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Four million of us have asthma. And as many as two million have no idea about it! – says Dr. Piotr Dąbrowiecki, MD, an allergist. How it’s possible?
As many as two million Poles do not know that they suffer from asthma ?! Have no symptoms or are they misdiagnosed?
Piotr Dąbrowiecki, MD, PhD *: They really don’t know they are sick, because the problem with asthma is that its symptoms are temporary – they come and go. Today there is, for example, a cough, shortness of breath, a feeling of lack of air, wheezing. These symptoms may not be present tomorrow. And in a while, they come back again, only to disappear soon. And the patient is confused, thinks: «Well, I am sick, am I not? I have symptoms, don’t I have them? ”.
If they disappear, he thinks: “I don’t have” and he doesn’t go to the doctor?
Yes, and even during the visit to the doctor, he does not mention these symptoms to him, he keeps them to himself, thinking: “Oh, it’s over, so it’s not a problem at all.” It is not so bad if these are symptoms of mild asthma – for example, there is only bronchial hyperreactivity that accompanies allergic rhinitis. It is worse if the symptoms worsen day by day and the asthma begins to make life difficult – it wakes the patient up at night and makes him unable to undertake any physical exertion. This is the final alarm bell – see your doctor.
This time, the man, scared by the symptoms, goes to the doctor and …
And this patient actually comes to the doctor, and the doctor says: “I don’t hear anything.”
He can’t hear because he can’t hear anything, or does he have a bad stethoscope?
I can’t hear it. Because that’s what asthma is – it changes. It gives nocturnal symptoms, exertion symptoms, and suddenly, in spite of anger, when the patient shows up at the doctor’s, nothing happens and the doctor has no chance to hear anything. This time there is no characteristic bronchospasm, it would only be shown by spirometric tests. Thanks to them, you can see what is really going on in the lungs. The fact that the doctor does not hear the wheezing does not mean that the patient is definitely not obstructed. The diagnosis would have been easier if the doctor had trusted the patient when he said he was short of breath two weeks ago, that she woke him up at night, and a week ago, when he was riding his bike, he had to stop to cough up.
One doctor will believe these stories, and another will believe that a hypochondriac visited him.
Tak.
And this attack of breathlessness can also look like an anxiety disorder, a panic attack?
This may look like an anxiety disorder, although asthma is at the root of the symptoms. I have many patients who said to me: “Doctor, look at my diagnosis – neurosis, depression!” An asthma attack occurs after contact with a specific allergen. And, for example, someone feels great, goes to grandma’s and gets bronchospasm. Then he thinks: ‘maybe it’s from the nerves, because I don’t like grandma?’ And the answer is different: “Grandma has a cat whose fur makes me feel allergic.” Someone else tells the doctor: “I feel good at home, I feel breathless whenever I leave.” The doctor asks: “do you leave the house often?” and hears: “rarely, I try not to go out”.
And it looks like agoraphobia to him?
Yes, and the truth is that there are, for example, grass pollen in the air. And the person’s bronchi spasms – the symptoms of the disease appear. And at the doctor’s house or waiting room, they are not. Or someone says that he goes to bed and begins to have attacks of breathlessness, so the doctor thinks it is neurotic, that this patient must think about something stressful before going to sleep. Unfortunately, this variability in symptoms is a trait that makes a correct diagnosis difficult and can lead us astray.
What else is asthma confused with?
With the common cold and chronic bronchitis, especially in tobacco smokers. Or you can mistake it for acid reflux and think it’s a “stomach cough”. And if dyspnoea is the predominant symptom of asthma, then it is confused with coronary artery disease.
On what basis is a certain diagnosis made?
You need to do a proper interview. When it is determined that the patient has shortness of breath, wheezing and that someone in his family has had allergies or asthma, and has spirometric tests that show abnormalities, he will perform a chest X-ray, which does not show any inflammation or tumor, then you can already recognize that the patient has asthma. And he must be treated immediately. Usually such a patient returns to the doctor after two weeks and says: «Doctor, what a relief! I’m finally living a normal life! ”. We are sure – this is asthma.
Patients also say: “finally stopped catching a cold”. Or “I don’t take antibiotics a few times a year anymore.” And it is already known that their asthma has long been mistaken for colds and bronchitis.
What should a less experienced doctor do to dispel his and the patient’s doubts?
We diagnose asthma mainly by symptoms. The doctor has to put them all together. Say to yourself: ‘The patient is coughing, wheezing, is short of breath, so perhaps he is allergic to something. I’ll do him tests. Perhaps he has obstruction, so I have to order spirometry too. ” And so it will come to the point that the patient has asthma. Finally, he can choose his medications. And now another problem begins.
I thought it was a happy ending.
No, because only half of the sick take medication regularly. If they are hit, they improve quickly. And the patient says: «A miracle! I coughed for six months but recovered. He has enough energy to take medications for a week or a month. And then he thinks he’s healthy. He discontinues medication, although he has been told by the doctor not to. He says to himself: “I’m testing you, doctor!” And on the second, third, fourth day, nothing happens. And after two weeks, there is another exacerbation of symptoms. Only the patient no longer associates them with the fact that the drugs have stopped working. He thinks he just caught a cold.
The patient is condemned to these drugs for the rest of his life, or can he discontinue them at some point?
Maybe. When there are no symptoms for a long time. We usually do this one year after asthma is diagnosed and treatment begins. This is a large amount of time, sufficient to avoid complications when discontinuing medications.
