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It is estimated that approx. 10 percent. Poles have asthma, but even half are not aware of it. Thanks to well-chosen drugs, patients can live a normal life – argues Dr. Piotr Dąbrowiecki from the Department of Infectious Diseases and Allergology of the Military Institute of Medicine, President of the Polish Federation of Asthma, Allergy and COPD Patients’ Associations. Unfortunately, in Poland, diagnosis takes a long time, and untreated asthma can lead to serious complications and pose a lethal threat. Dr. Dąbrowiecki explains what are currently available treatments for asthma.
- Asthma is a chronic respiratory disease that is very common
- Common symptoms include dry cough, shortness of breath and wheezing
- To detect asthma, lung spirometry is essential
- The doctor explains that the most common treatment is inhaled steroids. Some patients require additional medications
- Some patients need biological treatment, which is a very effective treatment for asthma. «The effects of biological treatment are spectacular. The patient recovers from day to day! » – emphasizes Dr. Dąbrowiecki
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Journalists for Health Association: What is bronchial asthma?
Piotr Dąbrowiecki, MD, PhD: It is a chronic inflammatory disease of the respiratory system. Symptoms include dry, exhausting cough, wheezing and a feeling of lack of air (shortness of breath). At least two of these symptoms must co-exist to be suspected of having asthma. If, for example, apart from dyspnea, there is neither coughing nor wheezing, ask the question: is it really asthma? The diagnosis, often supported by a spirometry test, is made by an allergist, pulmonologist or family doctor.
Children are most often affected, followed by young boys and adult women. In Poland, it takes about seven years to be diagnosed, and the European average is 3,5 years.
Where does asthma come from?
It is not entirely known. Certainly, genes and environmental conditions play a significant role in its development, such as smoking, chemicals in the environment, highly processed food or polluted air (e.g. smoke from a nearby stove).
Can stress trigger asthma?
Stress does not cause asthma, but it can worsen it.
What are the asthma statistics in Poland?
Research by prof. B. Samoliński (ECAP, 2007) revealed that more than 10 percent. Poles have symptoms of asthma. On the other hand, the analysis of the National Health Fund in 2019 showed that there are just over 45 million patients registered as “bronchial asthma” (J2). This means that twice as many patients do not have a diagnosis or treatment prescribed, and attribute their symptoms to another disease.
Meanwhile, untreated asthma develops and becomes increasingly intense. This can lead to the development of a more severe disease, chronic obstructive pulmonary disease (COPD), which shortens life by 10-15 years. That is why early diagnosis and treatment of asthma is so important. You can live 100 years with well-treated asthma! You just need to choose the drugs correctly.
How is a patient diagnosed with asthma treated?
The basis is the administration of the inhaled steroid into the lungs. It should not be confused with steroids used in oncology, RA or sports. We give the substance in a micro dose, that is 1-10. times lower than in a tablet (systemic steroids). The drug only works in the lungs and heals their inflammation.
If that’s not enough, we include a long-acting bronchodilator. Combined with an inhaled steroid, it forms the basis of therapy in the latest asthma treatment standards. And if these two drugs are not enough to keep the disease stable, add a third drug.
What is triple therapy?
A combination of three types of drugs: an inhaled steroid, a beta-receptor bronchodilator and an anticholinergic drug (also dilates the bronchial tubes, reducing the tone of the bronchial muscles). The patency of the lungs is then much greater, and the patient is much less exacerbated. This is how we treat asthma for the 4th to 5th. level of advancement.
Do Polish patients have access to triple drug therapy?
The May (2022) list of drugs reimbursed by the National Health Fund includes triple-drug preparations administered from one inhaler. It is the result of many months of efforts by the entire community – patients’ associations, doctors and scientists. Adding triple therapy causes the patient to flare up less by half and begin to live life to the fullest.
If triple therapy is not enough, biological drugs should be used. The effects of biological treatment are spectacular. The patient recovers from day to day!
What are the eligibility criteria for biological therapy?
Pretty high. This must be severe (e.g. eosinophilic) asthma where high doses of inhaled steroids and other bronchodilators are ineffective, and the patient must use an oral steroid twice a year due to exacerbation of the disease. He must also have a confirmed disease phenotype, e.g. excess blood eosinophilia. The biological preparation makes eosinophils disappear, and selectively – without destroying other cells.
What is the access to biological therapies in Poland?
From May 2022, biological treatment is more accessible because the criteria have been changed. Blood eosinophilia levels qualifying for biological therapy have been reduced from 350 to 150 per microlitre in people using oral steroids. This means that we are finally able to optimally treat the most seriously ill. I rate these changes very positively!
Most patients are relieved to do so, but there are some who postpone treatment. Unnecessarily, because each delay involves the risk of further exacerbations and complications, such as glaucoma, osteoporosis, diabetes, gastric ulcer and duodenal ulcer, etc.
An important change is also the possibility of continuing biological treatment for as long as the patient needs it, and the therapy brings benefits. Until now, the therapy was discontinued after two years with the possibility of returning to treatment only after further exacerbations of the disease, which was against common sense!
How do asthma patients get infected with the coronavirus?
At the start of the pandemic, they appeared to be particularly vulnerable to the development of COVID-19 and pulmonary complications. It turned out not to be. Asthma sufferers experienced less frequent, milder, and fewer complications, possibly due to chronic use of inhaled steroids. In covid infections, patients with asthma accounted for 1-2%, which is much less than it might seem based on statistics.
Are asthma patients willing to get covid, whooping cough or the flu vaccine?
Asthma or allergy are irrelevant, only whether the patient “believes” or “does not believe” in vaccinations. I urge my patients to vaccinate, and most respond very friendly to it. Every asthmatic patient should be vaccinated against influenza, whooping cough and, after the age of 65, against pneumococci. I also encourage patients to look for reliable, not so-called fictional websites, websites. I recommend, for example, the websites of the Polish Society of Allergology, Practical Medicine for Patients or the website of our Federation. Cooperation with the patient, i.e. compliance is extremely important to the success of asthma treatment. Therefore, for example, before visiting a doctor, patients should have an Asthma Control Test.
We have many refugees from Ukraine who also suffer from asthma. How can you help them?
We meet the refugees. We have prepared materials in Ukrainian for them: printed and electronic materials on the prevention and treatment of asthma. Refugees can take full advantage of the treatment options for this disease in Poland. Information for them is available at: www.astma-alergia-pochp.pl, also in some pharmacies or GP surgeries.
We are talking on the occasion of World Asthma Day in May. What is worth telling today to people with asthma and those who don’t know they have it?
GINA (Global Initiative for Asthma) presents a new slogan every year to accompany the celebration. This year’s focus is on leveling the differences in access to asthma treatment. This is all about getting diagnosed – so that anyone with a cough, wheezing or shortness of breath gets screened for asthma. And if he has it, so that he would start to heal properly and live normally, because today a patient may have asthma and not have its symptoms!