Daily use of maintenance inhalers results in better asthma control.

Simply treating asthma attacks when they happen is not always enough to manage patient condition.* I know that for a fact, as I have asthma and come from a family of "asthmatics". 

However, the reality is that asthma patients often underestimate their diagnosis and therefore fail to get the proper, persistent treatment that they need. Research shows that 6 out of 10 asthmatic individuals consider their condition to be controlled, despite 41.3% reporting shortness of breath at least three times a week, and 57.8% having to use their reliever inhalers at least twice a week.**

As a result, the chances of complications may rise. Those with under-treated asthma can suffer from sleep disturbance, fatigue, poor concentration***, or airway inflammation****. There's also the risk of needing emergency care or hospitalization for treatment. And in the most severe cases, asthma can lead to death.*****

Being a chronic condition, asthma requires medication that not only relieves current symptoms but also provides sufficient control to improve the patient’s quality of life. Here’s a rundown of the usual medication for asthma patients, as well as new evidence which cites daily treatments as a more effective way of managing asthma both in the short-term and long-term.

Asthma Relievers versus Controllers

The first medication type that asthma patients typically take is called a reliever. A staple in our home, and a must-have everywhere I go, these fast-acting medications relax tightened airway muscles and open them up, alleviating acute signs of asthma. Relievers help when a patient suffers an asthma attack, but may also be used as a preventive measure in some instances. For example, a reliever may be used prior to physical exercise to prevent asthma attacks.^

On the other hand, controllers are medications meant to reduce the inflammation in the lungs, therefore preventing asthma symptoms over time. These usually contain steroids. Unlike relievers which are used as needed for short-term symptom relief,^^  controllers are usually taken on a daily basis - even when patients are not experiencing any acute asthma symptoms.^^^

The Effectivity of Daily Asthma Treatments

A recent study by Professor Dave Singh looked into the efficacy of proactive treatments via inhaled corticosteroids (ICS) or maintenance inhalers. Singh’s study revealed that higher doses of ICS treatment and higher adherence to treatment schedule generally provided the best protection for most forms of asthma.^^^^

Supporting this is a post-hoc analysis of data from a GSK-sponsored AUSTRI study which finds that in patients with a one-year history of exacerbations, ~92% of those treated with a daily regimen of ICS/LABA did not exacerbate during the treatment period.

Additionally, this same study also showed that this specific approach to daily treatment was able to reduce asthma attacks by 21.8%.^^^^^ Patients treated with daily usage of ICS-LABA witnessed fewer asthma exacerbations compared to those treated with ICS alone.

"These new pieces of evidence simply tell us that the daily usage of ICS treatments can in fact treat both the immediate symptoms of asthma, while also providing long-term control for the condition," explains Dr. Gyneth Lourdes Bibera, Country Medical Director of GSK Philippines. “Asthma shouldn’t just be treated as a condition that happens occasionally. It's better to follow a consistent plan that involves daily asthma treatment, to address evident and underlying symptoms and ultimately decrease the number and severity of asthma attacks over time,” she says.

 
*Medication for people with asthma. (2017, November 30). National National Center for Biotechnology Information. Retrieved September 23, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK279519/

**Price D, et al. npj Prim Care Respir Med 2014; 24:14009; 2. Chapman KR, et al. Respir Med 2021;186:106524.

***Asthma. (2022, May 11). Retrieved September 23, 2022, from https://www.who.int/news-room/fact-sheets/detail/asthma

****Asthma: Treatments for Inflammation. (n.d.). Cleveland Clinic. Retrieved September 13, 2022, from https://my.clevelandclinic.org/health/drugs/11871-treating-the-inflammation-of-asthma

*****Asthma. (2022, May 11). Retrieved September 23, 2022, from https://www.who.int/news-room/fact-sheets/detail/asthma

^Medication for people with asthma. (2017, November 30). National National Center for Biotechnology Information. Retrieved September 23, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK279519/

^^Asthma medications: Know your options. (2022, August 19). Mayo Clinic. Retrieved September 23, 2022, from https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-medications/art-20045557

^^^Medication for people with asthma. (2017, November 30). National National Center for Biotechnology Information. Retrieved September 23, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK279519/

^^^^Singh, D. (2022, March). New Versus Old: The Impact of Changing Patterns of Inhaled Corticosteroid Prescribing and Dosing Regimens in Asthma Management. Springer Open Choice, 39(5). https://doi.org/10.1007/s12325-022-02092-7. Accessed 13 Sept 2022.

^^^^^USTRI post hoc analyses - Busse W, et al. J Allergy Clin Immunol Pract. 2022;S2213-2198(22)00341-5.

Daily treatment: key to managing asthma, according to new study.

