TAKING YOUR BREATH AWAY FUTURE SOLUTIONS

Gasping for breath is a terrifying experience, and something that threatens the comfort and lives of many. So what can be done to help asthmatics and their loved ones breathe a little easier?

New Zealand has a high prevalence of asthma, with the Health Quality & Safety Commission New Zealand revealing that about one in seven children aged 2–14 years (114,000 children) and one in eight adults (459,000 adults) report that they take current asthma medication. Data from the Organisation for Economic Co-operation and Development (OECD) indicates that New Zealand has one of the highest hospital admission rates for asthma of the OECD countries.

With the stakes so high, keeping your asthma well controlled is vital. Michele Goldman, CEO of Asthma

Australia, says there are questions you can ask yourself to understand whether your asthma is under control.

“The things we would ask you are: Are you needing to use your reliever medication twice or more a week? Is your asthma waking you up at night? Is it getting in the way of you being able to participate in physical activities?” she says. “If you answer ‘yes’ to any of those questions, your asthma isn’t as well controlled as it could be.”

She explains that a key ingredient in well-controlled asthma is to have an asthma management plan drawn up by your GP to let you know when to take (and when to step up the use of) your preventer medication, and when to take a reliever such as a blue Ventolin puffer. It’s also important to check back with your doctor every six months or so for a review, especially if you notice any changes. By doing so, you might be saving yourself an unnecessary trip to hospital – as up to 80 per cent of hospitalisations for asthma are considered preventable by proper management of the condition, according to Goldman.

KNOW YOUR TRIGGERS

The potential triggers for asthma are many and varied, and what might have a serious effect on one patient’s breathing might have absolutely zero impact on another. The list of things that can cause an asthma flare-up includes environmental factors such as dust, pollen, smoke and pollution; as well as exercise and perfumes. For some asthmatics, even laughter and sex can be triggers.

Many of these factors are impossible to avoid at all times, and they can often pop up when you least expect them. If you aren’t on top of your asthma, it can have pronounced effects on your way of life.

“At a minimum, if your asthma is not well managed, you’re probably putting up with disruptive sleep – it’s probably waking you a couple of times a week,” says Goldman. “As a result, you’re likely feeling tired or lethargic, unable to be your best productive self at school or in the workplace.”

Of course, the effects can also be much worse. If your asthma is more serious, you might be spending more time than necessary at the doctor’s surgery – or winding up in hospital.

People can be caught unawares, too, mistakenly believing they have grown out of their childhood asthma or not realising that you can develop it later in life. The reality is that your symptoms might change, or increase or decrease over the course of your lifetime, but your tendency to be affected by certain triggers will always remain with you.

“It’s a myth that you grow out of asthma,” explains Goldman. “If your airways are predisposed to inflaming when they come into contact with certain triggers, you’ll always have that predisposition.”

Stefanie Valakas was diagnosed as an asthmatic in her late teens. After a particularly bad cold, she had a cough that lingered for a month. Concerned, she visited several GPs, who told her she had post-nasal drip (a common

condition where excess mucus runs down the back of the nose to the throat) and needed to spray a saline solution up her nose. This didn’t help, and she found herself waking up every night coughing to the point where her ribs would be aching and she started to lose weight.

Finally, while on holiday, Valakas visited another GP, who diagnosed her with asthma based on her symptoms and prescribed a Symbicort inhaler – which acts to both prevent asthma and relieve symptoms. Valakas was not given a lung function test or an asthma management plan and, as it wasn’t her regular doctor’s surgery, there was no follow-up.

“Because they weren’t my regular GP, that was the only management I got. Then I pretty much went home and that was kind of it,” Valakas says. “It wasn’t until my first asthma attack that things became a bit more serious, in terms of the medical management, and I started taking it more seriously.”

A TROUBLING SITUATION

Valakas thought she only had to take her Symbicort when she was coughing or wheezing, so she was only using her inhaler sporadically. But six months after her diagnosis, she was catching a train home when, from a combination of stress and exertion, she suffered an asthma attack. “I got off the train and started walking home. I just remember feeling like I had to rip my backpack off because it felt like it was crushing my chest,” she says. “It wasn’t until I got home that I realised my heart rate was so high and not coming down and I couldn’t catch my breath.”

She went to the hospital emergency room and was put on a nebuliser (a machine that dispenses a fine mist of medicine for inhalation) and prescribed prednisone, a strong steroid. These failed to do the trick, and Valakas was readmitted a couple of days later coughing up blood. “I was referred to a specialist at the hospital and basically told, ‘If you don’t take your preventer, you will continue to show up in emergency, because your asthma is really bad’.”

