 |
|
| Home > Asthma Facts from Dr. Crim > Asthma Facts from Dr. Crim Part II |
|
 |
|
Speaking out about asthma
Learn more about asthma in the second part of our conversation with Dr. Courtney Crim, a board-certified pulmonologist and Group Director of the Respiratory Medicine Development Centre at GlaxoSmithKline.
As you may already know, Dr. Courtney Crim is a recognized expert on asthma. This is the second part of a recent interview with Dr. Crim about managing the risks associated with asthma. Read Dr. Crim's interview, Part I.
Following is a transcript of part of this interview.
One of the more frightening things we hear about asthma is that in the US, approximately 4,000 people die from it every year. What can we do about this?
Dr. Crim:
I've always been outspoken about the need for healthcare professional and patient education. Too little attention is paid to the risks of the disease. Both patients and healthcare professionals need to become more aware that even those with "mild disease" can have severe asthma attacks that can result in emergency room visits, hospitalization, or even death.
Often a person experiences only mild asthma symptoms 2-4 times a year. As long as their symptoms are mild, they put them on the back burner. In other words, if symptoms don't have a significant and negative impact on their lifestyle, many patients don't pay too much attention to the disease and don't treat it properly. This puts them at greater risk for having severe and even fatal asthma attacks.
Likewise, some healthcare professionals don't treat patients who only experience mild symptoms 3 or 4 times a year for a chronic condition. This, too, can put a patient at a greater risk for a fatal attack.
In my opinion, the best way to reduce the number of deaths is for both patients and healthcare professionals to recognize the need to treat asthma appropriately. This helps to eliminate the possibility of moderate or severe asthma attacks. My advice to patients with asthma is to work closely with their healthcare professionals to manage their asthma most effectively.
The National Institutes of Health (NIH)—part of the US Department of Health and Human Services and one of the world's foremost medical research centers—have published reports that say if asthma is left untreated or is improperly treated, people with asthma are at risk for permanent lung damage. Could you help us understand what permanent lung damage is and what can be done to minimize or prevent it?
Dr. Crim:
When you reach a point where medications are no longer as effective as they were, there's a good chance you have permanent lung damage. In effect, the horse is now out of the barn. To a certain extent, what reserve you had is gone, and you can't get it back with currently available therapy.
Today, we recognize that airway inflammation is the key driver of permanent lung damage. We try to minimize and help prevent these changes with anti-inflammatory therapy. The National Heart, Lung, and Blood Institute has indicated that inhaled corticosteroids are the cornerstone of anti-inflammatory therapy. In patients with persistent asthma, they are the preferred therapy to treat airway inflammation.
So the best way to minimize the potential for permanent lung damage is to treat it medically with inhaled corticosteroids?
Dr. Crim:
Yes, that's correct. But we need to add that, while the best way to minimize the likelihood of permanent lung damage is to treat the inflammatory component of persistent asthma with an inhaled corticosteroid, additional preventative medications may be required.
Is there one thing that you could point to in the last few years that has made a tremendous difference either in the way we treat asthma or how people can function with asthma?
Dr. Crim:
I think the biggest thing in terms of treatment in the past few years is the improvement we see when long-acting beta2-agonists are used in conjunction with an inhaled corticosteroid.
In terms of managing asthma, why is it important for someone with asthma to use a peak flow meter?
Dr. Crim:
A peak flow meter gets a person with asthma involved in and aware of their disease. By measuring their own lung function, patients can detect when their asthma is getting better or, more importantly, when it's getting worse.
Sometimes, a patient finds it hard to reach his or her healthcare professional right away. By monitoring peak flow, an individual can be made aware of a problem even before symptoms become troublesome or more severe. He or she can then take steps to speak to the healthcare professional sooner.
If someone with persistent asthma feels okay most days, why does he or she still have to take asthma medication regularly?
Dr. Crim:
Because asthma is a "chronic" condition. What that means is that it doesn't go away. Even though an attack may feel as if it happens suddenly, it actually may be building up over a few hours or days before you notice any symptoms. Inflammation is always there, even when you can't feel it. That's why it's so important to take your medication as directed—to help gain control over your asthma and help prevent sudden asthma attacks. Furthermore, there is increasing evidence that, if left untreated, asthma can cause long-term decline in lung function.
Some people say that their asthma is worse at night. What can they do?
Dr. Crim:
Research shows that being around a pet is a significant cause of nighttime asthma. Asthma patients who have a pet should make the bedroom an off-limits area. They should also ask their healthcare professional if additional medications are needed.
In some cases, GERD can contribute to nocturnal symptoms.
Healthcare professionals often prescribe 3 medications for asthma—a quick-relief or fast-acting bronchodilator, a long-acting bronchodilator, and an inhaled corticosteroid (ICS). What's the difference?
Dr. Crim
That is correct. The new thinking in treating moderate to severe persistent asthma calls for 3 medications.
The fast-acting inhaler is a quick-relief, or "rescue," medication to treat sudden symptoms. You should always carry it in case of an emergency.
The long-acting bronchodilator is a preventative medication that helps treat airway constriction.
The inhaled corticosteroid (ICS) is also a preventative medicine. It helps reduce inflammation in the airways, which causes the tiny air passages in the lungs to swell.
Airway constriction and inflammation cause the symptoms that may occur during an asthma attack.
The preventative medications should be used every day as directed—whether or not the patient is experiencing symptoms—to help manage asthma so that the fast-acting inhaler is needed less often. It is important for patients and their caregivers to know the differences among inhalers so they don't reach for the wrong one during a sudden asthma attack or flare-up.
If someone has both allergies and mild asthma, could allergy shots reduce his or her asthma symptoms?
Dr. Crim:
Patients who have both seasonal allergies and asthma may benefit from allergy shots. When shots are effective in easing allergy symptoms and when the same things that cause allergy symptoms also cause asthma symptoms, patients may have positive results. The benefits typically consist of reduced reactions to things patients are allergic to and less dependence on their fast-acting inhaler. But remember, allergy and asthma are two different conditions. And while there is some overlap in symptoms for people who have both, each needs special treatment.
About Dr. Crim
Dr. Courtney Crim is a recognized authority on asthma, a board-certified pulmonologist, and Group Director of the Respiratory Medicine Development Centre at GlaxoSmithKline. Dr. Crim is an outspoken advocate of the need for healthcare professionals and patients to learn more about the causes and treatments of asthma.
|
|
|
|
 |
|
Asthma Facts
from Dr. Crim |
|
 |
|
-
-
|
|
|
|
|