What are these complications?
What we fear most is severe shortness of breath. Because it can lead to death. It can also be the development of COPD – chronic obstructive pulmonary disease, which unfortunately is incurable. It is comforting, however, that a patient with asthma, if it is diagnosed and properly treated, can live up to a hundred years in full comfort. There are two conditions: he must know a lot about his illness and take medication regularly. And of course, do not change their dosage without consulting your doctor.
What are these drugs?
Steroids.
Do they put a lot of strain on the body?
They do not burden at all!
Really?! In fact, it did not surprise me that patients stop taking their medication when they feel better. Steroids have a terrible reputation.
We are indeed afraid of steroids. Unnecessarily, because they are safe and effective. The mother of a child with asthma comes to me and says, terrified: “my Johnny is taking steroids!”. And I was like: ‘and you should be happy about it’. Because the basis of asthma treatment is the administration of inhaled steroids, which are administered in a hundred times lower doses than the oral ones. I can compare it to a situation when, for example, I cut myself and the wound on my hand becomes festering. I put an antibiotic ointment on it, it heals quickly. It is similar with asthma – I have a diseased mucosa in the respiratory system, so I topically “lubricate” it with a steroid. Thanks to this, I am relieved of symptoms immediately. A topical inhaled steroid doesn’t really hurt. It can, of course, cause hoarseness or discomfort in the throat, because it is “pulled” through the mouth and throat. But oral discomfort is all that can happen to us.
Do patients get anything else besides steroids?
We also add bronchodilators, such as theophylline, to inhaled steroids. We also use a very modern method, the so-called biological treatment based on antibodies. This changes the lives of patients – even those who have had frequent exacerbations can return to school or work. When it comes to treating asthma in Poland, the situation is great. We already have all the drugs available worldwide. The only serious problems we have with asthma are the ones diagnosed with it, because really half of people do not know that they have asthma, and the next problem is that patients who are diagnosed do not follow the treatment regimen. As I mentioned – they stop taking their medications.
These inhaled medications are not as easy to take as a tablet that you just swallow. This can be discouraging.
You really need to learn how to use your ‘inhaler’. We run a school for chronically ill patients at the Military Medical Institute in Warsaw. Asthma patients come and learn how to take these medications, what to do if their disease gets worse, and how to fight allergens before their disease gets out of control.
What before he sneaks out? Without knowing about asthma, can you buy over-the-counter allergy medications at a pharmacy for years? Symptoms will then subside?
It can be different. It depends on whether the patient is really allergic, allergic rhinitis, or is already starting to develop asthma. Because asthma allergy medications won’t help. They may reduce the symptoms of sneezing, tearing and coughing a little, but they will not reduce the inflammation in the mucosa. In mild asthma, the patient will somehow function, but in moderate and severe asthma, there is no chance. He will be a frequent visitor to the clinic and hospital because he will have asthma symptoms all the time. And if it is not diagnosed, especially in young children, it will even lead to respiratory disability.
Usually, you have asthma from birth, can you get it at any stage of your life?
You can get it at any time in your life. From my experience, I can say that my mother used to come to me first, and then she would bring the children. Today, there is usually a family with a small child who notices a problem. I do tests and diagnose my child has allergic bronchial asthma. And then my mother remembers that she coughs quite often. I recognize asthma as well. And then grandma remembers that her nose is actually blocked all the time and that she is awakened by breathlessness at night. People only start to think about their symptoms when they see them in a loved one.
So we can live in ignorance for years?
We are not aware of the symptoms of the disease, although asthma has been with us almost forever, it was already described on papyri in ancient Egypt. Fortunately, today we don’t have to die of asthma, we don’t even have to have any troublesome symptoms. It is enough not to underestimate the disease. Because if someone ignores asthma, they will take revenge. Due to bronchial asthma, also of this mild form, 1500 people die each year.
1500 five hundred in Poland alone ?!
Yes. In Poland. There are 700 million people with asthma in the world. Not only those with a severe form die. Those with mild, too, because they downplay the disease. For example, someone comes to a party, there is a lot of tobacco smoke in the air. Then she dances with someone who, for example, has a cat at home. He has an attack, his bronchial tubes are constricting and the patient dies.
Does air pollution in cities have any impact on the development of asthma?
Pollution is powerful. And of course it has an effect on the respiratory system. In the fall and winter season, it seems to us that since the grass pollen is gone, we are safe. We go for a walk, and suddenly a lot of smoke comes out of the chimney, irritating the respiratory system.
Do we have a chance to defend ourselves against it?
If we have a fireplace at home, it should be closed, if we heat with coal, we must have a good-quality stove and good-quality coal. The self-awareness of the household members is also important – we do not throw rubbish into the stove, but what should be burned, i.e. good quality coal or eco-pea coal. You can also opt for gas or electric heating. You can also get a mask.
Are you talking about the masks that the Japanese wear on the streets of Tokyo?
Yes. People in Krakow already wear such masks. However, it should be a mask that actually protects against airborne dust, i.e. a specialized mask, marked with the symbols PM 10 or PM 2,5. It costs about PLN 50 and is really worth buying.
* Dr. Piotr Dąbrowiecki from the Military Medical Institute in Warsaw has a specialization in allergology and is the chairman of the Polish Federation of Asthma, Allergy and COPD Patients’ Associations.