Asthmatics can lead normal life


CONTROLLABLE: Dr Mariko Koh (far right) and Karen Tan (centre), Senior Asthma Coordinator, help Tan Chay Hua control his asthma.

PEOPLE with severe asthma can turn their health around with medication and proper treatment.

When his asthma flared up, he would be inhaling hard, trying to squeeze as much air as possible into his lungs. He heard wheezing sounds from his chest which felt tight, and he had coughing fits after every few laboured, phlegmy breaths. If his medication – always close at hand – didn’t let him breathe easier, he would have to seek emergency treatment.

“It felt like my airways were blocked and I was breathing in very little air,” said Mr Tan Chay Hua, who has suffered from asthma since his youth.

Because his family was poor, he didn’t pay much attention to his condition, dismissing it as a cold or cough. The disease – a chronic inflammation of the bronchial tubes or airways of the lungs – wasn’t diagnosed and treated properly, and it became progressively worse. Just a couple of years ago, Mr Tan’s asthma was so severe that he was getting an attack which required emergency treatment at the hospital a couple of times a week. Now in his early 70s, Mr Tan has his asthma under control and severe attacks have become rare – a turnaround in his health that he credits to Dr Mariko Koh, Consultant, Department of Respiratory Medicine and Critical Care, Singapore General Hospital.

“Dr Koh gave me the confidence to live without my nebuliser,” said Mr Tan, referring to the inhaling device that he uses to relieve the symptoms of asthma quickly. At the time, he was over-reliant on his reliever medication, using it more often than he should.

Under Dr Koh’s care, Mr Tan began to regularly use controller medications instead.

Controller or anti-inflammatory medications, when used daily, are the most effective and important treatment for asthma as they prevent attacks by making the airways less sensitive to irritants in the environment. They also help to reduce swelling in the airways and decrease the production of phlegm.

Through asthma counselling, Mr Tan also began to understand his condition, how to get his asthmatic symptoms under control, what causes an attack, how to avoid it and what to do when it strikes.

Asthma, said Dr Koh, is a common disease that affects about five per cent of adults and 20 per cent of children in Singapore. While asthma cannot be cured, its symptoms can be controlled with the proper use of medication and environmental control.

Because the airways of people with asthma are “hyper-reactive”, they react easily to anything from cold weather and exercise to dust mites, pollen, tobacco, and stress, she said. “That’s why asthma waxes and wanes.

There are good and bad days, depending on what can trigger an attack,” Dr Koh said.

When the person is exposed to something that triggers an attack, the airways narrow, their lining becomes inflamed, mucus or phlegm is produced and the patient must be given something to help him breathe.

Asthma patients have to use an inhaler containing a reliever medication, like salbutamol, to quickly open up their airways and allow them to breathe easily. If the attack is severe, the reliever medication alone may not be effective and patients will need to take a tablet kept on standby, usually prednisolone.

“It is important to recognise a severe attack of asthma and seek early medical attention,” said Dr Koh. If left till too late, patients may end up on life-support machines to help them breathe. And if they can’t breathe, they won’t have enough oxygen going to the brain and vital organs, and that can lead to a vegetative state or even death.

“Generally, around 80 per cent of asthmatics have mild to moderate asthma. It can be controlled with the use of daily controller medications and they lead normal lives. They can go to school and work, and even exercise or participate in competitive sports without any problems,” said Dr Koh, noting that footballer David Beckham and Olympic gold medallist and swimmer Mark Spitz (who won seven gold medals at the 1972 Munich Olympic Games) are among the many famous people who have asthma.

“Like Mr Tan, if you have symptoms suggestive of asthma, seek early medical help, use your medication as advised by your doctor and go for regular followup. Asthma can be controlled and asthmatics can lead normal, fulfilling lives.”


Control Test

If you have asthma and are older than the age of 12, take the Asthma Control Test questionnaire below to check if your treatment plan is keeping the disease under control. Be sure to review your results with your doctor or nurse.

Circle your responses, then add up the total score. For instance, the score for the first question is three if your response is “some of the time”, and five if it is “none of the time”.

Question 1:  During the past four weeks, how often did your asthma prevent you from  getting as much done at work, school or home?

Question  2: During the past four weeks, how often have you had shortness of breath?

Question  3: During the past four weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?

Question   4: During the past four weeks, how often have you used your rescue inhaler or nebuliser medication (such as salbutamol)?

Question   5: How would you rate your asthma control during the past four weeks?

Total score of 25 – Congratulations! You have total control of your asthma.

Score of  20-24 – On target. Your asthma may be well, but not totally, controlled.

Score of less than 20 – off target. Your asthma may not be controlled.

• This story was first published in Singapore Health, Mar/Apr 2012.