Asthma is a very common disease. In Malaysia, it is estimated to affect nearly 10% of children and about 5% of adults, and these numbers are probably on the rise. The disease stems from an interplay between various factors in the environment (such as smoke or pollutants) and an individual’s genetic predisposition. Asthma is associated with many conditions such as eczema, allergic rhinitis or chronic rhinosinusitis and therefore asthmatic patients often present with other conditions too, called comorbidities.
What Are Asthma Symptoms?
The symptoms of asthma are cough, wheezing, shortness of breath, chest tightness and excessive phlegm. They are the result of a process called airway inflammation in the lungs; often triggered by allergens, viruses or environmental irritants. The inflammatory process in the lungs is usually mediated by many cells such as a white cell called eosinophils or allergic protein called Ig E. Sometimes the severity of the disease can be assessed by measuring these proteins in the blood.
What Are The Severity Grades In Asthma?
Asthma can be mild, moderate or severe. Most asthmatic patients are either mild or moderate in severity, and only a small percentage of patients are in the category called severe asthma. Unfortunately, despite the small number, patients with severe asthma are the most challenging for doctors to manage and for disease control. They will be on a few inhalers and tablets to control the disease, but some remain uncontrolled. Severe asthma patients may also end up missing work or school and sadly get admitted to hospitals or have to visit clinics or emergency departments for acute treatment of asthma involving steroids and nebulisers.
What Is Severe Asthma And Why Should We Be Concerned?
Severe asthma is a type of asthma that remains uncontrolled despite being on maximum treatment using inhalers and oral medication or sometimes oral steroids. It also includes asthma that becomes uncontrolled the moment the treatment is reduced.
We should be concerned about severe asthma because of the complications of uncontrolled disease. Patients with severe asthma have poor quality of life because of the persistent asthma symptoms. They are also at risk of severe asthma attacks that can lead to hospital admission or even death. The financial and psychosocial cost of uncontrolled severe asthma is also substantial to both the patient and his family or carers. They are also exposed to the treatment side effects because they are on many inhalers and oral medications.
What Can Be Done For Patients With Severe Asthma?
Patients with severe asthma should be assessed and managed at a severe asthma clinic. The diagnosis must be confirmed and its severity documented. After addressing compliance and inhaler technique issues, the appropriate initial treatment must be commenced without delay after a series of tests called endotyping is done to find out the specific severe asthma type. They must remain closely monitored by regular follow ups at the clinic.
What Are Biologics And Can They Be Used In Severe Asthma?
A proportion of patients with severe asthma remain uncontrolled despite the maximum treatment using inhalers and/or oral tablets. If suitable by endotyping process, patients with severe asthma can try a biologic to control the disease.
Biologic treatments used for asthma are also known as monoclonal antibodies or written as mAbs in short. These are specialised treatments using antibodies produced from cells in a laboratory which can target specific cells in the body. Many studies have shown that if proper patient selection is made, they can be very effective at asthma symptom control – reducing the need for hospital admission or oral steroids and reduction of regular asthma treatment with inhalers.
Severe Asthma Clinic at Thomson Hospital Kota Damansara
At Thomson Hospital Kota Damansara, any patient with asthma, especially severe asthma with uncontrolled symptoms, will be assessed and investigated to exclude other causes unrelated to asthma. Once the diagnosis of asthma is confirmed and severity determined, evidence-based treatment will be administered including the use of biologics to ensure asthma control is achieved. Patients with severe asthma or uncontrolled asthma will remain in our follow up until they have achieved total asthma control. This is why we say that our clinic offers a chance to experience asthma symptom-free life.
Reach out to our Severe Asthma Clinic by calling 03-6148 7217 (ask for Staff Nurse Amalina) for bookings and enquiries.