Take control of asthma

PHOTO: Take control of asthma

Doc Talk: Dr Tang Wern Ee

Madam T declared: "I'm much better today."

Indeed, she did appear to be much better. A week earlier, she had been breathless and wheezing when she visited the polyclinic to get urgent treatment for an asthma attack.

"I want the blue puff today. Don't need this brown puff," she said, pushing the inhaler containing her asthma preventer medication across the table. She was after the quick relief, which the blue puff promised.

"The nurse says I must keep using the brown puff, but I'm okay already. I want only the blue puff," she insisted.

Madam T has asthma, a lung condition characterised by episodic attacks of breathlessness, chest tightness, wheezing and coughing caused by the swelling and narrowing of the airways in the lungs.

It is a chronic disease, which means that it does not go away like a simple cough or cold.

It is a condition which patients live with and has the potential to escalate in severity.

It is important to manage the root of the problem to prevent asthma attacks rather than to just treat the symptoms when they appear.

While people with asthma may feel perfectly well between attacks and experience asthma symptoms episodically during an attack, airway inflammation is constantly present.

The airways of people with asthma are also hyper-responsive.

When exposed to certain triggers, such as viral infections, smoke and dust mites, the muscles surrounding the airways contract and the lining of the airways produces more secretions and thickens further.

As a result, the airways narrow and constrict, prompting an asthma attack. These attacks can vary in severity - from mild to severe - and can even be fatal.

Studies have shown that regular use of inhaled corticosteroids in patients with asthma decreases asthma hospitalisations and deaths.

However, many people with asthma, such as Madam T, stop using their inhaled steroid medication once they feel better.

To improve asthma awareness and asthma care around the world, the Global Initiative for Asthma has designated May 6 as World Asthma Day.

This year's theme is "You Can Control Your Asthma".

Asthma is a long-term disease with no permanent cure. But it can be brought under control.

To achieve asthma control, it is important that people with asthma, as well as their families and people they come into contact with, have an understanding of what asthma is and how it can be managed.

It is not contagious and it does not spread from person to person.

However, asthma does run in families. If one or both your parents have this lung condition, you are more likely to have it too, compared with someone who does not have a parent suffering from asthma.

It can affect children, adults, men, women and people of all races.

Although asthma attacks may occur only occasionally, it is a chronic, long-term disease.

The goal of asthma management is to control the condition, so that asthma attacks do not happen and the person does not experience symptoms, such as frequent coughing, wheezing, breathlessness and chest tightness.


There are two main groups of medication to treat asthma - the preventer (or controller) medication, which wards off asthma attacks and helps maintain asthma control; and the reliever (or rescue) medication, which alleviates asthma symptoms when an attack occurs. Preventer medication, which is taken daily through the mouth, is the cornerstone of treatment.

It reduces the inflammation (swelling) in the airways which causes asthma symptoms.

Inhaled corticosteroids are the most commonly used medication in asthma prevention. These are different from the type of steroids (anabolic steroids) used by some athletes to enhance their sporting performance.

Inhaled corticosteroids for asthma (such as beclomethasone, budesonide and fluticasone) are safe for long-term use. When used consistently and regularly on a daily basis, they prevent asthma symptoms from occurring.

One of the possible side effects of long-term inhaled steroid use is oral thrush (fungal infection of the mouth). However, this can be prevented by rinsing the mouth with water each time after using the medication.

Meanwhile, reliever (or rescue) medication is used during an asthma attack to provide quick relief, of which the most commonly used is inhaled salbutamol.

This medication works within minutes to relax the muscles around the airways, reducing airway constriction during the attack.

Reliever medication can be administered using a handheld inhaler or through a nebuliser, a machine that converts the medication into a fine mist, which is then inhaled through a face mask.


People with asthma should always have a reliever inhaler with them, especially when they travel abroad.

In a severe asthma attack, oral corticosteroids are used to relieve airway inflammation. As prolonged use of oral steroids causes serious side effects, they are usually used for short periods and only during severe asthma attacks.

Asthma medications are often administered using handheld inhaler devices.

At polyclinics, family physicians, nurses and pharmacists help to teach and check that patients use the inhalers correctly.

Before seeing me that day at the polyclinic, Madam T had a session with the clinic's care manager, who noted that she usually stops using her preventer medication a week or so after an asthma attack.

This had resulted in several visits to the polyclinic over the past year for recurrent asthma attacks. She advised Madam T to continue using her preventer inhaler daily.

However, Madam T remained unconvinced. During her consultation, I spent some time addressing her concerns about using the preventer inhaler and identifying the possible triggers for her asthma attacks.

At the end of the consultation, she agreed to continue using her preventer inhaler daily for the next month.

Over the next few months, Madam T continued with her asthma follow-ups at the polyclinic.

She was eventually persuaded to continue using her preventer inhaler daily and has remained symptom-free since.

During her clinic review several months later, she said: "Don't need the blue puff today. I use the brown puff every day now."

She smiled, glad the asthma prevention medication was working.

And I was glad that she finally had her asthma under control.

Dr Tang is a family physician and consultant with the National Healthcare Group Polyclinics.

This article was first published on May 22, 2014.
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