Your asthma attacks can be controlled

Local statistics show that 15 per cent of Maltese schoolchildren suffer from asthma, compared to 10 per cent of adults. Stephanie Fsadni finds that although the latest studies are expected to yield the same prevalence, a marked decrease in the number of hospitalisations has been registered in recent years.

The theme for World Asthma Day, being celebrated today, is You Can Control Your Asthma, a positive message for an estimated 300 million individuals affected worldwide.

Asthma is the most common chronic condition among children, and is more prevalent in some countries than in others, mostly in developed and English-speaking countries, foremost of which are the UK, Australia and New Zealand.

Control can be achieved primarily in two ways: through proper medication and by avoiding triggers that can cause an attack, especially those found in the environment, according to Stephen Montefort, lead consultant respiratory physician at Mater Dei Hospital.

“Thanks to novel drugs, nowadays, it is only the minority of asthmatics who find difficulty in controlling the condition,” says Prof. Montefort, adding that there has been a marked decrease in the number of hospitalisations locally in recent years.

Thanks to novel drugs, nowadays, it is only the minority of asthmatics who find difficulty in controlling the condition

Local statistics on asthma dating back to 2002, when the ISAAC (International Study of Asthma and Allergies in Childhood) study was carried out, had shown that 15 per cent of Maltese schoolchildren suffered from asthma, compared to 10 per cent of adults as found in other studies. The ISAAC study is being conducted again this year, but preliminary figures show that the rate is “probably going to be the same or higher”.

The mainstay of asthma treatment is to target inflammation in the lining of the airways, which is mostly done with inhaled corticosteroids.

“If given in the right dose, there would hardly be any significant side effects and one would be treating the condition and not just the symptoms,” explains Prof. Montefort.

This is not only important for the short term but even more so for the long term as uncontrolled inflammation of the airways can lead to “airway remodelling”, meaning that the airways become more and more rigid and would be less likely to respond to common asthma drug therapy.

Very severe asthmatics are also treated with drugs such as injectable monoclonal antibodies.

The environment is harder to control, but one can do one’s best to keep living quarters as allergen-free as possible.

“We spend a good portion of the day indoors,” Prof. Montefort says. “First of all, one must decrease exposure to irritants and allergens encountered in confined spaces. Thus one should be aware of passive smoking and furnishings that harbour many important allergens such as house dust mites, found mostly in carpeting, blankets, soft toys and, especially, mattresses.”

Several studies have also examined the possible link between the incidence of asthma and pets, but this remains a grey area, with some studies suggesting that animals can offer protection against the condition and others showing that such exposure is detrimental to allergic persons.

More light on indoor environs may be shed when the results of two EU-funded projects named Respira and Sinphonie, studying the impact of indoor air quality – including that of schools – on children, are released.

As regards the external environment, there is a limited amount a person can do, apart from reducing exposure to triggers.

Some asthma patients experience an increase in symptoms when pollen counts are at their highest.

“This year, because of a prolonged winter, these symptoms will persist for longer,” claims Prof. Montefort.

Other factors that can be detrimental to susceptible patients are diesel fumes from traffic and emissions from stone quarries, factories and power stations.

According to some foreign studies, potential air pollutants can also emanate from firework displays, especially when one encounters a heavy density of smoke at ground-level displays.