By: Maria Theresa R. Termulo, MD
Globally, asthma is 28th among the leading causes of burden of disease and is acknowledged as one of the most prevalent chronic respiratory diseases worldwide. In 2016, there were 339.4 million people worldwide affected by asthma based on the Global Burden of Disease (GBD) Study.
In the Philippines, the overall prevalence of asthma (either self-reported or doctor-diagnosed) is estimated at 8.7%. This translates to 1 out of 11 Filipino adults being diagnosed with asthma, with males being reported as having higher prevalence compared to females. Additionally, according to the World Health Organization (WHO) data in 2017, there are 13,186 deaths attributed to asthma or 2.13% of total deaths. In age- adjusted death rate due to asthma, the Philippines rank number 15 in the whole world and, in the low to middle-income countries, the Philippines rank number 2.
Asthma, indeed, is common. Yet, there are a lot of myths and misconceptions about it. The misinformation only contributes to lack of awareness and hesitancy in seeking medical treatment for a chronic disease that is controllable and can potentially be fatal, if not treated adequately.
So, what are these misconceptions and myths about asthma?
1) A person who is frequently coughing has asthma
Asthma is diagnosed based on the identification of a characteristic pattern of respiratory symptoms such as wheezing, shortness of breath, chest tightness or cough. The probability of a diagnosis of asthma increases when symptoms are more than one, worse at night or early morning, vary in intensity over time, and triggered by certain factors like exercise, changes in weather, laughter, smoke or strong scents, and respiratory infections. Personal history of allergies like eczema or allergic rhinitis and or a family history of asthma or allergies also increase the probability of having asthma.
Doctors may use spirometry, peak flow diaries and bronchial provocation to establish a clinical diagnosis of asthma. Wheezing that occurs during expiration (or when you let out breath) is the most frequent finding for asthma.
While allergies are different from an asthma attack, allergens or triggers of allergic attacks may also trigger an asthma attack.
2) Asthma is just a childhood disease and can be outgrown once a patient reaches adulthood.
In the Philippines, asthma affects over 6 million children. Some children’s asthmas will eventually go in remission or disappear, only to return years later, during adulthood. There is no cure for asthma. However, for most, asthma can be controlled with appropriate treatment and management.
One important factor in adult-onset asthma is smoking. Asthmatic smokers are also at risk of developing more severe symptoms, higher frequency of exacerbations and worse quality of life compared to asthmatic non-smokers. There are also studies that show long-term exposures to air pollutants, especially traffic – related air pollution, can contribute to new- onset asthma in both children and adults.
3) Asthma is treated only when patient exhibits symptoms
While there are patients whose asthma symptoms are mild and would only necessitate rescue doses of bronchodilators and inhaled corticosteroids, there are patients who have moderate to severe asthma symptoms that require control with daily low- to medium-dose inhaled corticosteroids and long-acting beta-agonists. It is important that patients are followed-up regularly for personalized and timely adjustment of asthma medications.4) Medications used to treat asthma have steroids that are harmful and have too many side effects.
Inhaled corticosteroids are part of the management of asthma, depending on the severity of symptoms. Patients who have moderate to severe symptoms of asthma would usually need daily doses of inhaled corticosteroids to control their symptoms, which lead many people to think that taking corticosteroids long-term can bring about unwanted side effects. While that steroids can cause side effects such as weight gain, bruising, elevation of blood sugar, and heartburn, inhaled corticosteroids usually have less amount of dosage compared to orally taken steroids. Under the supervision of a physician, the use of inhaled corticosteroids is safe and very effective for proper asthma control.5) Asthmatic patients cannot receive COVID-19 vaccines
Overall, patients with well-controlled asthma are not at increased risk of COVID-19 related deaths. However, the risk of COVID-19 related death was increased in people who recently needed oral corticosteroids to be able to control their asthma or those hospitalized patients with severe exacerbations of asthma. Due to these risks, it is important, more than ever, to control asthma symptoms adequately and for patients with well-controlled asthma to receive COVID-19 vaccines.
Asthma is a long-term condition affecting both children and adults. If under-diagnosed and under-treated, there will be significant impact on daily life, particularly in patients belonging to low and middle-income countries. Asthma patients may miss school and work, with financial impact on the family and the general community. They may also need hospital admission for treatment and monitoring. In most severe cases, asthma can also lead to death. And in the time of a pandemic, it is more important than ever that asthma will be diagnosed and treated timely and adequately.
Recognition of symptoms, close follow-up with physicians, and preventive measures, including vaccination against immediate threats like COVID-19 and flu, will help keep asthma exacerbations at bay and maintain a good quality of life. For any question on asthma, you can Call Doc, Anywhere, Anytime, with Medgate.
Global Initiative for Asthma Global Strategy for Asthma Management and Prevention 2021.
Linda L. Varona, M.D., et al. Prevalence of Asthma Among Filipino Adults Based on the National Nutrition and Health Survey (NNHES).
Philippine Journal of Internal Medicine. 2014: Volume 52 Number 4.Philippine Consensus Report on Asthma Diagnosis and Management 2019