In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
Conversation with dr. n. med. Piotr Dąbrowiecki, Chairman of the Polish Federation of Asthma, Allergy and COPD Patients, as well as an employee of the Infectious Diseases and Allergology Clinic at the Military Medical Institute in Warsaw
Journalists for Health Association: What do you associate with the beginning of the coronavirus pandemic?
Dr. n. med. Piotr Dąbrowiecki: First of all, with great concern about patients with obstructive pulmonary diseases [obturation – bronchoconstriction, ed. ed.]. We were concerned that the additional inflammation in the lungs from the SARS-CoV-2 virus and COVID-19 disease would be fatal for them. Fortunately, it was found that COVID-19 developed 2 to 10 times less often in asthmatics than in other people. Already at the end of March 2020, the European Academy of Allergology and Clinical Immunology handed over its position on the treatment of asthma during a pandemic. It emphasized that asthma did not increase the risk of developing the disease or the more severe course of COVID-19. Similar information can be found in the guidelines of the Polish Society of Allergology.
Has the pandemic changed the standards of asthma, allergy and COPD management?
The standards have not changed. However, it changed the situation so much that it made contact with the sick more difficult.
Many patients, fearing infection, stayed at home, avoiding follow-up visits, skipping scheduled consultation dates. This translated into poorer disease control among patients. We breathed a sigh of relief when it turned out that we could treat patients normally, in accordance with the latest GINA recommendations of 2020 [GINA – Global Asthma Treatment Initiative, ed. ed.]. The change in the paradigm of asthma treatment, where the main therapy is the use of an inhalation steroid with a bronchodilator, has allowed for the optimization of the treatment process. The pandemic – paradoxically – also contributed to the fact that patients with previously diagnosed asthma began to follow medical recommendations more closely. On the other hand, limited contact with a physician has made it more difficult to diagnose asthma or COPD.
The rest of the article is available under the video.
How many people with asthma know about their disease and are under treatment?
There are over 4 million people suffering from asthma in Poland. According to the NHF data, in 2019 there were 2,2 million registered patients with diagnosed asthma and 1,1 million patients treated for this disease. This means that one in four asthmatics is actively treated in Poland.
What diagnostic problems are particularly important in the era of a pandemic?
We recognize asthma too late. Before the pandemic, the Polish patient waited for diagnosis for over 7 years, and the European average was 3,5 years. The situation worsened during the pandemic. In addition, there are doctors who avoid diagnosis despite coughing, wheezing and breathlessness in the patient. Moreover, some doctors now only associate asthma symptoms with COVID-19. If this does not change, the time it takes to diagnose asthma will be longer.
Fortunately, there is telemedicine, which allows, among others Performing spirometry yourself at home or sending the doctor a recording of a respiratory murmur in mp3 format. However, it is not a solution for everyone, but only for those who want to use it and have access to modern medical services.
- Go online for a visit. Specialists are available on the haloDoctor.pl platform
How is inhaled steroid medication related to complications from COVID-19 in asthmatics?
Research indicates that asthma patients who use inhaled steroids have a milder COVID-19 experience and are less likely to develop respiratory complications. It also seems that inhaled steroids can protect against the development of fibrotic lesions. In turn, for patients with asthma who do not use inhaled steroids (50-75% of patients with asthma), COVID-19 may be a problem.
Why should asthma treatment continue during a pandemic?
Because these are the recommendations of GINA, the 200 most outstanding specialists in the treatment of asthma in the world. Experts recommend that during a pandemic, special care should be taken for patients with severe asthma, because they may suffer more from COVID-19, and, moreover, discontinuation of drugs, e.g. biological ones, may lead to the development of exacerbations.
How dangerous can SARS-CoV-2 be for patients with asthma and COPD?
Patients with asthma, who are under medical care and are treated as prescribed, suffer rather mildly and rarely experience exacerbations. As for COPD patients, they suffer more intensely than patients with asthma and die more often.
What is triple therapy for asthma and who should benefit from it?
We reserve triple therapy for patients in the 4th and 5th stages of treatment, i.e. those who have abnormal spirometry test results, severe symptoms during the day or wake up at night due to asthma. In patients who have previously used an inhaled steroid with a bronchodilator, the addition of a third substance – a long-acting anticholinergic drug (LAMA) – reduces the frequency and severity of symptoms, both during the day and at night. The patient ceases to experience shortness of breath, there are fewer exacerbations, thus improving the quality of life. The results of spirometric tests are improving. This treatment also evidently reduces the risk of developing severe asthma.
Do patients in Poland who need triple therapy have access to it?
They have access to triple drug treatment, but unfortunately it is not reimbursed. And yet we are talking about highly symptomatic patients whose life is greatly disturbed by asthma. They often have to quit their jobs and go on a disability pension. Therefore, especially for this group of patients, one or two combined preparations for chronic use should be available. Ideally, it should be a drug administered from one inhaler, because it definitely increases the patient’s willingness to continue therapy. With the need to use three separate inhalers, only 8 percent. patients regularly take medication, and as much as 75% with one inhaler. For this reason, the Polish Federation of Asthma, Allergy and COPD Patients’ Associations sent a petition to the Minister of Health, Adam Niedzielski, with an appeal to introduce as soon as possible reimbursement of new complex inhaled medications in the treatment of asthma. I hope the petition will be understood by the decision makers.
The petition is available at: https://www.petycjeonline.com/chorzy_na_astm_nowe_zoone_leki_wziewne_terapia_trojlekowa_to_dla_nas_nadzieja
In many European countries, triple therapy is fully reimbursed by the national payer.
- Try herbal tea for your lungs. Available for purchase at Medonet Market
What is the most difficult for doctors to effectively treat asthma?
First, it takes too long from the first symptoms of asthma to be diagnosed. Secondly, a pandemic that causes patients to often avoid visiting a doctor. What’s more, when the patient decides to visit, he is often offered a telephone consultation. Another problem is the limited contact with specialists whose hospitals have been reclassified as covid ones.
Another problem is the maintenance of long-term therapy by the patient. Usually, this urge diminishes over time. After a year of therapy, only 10 percent. patients continue treatment. The rest stop because they are asymptomatic, but then the symptoms come back! That is why combination therapies are so necessary. Patients use them more willingly!
Patient education is also an antidote to this. Unfortunately, it is not refunded here. In Finland, educational programs are reimbursed. Annually, a dozen or so people die from asthma there, and in Poland – several hundred. That is why I encourage doctors to educate the sick at each visit. For those who do not have time, I encourage them to direct the patient’s attention to the proven websites: www.dlapacjentow.pta.med.pl, www.szkolaastmy.mp.pl
Why should people with asthma and COPD be vaccinated against SARS-CoV-2 and the flu?
These vaccinations reduce the risk of pneumonia and death. This should be borne in mind by everyone with asthma, COPD and other chronic diseases. Moreover, not vaccinating is an expression of a lack of social solidarity. That is why I urge you to vaccinate, not only against COVID-19. Let’s take flu and pneumococcal vaccines. Let’s vaccinate ourselves on our health.
Authorized press interview prepared by the Journalists for Health Association in connection with a lecture by Dr Piotr Dąbrowiecki, PhD, during the 19th National Conference “Polish Woman in Europe”, organized under the slogan Not only COVID-2021! Medicine in the era of the coronavirus pandemic. October XNUMX.
This may interest you:
- The most common symptoms of lung diseases. Not only a cough!
- It’s not a more severe cold. This disease is still killing
- Have you noticed such changes on your face? It could be lung cancer
The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.