Severe Asthma: Difficulty in Control and Increased Mortality Risk

Persistent coughing and wheezing or asthma attacks. It is estimated that there are more than 400,000 asthmatics in Hong Kong. On average, 70 to 90 people die from asthma attacks every year, and 20 to 30 of them die in their prime, that is, between 15 and 44 years old. . According to a specialist in the respiratory system, 5 to 10% of asthma patients have severe asthma, and even with large doses of drugs, their condition cannot be controlled. Their 2-year mortality rate is 2.3 times higher than that of the general population, and the chance of exacerbation of the disease is 5 to 5 times higher than that of other patients. 6 times, about 3 to 4 adults suffer from depression as a result.

Doctors advise patients to help control the disease through strategies such as prescribing the right medicine and self-management.

Shi Lanxuan, a specialist in the Department of Respiratory System, explained that asthma generally refers to long-term inflammation of the allergic bronchi. When the bronchi develops, the inflammation will intensify and become swollen and sputum will accumulate, causing difficulty in breathing. About 10% of children and 5% of adults experience symptoms of asthma every year, including persistent or recurrent coughing and wheezing, especially at night and when the seasons change.

30% to 40% of patients suffer from depression

Severe asthma accounts for about 5 to 10% of asthmatic patients. Even if large doses of inhaled corticosteroids are used, combined with a second controller drug and/or oral corticosteroids, the condition will still be out of control, such as being unable to sleep well due to persistent symptoms, etc. ; Risk factors include obesity, smoking and so on.

Last year, a French study analyzed the health of more than 16,000 asthmatics, 739 of whom suffered from severe asthma. The study found that the 2-year mortality rate of severe asthmatics was 2.3 times higher than that of the general population, and 65% of them had been hospitalized due to emergencies. Another study showed that patients with severe asthma had a higher risk of morbidity and death, and the chance of exacerbation was five times that of patients with mild/moderate asthma. In addition, according to clinical observations, about 30% to 40% of patients with severe asthma suffer from unbearable pain and depression.

In fact, as long as patients follow the three major strategies as soon as possible, they can reduce the related risks. Shi said that the first strategy is to prescribe the right medicine. Patients should follow the doctor’s instructions to use inhaled drugs that can take effect quickly. If the condition is serious, they can use oral drugs at the same time, such as oral steroids. However, oral steroids have more than 20 side effects, including increased infection. risk, cardiovascular disease, etc., and the higher the dosage, the higher the risk of complications. Therefore, patients with severe asthma who need long-term medication may consider using biological agents to reduce dependence on steroids.

Doctors teach 3 strategies to reduce risk

The second strategy is self-management. Regularly write an asthma diary and take the Asthma Control Index Test (ACT) to understand your own condition. It is also advisable to use the highest flow rate meter to measure the normal value of expiratory volume when the disease is not attacking, and measure it in the morning and evening when you are not feeling well Data and comparative records, if the difference between the readings is greater, it means that the condition is more unstable, which is helpful for early detection of asthma exacerbation. The last strategy is to start with life, avoid smoking, wash plush dolls every week to eliminate allergens, etc.

In his 60s, Mr. Feng suffered from severe asthma. He went to the hospital 8 to 10 times a year, and he had to go to the hospital every week for 2 to 3 years in the worst case. He described the attack as if he was drowning and couldn’t breathe, and even fainted, “It was like a ticking time bomb, so depressed and anxious, thinking about committing suicide.” Fortunately, after using biological agents and doing more exercises, he has almost fully recovered. He laughed and said that he had a second life, and urged other patients to follow the doctor’s instructions and do their part.

Reporter: Liang Xixin

Art: Zhao Runhong