Severe asthma can be managed successfully

Kolkata: Smitha, a 52-year-old lawyer (name changed) suffered from asthma and had a history of heavy tobacco use. Though she quit smoking 2 years ago, she had been suffering from breathlessness over the last few weeks. Repeated use of rescue medications proved ineffective. She was brought to the emergency ward of the hospital with a severe exacerbation. She was immediately put on intravenous medication to control her symptoms. A quick glance at her medical history showed the treating physician that she had been hospitalised twice before in the previous month.

Asthma, a chronic non-communicable disease, hinders the smooth functioning of the airways, causing symptoms such as cough, tightness in the chest, shortness of breath, wheezing or a combination of these.

Asthma usually causes three changes in the airways: Swelling; Clogging due to excess mucus production; Tightening of the airway muscles.

These changes can be caused by common allergens including mould, cigarette smoke, animal allergens, cockroaches, rodents, strong odours or aerosols, chemicals, and pollen. Certain comorbid conditions like food allergy, obstructive sleep apnoea, gastroesophageal reflux disease (GERD), obesity, and respiratory infections can also trigger asthma symptoms. 

Though not curable, doctors can use specific medications to manage its symptoms. Asthma that cannot be adequately controlled with maximally allowed therapy and even after resolving all modifiable factors is termed severe asthma. Nearly 1.9 million people in India suffer from severe asthma.

Although the symptoms of severe asthma are similar to asthma, the intensity of episodes is greater and may even lead to hospitalization.

Some of the symptoms of severe asthma may include: Not being able to inhale or exhale completely; Coughing, wheezing, and rapid breathing; No relief even after optimal use of rescue medication; A blueish hue on the face, lips, or fingernails; Not being able to speak in full sentences.

Individuals who suffer from severe asthma often face symptoms on most days and nights. Hence, it impacts daily activities and affects a patient’s quality of life. They may even be forced to miss work or school.

Timely intervention and treatment: If symptoms are not properly controlled despite the optimal usage of prescribed medications, it is essential to consult a pulmonologist to identify the underlying cause. Depending on the frequency of a patient’s symptoms and their history of hospitalisation due to flare-ups, the specialist may recommend pulmonary function tests (spirometry) and fraction of exhaled nitric oxide (FeNo) to assess the amount of inflammation, the status of lung function and specific phenotype of asthma. The doctor may also prescribe a simple blood test to evaluate the underlying cause of severe asthma.

Since no two cases of severe asthma are similar, the treatment plan is usually modified to cater to the patient’s personalized needs. The treatment is symptom-based and focuses on managing the inflammation of the airways. The doctors also urge their patients to avoid all allergic triggers. A better understanding of the disease has made newer treatment options also available for patients with severe asthma.

The goal of severe asthma management is to minimise symptoms, maximise a patient’s quality of life, and avoid complications. Hence, it is essential for the patient to adhere to the prescribed medication to reduce the risk of exacerbations.

Severe asthma can be unpredictable. However, a patient can lead a normal life by accurately following the treatment modalities. While avoiding places and situations which can trigger asthma episodes is of utmost importance, it is also essential to reach out to a specialist when symptoms become unmanageable.

Author: Dr Saibal Moitra, Adjunct Professor and Senior Consultant-Allergy Immunology, Apollo Multispecialty Hospitals, Calcutta.

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