Crunch time
Asthma is the ninth major killer in Hong Kong. Chinese University research shows that Hong Kong children are 50 per cent more likely to develop the illness than youngsters on the mainland.
'The situation is all the more alarming because incorrect and under-treatment of asthma is resulting in permanent lung damage,' says Dr Alfred Tam Yat-cheung (below), president of the Hong Kong Society of Paediatric Respirology. 'I view this as an asthma crisis.'
At present, 5 per cent of the SAR's adults and 11 per cent of young people between 10 and 20 are sufferers, but control is only achieved in 0.5 per cent of patients here, he says, far below the goal set out in Global Initiative Against Asthma guidelines.
'The problem is the over-reliance on bronchodilator drugs,' Tam says. 'These dilate the airways, temporarily relieving the symptoms but doing nothing to help the chronic inflammation of the lungs which, if left untreated, can result in permanent lung damage, disability and death.'
The inflammation can be treated by inhaling corticosteroids, which does control the disease. 'There are two reasons that inhaling steroids is not used more,' Tam says. 'One is patients' reluctance to use steroids because of the reputed side effects, and the other is the lack of trained people to show patients how to do the inhalation, which is a complicated procedure using special equipment. It is much easier to take the bronchodilator drugs in tablet form which result in immediate easing of the symptoms, so patients tend to rely on these.'
Tam, who is also vice-president of the Hong Kong Asthma Society, says another problem doctors face is that parents bringing in children with asthma will often downplay the severity of the symptoms. 'There is a lot of denial and rejection that their child has asthma,' he says. 'There is no simple clinical test. Doctors need a period of repeated observation to correctly diagnose asthma. So it is often under-diagnosed. Then again, when the symptoms cease, the parents stop treatment, thinking the problem is cured. Asthma is never cured. When it is successfully treated it is controlled, but treatment is a lifetime commitment.' The inhalation of corticosteroids has caused a revolution in treatment and has resulted in many patients being able to lead an active, productive life, he says. 'The amount of steroids in the inhalation is so low that there is very little fear of side effects,' Tam says.
With regard to the higher ratio of asthma among children in Hong Kong than the mainland, he says there are always more asthma sufferers in developed societies, partly because of a richer diet and more pollution. 'Low-fat, low-sodium diets with plenty of fruit and vegetables are the best protection,' Tam says. He does not believe air pollution causes asthma, but aggravates it.
