Too many people with asthma are accepting regular breathlessness and wheezing as normal, when these are signs their condition is under-treated.
Not treating asthma appropriately leaves people vulnerable to severe attacks like those experienced in the recent Melbourne thunderstorm asthma event, said a leading respiratory physician.
Also some people with asthma aren’t aware they have the condition, and this could have been an added factor in Melbourne, said Matthew Peters, professor of respiratory medicine at Macquarie University.
Asthma deaths overall in Australia have dropped dramatically in the last 25 years, but poor control of symptoms remains a problem many people with asthma.
Research by Professor Peters and others has shown one in four people with asthma do not have their symptoms managed properly.
This is mostly because they are not using regular asthma preventer medication (or not using it properly), leaving them vulnerable to severe asthma events.
While a combination of weather and high pollen counts was thought to be the trigger in Melbourne, vulnerable people could also have bad attacks triggered by things like viruses.
“That group out there with poor current asthma control … that’s a lot of people. They are just sitting ducks.”
Under-treating asthma may also cause lung function to get worse over time, and this may not be reversible.
Asthma occurs when people with sensitive airways respond to certain triggers in the environment, causing their airways to become narrowed, inflamed and to secrete mucus.
In Melbourne, it is thought the cause was a freak combination of rain and winds, which caused pollen to break into tiny particles that were inhaled deep into people’s lungs.
Acute asthma attack
A person having an acute asthma attack (a sudden or severe flare-up of symptoms) will usually:
- Breathe quickly
- Have tightness in their chest
- Feel distressed about not getting enough air
- They may have an audible wheeze but this can disappear in a bad attack because there is little air movement.
- Often they can’t speak or can speak only a few words or in short phrases.
- In extreme cases, they may turn blue from lack of oxygen.
- Treatment is to give Ventolin if you have it, and call an ambulance.
Key warning signs
Feeling breathless or wheezy, particularly at night or when trying to exercise, are key signs asthma is poorly controlled, Professor Peters said.
People tended to think ‘Oh everyone with asthma has this’, he said.
“But what people have come to know and accept as normal is not the best achievable in terms of reducing the risk of really bad attacks.”
This means their quality of life is not as good as it could be, but also means they are vulnerable to potentially life-threatening episodes.
“They’re not using enough treatment to get them better and reduce the risk of bad asthma episodes.
“Thunderstorm asthma is an extraordinary event and the deaths are tragic. But I would probably predict most of them were avoidable in some way.”
‘Preventer’ medication vital
Many people with asthma think it is normal to use medication like Ventolin to relieve asthma daily.
“If people are having to use their Ventolin [asthma relieving medication] every day, they’ve definitely got a problem and they need to see their GP,” Professor Peters said.
Anyone with more than occasional symptoms should be taking a preventer medication, which reduces the frequency of severe attacks and improves lung functions.