Severe asthma is on the rise

In India, an estimated 15-20 million people have asthma and most of them rely on a number of well-known medicines for relief. These medicines include treatment with inhalers, which help relieve swelling in the lung's airways and widen them to make breathing easier.

However, at least 1.6 lakh asthmatics in India get no relief from available medicines. They live in constant fear of the next difficult-to-treat asthma attack and are at a greater risk of recurrent episodes requiring doctor and hospital visits. These patients are classified as suffering from severe or difficult to treat asthma.

Symptoms of asthma include coughing, wheezing, chest tightness and difficulty in breathing. Patients are said to have severe asthma when these symptoms persist for the whole day and night and continue into the next day. Severe asthma increases the need for medicines and healthcare resources and could be life threatening, too.

Treatment and management of severe asthma: Doctors diagnose severe asthma based on symptoms, frequency and impact on quality of life. Patients are then put on a treatment regimen that is best suited to their condition.

For patients with severe allergic asthma, newer molecular targets attempt to slow down the function of an erratic immune response, which otherwise works to worsen the asthma. The target is an abnormally elevated immunoglobulin (IgE) in the body, levels of which rise dramatically in an allergic reaction. Injectable agents work against this immunoglobulin resulting in 50% reduction in the frequency of severe exacerbations, and it also improves asthma control.

Another new and advanced treatment is bronchial thermoplasty, a minimally invasive procedure for patients with severe and resistant asthma. It can be best understood with this simple analogy: if there are too many cars parked on a road, the passage through it narrows. Similarly in severe asthma, lung airways narrow through chronic inflammation and swelling.

Bronchial thermoplasty uses heat energy to re-open the narrowed airways by reducing the swollen muscle, just as we would to widen the road through reducing the parked cars.

Through this procedure, as the airways widen, it becomes easier to breathe, hence, reducing severe attacks. Bronchial thermoplasty is performed over three sessions, three weeks apart.This is a one-time treatment and can be used in all types of asthma.

Bronchial thermoplasty is now available in India in specialised centres. Updated GINA guidelines now recognise Bronchial thermoplasty as a treatment option for adult patients whose asthma remains severely uncontrolled despite optimised therapeutic regimens. It offers hope for patients who otherwise have no respite from the upsetting effects of severe asthma.

In summary, severe asthma is on the rise in India and globally. It is one of the most common problems affecting lung health worldwide and needs mass awareness to create an impact on the health of the population as a whole.

In addition to the physically debilitating nature of severe asthma, the condition places a great emotional and psychological burden on individuals and their families.

People with severe asthma struggle with feelings of isolation, stress and frustration and tend to live in fear of their next attack. This affects their relationship with family and friends, which leads to an overall poor quality of life. It is very important to recognise this, as proactive management can improve both health and quality of life.

It is also important to act in time, otherwise irreversible damage can happen to the airways, with life-long consequences and with few options to reverse the situation.

Indeed, a good lifestyle, allergen avoidance and societal and governmental commitment to reduce pollution, form the basics of control. Medication (combination of inhalers) is the next step for control and treatment and needs to be taken proactively under medical supervision.

Newer therapies such as anti-IgE injections are useful in specific allergic asthma and the latest procedure which widens the airways bronchial thermoplasty offers further options for this difficult condition.

On an encouraging note, given the growing effort in severe asthma research and the development of newer treatments, patients with severe asthma can hope to have a better quality of life.

There are far too many people living with severe asthma who compromise on their quality of life unaware of new treatment options. Fortunately, scientific developments in recent years offer hope through new treatments when other medication do not provide relief.

(The writer is chief of pulmonology and critical care, Apollo Hospital, Bengaluru)

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