Debunking asthma myths as SA ranks 5th for related mortality globally

South Africa ranked fifth in the world for asthma mortality, with the condition’s prevalence in the country among the highest globally.

A new awareness campaign, #yes2breathe, highlights the need to re-examine asthma treatment based on updated global recommendations overturning decades of asthma care.

The Global Initiative for Asthma (GINA) shows that poor asthma control and over-reliance on reliever inhalers – specifically the short-acting beta2 agonists (SABA) which are blue in colour – are linked to an increased risk of asthma attacks.¹

GINA’s findings point toward the most significant change in asthma management in over 30 years.

Johannesburg-based GP, Dr Marlin McKay, who practices at the Goldman Medical Centre, says that as asthma’s prevalence climbs, so too do the myths surrounding the lung disease.

Exercise and asthma

One of the more pervasive myths is that you should avoid exercise if you have asthma.

“There are so many exercise options to choose from that will benefit those who live with asthma,” explains Dr McKay.

These include less strenuous options like walking, hiking, golf, to higher-intensity modalities such as swimming, jogging, or playing a team sport.

“With the right approach, being active can benefit your asthma symptoms. Exercise can increase lung capacity, it tackles inflammation and will generally improve lung health. If you’re nervous about getting active, speak to your doctor or healthcare professional and work out some fitness goals.”

Dr McKay highlights other common asthma myths and provides guidance for those who are asthmatics, or those who care for them.

Myth: You cannot die from asthma

The fact that SA ranks fifth globally for asthma mortality affirms that asthma can be a life-threatening illness.

Dr McKay urges people to note that SA’s asthma prevalence is among the highest in the world, and adds: “we have to take action, and that starts with examining over-reliance on asthma reliever pumps.”

Myth: You can never rely too much on your asthma pump

“Many asthmatic patients use a maintenance inhaler which contains an anti-inflammatory medicine,” explains Dr McKay.

“They also use a symptom reliever inhaler, which is blue in colour and contains an item that opens up the airways also known as short-acting beta2 agonists (SABA).^1,2”

However, asthma patients frequently underuse anti-inflammatory maintenance therapy and instead, over-rely on SABA reliever therapy, which provides rapid and temporary relief.

“The problem with this approach is it can mask worsening symptoms and actually increases the risk of asthma attacks^3-6,” adds Dr Dr McKay.

Myth: COVID-19 increases your chances of an asthma attack

COVID-19 can affect your nose, throat, lungs (respiratory tract), which in turn may cause an asthma attack.

“We also know that an attack could possibly lead to pneumonia and acute respiratory disease, making patients vulnerable to contracting COVID-19,” explains Dr McKay.

“However, if your asthma is well controlled, and you are not over-using your reliever pumps, you are no more likely to be hospitalised than patients without asthma⁷.”

Myth: Asthma can be cured

Dr McKay confirms that is no cure for asthma, “It is a highly treatable disease, in fact, asthma treatments are so effective that many of my patients have near-complete control of their symptoms.”

Myth: Stress and asthma are unrelated

Our fast-paced life brings with it a lot of stress, and for those with asthma is can be a common trigger10.

Dr McKay explains: “Daily stress, anxiety and panic can make you feel short of breath, which can present as asthma. Many of my patients report that focusing on breathing exercises helps them relax and work through the anxiety at a steady pace. Asthmatics should also avoid alcohol and caffeine and seek support from loved ones.”

Myth: Diet is irrelevant for asthmatics

Dr McKay says there is no specific diet recommended for asthmatics. Certain foods and nutrients can help support lung function and reduce asthma symptoms. Dr McKay explains,

“Eating the right foods gives us energy throughout the day and supports our immune system. Some patients report that eating less refined sugars carbohydrates and more healthy fats helps them breathe easier. The role of vitamin D (found in oily fish such as sardines, salmon, as well as orange juice, egg yolks, mushrooms) and vitamin E (almonds, hazelnuts. raw seeds, kale, broccoli) play an important role in boosting the immune system¹¹.”

Check your reliever reliance

Importantly, those living with, or caring for people with asthma, must separate the facts from the myths, asserts Dr McKay .

“To overturn the prevalence of asthma in South Africa let’s start with helping asthma patients assess their levels of over-reliance.”

The #yes2breathe campaign offers a first-of-its-kind digital assessment tool known as the Reliever Reliance Test. This evidence-based questionnaire will empower patients to assess their over-reliance on their blue reliever inhaler, SABA¹², by answering five short questions.

For more information about the Break Over-Reliance campaign and to take the Reliever Reliance Test, visit www.yes2breathe.co.za or www.rateyourreliance.com. Check Facebook and Instagram for regular updates.

References:

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020 Update. Available at:https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020- report_20_06_04-1-wms.pdf Last accessed July 2020.
2. Burki TM. New asthma treatment recommendations. Lancet Respir Med 2019;7:479.
3. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the asthma insights and reality in Europe (AIRE) study. Eur Respir J. 2000; 16: 802–807.
4. Tattersfield AE, Postma DS, Barnes PJ, et al. on behalf of the FACET International Study Group. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. Am J Respir Crit Care Med. 1999; 160: 594–599.
5. Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol. 2002; 110: 58–64.
6. Larsson, K., Kankaanranta, H., Janson, C. et al. Bringing asthma care into the twenty-first century. NPJ Prim. Care Respir. Med. 2020; 30, 25,
7. That analysis, which looked at data from more than 1,500 patients, found that Covid-19 patients with asthma were no more likely than patients without asthma to be hospitalized. 
8. Price D, et al. Asthma control and management in 8,000 European patients: the Recognise Asthma and Link to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24: 14009.
9. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet. 2017; 391: 350-400.
10. https://my.clevelandclinic.org/health/articles/9573-stress–asthma
11. https://www.lung.org/blog/asthma-and-nutrition
12. International Primary Care Respiratory Group. Blue Reliever Reliance Test. Available athttps://www.ipcrg.org/SABA_Reliance_Questionnaire_publication

Author: Pedro van Gaalen

When he’s not writing about sport or health and fitness, Pedro is probably out training for his next marathon or ultra-marathon. He’s worked as a fitness professional and as a marketing and comms expert. He now combines his passions in his role as managing editor at Fitness magazine.

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