In the Philippines, the National and Health Nutrition Survey states that the overall prevalence of asthma was estimated at 8.7% based on wheezing for the past 12 months. And according to the 2017 WHO data, asthma deaths in the country reached over 13,000.****

According to this research, “New Versus Old: The Impact of Changing Patterns of Inhaled Corticosteroid Prescribing and Dosing Regimens in Asthma Management” by Professor Dave Singh, daily usage of inhaled corticosteroids (ICS) or maintenance inhalers, addresses both the evident and underlying asthma symptoms that patients experience, decreasing the number and severity of their asthma attacks. This also solves the tendency of patients' over-reliance or under-reliance on their needed medication.*

An additional study shows that nearly 50% of asthma patients in Asia have uncontrolled asthma, despite the same research stating that over 80% of patients consider their asthma to be controlled.**

Consistency over complacency

“When it comes to asthma, poor patient perception is a serious risk. The belief that patients usually have is that their condition is not as serious as it actually is. When in reality, they are already experiencing underlying complications, such as airway inflammation, airway remodeling, decreased lung function, and bronchial hyperreactivity,” says Dr. Gyneth Bibera, Country Medical Director of GlaxoSmithKline Philippines Inc. “The underestimation of their disease's severity often leads to complacency, assuming that they only need treatment to react to symptoms when experienced. What this does is heightens the risk of asthma attacks, emergency hospital visits, a decreased quality of life, or even death.”

Asthma is a chronic respiratory disease that requires maintenance medication. An effective way to manage it is through a preventive daily treatment using ICS therapies, alongside other prescribed medication that a patient might have. It helps to address the underlying source of the asthma attacks***, as opposed to only using ICS as a reliever once symptoms are already present. By committing to early and consistent treatment, patients can avoid experiencing asthma symptoms and exacerbations.****

“Patients must view their asthma treatments as preventive rather than a reactive measure to control their condition. In partnership with their physicians, it's about maintaining consistency of treatment to provide them the best outcome in managing a chronic condition like asthma.” Dr. Bibera ends.

-------------

*Singh, D. (2022, March). New Versus Old: The Impact of Changing Patterns of Inhaled Corticosteroid Prescribing and Dosing Regimens in Asthma Management. Springer Open Choice, 39(5). https://doi.org/10.1007/s12325-022-02092-7. Accessed 13 Sept 2022.

**Price D, et al. NPJ Prim Care Respir Med 2014 Jun 12;24:14009. Price D, et al. J Asthma Allergy 2015; 8, 93-103. Accessed 13 Sept. 2022.

***Asthma: Treatments for Inflammation. (n.d.). Cleveland Clinic. Retrieved September 13, 2022, from https://my.clevelandclinic.org/health/drugs/11871-treating-the-inflammation-of-asthma 

****Philippine Consensus Report on Asthma Diagnosis and Management 2019; Executive Summary; CH1; p7; PCRADM-2019-Exec-Summary-.pdf (philchest.org)

Kids and Pets: Top 5 Kid-Friendly, Hypoallergenic Dog Breeds.

My son has been begging me to get him a pet for the longest time. He started asking for it around Christmas time last year, when we chanced upon a Korean family buying a pet hamster at eMart. (Oh yes, in Korea they sell pets at their discount stores.)

A few weeks later, he asked me if we can raise an iguana at home - an idea most likely inspired by watching Nat Geo Wild day in and day out. I vehemently disagreed, of course. Save for turtles, I really can't stand the sight of reptiles.

These days, he's been leaning towards more 'normal' pet choices, like a cat or a dog. And if you've been a long time follower of this blog, then you might recall that I used to have a dog - a Shih Tzu-Poodle named Stalin.

After Stalin passed away in 2012, it never occurred to me to get a new dog or a new pet. Losing Stalin had been very traumatic and emotionally devastating, and I thought I can never love another dog again the same way I loved my Stalin. However, it's a totally different story when your child earnestly begs you for a pet dog and wholeheartedly promises to care for it and attend to its needs. *sigh*

My husband has already agreed to Yue's idea, and now it's up to me to choose which dog to get. The Goody Pet has a comprehensive list of child-friendly dog breeds, which I have narrowed down to these hypoallergenic, asthma-friendly choices.

Poodle

Photo credit: Pup Home.

When it comes to hypoallergenic or non-shedding dogs, Poodles are at the top of the list. They come in three different sizes - toy, miniature, and standard. The latter make good family dogs, as they get along very well with children. Poodles are one of the most obedient and smartest dogs; they love to play, and enjoy physical activities. Poodles have hair - not fur - which do not shed, making them the perfect companion for dog-lovers with asthma and/or allergies.

Maltese

Photo credit: Spoiled Maltese.

One of the more popular breeds of lap dogs, Maltese are known for their straight and long white coat. Maltese dogs can weigh up to 7 pounds, and have a lifespan of 12 to 14 years. Extremely lovable and playful, Maltese also make good watchdogs as they bark at strangers and other dogs. Shedding is almost non-existent in this breed as they have no undercoat. They do, however, require regular grooming to keep their white coats clean and free of mats.

Bichon Frise

Photo credit: Dogster.

A Bichon Frise is a small breed of dog which traces its origins from Spain and Belgium. One of the sweetest and most affectionate breeds, Bichon Frise dogs are known for their cotton ball cloud of curly white hair which have minimal shedding. They are playful and energetic, and very amicable towards children. Like the Maltese, the Bichon Frise also requires regular grooming to keep their coat in good shape.

