What is Asthma

Asthma is a common respiratory disease that is driven by chronic airway inflammation, resulting in breathing difficulties. Symptoms include wheezing, difficulty in breathing, chest tightness and coughing and can vary in frequency and intensity. Symptoms tend to be worse at night or in the early morning. They can be triggered by changes in weather, respiratory infections, exercise or exposure to allergens or irritants. In most cases, symptoms can be minimised with good asthma management and preventer inhalers.

Asthma tends to start in childhood, but some develop it in adulthood. Allergic asthma can be associated with allergic rhinitis, conjunctivitis, eczema and allergies. Non-allergic asthma may be associated with obesity, chronic rhinosinusitis or nasal polyps. Exercise-induced asthma, which some elite athletes have, can be triggered by physical exertion, cold or dry air inhalation. Proper asthma treatment will improve exercise performance and reduce symptoms.

Severe asthma

Asthma specialists will first exclude the most common causes of continual symptoms - poor inhaler technique, not following treatment plan, cigarette smoking, environmental factors or another medical condition.

However, a small group of people will still have poor asthma control and severe asthma attacks despite best efforts. It is important not to be discouraged. They can still benefit from systemic evaluation by a severe asthma specialist and individualised treatment with macrolide therapy, targeted biologic therapy, immunotherapy or bronchial thermoplasty (adults).

Common misconceptions in asthma

1.    The blue inhaler (SABA) can control my asthma. I don't need the preventer inhaler.

The blue inhaler only temporarily reduces the symptoms but can increase inflammation and worsen asthma, causing "over-reliance" on the blue inhaler (also known as SABA). Preventer inhalers are very important because they treat inflammation and reduce symptoms. After only a few week your symptoms will have reduced and you will be liberated from the blue inhaler.

2.    Steroids are bad for my health and I will become dependent on them.

The asthma preventer inhaler contains low and safe levels of inhaled steroids which are not addictive. Your doctor will help you find the right dose that will manage your asthma. These doses are much lower and safer than the large doses used during asthma attacks.

3.    Steroids will stunt my child's growth.

Child growth can be stunted by oral steroids given during attacks, which tends to happen when the asthma is not controlled. A sickly child grows poorly. So the best way to reduce the risk of poor growth is to manage their asthma with the right inhaled steroids.

4.    I stopped my preventer medication because I am pregnant and am worried it may cause foetal abnormalities.

The hormonal changes during pregnancy leads to a worsening of symptoms in about 30% of women. If you stop your asthma treatment, you are at high risk of an asthma attack, which increases the risk of miscarriage, oxygen deprivation and high steroid exposure due to emergency treatment.

5.    I only get asthma attacks 3 times a year, during a cold. I am fine with just my blue inhaler and do not need a preventer.

Asthma attacks are not like the normal cold - it is a "lung attack". Every attack is considered severe if you need emergency treatment like nebulization and high-dose steroids. Repeated high-dose steroid treatment can lead to side effects like weight gain, thin skin, bruising, muscle wasting, lower immunity, osteoporosis and diabetes. To control your asthma, agree an action plan with your doctor including preventer inhaler treatment.

6.    Severe asthma attacks only affect severe asthmatics. I am safe because I have mild asthma.

Paradoxically, mild asthmatics who do not control their asthma and overuse their blue (SABA) inhaler develop worse symptoms and become tolerant to the blue inhaler. So in an emergency situation, treatment doesn't work and it can be life threatening. Know whether you are controlling your asthma well.

7.    I cannot exercise and drink cold drinks as it worsens my asthma. I feel worried when my blue inhaler is not at my side.

Asthma should not limit your lifestyle. Most asthma patients can lead a normal life with preventer therapy. When controlled, they hardly use their blue inhalers and have few symptoms.