The world celebrates this year the World Asthma Day, which falls in May each year, under the theme “Asthma Education Empowers” to shed light on this chronic and prevalent disease, which affects approximately 260 million people worldwide. The primary goal of this day is to control and reduce asthma complications, as it may sometimes pose a life-threatening risk to patients as well as negative impacts on the quality of life and productivity if not properly managed.

Bronchial asthma often presents as intermittent episodes, induced by triggers that cause inflammation in the airways. This inflammation causes swelling in of the airway lining, leading to their constriction, consequently, appears as difficulty breathing, coughing, chest tightening and wheezing.   

Dr. Mohammed Al Otaibi, Family Medicine Consultant at Leabaib Health Center – PHCC, has highlighted the genetic impact on asthma, which explains its higher prevalence in communities where consanguineous marriage is common. In addition to genetics, there are various environmental factors that contribute to asthma attacks, including air pollution, smoking, dust, humidity, and certain odors like Bakhoor, animal dander, bird feathers, certain plants and pollen grains. Respiratory illnesses and colds also play a significant role in triggering asthma; however, the impact may vary from one person to another.  

Asthma attacks can occur at any time of the year, but they are more likely to increase during winter due to a higher prevalence of triggers, particularly viral respiratory infections like flu and colds. In addition, the summer season, with its humidity and dust, exacerbate asthma attacks. The return of students to school often lead to a spike in asthma attacks as students come into contact and potentially spread viral infections which then can be transmit to their households. Asthma attacks also tend to increase during periods when certain pollen grains are dispersed and when certain plants that trigger allergic reactions are in bloom.    

All these factors contribute to increased asthma attacks for many people, demanding preventive and curative actions prior to and during its occurrence to ensure safety without affecting the quality of life or experiencing severe complications that may require hospitalization.

“Misconceptions”

Dr. Al Otaibi emphasized the importance of addressing some asthma-related misconceptions in light of this year’s theme centric on awareness and empowerment. The first common misconception is that individuals with asthma must limit their lifestyle, movement, and sports activities to prevent asthma attacks. Parents often visit their physician seeking physical education exemptions for their children with asthma, but it is inaccurate to restrict their movement or engagement in sports activities such as swimming, jogging and more. With the right preventive and curative medications, individuals with asthma can engage freely and efficiently in physical activities, compete in athletic competition and even win championships. 

The second misconception is the fear of children becoming dependent on inhalers. This is a misunderstanding because there is no risk of dependency on inhalers. Children only use inhalers when needed, and if there is no need, they stop using them. Medications administered through inhalers (such as bronchodilator) contain very small doses compared to pills or syrups. They go directly to the lungs, making them faster and more effective in treatment, with fewer side effects. For very young children who may struggle to use inhalers correctly, a spacer can be attached to the inhaler, enabling them to inhale the medication through it.  

“Corticosteroid Inhaler is Safe”

The third misconception is fear of corticosteroid inhalers and the reluctance to give them to children due to concerns about the side effects of corticosteroids. As stated earlier, the amount of corticosteroid in inhalers in minimal, and most of it go directly to the lungs. Therefore, corticosteroid inhalers are safe for children and do not impede their growth. These medications are essential for controlling and preventing asthma attacks.

The fourth misconception is that parents reject asthma treatment when informed by the physician that their child has chest allergy. This refusal stem from the belief that their child does not have asthma, therefore questioning the necessity of asthma medication. In fact, it is important to note that asthma, bronchial asthma and chest allergy are different terms used interchangeably to describe the same condition. Healthcare professionals should clarify this fact to patients and their families to avoid underestimating this disease.   

“Prevention Before Treatment”

It can be challenging for many people to understand that asthma is a chronic condition that requires regular follow-up regardless of weather an attack occurs or not. Unfortunately, many asthma patients only seek medical attention when an attack occurs, which is not ideal. Asthma treatment primarily relies on the principle that prevention is better than cure, meaning it focuses on preventing and averting asthma attacks. Merely experiencing an asthma attack or even some symptoms is considered as treatment failure or insufficiency, requiring corrective actions to prevent future attacks or symptoms.

Preventive actions can be pharmaceutical or non-pharmaceutical. The most important non-pharmaceutical measure is avoiding asthma triggers, which may vary from one person to another, including:

-          Smoking: whether the asthma individual is a smoker or is exposed to secondhand smoke, it is crucial for everyone in the household or environment of asthmatic person to refrain from smoking.

-          Household dust: dust mites, present in every home, can trigger asthma. It’s advisable to remove carpets from the house, regularly vacuum curtains and furniture, and avoid strong odors such as bahkoor, perfumes, paints, air fresheners and other strongly scented substances.   

“Domestic Animals and Plants”

Dr. Mohammed Al Otaibi emphasized that animal dander and bird feathers are asthma triggers. Therefore, many individuals with asthma should remove these animals from inside their house and avoid using feather pillows, woolen blankets, indoor plants and pollen grains. They should also avoid crowded indoor areas as much as possible, ensure regular ventilation in their homes, take precautions against flu, colds and respiratory infections by getting the recommended vaccinations, including the flu vaccine at the beginning of October each year, as well as other vaccinations recommended by the health authorities.

As for pharmaceutical prevention, it involves the use of specific medications prescribed by the physician prior to or at the beginning of the anticipated season of asthma attacks, based on previous year’s experiences. The objective of these medications is to avert asthma attacks during the expected season. These medications differ from one person to another depending on the severity, duration, and seasonal pattern of the disease. Generally, these medications include corticosteroid inhalers with or without long-acting bronchodilators, to be taken regularly before the asthma season begins, without waiting for an attack or symptoms, and usually continued throughout the season.

“Attack Treatment or Symptoms”

When an asthma attack or symptoms occur, this indicates a failure of preventive measures or exposure to some of the mentioned triggers. The physician will prescribe treatments according to the condition and severity of the attack.

The signs that necessitate a visit to the doctor are crucial because asthma attacks can have serious consequences if signs of danger are not recognized, requiring prompt medical intervention. The most important signs of danger include absence of response to bronchodilators, whether administered through an inhaler or a nebulizer, as well as heightened breathlessness, rapid breathing, inability to speak or move, feeling fatigue, and other symptoms that individuals and caregivers should remain vigilant about.

Every person with asthma aged 8 years and above should possess a simple device called a peak flow meter. The physician trains the individuals and their family on how to use it, and when the reading indicates the severity of an attack, then immediate medical attention becomes imperative.

It's important to mention that treatment failure is often due to improper use of inhalers, as there are various types and forms, each with a specific method of use to ensure that the spray reaches the affected area. The physician, pharmacist, or nurse must provide practical training to the patient and ensure correct usage during every visit.

In conclusion, PHCC aspires for asthma patients to live a normal life free from attacks and symptoms, with the hope of eventually overcoming the disease, considering a significant proportion of children fully recover from asthma as they grow older.