Control key to asthma

Measures taken to stop the spread of COVID-19 could be responsible for a significant drop in the number of emergency department presentations at WA hospitals for asthma and chronic obstructive pulmonary disease. Figures from July 2019 to June 2020 show there was an 8 per cent decrease in asthma ED presentations and a 12 per cent fall in COPD ED presentations. However, WA’s peak asthma body Asthma WA is using World Asthma Day today to issue a timely reminder for those with the respiratory condition to not be complacent as winter approaches. With Australia having the highest prevalence of asthma among adults aged 18-45 worldwide, the organisation warns those with the condition to be prepared for the season ahead and not to be fooled asthma symptoms are on the decline. Respiratory physician Dr John Blakey believes there are two main contributors to the significant reduction in admissions. “Firstly, a substantial proportion of asthma attacks are caused by viral infections. The increased awareness of physical distancing and hand hygiene due to COVID-19, coupled with the reduced travel to other areas, have helped greatly reduce the number of respiratory viral infections and “influenza-like illnesses,” he explains. “Secondly, most people with asthma do not take their preventative treatment regularly as intended. Concern about COVID-19 has encouraged more people to take their prescribed doses and has thus reduced their risk of having an asthma attack,” he adds. Asthma WA chief executive Donna Rendell says the decrease in people presenting at hospital may have also been due to fear of contracting COVID-19 or other viruses. “But asthma is still a respiratory disease that needs to be taken seriously. If someone is having difficulty breathing, it’s critical that they commence asthma first aid and do not delay calling 000,” she said. “As we head into winter, it’s essential respiratory conditions are well managed. People need to have an up-to-date asthma and/or COPD action plan and ensure they are taking their medication as prescribed.” She said it was important for people with asthma or COPD to get both the flu vaccination and COVID-19 vaccination when it’s available. Normal life regained Perth executive assistant Meaghan Mickle is breathing a whole lot easier these days. The 29-year-old has been presenting to the emergency department with asthma episodes every winter for the past decade but that changed when her general practitioner put her in touch with Asthma WA. “2018 was a really horrible year for me. I think in the space of maybe six weeks, I presented to ER twice with asthma symptoms. From those two admissions, my GP referred me to Asthma WA,” she recalls. Ms Mickle was entered into the organisation’s COACH program, and received support and training to better manage her condition. “So I received that from late 2018 to early 2019 and since then I haven’t had a asthma-related hospital admission or ED visit since,” she reveals. The confidential, free health coaching service for people with asthma taught Ms Mickle how to correctly use her medication and how to take charge of her asthma so she no longer had to live in fear of doing the things she loved — hiking, exercising at the gym and even laughing. “It turns out my entire life, I had not been taking this medication correctly,” she reveals. Most importantly, the program made her realise she could live a normal life with asthma. “I did not know that I didn’t have to suffer with this forever. And I didn’t realise how much asthma was limiting me,” she says. “I had a lot of fear of being stuck somewhere and not being able to breathe. That was something that was coached quite well to me through that program. I go on hikes now and I can laugh without having an asthma attack. It’s changed my life.” Ms Mickle also discovered through the program that she was using ventolin at an alarming rate. “Ventolin is the medication you take whenever you feel yourself getting really tight in the chest or struggling to breathe and you’re only supposed to take it on a very rare basis,” she says.“I was taking it maybe seven times a day at one point and I thought that was normal and when I told my coach this, she was like, ‘Oh no, that is not normal.’ She helped me realise that it was almost like I was so anxious about it that I was taking it without needing it.” Asthma WA chief executive Donna Rendell says both the prevalence of asthma and its impact are higher than many people realise. “One in nine Australians have asthma, so we all know someone who is affected by the condition, and its impact is far reaching. It doesn’t always end up in emergency situations, but it can and often does, have a significant effect on their quality of life including mental health, absenteeism and stressful hospital visits — usually due to inadequate management,” she says. “And that’s where the free services Asthma WA offers can make a difference, by continuing to help reduce the number of hospitalisations and improve quality of life through education and empowerment of people to take control of their respiratory health.” The importance of prevention While taking preventative treatment regularly can dramatically reduce the frequency of attacks, Dr Blakey reveals most people don’t. He says at least 75 per cent of asthma attacks and 90 per cent of asthma deaths are preventable with treatments we have in common use. “However, these are preventative treatments that need time to work as people with asthma have low-grade inflammation they might not be aware of,” he explains. “To get protection, people need to take them now whilst they feel well. You don’t put a helmet on once you’ve already crashed your bike, or just take blood pressure tablets when you’ve already had a stroke.” Often, Dr Blakey says, there hasn’t been a full discussion around why preventer inhaler treatment is important, and what it does to the lungs. “If people can’t see a clear reason it will benefit them, and are worried about the treatment, they won’t take it.” He says this is commonly seen in pregnancy where safe inhaled drugs are not taken and women risk serious harm to the baby by having uncontrolled asthma — a situation made worse by well-meaning but incorrect advice. He also believes cost could be a barrier. “As well-paid doctors, we sometimes overlook the cost involved in inhalers — some people simply can’t afford their medicine,” he adds. “It’s therefore important to have an open discussion about this as solutions can often be found like combination products or ones with more doses per inhaler.” Further complicating the issue is that even those who take their preventative medicine are often doing so incorrectly or infrequently because the need for daily therapy hasn’t been explored with them. “Commonly, we see people only using salbutamol (which has no preventative action), then starting their preventer when they have already become symptomatic and damage is occurring to the lungs,” Dr Blakey says. He says those who stop using treatment because of side effects are often unaware of a large range of devices and treatments available. “Some people simply forget doses, especially when they feel well. Setting alarm reminders or switching to a less frequent or less complicated medicine is often helpful,” he suggests. According to Dr Blakey, the great majority of people with asthma also make mistakes when taking their inhalers. “Studies involving thousands of people with asthma show that relatively minor mistakes in inhaler technique are associated with worse control and more attacks,” he reveals. Unfortunately, he says research also shows that only one in six healthcare professionals can use common inhalers properly, and they usually don’t know they are making mistakes. “It’s therefore very important to check technique with the videos available through the National Asthma Council and Asthma WA, or with one of the specialist hospital asthma clinics such as the one at Sir Charles Gairdner Hospital. Having the same device type for all your inhalers also helps, and some inhaler device types are easier to use.” How viral infections impact asthma Viruses are the most common cause of asthma attacks, responsible for more than half of attacks in adults, and an even higher proportion in children. Dr Blakey says they directly damage the lining of the airways, releasing chemical messengers that cause more inflammation. “People with asthma are also relatively less efficient at clearing viruses using defence mechanisms like interferons,” he explains. “This cascading inflammation brings in other types of cells to the lung, which cause more swelling of the airway wall, more twitchiness of the muscles around them, and greater production of mucus. These three aspects make the airways narrow or even blocked, and so make it difficult to breathe.” For more information, visit asthmawa.org.au