KUALA LUMPUR, Sept 1 – Asthma isn’t just a general medical condition, as severe asthma is a chronic condition with potentially life-threatening symptoms that can be difficult to control with treatment, according to patient group Asthma Malaysia.
According to the National Health and Morbidity Survey (NHMS) 2011, about 6.4 per cent of the Malaysian population has asthma, with prevalence highest in those aged above 75 years at 10.7 per cent, followed by children aged five to nine years at 8.5 per cent.
Fewer people in Penang were told by a medical practitioner that they have asthma (3.5 per cent), while those in Putrajaya reported the highest at 10.4 per cent.
The specific proportion of Malaysians with the four different categories of the lung condition (controlled asthma, uncontrolled asthma, difficult-to-treat asthma, and severe asthma) is currently unknown.
“It is important to get diagnosed early in order to prevent attacks that can be both disabling and debilitating. Early and proper control with appropriate medication can not only prevent severe illness (and in some cases, death), but improve one’s quality of life,” consultant respiratory physician Dr Helmy Haja Mydin told CodeBlue.
Severe asthma symptoms include shortness of breath that continues to worsen, pain or tightness in the chest, cough, and wheezing that persists after treatment, according to the Asthma Malaysia portal.
“Severe asthma usually requires lifelong treatment and medical management. Severe asthma is difficult to treat and the length of recovery time from a severe asthma attack will vary based on your individual situation and the length of time it takes to get the attack under control,” Asthma Malaysia told CodeBlue.
“Severe asthma can sometimes lead to lung damage, which may be permanent and may require additional treatment. That’s why it’s so important to get help as soon as possible during a severe asthma attack.”
Severe asthma – diagnosed with biomarkers positive for type 2 or non-type 2 inflammation – requires the use of multiple medium-to high-dose long-term controller medicines.
According to the American Lung Association, there are two main categories of severe asthma – type 2 inflammation and non-type 2 inflammation – which are based on a person’s response to treatment.
Dr Helmy said to get diagnosed with severe asthma, one needs a physical examination and a specialist to review their medical history. Once the specialist determines that the person may have severe asthma, additional testing is required to determine the type of severe asthma.
“Severe asthma treatment would be on a case-to-case basis, where the specialist can tailor treatment based on the individual’s specific type of severe asthma.”
Common tests to identify biomarkers include taking a blood sample, analysing a mucus sample (sputum), or taking a breathing test that measures substances in one’s breath droplets, according to the American Lung Association.
For the first step, people with asthma can take a self-test through a reliever reliance test on Asthma Malaysia’s severe asthma microsite here to ascertain their reliance on the usage of inhalers and to identify the level of their asthma condition.
As Malaysia emerges from pandemic lockdown measures, Dr Helmy recommended that people with asthma restart certain physical activities or exercise routines to manage their condition better.
“Alongside maintaining the right treatment to ensure good disease control, I think patients should be mindful of the risks that they take (for example, avoid poorly-ventilated indoor areas) whilst taking the opportunity to do more in appropriate settings (for example, start going for walks and being physically active).”
A review by Gaspar-Marques J. et al from January to February 2022, published in the journal Pulmonology, said major respiratory societies recommend that patients with severe asthma continue their biologic treatment during the Covid-19 pandemic, preferably in a self-home administration programme.
The review cited mixed evidence on whether severe asthma patients are more likely to contract Covid-19, as some studies showed an increased risk of infection and disease while others indicated lower risks.
Dr Helmy said patients with well-controlled asthma generally do not face an increased risk of complications from Covid-19, which shows the importance of appropriate treatment and management.
“Indirectly, the pandemic also disrupted the care of many patients with chronic diseases, leading to a delay in diagnosing and treating patients.”
Health director-general Dr Noor Hisham Abdullah, in a statement in May 2018, cited World Health Organization (WHO) data from 2014 that found 1,642 asthma deaths in Malaysia, or 1.29 per cent of total deaths.
According to the NHMS 2006, nearly a quarter fulfil the criteria of persistent asthma with a history of regular exacerbations that necessitate visits to the emergency department and hospital admission.
“Asthma carries heavy disease burden in view of high utilisation of health facilities,” said the NHMS 2006, nothing that about 10 per cent of the asthmatics reported admissions to the hospitals in the last six months and about 46.4 per cent of the asthmatics were not on inhalers.
Dr Helmy said the Covid-19 pandemic and ongoing planetary health challenges have shown the need to focus on respiratory diseases like asthma.
“I think that asthma is one of the key NCD (non-communicable disease) areas that require more focus in terms of research and funding for treatment.
Dina Nadzir: Know Your Triggers
Sinar FM radio presenter Dina Nadzir was first diagnosed with asthma at around two years old.
“I always hear my mother telling me that I was technically living in the hospital because I was too small to manage the attacks,” Dina told CodeBlue.
The 36-year-old woman, who is also a singer, actress, host and businesswoman, has had numerous asthma attacks at work, shows, the gym, and on vacation, but mostly at home and at night or on a cold day.
“Mostly, activities that I need to be extra careful with are ones involving cold surroundings, like swimming and working out in an air-conditioned room.”
Dina advised people with asthma to know the triggers for their condition.
“When I was at the peak of my health, at the time my body was at its fittest, I started getting asthma attacks a little bit too often. But now after reading and understanding more, I am so happy that I could say I know my body and its triggers well enough for me to take precautions. That’s why I always feel like the best survival skill one should have is knowledge.”
To know more about Severe Asthma, you can take a self-test to ascertain your reliance on the usage of inhalers and to identify the level of your asthma condition at https://asthmamalaysia.org/listentoyourasthma/.
This article was brought to you by AstraZeneca Malaysia.