Asthma patients often underestimate severity of symptoms
The sudden death of a 13-year-old girl from asthma, reported in the Chinese-language press earlier this month, was a tragedy. Nobody should die from asthma any more. Guidelines on how to manage asthma have been distributed worldwide and there are many effective anti-asthma drugs. Nonetheless, 94 people, on average, still die from asthma in Hong Kong annually.
It is essential to understand the circumstances surrounding asthma deaths to try to identify shared features or warning signals that, if managed early, can reduce the risk of future fatalities.
The Royal College of Physicians' confidential National Review of Asthma Deaths in the UK (2014) is the largest study in the world. Data was available for analysis on 195 people who died from asthma during 2012 to 2013. Almost 50 per cent had died without seeking medical assistance.
Asthmatic patients often underestimate the severity of their symptoms so, by the time they arrive as an emergency, they can be very ill. There are warning signals and, if medical help is sought early enough, fatalities might be avoided. This is especially important at this time of year when viral infections may precipitate severe asthma attacks.
The warning signals include the fact that the reliever inhaler isn't helping or its benefit is lasting for less than four hours. Symptoms of cough, breathlessness, wheezing or tight chest are getting worse. You are too breathless to speak, eat or sleep and it feels like you can't get your breath in properly. You may be missing a lot of time from school or work because of repeated chest problems; or you are consulting doctors frequently to obtain reliever inhalers or attending the emergency room for treatment of asthma.
When it comes to treatment, asthmatic patients should not be afraid to use steroids when advised to do so. Their short-term use is safe and could be life saving. Many people who have died of asthma have used steroids either too late or not at all. Steroids used in asthma are anti-inflammatory and different from the ones that athletes use to enhance performance or build musculature.
Finally, if you have asthma, request that your doctor provides you with a personalised asthma plan so you know why, when and how to use your medicines.
Dr Lee Tak-hong, specialist in immunology and allergy, Hong Kong Sanatorium and Hospital, Dr Marco Ho, specialist in paediatric immunology and infectious diseases, Queen Mary Hospital