Tuesday, December 13, 2011

Asthma Prevention: you've gotta suck it up!


Most Doctors who write prescriptions for their patients live under the impression that the patient will follow the Doctors advice and take the medications "As directed". Sadly, in a great number of cases this is not the truth: antibiotic courses are not completed, contraceptive pills are missed, 'Statin usage drops off as the patient feels OK - the list is depressingly long. One of the key principals of modern medicine is Prevention, and that means that patients need to comply with the advice given, if we are to achieve a good level of success.

Asthma is a good case example. In asthma, a trio of events occurs,

  • Inflammation of the lining of the airways leading to a narrower tube through which to breath.
  • A thickening of the normal dust-trapping, watery mucous secreted by the inner lining, which leads to blocking of the narrowed airways with these thick, sticky mucous plugs.
  • A thickening of the circular muscle that controls the diameter of these small breathing tubes and which exacerbates the overall narrowing of these smaller airways.

In an asthma "attack", some irritant or triggering event - smoke, virus infection, stress - causes the circular muscles in the tubes to contract and narrow the tube, reducing airflow. Now if the diameter of that airway is already narrow due to inflammation, and has thick mucous plugs blocking up the smaller tubes, then the patient is going to wheeze and to get very short of breath: sometimes fatally so!

So the key to reducing the risks of suffering a significant asthma attack is to reduce the inflammation so that the airways are at their maximal diameter, and to make sure that they are not clogged with tenacious mucous: enter the principal of using Inhaled Cortico-Steroids (ICS). If it's going to be effective and keep people out of hospital, then they've got to take the medications on a daily basis. This has been backed up by research just released by the Henry Ford Centre in the US where lead author Dr Keorki Williams reported "We found that every 25 percent increase in ICS adherence was associated with an 11 percent decrease in asthma attacks, but most importantly, we found that causal use of these medications is not enough, especially among patients whose asthma is not controlled. Patients must use their asthma controller medication as prescribed if they want to have the best chance of preventing serious asthma attacks."

As my dear old Mum used to say: "An ounce of prevention is worth more than a pound of cure".
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5 comments:

Duncan D. Horne - the Kuantan blogger said...

Thanks Duncan, helpful reminder indeed. Fortunately for me, my asthma completely disappeared when I moved to Malaysia from England! I used to use my inhaler twice a day in England. Now I've barely touched it for the last 5 years whilst living in Malaysia. Is it the hot climate that has dramatically improved my condition?

Dr Duncan Jefferson said...

It could be, but may also be due to the fact that you have left an environment which contained a trigger for your asthma.
Enjoy your good health!

Mariodacatsmom said...

Good advice Dr. Duncan and a good reminder of the importance of finishing out the prescription. And some drugs can't be stopped suddenly - they need to be tapered off or you will suffer serious consequences. That is the case with my Parkinson's drugs and also with antidepressants.

GraceRivac said...

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