I WRITE in response to the questions raised by Mdm Doris Chng Kim Leng with regard to the appropriate treatment of acute asthma ('Hubby hit by asthma but pharmacies won't sell inhaler'; ST, Nov 20).

These questions have been considered by the Ministry of Health in consultation with asthma experts over a year ago and the decision was not to allow over-the-counter sale of quick-relief inhalers for the treatment of acute asthma. This is for the sake of patient safety.

Acute, severe asthma is a life-threatening illness which is best prevented by long-term daily treatment with preventive medication, usually also by inhalation.

However, the 'instant relief' inhalers Mdm Chng referred to are quick-relief medications which do not prevent asthma attacks. They provide only short-term symptom relief and do not prevent asthma relapse nor deaths. They are effective only for the self-treatment of mild asthma attacks and are not effective in treating severe life-threatening acute asthma.In fact, excessive use of, and dependency on, these drugs have been linked to asthma deaths in many studies.

Thus, it will be most dangerous for patients with acute asthma attacks to rush to pharmacies (instead of clinics or emergency departments) for quick-relief medication as a primary treatment step because evaluation of the severity of acute asthma and effective treatment of severe asthma attacks should be monitored and administered directly by a doctor.

Imagine the scenario of a patient with severe asthma collapsing in a pharmacy because his quick-relief medication fails and more intensive emergency treatment is needed.

The appropriate self-management of an acute asthma attack involves several action steps and is directed by personalised/customised written asthma action plans. This is a recommendation in all local and international asthma guidelines.

Patients should consult their doctors about their own asthma action plans. Going to the pharmacy for quick-relief medication during an acute attack is not an action step recommended by any asthma guideline.

Dr Lim Tow Keang
Chairman
Singapore National Asthma Program