If you suffer from asthma and have experienced attacks that necessitate emergency medical help, you are not alone.
In fact, asthma-related emergency department visits and hospitalisations in Singapore are two to three times higher than other developed countries such as the US, according to a local survey on 400 asthma patients, including 250 adults from ages 18 to 65.
Almost 80 per cent of this age group went to the hospital at least once in the last year because of severe asthma symptoms.
The study, which was conducted in August this year by the Asthma & Allergy Association (AAA) Singapore, found that adult asthma sufferers aren’t quite managing their condition as well as they should. Here are more findings from the survey:
- 88 per cent woke up at least once at night in the past month due to asthma symptoms.
- 80 per cent had to limit their activity at least once in the last month because of their asthma condition.
- 67 per cent reported that they often or always feel down because of their asthma.
- 56 per cent said that they feel embarrassed to admit they have asthma.
The most worrying finding, according to Dr Adrian Chan, a consultant respiratory physician at Respiratory Medical Associates and the president of AAA, is that “poor asthma control continues to have a considerable impact on people’s mental health and wellbeing”. “It affects their sleep and also has an impact on their physical activity,” he said.
WHY THE HIGH ASTHMA RATES IN SINGAPORE?
“Asthma is a chronic inflammatory airway disease that affects around 5 per cent of adults in Singapore. This is one of the highest asthma prevalence rates in the world,” said Dr Chan.
The high asthma rates could be a reflection of patients’ behaviour during the height of the COVID-19 pandemic. “Some patients may have avoided going to the hospital or clinic to replenish their preventive medication when there was a surge in COVID-19 cases,” said Dr Chan. This could have resulted in uncontrolled asthma, leading to more frequent symptoms.
It is a worldwide phenomenon. “In some countries, it has been observed that following the easing of COVID-19 precautions, asthma-related emergency department visits rose as compared to during the lockdown,” said Dr Chan.
Other experts have another interpretation of Singapore’s high asthma prevalence rates: The lack of compliance when it comes to inhaler usage. There are two types of inhalers: Controllers or preventers (inhaled corticosteroids) and relievers (short-acting b2 agonists or SABA), according to Dr Liew Mei Fong, the director of Intensive Care Unit and deputy head of FAST Programme at Alexandra Hospital.
Relievers (blue coded) work quickly to treat acute symptoms when you have an asthma attack. On the other hand, controllers or preventers (can be brown, orange or yellow coded) work slowly over time and are to be used regularly to prevent attacks.
“Patients fail to understand that asthma brings out chronic inflammation in their airways and hence, the need for controllers to control the airway inflammation,” said Dr Liew, who is also a consultant with Division of Respiratory and Critical Care Medicine at National University Hospital.
“Patients tend not to use their controllers when they do not experience symptoms. However, asthma is a disease that brings on intermittent symptoms when there are triggers,” she said.
Instead, patients tend to just fall back on the blue reliever for quick relief during a bout of asthma. “With the quick relief, it is no wonder that patients only feel the need to use their relievers,” said Dr Liew. But “relievers do not control the airway inflammation”.
WHY IT’S NOT A GOOD IDEA TO RELY SOLELY ON THE BLUE INHALER
If you find yourself puffing on the blue reliever inhaler three or more times a week, it is a sign that your asthma isn’t well controlled, said Dr Chan, as it merely masks the worsening symptoms. (You can assess your level of reliance on the blue inhaler here.)
He explained: “Although the blue reliever inhaler works fast, its effects last only four to six hours. What many people do not know is that it is dangerous and can worsen asthma if taken alone. Many asthma deaths have occurred in mild asthmatics because they rely on the blue inhalers alone”.
In fact, “when used alone without the controller or preventer medication, the blue inhaler can worsen airway inflammation”, said Dr Chan.
Fortunately, there are now “combination preventer-reliever treatments that can treat and relieve the symptoms to achieve control faster”, he said.
TRUE OR FALSE: WHAT YOU’VE HEARD ABOUT ASTHMA
If you’ve been battling asthma all your life, you would have heard of some “solutions” or notions about the chronic condition. CNA Lifestyle got the doctors to examine some common ones below:
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- You’ll outgrow asthma when you enter adulthood
Don’t write this off yet because you could outgrow asthma, said Dr Liew. More specifically, about 10 per cent to 30 per cent of children do, according to Dr Chan, who said that “the symptoms of asthma might disappear in adolescence and young adulthood”.
During this outgrowing period, young patients may need “step-up care with the preventers when their lungs are responding too dramatically to inciting infections and allergens”, he said. However, “there is always a risk for asthma recurring in adulthood and in later years”, said Dr Liew.
The reasons could range from weight gain to pregnancy, smoking or even being put on new medications to treat common middle-age issues such as hypertension, heart disease or gout, said Dr Chan.
- If you didn’t get asthma as a child, chances are, you won’t get it in adulthood
Not true. “Adult-onset asthma is a known entity and can happen without a history of childhood asthma,” said Dr Liew.
Adults can develop asthma in a few ways, added Dr Chan, such as being exposed to allergens including dust mites, animal dander or pollen. Asthma can also be triggered by changes in weather, respiratory infections or exercise (more on exercise in the next point).
- You cannot exercise if you have asthma
Exercise-induced asthma, which some elite athletes have, can be triggered by physical exertion, cold or dry air inhalation, said Dr Chan. But, of course, not every asthmatic’s symptoms are triggered by exercise.
In fact, “a well-controlled asthmatic is able to live freely and without disease symptoms, even with exercise,” said Dr Liew. “That is why it is important to control asthma airway inflammation with controllers.”
- Avoid using inhalers if you can as they contain steroids, which can lead to addiction
“There are no addiction properties in controller or preventer inhalers, that is, zero risks for addiction,” emphasised Dr Liew.
“A controller inhaler is like any chronic medication that you take for chronic diseases such as diabetes or hypertension. Since asthma is a chronic disease, patients should take their controllers just like how they would take other chronic medications for other diseases,” she said.
Dr Chan reiterated that you cannot become addicted or reliant on controller or preventer inhalers. “These doses are much lower and safer than the large doses doctors use during asthma attacks.”
If you’re still concerned, discuss with your doctor about adjusting the dosage that will still reduce your risk of attacks, he advised.
- Don’t drink cold drinks or eat food that contains “toxins” food such as prawns
It depends on your asthma trigger, said Dr Liew. If cold drinks really do set off an attack, then yes, avoid cold drinks, especially when your asthma is not well controlled. “It is easier for a known trigger to cause asthma symptoms if the underlying asthma is not well controlled,” she said.
As for “toxic” food, it is not so much the nature of the food as it is the additives found in it, said Dr Liew. “It is often the additives in food that may cause asthma symptoms.” And even so, not every asthma patient is triggered by the same food additives.
The key thing is, when your asthma is under control, you can eat whatever you like without any issues, said Dr Chan.
- Sleep with a dehumidifier on
This is untrue. “Humidity can be an asthma trigger but so can dry air,” said Dr Liew.
“Dehumidifers can reduce dampness in the air, and hence, reduce mould and other allergens in the environment. This may help if one’s asthma is driven by sensitisation to mould and allergens. But this does not apply to all asthmatics,” she said.
“Currently, there is also no clear evidence or consensus that a dehumidifier can reduce asthma symptoms and its usefulness.”