Asthma – a disease with many faces

Interview with prof. dr hab. n. med. Marek Kulus, president of the Polish Society of Allergology, head of the Department of Pneumology and Children’s Age Allergology of the Medical University of Warsaw.

Allergens are waiting for us almost everywhere, and since allergens, also asthma.

We usually remind ourselves of allergens in spring because many patients suffer from allergies to pollen from trees and grasses. However, we should always remember about them, because, for example, house dust mites or mold (air conditioning!) Can be felt all year round. Better and better diagnostics allows us to precisely determine what to avoid, and more and more modern drugs make the symptoms of allergy or asthma less troublesome.

The prerequisite, however, is a good diagnosis. How do you recognize asthma?

Its symptoms include shortness of breath (especially at night; it is more difficult to exhale than gasp), a dry, exhausting cough and wheezing. If the latter symptom occurs intermittently, it is usually related to an infection. However, when it is repeated more often in certain situations, such as exertion or nervousness, it should be looked at.

As a pediatrician, I also know that sometimes parents who feel unwell take medications from their asthmatic children and feel a definite improvement. This means that you have almost certain diagnosis of the disease, as its hallmark is that treatment controls symptoms.

This disease often begins in childhood. And what’s next?

Asthma that manifests itself in childhood is not always noticed. Sometimes it becomes silent, i.e. in remission, and later reveals itself, e.g. in difficult life situations, in certain environmental conditions (e.g. with very polluted air) or when animals appear in the house.

Are its causes known?

Asthma has many faces. In addition to the typical allergic asthma There are also symptoms that appear in an incomprehensible and unexpected way. There are patients who only get asthma symptoms in certain circumstances and only a few days a year. And there are also those who are severe (grade 5 or 6 – according to the American scale), when symptoms appear every day and require very intensive, burdensome and expensive treatment.

The key condition in treat asthma is keeping it in check, which is good control. This ensures that chronic inflammation in the bronchi is suppressed. Medicines prevent this process from progressing, destroying the normal structure of the bronchi (the so-called remodeling). Untreated or improperly treated asthma leads to irreversible disability of the airways.

How is asthma treated?

The mainstay of treatment are anti-inflammatory drugs – inhaled glucocorticosteroids (in addition, bronchodilators are used). If we do not allow the situation when high doses of these drugs are required, their side effects are unnoticeable. On the other hand, with high doses and the use of these drugs by the oral route (so-called systemic steroids), side effects may be much more serious. But we also have something to offer to these patients that reduces the need to administer large doses of systemic steroids. They are biological drugs.

How do biological drugs work?

They block certain inflammatory mechanisms. This treatment is effective only for this group of patients with severe asthmain which the mechanism is present, well-known and documented. Thanks to biological medicines, we can better heal the individual needs of our patients and meet what they expect – so that they can enjoy life as if they were healthy.

Patients sometimes worry that biological drugs are too expensive for them. Is it right?

These drugs are quite expensive for now, but will likely become more available over time. They are reimbursed in full for patients with the most severe form of asthma. Qualification for biological treatment and the treatment itself take place in specialized centers throughout Poland. The distance to such a center usually does not exceed 100 km.

There are also new drugs that are not yet reimbursed, because their effectiveness must first be proven. The opportunity for patients is participation in clinical trials on the effectiveness of such drugs.

What does Poland look like in terms of the occurrence of asthma compared to Europe and the world?

We’re half way through the stake. In the forefront are highly developed Anglo-Saxon countries, where asthma affects 20 percent. population. In Poland, it is respectively 6-9 percent. In African countries, the incidence rate is below 2%. There, however, there is a dramatic increase in allergic rhinitis, which is followed by asthma. These statistics will probably grow along with the changes in civilization.

In Poland, the prevalence of asthma is increasing, but the rate of increase is lower than in the 90s. Children suffer most frequently: approx. 9-10%. In younger age they are more often boys, and in adolescence – girls. When it comes to adults – women are sick more often.

We live more and more sterile. When a child is allergic, parents protect them even more. What do you think about it?

The environment changes so much and so quickly that genes cannot keep up with it. Aggressive external conditions force our genetic response to something that has not happened before. It is especially about air pollution. So environmental changes mean that allergy will continue to compete with us.

What should you do then?

Try to reduce environmental pollution, use air purifiers and use common sense – smoking in the presence of a child should be prohibited! It is also important that the child’s body is able to respond to the environmental conditions it comes into contact with. So don’t keep it under a shade.

Who should be educated in the first place – parents, doctors, students?

I encourage everyone, including government officials and politicians, to use reliable websites, e.g. the website of the Polish Society of Allergology www.pta.med.pl.

Since 1998, we have been celebrating World Asthma Day at the beginning of May. Why?

It is an occasion to remind about the needs of a large group of patients. In our country, it is about 10 percent. population. Some people who have recurring, unexplainable symptoms may learn something important about their health that day. Also, people who know about their asthma, but pretend that the problem does not apply to them, can choose the right treatment that day.

What has changed in asthma management in recent years?

In the 30 years I have been a doctor, there has been tremendous progress in treatment. As a young doctor on duty, I saw patients with severe asthma attacksfighting for their lives all night long. Thanks to inhaled corticosteroids, we have only a few such patients in a year.

Asthma, as I mentioned, is a disease with many faces. It can be sporadic, but it can also be intermediate or severe. Each of them is assigned an appropriate, more and more individualized and modern treatment. If treated effectively, asthma should not cause any problems for the patient.

Interview prepared by the Association of Journalists for Health for the workshops in the series “Quo vadis medicina ?, 2019th edition: Stopping asthma!”, April XNUMX.