The topic of this month’s newsletter is not a pleasant one. It’s not pleasant for me to write and it’s not pleasant for you to read. But this topic must be addressed. It cannot be brushed under the carpet.
Deaths due to a sudden catastrophic disease are very tragic and painful. Asthma deaths are all the more tragic because most, if not all of them, are preventable.
Asthma deaths have been extensively analyzed to get information as to how they could have been prevented.
The reasons behind asthma deaths are usually a combination of the following factors. I say a combination of factors because usually a series of errors occurs before a fatal outcome.
Denial : - The patient or, in the case of a child, the parents are in a denial mode. This results in either treatment not being taken or being taken very irregularly, allowing the asthma to deteriorate to a dangerous level.
A disinclination to take steroid inhalers : – Steroids inhalers are both effective and safe in asthma. But most patients are afraid of them fearing possible side effects. Thus asthma remains uncontrolled and triggers like pollens or infections can lead to a catastrophe.
Misjudgment of severity :- Both the patient and the doctors make this mistake. The reason is that past experience of an attack and subsequent improvement dulls them into a false sense of security.
Psychological issues :- About 80% of asthma fatalities have a severe personal or familial psychological issues- depression, family discord, legal problems, alcoholism and extreme poverty. These problems appear to be, and infact are, so grave that asthma treatment is pushed to the back burner.
A severe variety of asthma :- Severe asthma present since age of 3 years and a rare type of asthma called brittle asthma is more at risk for fatality.
Wrong type of treatment : - over reliance on relievers a and under use of preventer inhalers. Use of aspirin or beta blockers.
Others situations associated with asthma deaths are :-
- Exposure to cigarette smoke
- Female Sex
- History of hospitalizations for asthma
- History of severe drug reactions
- Associated severe heart or lungs disease
- Sudden exposure to pollens, dust, emotions.
Asthma deaths usually follow two patterns
- Slow deterioration over 2-3 days with under estimation of severity by all concerned and then suddenly getting very bad. This is more common.
- Very sudden (within hours) deterioration without much warning. This is rarer.
WHAT CAN BE DONE:
- Asthmatics should be cared by an expert. This is more necessary for severe or brittle asthma.
- Asthma patients taking responsibility of regularly taking their preventer inhalers.
- Identifying the asthmatic who is at risk and be extra careful.
- Better awareness that asthma can be fatal, if not properly controlled.