Posted on Jul 23, 2014 by Ruth Loftus
Asthma is a serious condition and one which is still too often fatal. However, the intermittent nature of the disease means that its grave nature is sometimes ignored. Recent research in the UK suggests that because of this, there is a degree of complacency in both those who suffer from it and those who treat the condition.
Perhaps the most worrying statistic from recent research was that some 10% of people who died as a result of an asthma attack had actually attended hospital in connection with their asthma in the month prior to their death, and two thirds of them had not had a proper follow up after the hospital treatment. According to the research, in almost half of the fatal cases investigated, patients did not receive any medical attention at all in their final attack.
There is an unfortunate tendency to regard asthma as a low level, low threat condition when in actual fact, asthma affects some 8% of the British population and is the cause of up to 1200 deaths each year. This figure is falling but still represents one of the highest mortality rates in Europe. Another particularly chilling fact is that it is estimated that almost half of these deaths could be prevented if there was better access to well established and understood treatment.
Asthma is essentially an inflammation of the air passages in the lungs – specifically the bronchi. With this inflammation comes an increased sensitivity. If the air you are breathing contains specific irritants (or triggers) then the airways narrow, the associated muscles tighten, and this results in an increased production of phlegm. All this manifests itself in the wheezing, coughing and breathlessness that are the symptoms of an asthma attack.
Treatment of asthma involves the relief of the immediate distress of an attack ( which can be very distressing both for the sufferer and for those around them) and also seeking to prevent future attacks from occurring at all. The failures with accessing treatment seem to lie at the door, both of the sufferers from the condition and those who treat it.
Since asthma is an intermittent rather than an ever- present condition, some asthma sufferers are less scrupulous about taking medication than they ought to be and fail to regularly attend check ups. In addition, a significant minority (nearly 20%) of the fatalities reviewed in the research were smokers and others were exposed to second hand smoke in their home. It should go without saying that smoking and asthma should be utterly inimical.
The research also indicated that doctors treating the condition sometimes fail to appreciate just how serious it is – and how at risk their patients actually are. Many of those who have died as a result of a major asthma attack were regarded by their doctors as having just ‘mild’ or ‘moderate’ asthma. Research indicated that there wasn’t just a need for more medication, but also the right kind of medication. For example, there was a significant underuse of preventive inhalers and an overdependence on inhalers that simply provide relief.
Evidence suggests that in the past, the specific triggers for individuals’ attacks have not been properly appreciated nor put under specialist supervision. This may involve fuller insight into the individuals triggers and reviewing one’s lifestyle to see how these triggers might best be avoided. In addition to tobacco smoke, other common triggers are things like house dust, animal fur, pollen and even exercise.
The challenge of living successfully with a long term condition such as asthma requires use of any required medication, engaging in regular check ups to monitor the illness, looking to manage general health as well as possible (having an annual flu jab for example, and other preventative treatments). Asthma sufferers must of course give up smoking and also avoid smoky atmospheres. In addition, people with asthma must be sure to take appropriate exercise (after consulting a doctor or specialist to ensure that this is consistent with the condition itself). They must also pay sensible attention to diet and be aware that some foods could also be an asthma trigger.
Recent reports have called for a greater awareness among both sufferers and their medical support in dealing with asthma. As a priority, people with the condition need to have the capacity to take greater care of themselves. This requires a personal plan for management of the circumstances of their own asthma, the development of effective use of their inhaler and a detailed understanding of the nature of the triggers to which they are susceptible.
On the professional side, the need for suitable regular asthma care by doctors has been stressed and the idea of a nominated asthma specialist in every general practice team, with the responsibility to maintain awareness of best practice with regard to the condition, has been recommended.
Perhaps the most worrying aspect of the research in question was that it suggested that levels of care had fallen in the last decade. However, this is a condition which is eminently controllable and where almost all deaths are preventable. If this report at the very least disturbs some of the complacency that appears to have grown up around treatment and care, it will have more than served its purpose.