Yorkshire Terrier

Photo credit: Pinterest.

Yorkshire Terriers are tiny dogs with a big personality. Good-natured and playful, Yorkies - as they are often called - usually weigh less than 7 pounds and have a lifespan of approximately 14 to 16 years. The hallmark of this breed is its coat color - a lovely shade of tan with a dark steel blue hue. They don't have an undercoat and they hardly shed, but it does take a lot of work to keep their coat fine, silky, straight, and free of mats. Yorkies also make good guard dogs as they tend to bark excessively (sometimes a little too much) at strangers.

Shih Tzu

Photo credit: Vet Street.

Originally bred for for royalty in China, Shih Tzus are known for their warm and friendly personality which makes them one of the most popular toy breeds around the world. Playful and affectionate, Shih Tzus are friendly towards just about anybody - whether its kids or strangers or other dogs. Shih Tzus are also one of the few breed of dogs whose coat is made up of hair. They shed very lightly, but their coat needs to be combed daily to keep tangles at bay. Professional grooming is also recommended, especially during the hot summer months when their coat needs to be kept short.

So, which breed will we be getting? Honestly, I'm still undecided.
I guess we have to visit the pet shop soon so we can see the dogs in person. Hopefully, one adorable pup will steal my heart again, the way Stalin did when I first met him eleven years ago. :)

The 'ber Months, and Asthma.

As the 'ber months and the cold and nippy weather kick in, so do colds, cough, and flu. But for people with asthma (like me), it could be worse, as a simple cold virus can easily lead to a nasty asthma attack.

When this happens, the lining of the bronchial tubes swell, which then causes the airways to narrow and reduce the flow of air into and out of the lungs. Asthma has a relatively low fatality rate compared to other chronic diseases, however, it is the most common chronic disease among children.

According to estimates by the World Health Organization (WHO), there are 235 million people around the world who suffer from asthma. And these 235 million people are the ones who need to take extra precaution during the onset of cold weather.

Here are five easy tips to avoid asthma attacks during the cold seasons:

1) Take your asthma medicines regularly, as prescribed by your doctor.
2) If your asthma is easily triggered by cold air, make sure to take a puff or two of your inhaler before stepping outside.
3) Bring your inhaler wherever you go.
4) Dress warmly. Wear a scarf if possible, and make sure to cover your mouth and nose with it.
5) Be extra careful when exercising outside, in the cold weather. Warm up for at least 10-15 minutes before exercising, and take one or two puffs of your inhaler before you start.

This may sound so cliche, but an ounce of prevention is always, always worth a pound of cure.

Asthma is Evil.

The past few days had been very stressful.
I had colds and a slight fever two Fridays ago (November 16), and by Sunday (November 18), the little man was sniffling as well. He woke up with a cough and a 38 degree fever the following morning (November 19) so I took him to his pedia for a check-up. His fever was gone by Tuesday (November 20), but the little man still had cough and colds, causing him to eat very little.

Things took a turn for the worst on Wednesday afternoon (November 21) - the fever came back (rising as high as 38.5 degrees), his cough was nasty and his colds prevented him from breathing through his nose, plus he wasn't eating anything save for a few spoonfuls of soup and small sips of water. I had no choice but to have him admitted to the hospital, and that same evening we were back to where we were three weeks ago - the San Pablo City Medical Center.

First confinement, October 25-28.

Although his first confinement was because of pneumonia and UTI, his condition back then was actually much better. He had no fever, he ate well, his cheeks had more color, and he was his usual sprightly self.

Second confinement, November 21-25.

His second confinement worried me (and stressed me) a lot because he had no appetite, he looked really pale and wan, and he was overly cranky most of the time. He lost weight drastically, which you can easily tell just by looking at his face. All this just because of bronchial asthma.

Asthma is evil, and unfortunately it runs in my (mother's) side. My brother has it, Mum has it, my late grandfather had it. And now, of all the things the little man can inherit from me, it had to be the asthma. 

Back when Yue was still in my womb, I prayed that along with the pretty face, he'd also inherit his Dad's strong immunity. I suppose St. Jude wasn't able to hear the last part of my prayer. (This may come as a surprise, but yes, I am a Catholic and I know how to pray. LOL!)

As of this writing, we're out of the hospital and back at home. The little man hasn't gone back to school; I want his body to rest for another week before we go back to the daily grind. He's still coughing a bit, but the fever is gone and his appetite is back. Once he finishes this round of Clarithromycin, we're going back to his pedia for a follow-up check-up where he will be given a new set of meds.

We're starting a six-month treatment for his lungs, something similar to the treatment given to kids with Primary Complex. He's also on Seretide now, which he has to take (inhale) for the next three months. I've been on Seretide before, and although I hated it (and its price), it's a big help to those with asthma. Good thing I'm back to good ol' Ventolin. (Meaning my asthma isn't at its worst.)

Baby inhaler (Seretide) and Mommy inhaler (Ventolin).

I hope the little man's health gets better, too. Me getting sick is bad enough, but when Yue is sick it feels like all hell has broken loose.