SA has one of the highest rates of childhood asthma in Africa, and teenagers are experiencing more severe asthma symptoms than ever before.
Available research shows that we have not been treating the condition properly for a long time, only focusing on symptoms.1
Major changes have occurred in recent years in the management of asthma. All patients with asthma regardless of severity should now be treated with an anti-inflammatory drug, and no patients should be on bronchodilator therapy alone.
According to the Global Asthma Report from a sample of over 450 000 people, from 63 centres in 25 countries, the proportion of people with severe asthma symptoms not taking the corticosteroid was high in all ages. An average of around 45% of children, 60% of adolescents, and 55.5% of adults were not using correct regular anti-inflammatory therapy, with significantly higher rates of incorrect management in middle-to-low-income countries, like SA.2
Reliever pumps (short-acting beta-2 adrenergic receptor agonists and anticholinergics) relax airway smooth muscles resulting in quick symptom relief. However, treating asthma with bronchodilators alone may lead to complications, as the inflammation of the airway will persist, even when the muscle is relaxed.3
Controller medication contains steroids and are taken daily to control symptoms, reduce inflammation, and prevent asthma attacks. Controller medications should be taken daily even when patients don’t have symptoms.
Significant confusion still exists about the appropriate use of medications containing combinations of inhaled steroids with bronchodilators. Combinations of an inhaled steroid with salmeterol can be used as controller therapy, whereas combinations of inhaled steroids with a rapid onset bronchodilator such as formoterol, can be used as controller therapy and reliever therapy (single maintenance and reliever therapy) or only when symptoms occur (as an anti-inflammatory reliever). The MIMS drug formulary has amended its classification schedule to clearly distinguish the controller and reliever medications from each other, allowing medical professionals to correctly prescribe medication for asthmatics.
Asthma management plans are an integral part of asthma management and can be downloaded free of charge from www.allergyfoundation.co.za. Patients must be educated on how to use their medication effectively to ensure optimal lung deposition. All children younger than three, and any adult with difficult to treat asthma, should be using a 500ml spacer device breathing through the mouthpiece. For very small infants of three years and less, a facemask is necessary, but should be removed as soon as the child is able to breathe in and out through the mouthpiece with a good seal between the lips and the spacer.
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