Most asthma deaths can be prevented
The month of May is used to create more awareness of a disease that everyone has probably heard of, but not many truly understand: asthma.

In fact, the Global Initiative for Asthma (GINA) chose “Asthma Education Empowers” as its theme for this year’s (2024) World Asthma Day, which was marked on May 7.

As with most chronic diseases, empowering patients and their carers or loved ones with the right education to manage the disease goes a long way in ensuring optimal outcomes.

What is asthma?

Asthma affects more than two million Malaysians.

It is a chronic (i.e. long-term) disease that affects the airways in our lungs.

When asthma is active, the walls of the airways become swollen, which leads to narrowing of the space that allows air to move in and out.

The swelling can also lead to the production of excess secretions, which can further block the airways and manifest as phlegm.

As a consequence of the airway swelling, patients may find themselves more sensitive to changes in the environment (especially when the temperature changes), with symptoms such as coughing, the more classical wheezing, and in worst-case scenarios, difficulty breathing.

Unnecessary deaths

Ten years ago (2014), a confidential enquiry (titled The National Review of Asthma Deaths) was published in the United Kingdom.

It involved in-depth scrutiny of the asthma care for 276 people who were deemed to have died because of asthma.

A few important findings were noted:

Potentially preventable factors were identified in two-thirds of the cases. These included inappropriate prescription of medication.

Forty-five percent of those who died from asthma did not call for or receive medical assistance during their final fatal attack.

Overall asthma care in both clinics and hospitals were judged to be good in less than 20% of those who died.

The key take-away from the report is that most asthma deaths are preventable.

It is a matter of achieving the right diagnosis, followed by continued engagement with the patient in order to ensure that they understand the rationale for interventions and know what to do in order to achieve good asthma control.

Uncontrolled asthma can also affect a patient’s quality of life in many ways, from being unable to play sports at school to absenteeism at work.

However, the vast majority of patients should be able to lead a normal life.

A manageable condition

Although asthma has no cure, it can be controlled with the right inhalers taken at the right time in the right way.

There are generally two groups of inhalers: relievers and preventers.

Relievers provide immediate, but temporary relief of symptoms.

Preventers contain medication that reduce the airway swelling and are used on a regular basis.

Some inhalers can play both reliever and preventer functions.

For a minority of patients with severe asthma, inhaler use may be insufficient and they may require the use of a group of medications known as biologics.

These medications contain antibodies that target specific cells in the body that are responsible for the airway swelling.

Alongside asthma-specific medication, controlling the triggers for asthma play a role too.

These triggers may differ depending on the patient.

Common triggers can be categorised as internal, like acid reflux and stress, and external, such as air pollution and the vapour from electronic cigarettes.

Prioritising asthma

GINA has called for policymakers and the pharmaceutical industry to “increase their awareness of the continuing preventable morbidity associated with this common disease in spite of the existence of highly effective controller treatments”, as well as to “increase their efforts to ensure that environmentally-friendly inhaled medications are made available in all countries, leaving no one behind”.

Despite being prioritised in the World Health Organization’s Global Action Plan for Non-Communicable Diseases (NCDs), asthma and other chronic lung diseases are given far less weightage in Malaysia as compared to other NCDs such as diabetes, cardiovascular (heart) diseases and cancer.

There is no dedicated National Strategic Action Plan or national policy for asthma that would result in regular audits, quality monitoring or data collection for asthma.

Access to life-saving and life-changing treatment are not always easily available.

The underuse of inhalers that control airway swelling is often exacerbated by its unavailability in situations where local budgets are stretched or when there is a lack of awareness regarding the importance of its regular use.

For patients with severe asthma, a database should be created and maintained in order to track their asthma control.

Such a database would help ensure that those who require biologics would have access to it, especially as this group of medications is not cheap and is often not covered under insurance packages.

Improving outcomes

We have come a long way in the management of asthma, but more can be done to improve the lives of patients.

Gone are the stigmatising days (often shown in movies) in which a patient with asthma is meek and reaches out for their inhaler in a moment of weakness.

Improving health literacy and ensuring that the necessary care is made available for the patient are essential components in ensuring that we minimise death and maximise life.

Dr Helmy Haja Mydin is a consultant respiratory physician and co-founder of Asthma Malaysia. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Health Matters,Asthma,chronic diseases,respiratory diseases,non-communicable diseases,NCDs
Although asthma can be well-controlled, many patients still suffer its ill effects, and even die unnecessarily from the disease.