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Changi General Hospital’s Respiratory Medicine doctors organised a “Taking Control of Your Asthma” public forum at CGH on asthma on 8 May 2004. Asthma counselling stations were set up and an exhibition was also held at the CGH Training Centre to educate the public on asthma.

Asthma is a disease in which the airway (bronchial tubes) in the lungs become inflamed, narrowed and obstructed, causing breathing problems. Asthma is a potentially fatal condition. It can develop at any age and is fairly common worldwide. In Singapore, 1 in 20 adults and 1 in 5 children are asthmatic.

Myths & Misconceptions about Asthma
Dr Hui Kok Pheng
Senior Consultant
Department of General Medicine

Accordingly to Dr Hui Kok Pheng, Senior Consultant, patients sometimes do not recognise asthma, as typical symptoms are not often present. In fact, wheezing which is a symptom most often associated with asthma, is actually an uncommon symptom of asthma.

Dr Hui also debunked some other common myths about asthma. “There is no such thing as being too young or too old to have asthma.” In fact, a CGH study of asthma patients revealed that asthma patients ranged from 13 to 83 years old.

The use of preventer and reliever medicines can help control asthma. Preventer medication acts to reduce the inflammation or swelling of the airway lining and reduce mucous production. They do not provide immediate relief of symptoms but treat the underlying disease, making the airway less sensitive to triggers and irritants in the environment.

Relievers are medicines that are taken only as and when necessary to provide quick relief of asthma symptoms. They act to relax the muscles around the airway. They relieve the obstruction to airflow rapidly and make breathing easier.

Another myth is that an asthmatic patient should not exercise. About 80% of the patients with symptomatic asthma have some degree of exercise induced asthma (EIA). However, this does not mean that one should stop exercising because exercise does not cause asthma. The aim of treatment is to control asthma to return to normal daily activities and this includes exercise.

Many patients also perceive that anti-asthma medication is addictive or harmful. The truth is medication keeps asthma under control and must be continued. Steroids have been a major player in the control of asthma symptoms for decades. But, it is important to distinguish these steroids from anabolic steroids. It is a myth that steroids can cause a flare up in hepatitis and cause diabetes because the steroids used to control asthma deliver a very small dose and have little side effects.

Patients who think that their asthma is under control sometimes stop taking their medication but the fact is fatal asthma attacks occur every year and most asthma deaths are in patients who were not taking preventers.

Common Management Issues in Asthma
Dr Vijo Poulose
Consultant
Department of General Medicine

Asthma can be triggered by dust, weather changes (sudden cold spell), cigarette smoke, pollution, pollen, pets, cockroaches, food, exercise or sinus problems.

Incidence and deaths from asthma is increasing all over the world. It can also present for the first time in children and adults.

“Asthma severity is graded from 1 to 4. Grade 1 is the least severe with daytime attacks occurring less than twice a week. Grade 4 is the most severe with attacks occurring continuously,“ said Dr Vijo Poulose.

Rescue drugs (relievers) are bronchodilators that act fast and dilate the airways. However, they do not address the real problem, which is inflammation. Preventers however act to reduce the inflammation.

Treatment of acute asthma attack includes the use of bronchodilators e.g. Ventolin, steroids, oxygen or admission to ICU and intubation for very severe attacks.

Specific treatment of asthma depends on the grade of asthma. Rescue drugs such as Ventolin can be used as needed in Grade 1. Ventolin, steroid inhalers and long acting bronchodilators are used in Grade 2 and 3. Treatment for Grade 4 or severe asthma would involve all the above with the addition of oral steroids.

Asthma in Special Groups
(Pregnancy & Exercise-induced Asthma)
Dr Sridhar Venkateswaran
Associate Consultant

According to Dr Sridhar Venkateswaran, Associate Consultant, Respiratory Medicine, EIA is asthma that occurs during or soon after vigorous exercise. About 80% of the asthmatics suffer from exercise induced asthma, however in some, asthmatic attack occurs only with physical exercise. EIA is triggered by inhalation of large volume of cool dry air during exercise.

Another special group of asthma patients is pregnant women. Pregnant women are breathing for two therefore it is very important to have the asthma under good control. Breathing difficulties in the mother affect the foetus by compromising the oxygen supply.

“Asthma affects 1-5% of pregnant women. Pregnancy has a variable effect on asthma. It can become worse, less severe or unchanged,” said Dr Sridhar.

When asthma is controlled, women with asthma have no more complications during pregnancy and giving birth compared to women with no asthma. However, uncontrolled asthma during pregnancy can produce serious maternal and fetal complications.

Uncontrolled asthma is associated with complications such as premature birth, low birth weight and maternal blood pressure changes.

Acute episodes endanger the foetus by reducing the oxygen it receives. It is therefore important to manage asthma during pregnancy.

Near-Fatal Asthma
Dr Augustine Tee
Registrar

There is no denying that asthma can be fatal. ”Up to 7% of asthmatics die from an asthma attack. Unfortunately, it is hard to predict which asthma patients will have a fatal or neat-fatal attack,” said Dr Tee.

From 1999 to 2003, 23 deaths in CGH are attributed to asthma. In a study of asthmatic patients who suffered fatal asthma attacks, 26% have a low perception of breathlessness ie. they underestimate their own severity of an attack. They tend to be older, female and have a longer duration of the disease. They also tend to have more A&E visits, hospitalisations and more near-fatal asthma attacks.

While fatal asthma attacks do occur, it can be prevented with proper treatment and patient education. Dr Tee stressed that asthmatics must learn to recognise when their asthma is getting worse so that they can seek treatment early. This can be done by recognising clues such as:

• Waking more often at night with cough or wheezing
• Inhalers do not give relief like they normally do.
• The need for more and more bronchodilator treatment.