The experience prompted Valakas to change her outlook on her asthma. She now sees a specialist, and feels more in control of her condition.

“I’m actually very grateful that it happened because now I have my own dedicated asthma team, and it makes it a lot better to manage,” she says. “I had an asthma management plan done up, I take my preventer

• New evidence suggests eating fish can help prevent asthma, and that the surge in asthma diagnoses over the past 30 years may be as a result of our changing diet. A 2019 study by James Cook University found consuming certain kinds of fish oil decreased the risk of having asthma or similar symptoms by up to 62 per cent, whereas a high intake of vegetable oils increased the risk by up to 67 per cent.

• A Swedish study published in the Scientific Reports journal has linked growing up with dogs to a lower risk of developing asthma, especially if the dogs are female. Those raised around female dogs had a 16 per cent lower asthma risk than people raised with male dogs. However, dog breeds known as “hypoallergenic” – such as Maltese, poodles and Yorkshire terriers – were found to have no effect on asthma risk.

• Research presented last year at the European Respiratory Society International Congress found that children able to access green spaces near their homes have a decreased risk of displaying respiratory illness symptoms such as coughing and wheezing.

• A strong steroid, prednisone, has been used successfully for decades to treat severe asthma symptoms – but it comes with a list of rather undesirable side effects. A new drug, vamorolone, has been shown to mirror prednisone’s positive attributes, without the detrimental effects. religiously – sometimes I’m on two preventers, depending on my lung function tests. I also carry Ventolin on me all the time, just in case.”

COUNTING THE COSTS

Situations such as Valakas’, where patients underestimate the severity of their asthma, are not uncommon.

“Now that we’ve got great therapies on the market, people can for the most part get on with life, and as a result people don’t think asthma is a big deal,” says Goldman. “Asthma is significantly underestimated. It’s a serious condition. An asthma attack can come on very quickly. If you don’t have the right medication available, if you aren’t able to access the right healthcare, it can be fatal.”

Apart from being lulled into a false sense of security by increasingly effective treatments, Goldman says that a common reason some asthma patients aren’t properly managing their condition is the time, money and discipline it requires to stick to

“Asthma is significantly underestimated. It’s a serious condition … it can be fatal.”

taking medicines regularly. This is especially the case when they don’t understand what’s happening in their airways – and how important it is to take preventive medications rather than simply rely on relievers.

Recent research led by the Woolcock Institute of Medical Research and The George Institute for Global Health discovered that the out-of-pocket expense of medications was a significant factor in asthmatics under-dosing and putting their health at risk. The study found half of adults and one third of children with asthma were either skipping or reducing doses to make their medicines last longer. This is a dangerous situation that must be addressed.

Teresa Demetriou, the head of education and research at the Asthma and Respiratory Foundation NZ, says that there are a number of initiatives and systems in place to make paying for medicine as easy and affordable as possible for patients. “The cost of collecting a prescribed medication in New Zealand is capped at five dollars – although some pharmacies charge less than this,” she explains. “There are funded versions of all inhaler types in New Zealand, and there are also currently some partially funded options. Prescriptions for children under 13 are free of charge, and students are also subsidised.”

With regards to reliever inhalers such as Ventolin and Bricanyl, which can be purchased without a script in countries such as Australia, Demetriou says that, “There is no option to buy over-the-counter inhalers in New Zealand – as this goes against our guidelines and best practice. Still, patients using reliever medication need to be monitored very closely, as research shows that overuse of reliever medication can lead to more frequent exacerbations and higher mortality.

“Some families still struggle to pay for prescriptions, and they share inhalers to overcome this. But this is a dangerous practice and should not be encouraged.”

Professor Helen Reddel of the Woolcock Institute says that another stumbling block to patients being able to afford the correct medication is a reluctance to talk about medication costs during a consultation.

“GPs didn’t know how much patients were paying and they tended to assume that it wasn’t a problem, so they didn’t initiate conversations about it,” explains Reddel. “There is a bit of hesitancy in asking a patient whether they can afford something – that’s a personal question.”

Reddel stresses the importance of both patients and GPs knowing that treatment alternatives might vary in cost, depending on dosage – and they must be willing to discuss the options. This communication and awareness will help break down barriers to keeping asthma attacks at bay.

For more resources on asthma, go to asthmafoundation.org.nz