, but many remain out of control, in danger of escalating into a life-threatening attack.
And there are other factors to keep in mind – think of the tragic death of nine-year-old Ella Kissi-Debrah from South London. Air pollution was cited as an exacerbating factor.
Poorly controlled asthma is when patients have asthma every day, waking up in the night, having more than two serious attacks a year, or some limitation on their life.
But arriving at a suitable treatment strategy can pose challenges for doctors and patients.
Orla O’Carroll of St Vincent’s Hospital, Dublin, and colleagues give some useful advice. If symptoms are worsening, speak immediately to your doctor, and discuss whether you have been sticking to your meds, you have had another illness, and any environmental factors.
It’s essential that a management plan is drawn up by you and your doctor together. The written-up plan is yours to administer yourself and if you stick to it, it’s been shown to reduce the need for A&E attendance and going into hospital.
Asthma meds traditionally are “preventers” (stopping an attack from occurring) and relievers (relieving symptoms if an attack should occur).
Modern asthma regimes combine the two and now in a single inhaler. These are known to reduce attacks and improve your quality of life.
Are there treatments for poorly controlled asthma? The answer is yes, in the form of various inhaled corticosteroids combined with a menu of LABA, long-acting bronchodilators.
They’re the mainstay of treatment for poorly controlled or moderate asthma. The steroid suppresses airway inflammation leading to less bronchial irritability. LABAs then cause the airways to open up and help breathing.
A short-acting dilator (SABA) can be added when needed to provide reliever treatment.
There’s one more potent medicine for patients whose symptoms aren’t well controlled. Montelukast can be added to enhance bronchodilation and reduce airway mucus production.
There are newer add-on treatments for patients whose asthma still presents problems.
These are usually prescribed by a specialist and they include biological therapies.