Empowering Asthmatics: Knowledge and resources for improved lives
Physician's Weekly
August 22, 2023

Empowering Asthmatics: Knowledge and resources for improved lives

Arming asthmatics with the relevant knowledge and resources can help them lead almost normal lives. On the other hand, a nonchalant approach to asthma can result in frequent hospital visits and even death.

Asthma is a non-communicable disease (NCD) that affects approximately 7 per cent of the population.

It is the most common NCD in children. Asthma is a lifelong condition. Attacks often become less frequent and less severe with time, however, the underlying pathology that facilitated the initial asthma attack never goes away.

Chief symptoms reported by asthmatics:

  • Coughing
  • Chest tightness
  • Shortness of breath
  • Wheezing

Symptoms are often worse at night

Pathology generating the asthma attack:

  • Inflammation of the lining of the airways
  • Spasms of the muscles encircling the airways (bronchoconstriction)
  • A build-up of thick mucus within the airway
  • Thickened airway walls over time
  • Hyperresponsiveness of the airways to asthma triggers

More common types of asthma treatments:

  • Relievers (Bronchodilators) – e.g. Ventolin (Salbutamol), Albuterol, Berotec (Fenoterol), Theophylline
  • Preventive (Antiinflammatories/ Membrane stabilizers) – e.g. Prednisone, Prednisolone, Becotide (Beclomethasone), Pulmicort (Budesonide), Advir (Fluticasone), Atrovent
  • Combination (Bronchodilators + Antiinflammatories/ Membrane stabilizers) – e.g. Symbicort, Seretide, Fostair, Combivent

For sustained relief from an asthma attack, BOTH reliever and preventive inhalers are often needed.

It’s common for only the reliever inhaler to be used when treating an asthma attack. This inhaler reduces airway narrowing by relaxing the encircling airway muscles, however, it has no impact on inflammation and the build-up of mucus. If you need to use a reliever inhaler 2 or more times a week, you should also be using your preventive and or combined inhalers to accelerate the resolution of the inflammation and reduce the formation of additional mucus.

Know what triggers your asthma attacks.

Common triggers include:

  • Respiratory tract infections
  • Allergens – environmental/ food
  • Irritants – smoke from cigarettes/ burning trash, fumes, dust, recently cut grass, pollen, cold air, cockroach droppings, indoor mold, pet dander, strong odors
  • Exercise
  • Hormonal changes – pregnancy, when having a period
  • Anxiety/ stress

Allergy testing often helps with identifying not-so-obvious triggers.

A SPACER (holding chamber) significantly improves the effectiveness of metered dose inhalers (MDIs)

Spacers are highly recommended for those asthmatics who may have challenges with their hand-breath coordination – for example, the very young and the very old. A spacer is a tubular device made from transparent plastic. At one end is an opening, allowing the snug fit of the MDIs’ mouthpiece. At the other end is a mask or mouthpiece for the asthmatic’s use. The contents of an MDI when initially expressed, travel at approximately 60 miles per hour.

Without good hand-breath coordination, most of the spray becomes deposited on the tongue, roof of the mouth, and back of the throat, with little reaching the lower airways where it is needed to be effective. The air in the spacer slows the speed of the MDIs’ expressed contents. At this reduced speed, most of the medication expressed by the MDI reaches the lower airways.

Studies show that spacers in combination with MDI are just as effective as, or even better than nebulizers. Asthmatics who use spacers require less medicine to control their asthma and suffer with fewer side effects from their aerosolized medicines.

A PEAK FLOW METRE allows asthmatics and their parents to determine the precise narrowness of the airways.

A peak flow metre is a hand-held device that gives a real-time and accurate appreciation of the narrowness of the airways. It is capable of detecting narrowness at an early stage, even before the asthmatic has any symptoms. The peak flow metre also allows the asthmatic to determine how well they are responding to treatment and if there is a need to go see a doctor or visit the emergency room. To determine what the normal peak flow one is advised to use it every morning for a week when asymptomatic. This would give the asthmatic a precise appreciation of their maximum peak flow. Subsequently, if there is more than a 20% reduction in peak flow, it is recommended that the asthmatic seek medical care.

Oral steroids, when used as directed, have few side effects and significantly reduce airway inflammation

When asthmatics are initially placed on oral steroid medications (e.g. tablets or liquid), it is not unusual to see some degree of apprehension on the faces of the patient or the parents. The steroids used to treat asthma are corticosteroids, and not anabolic steroids. There is a significant difference. Corticosteroids, e.g. prednisone, prednisolone, etc. are prescribed to asthmatics in order to clear airway inflammation and reduce airway hyperresponsiveness. Once used as prescribed, often for 5 days or less, there is only a remote chance of experiencing any significant side effects. Oral corticosteroids can be used in pregnancy to help manage acute, severe, and persistent asthma, for the benefits outweigh the risks.
“When you can’t breathe, nothing else in life matters” – Anonymous


Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.