Asthma is a chronic condition characterized by inflammation of the airways. The inflammation is usually caused by various triggers such as pollen, exercise, or cold air. During these flare-ups, your airways narrow, swell up, and fill with mucus, making it hard to breathe and causing coughing and wheezing.
Respiratory specialist Dr. Alvin Ng shares more about this chronic condition, including ways to manage it and the stigma surrounding asthma management in Singapore.
According to the World Health Organisation, an individual is more likely to develop asthma if a close family member also has it, or they have a pre-existing allergic condition, such as eczema or rhinitis.
Asthma is highly prevalent in Singapore, with approximately one in five children living with the condition. Although some children manage to outgrow asthma over time, it is possible for symptoms to recur after reaching adulthood.
While asthma affects individuals differently, there are several symptoms that commonly occur, such as:
As asthma is a chronic disease, there is no cure for it, but there are ways to control your asthma symptoms and prevent asthma attacks. The most common treatment for asthma is to use an inhaler, which delivers medication directly to your lungs.
There are two main kinds of inhalers used to manage asthma:
The maintenance inhaler is used for long-term asthma control and is meant to be taken every day, even when the individual is feeling fine.
However, according to Respiratory Specialist Dr. Alvin Ng, patients are relying too heavily on rescue inhalers. Although effective, some patients depend on it for symptom relief too often.
“The problem is that many patients rely mainly on the rescue inhaler, which gives immediate relief, but does not treat the underlying inflammation,” Dr. Alvin explains. “You feel better in the moment, but it is just a temporary fix, and you are not treating the underlying problem.”
If you find yourself using the rescue inhaler three or more times a week, it is a sign that your asthma is not as well managed as it should be and you are at an increased risk of asthma attacks.
Local guidelines now stipulate that rescue inhalers should not be prescribed alone. Doctors are encouraged to prescribe both rescue and maintenance inhalers together.
Dr. Alvin explains that asthma is a chronic condition that can be controlled but not cured.
For those who worry about the hassle of using two inhalers, Dr. Alvin shares an asthma management strategy known as Single Maintenance and Reliever Therapy (SMART). Patients use a single inhaler containing both an inhaled corticosteroid to relieve inflammation of the airways and a bronchodilator to provide quick relief from asthma symptoms.
Studies have shown that this approach has been beneficial in preventing serious asthma attacks. This is important because poorly controlled asthma can lead to serious long-term complications.
If left unmanaged, uncontrolled asthma may lead to airway remodelling. This causes the lining of the bronchi and bronchioles to thicken and become less flexible. This leads to progressive loss of lung function, chronic coughing, increased mucus secretion, and sensitivity to asthma triggers. As such, asthma patients may experience more frequent asthma attacks.
In addition to long-term airway damage, poorly controlled asthma may also leave individuals more vulnerable to infections such as pneumonia and influenza.
“When the infection comes and your lung reserves aren’t high, your infection could be severe as you are dealing with two problems instead of just one,” Dr. Alvin states.
Despite the importance of proper asthma control, some patients remain hesitant about long-term treatment. Dr. Alvin notes that some patients may feel apprehensive about using the maintenance inhaler after learning that it contains steroids.
“I tell my patients that the inhalers have steroids in them and the look in their eyes changes,” Dr. Alvin notes. “They think it’s dangerous to be using something that has steroids in it for an extended period of time.”
According to Dr. Alvin, steroids got their bad name from the side effects of oral steroids when taken in high quantities. However, steroids in maintenance inhalers are aerosolised and inhaled directly into the lungs, resulting in very few side effects.
Some parents may also fear that taking steroids may inhibit their child’s growth. However, studies have shown that these effects in low doses of inhaled corticosteroids are small, nonprogressive, and potentially reversible. Meanwhile, inadequate management of asthma has been associated with reductions in growth.
Some may also feel apprehensive about using an inhaler in public because they want to avoid being judged for having a chronic condition. Dr. Alvin points out that there are several celebrities and athletes who have openly discussed managing their asthma, including star soccer player David Beckham, who was pictured using his inhaler during halftime at a soccer tournament.
Ultimately, proper asthma management begins with recognising symptoms early and staying consistent with treatment. Although asthma is a lifelong condition, it does not have to limit a person’s daily life, career, or physical activity when properly managed.
Greater awareness, regular use of preventive treatment, and early medical intervention can significantly reduce the risk of severe attacks and long-term lung damage. Just as importantly, addressing misconceptions surrounding inhaler use and steroid therapy may encourage more individuals to seek treatment early and stay consistent with their medication.
With the right treatment plan and support, many people with asthma will be able to lead active, healthy, and fulfilling lives.
