How to control asthma

Originally published in The Ottawa Citizen July 2, 2004
Original Title: Asthma Perspectives

How many asthmatics think their asthma is under control? If you are like most Canadians, 91 per cent believe so. Indeed, perception is not a mirror of reality.

An Asthma in Canada survey done by the Division of Respiratory Medicine, University of Toronto, Division of Clinical Epidemiology, McGill University, the Angus Reid Group and Glaxo Wellcome indicates that 57 per cent of those who believe their asthma is well-controlled are wrong.
Ninety per cent of respirologists and 77 per cent of primary-care doctors believed their patients were managing their asthma well. In fact, only 43 per cent of these patients were controlling their asthma.

The impact of poorly managed asthma results in a poor quality of life, diminished physical functioning, absenteeism, increased emergency department and office visits, hospitalization and, for some, death.

Many will not notice their deteriorating condition because of the body’s ability to adapt to chronic disease; the gradual decline is insidious.

How can we reverse the trend that is seeing asthma control falling behind national standards set out in the Canadian Asthma Consensus Guidelines?

Knowledge is power. Many asthmatics mistakenly believe they will remain symptomatic from their asthma throughout their lives. They do not understand the role of various medications.

Education is the means to reduce the suffering because it empowers patients to take control of their illness and make decisions on-the-fly instead of waiting to see their doctor for advice. Asthma medications will effectively control different mechanisms of the disease (for a full review of asthma, please go to http://members.rogers.com/barrydworkin/be_alert.html).

Inhaled corticosteroids, the mainstay of treatment, reduce and reverse the inflammation, mucous production and tissue destruction within the airways. Once started, they require about a week to reach their full therapeutic benefit.

Bronchodilators or beta-2 agonists (the blue puffers) relax the rings of muscle that encircle and squeeze the airways during an asthma attack. They are not to be used as the sole means of asthma control. Indeed, using them more than two or three times a week indicates uncontrolled asthma. Growing bodies of evidence indicates that combination therapy (a corticosteroid and long-acting bronchodilator like Advair and Symbicort) provides a better therapeutic effect.

Many people reduce inhaled corticosteroid use over the summer. Given that asthma is an inherently unstable disease, this action increases their risk of asthma exacerbations.

A study looking at childhood asthma attack frequency shows a spike at week 38 of the year (Sept. 10 to 18). Most children return to school at week 37. Viral infections spread quickly with the children at close quarters. This effect, in combination with a reduction of their medication use, accounts for this spike.

Parents should ensure that their children restart their inhaled steroids at least midway through August if they have reduced or discontinued them. This will help to ensure they are protected once they return to school.

A new asthma education program has started at the Ottawa Hospital. The program, PRIISME, is a co-operative effort between the hospital and GlaxoSmithKline. Glaxo is providing the funding and materials for the program.

PRIISME provides disease management tools for prevention, diagnosis, treatment, patient compliance and follow up. It offers patients a series of educational interventions centred on self-management. The goal is to improve detection of asthma sufferers with poor control, provide education about optimizing control and the role of their medications and provide medical services through the respirology clinic at the General campus of the Ottawa Hospital.

Dr. Bob Dales, chief of respirology, is providing his department’s services to support PRIISME. The program will offer family doctors the opportunity to educate their support staff so they can teach their patients about asthma. A certified asthma educator will book educational sessions at various clinics. Asthma education referrals can be directed to the Lung Association Education Center.

The goal is to reduce the workload of primary-care physicians yet improve patient education and asthma management. PRIISME will co-ordinate community services, provide continuing medical education and education for patients and their families. Emergency room visits, unscheduled doctors’ visits and hospitalizations in Quebec for asthma are down since PRIISME’s inception in 1999.

If you have daytime asthma symptoms four days a week or more, night-time symptoms more than once a week, diminished physical endurance, frequent asthma exacerbation, missing school or work and using you bronchodilator inhaler more than four times per week, you should consult your doctor; your asthma is not controlled.

There is no reason to suffer with this illness. Indeed, there is little reason to experience many of the symptoms associated with asthma if treated correctly. Your quality of life should be equal to someone who does not have asthma.

For more information about PRIISME, contact Kathleen Devecseri at the Ottawa Hospital, General campus.


© Dr. Barry Dworkin 2004

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