Why Is My Asthma Not Controlled – Despite Compliance To Treatment

Definition

Asthma affects an estimated 6.4% of adults in Malaysia. The number of teenagers with asthma was 9.1 %. Most patients with asthma do well with treatment.

Patients who remain symptomatic despite treatment have uncontrolled asthma

What is uncontrolled asthma?

The Global Initiative for Asthma (GINA) classifies asthma control into three categories (see table below).

Levels of asthma control

Characteristics	Controlled (All of following)	Partly controlled (Any measure present)	Uncontrolled
Daytime symptoms	None (Twice or less per week)	More than twice per week	Three or more features of partly controlled asthma
Limitation of activities	None	Any
Nocturnal symptoms/ awakening	None	Any
Need for reliever/ rescue treatment	None (Twice or less per week)	More than twice per week
Lung function	Normal	Less than 80% predicted or personal best

Why asthma must be controlled.

Uncontrolled asthma impacts negatively on the health and quality of life of its sufferers.

People with uncontrolled asthma are more likely to require emergency care and hospitalization. Some die because of their asthma. Even fetuses of asthmatic mothers are not spared.

Uncontrolled asthma affects job performance, school performance, and family relationships. It also affects the leisure activities people with asthma.

So why is asthma not controlled?

The five main reasons for uncontrolled asthma are:

1. Non-compliance (adherence) to treatment
2. Disease progression
3. Continued exposure to asthma triggers
4. Concomitant medical conditions
5. Inappropriate asthma medication or device

Poor treatment compliance is arguably the most important cause of poor control. In this article, other causes of uncontrolled asthma will be discussed.

Disease progression

In some patients, asthma is a progressive disease. Large epidemiological studies show that people with asthma lose their lung function faster over time. People with asthma who smoke lose their lung function even faster!

Pregnancy affects asthma. Asthma deteriorates in one third of women during pregnancy.

Continued exposure to asthma triggers

Asthma triggers such as haze, dust, smoke and allergen can overcome even the most potent asthma controller medication.

Breathing fresh, clean air helps many people with asthma. Avoid polluted air. Stop smoking!

For some, asthma control deteriorates in their workplace. Asthma control typically returns during holidays or during vacation.

Concomitant medical conditions

Allergic rhinitis and gastro esophageal reflux are two conditions that wreck asthma control. These conditions should be actively sought and treated when asthma is uncontrolled.

Obesity is associated with uncontrolled asthma. How obesity leads to uncontrolled asthma is uncertain. Nonetheless, weight loss helps regain asthma control.

Inappropriate asthma medications or device

Asthma medications are adjusted to achieve control. When asthma is not controlled, asthma controllers are ‘stepped up’, either by increasing dose, combining with other medications or changed.

Asthma medications should not be shared. This is because response to treatment is individualized. It is best to get a doctor’s advice before adjusting one’s medications.

Patients should be familiar with their inhaler devices. The wrong inhaler technique will result in suboptimal drug delivery. Please confirm with health care professionals the right inhaler technique when using new or different devices.

Living with asthma

Living with asthma means living with the least symptom or disability from asthma. If you or someone you know has uncontrolled asthma talk to your nurse or doctor about it.

Non Government Organizations

Lung Foundation Malaysia http://www.lfm.org.my/index.html

Reference

1. A 15-Year Follow-up Study of Ventilatory Function in Adults with Asthma. Lange P.Parner J.Vestbo J.Schnohr P.Jensen G. N Engl J Med 1998; 339:1194-1200
2. Asthma in pregnancy: Management strategies. Jennifer W. McCalister. Current Opinion in Pulmonary Medicine 2013, 19:13-17
3. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control Study. Bateman ED, Boushey HA, Bousquet J, Busse W, Clark T, Pauwels RA. Pedersen SE for the GOAL Investigators Group. Am J Respir Crit Care Med 2004;170:836–844
4. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2012.
5. National Health and Morbidity Survey 2011
6. The Global Asthma Report 2011. The International Union against Tuberculosis and Lung Disease, 2011
7. Severe refractory asthma: an update. Reinier R.L. Wener and Elisabeth H. Bel. Eur Respir Rev 2013; 22: 227–235

 

Last Reviewed	:	13 Oktober 2015
Writer	:	Dr. Goon Ai Kiang
Accreditor	:	Dr. Jamalul Azizi b. Abdul Rahaman