Good Advice for Good Breathing

Mumbai
Chronic respiratory conditions account for a massive health burden in India. According to Global Burden Disease Report, “In India, around 93 million people suffer from chronic respiratory; out of this, around 37 million are Asthmatics. India contributes to only 11.1% of the global asthma burden, it accounts for over 42% of all global asthma deaths making it the asthma capital of the world.”

Respiratory viral infections are the primary cause of asthma exacerbations. For patients at risk of asthma, or with existing asthma, viral respiratory tract infections can have a profound effect on the expression of disease or loss of control. It is important to know that currently there is no evidence of increased infection rates in those with asthma. However, there are estimation, which states that patients with moderate-severe asthma could be at greater risk for more severe disease, but there are no published data to support this.

In view of the effect of respiratory viruses on asthma it is of paramount importance that Asthmatics take utmost care in the current times. In order to completely stop/prevent virus-induced exacerbations from occurring, good asthma management would be critical to implement.

Doctors across India consistently urge asthmatics to take extra care of themselves in current situation. Below are the FAQs

Is it advisable for asthmatics to continue using their corticosteroid inhaler?
Dr Parthasarathi Bhattacharyya, MD(Medicine), DNBE, DM (Pulmonary Medicine). Institute of Pulmocare and Research, Kolkata said, “Stopping steroid inhaler will put the person at risk for developing an asthma exacerbation. In the current pandemic, treatment of an exacerbation will likely require going to the emergency department or urgent care, where the individual has a much higher risk of being exposed to SARS-CoV-2. So, it is always advisable to a patient of asthma not to go to anywhere that increases the chance of exposure to viral infections.”

Dr C Vijay Kumar, Pulmonologist, Apollo Hospitals, Jublihills, Hyderabad said, “Patients with asthma should never stop taking their corticosteroid inhaler unless asked to do so by a medical professional. Stopping the steroid inhaler could put the patient at higher risk of complications with infections as it would impair asthma control. People with asthma are placed on steroid inhalers to keep their asthma under control. In the current pandemic, the best thing a person with asthma can do (with respect to asthma) is to get and keep their asthma under control.”

2.     What should be done to ensure that the inhaler does not get infected? What should an asthmatic do if he experiences worsening of his symptoms?

Dr Rajeev Paliwal, HOD, Chest Department, Shree Krishna Hospital & Pramukhswami Medical College, Karamsad mentioned, “Never share inhalers with others. Wash the inhalation devices regularly to keep them hygienic and clean. Asthmatics should follow the Asthma Action Plan as recommended by their Doctor. If he doesn’t have one, ask the doctor. It is recommended to use an MDI with a Spacer to relieve acute symptoms.”

Dr S K Jindal, Director, Jindal Clinics, Chandigarh and Former Professor & Head, Pulmonary Medicine, at Postgraduate Institute of Medical Education & Research, Chandigarh added, “Use of Nebulisers should be avoided as they carry a high risk of transmitting viral infections because they generate aerosols that can spread infectious droplets for several metres. However, there could be situations when a nebulizer is absolutely required. In such it is of utmost importance to follow Good Nebulization and Infection control practices. Your doctor can advise you on these practices to be followed.”

3.     Should asthmatics go ahead with scheduled appointments or should they avoid going to medical centres or hospitals?
Dr Suryakant Tripathi, Prof and Head of Dept – Respiratory Medicine, KGMU, Lucknow and President, Indian College of Allergy Asthma and Applied Immunology said, “If the asthma is under control avoid visiting to a clinic of a hospital. You may want to contact your doctor telephonically and update him about your progress. If it is absolutely necessary for you to visit the doctor please take a prior appointment and visit him. Asthmatics should avoid making any unscheduled visits to the clinic.”

What should people with asthma do if they have symptoms of fever and cough?

Dr Rajesh Swarnakar, National Secretary, Indian Chest Society, Director & Chief Consultant Pulmonologist, Getwell Hospital & Research Institute, Dhantoli,

NAGPUR mentioned, “Though asthma is associated is with cough and breathlessness, fever is unusual. In such a situation asthmatic, must immediately consult the doctor and follow all instructions given. It is important to continue taking your controller medications and do not stop them. In the current situation, the best thing a person with asthma can do is to get and keep their asthma under control. Stopping a controller medication will put the person at risk for developing an asthma exacerbation—especially as we enter spring allergy season. In the current pandemic, treatment of an exacerbation will likely require going to the emergency department or urgent care, where the individual has a much higher risk of being exposed to infections.”

Dr Parthasarathi Bhattacharyya, MD(Medicine), DNBE, DM (Pulmonary Medicine). Institute of Pulmocare and Research, Kolkata further shared the list of advice for asthmatic:

a.     Do not panic, I often get phone calls from people with sneezing. They think that it could be corona virus infection. No, the chance is less if you have no fever and if you have not exposed yourselves to corona virus infected patients. I recommend people to try any antihistaminic tablet for a few days. If it gives relief in a day or two, it is most likely allergic rhinitis and not the Co-V infection.

b.     Use your medications regularly and properly.

c.     If you have asthma symptoms or need of extra SOS inhaler-use, please discuss it with your doctor on telephone, try to get some help or go with teleconsultation.

d.     Avoid using nebulization: it has to be only when everything fails. To my experience and, of course scientifically too, nebulization is not essential and meter dose inhalers with spacers can do as good as nebulizers. Some people feel happy with nebulizers; it is mostly psychological to me. I hardly treat my patients with nebulization. In COVID time it increases the risk of contamination and spread of the virus.

e.     Try to avoid the precipitants: This is very important. Most of our patients know the situations that precipitate their attacks. Lucky that we are in summer days now; avoid cold drinks, ice cream, smoke, dust, etc.

f.      Try to remain at the best of your health. Please think that for now and also for no point of time you can afford to have an attack or exacerbation. Hence, be meticulous in using medications. Remember that observing the technique in the best possible fashion is most important in inhalation therapy. Please give attention to it. A lot of teaching material is available in the internet and elsewhere, Do use them. Someone in the household van take the charge of the elderly member of the family to assist him or her personally to use spacer properly.

g.     Do not try any experimental therapy now.