Asthma is a chronic disease of the respiratory system, in which the bronchial tubes become inflamed and obstruct the passage of air, due to their irritative-inflammatory response to different environmental stimuli and which gives rise to symptoms such as coughing, chest tightness, wheezing, shortness of breath of air or suffocation. The intensity of these symptoms is highly variable and changes over days and months.
Asthma affects 5% of the adult population in Spain. But in the Canary Islands, the subtropical climate with high humidity existing in the Islands favors the development of mites, which in turn influences the fact that this disease ends up affecting more than 300,000 people, with a prevalence much higher than that of the rest of Spain, with between 12 and 15% of the population.
Currently, there is no cure for asthma, although it can be treated and controlled. For this reason, it is essential that patients know and carry out the treatments correctly, in addition to avoiding possible triggers for asthma. Factors such as cold, dust, tobacco, pollution, pollen or cleaning products can, for example, trigger asthma.
The first thing we should know is that people with asthma can lead a normal life, without symptoms, if the treatment is followed correctly. At any age, we can maintain a good quality of life and be able to perform activities of daily living normally, such as working, going to school, exercising, playing sports and others.
The drugs used for the treatment of asthma can be differentiated, according to their mechanism of action, into three groups:
-Anti-inflammatories, which reduce bronchial inflammation.
-Bronchodilators, which open the bronchial tubes.
– Immune response modulators, immunotherapy with hyposensitizing substances (vaccines to reduce or suppress allergies) being the most used.
The first two types of drugs are basically used in an inhaler format to allow the medication to reach the lungs directly and have much less effect on the rest of our body.
The use of one or the other depends on the characteristics of each patient and each moment of their illness. It is common to use two or more types of medication in the same patient. Based on the symptoms you have and observing the evolution of your asthma, it is your doctor who will establish the most appropriate treatment for each case, in accordance with the most up-to-date guidelines in clinical practice.
But despite having very effective treatments for this disease today, and as studies like the one published recently have already been observing “Clinical consequences of excessive use of short-acting beta-2 adrenergic agonists (SABA) in the treatment of asthma in Spain: the Sabina study” which notes that up to 28.7% of patients overuse (≥3 inhalers/year) SABA treatments and, in addition, 13.4% underuse (≤4 inhalers/year) inhaled corticosteroids.
That overuse of rescue or relief treatments is associated with an increase in the estimated number of exacerbations per year and in mortality rates.
The rapid relief of symptoms from using SABA treatments is one of the main causes identified for overuse, as patients notice immediate improvement. However, these treatments are really short-acting bronchodilators; they only open the bronchi momentarily, but they don’t treat the inflammation causing the blockage, so the symptoms soon get worse again.
Another cause of this lack of asthma control is many patients abuse their inhaler. In general, all devices are based on the same technique: exhale, inhale the medication, apnea and exhale. However, each of them has specific characteristics that require knowledge and training. This fact gives rise to a lack of knowledge on the part of health professionals and patients who need to use it, so that a poorly used inhaler means that the medicine does not reach where it should go, that is, to the lungs and in particular to the small bronchi. more distal where they will perform their function, reduce inflammation and dilate so that more air reaches the exchange area, the alveoli.
In the image we can see the use of three inhalers, in photo A a poorly used inhaler where little medication reaches the lungs, until you reach photo C, where the medication reaches the lungs a lot more.
In addition, around this disease there are many misconceptions such as that it is a childhood disease that is overcome with age and cannot appear in adulthood, that it is infectious, that asthmatics should not exercise or that it can only be controlled with high doses of corticosteroids, among other mistaken beliefs.
The reality is that asthma can appear at any age and is not an infectious disease. Yes, it’s true that viral respiratory infections like colds and flu can trigger asthma attacks and make it feel like you have the flu or bronchitis that lasts for several weeks. It is also wrong to think that people with asthma cannot exercise and even play sports at a high level, if the asthma is well controlled you can do everything and without limitations.
Scientific studies in search of new molecules that produce a greater effect on the bronchi of our lungs with minimal side effects have made it possible to control asthma, which I insist is an inflammatory disease, and should only be used in most cases in low doses of inhaled corticosteroids ( combined or not with bronchodilators for 12 or 24 hours) and correct use of the inhaler.
Pedro J. Martin Perez
Family and Community Doctor
University Specialist in Clinical Nutrition and Nutritional Health