SIKESTON - The feeling of being too exhausted to draw the next breath through narrowed breathing passages can be a terrifying experience, yet Missourians with asthma are still not effectively managing their disease.
"We need to educate people more about asthma because this is a very serious disease," said Dr. Musa A. Wadi, pulmonologist at the Southeast Missouri Health Network. "Asthma is a chronic inflammatory disease of the airways and lungs which eventually leads to a closure of the airways."
Data released recently by the Missouri Department of Health and Senior Service's Missouri Asthma Prevention and Control Program indicates many of those living in our state age 18 years or older are not managing asthma effectively.
The 2001 Behavioral Risk Factor Surveillance System data suggests many adult Missourians with asthma continue to experience asthma attacks and that the disease makes a significant impact on the quality of their lives.
"Most of the time asthma patients will be in a stable condition," Wadi said. In this stable condition, they typically only experience minor symptoms such as wheezing and shortness of breath. An "asthma attack," he explained, is "when the shortness of breath becomes progressive with some of the symptoms being excessive coughing, dizziness and distress."
The impact asthma has on a person's life largely depends on how severe their disease is.
The severity is described by one of four terms based on the individual's symptoms and a lung function test. The least severe form is mild intermittent asthma. "Normally these people do not have a lot of symptoms," said Wadi.
The other three classifications are mild persistent, moderate persistent and severe persistent.
"Normally those patients who have severe persistent asthma have more emergency room visits and almost every night have symptoms," Wadi said. "This is the group we need to be careful about."
Wadi added that even those with only mild asthma still run the risk of having an asthma attack, usually brought on by an allergic reaction.
The disease's impact can also be heavily affected by the access to health care. "It may be difficult to visit a specialist," Wadi said. He noted services at SEMO Health Network are "easy to access - we don't ask anybody about money up front."
"The whole Bootheel region has been identified as being a priority population (for asthma)," said Andy Shea of the Bureau of Chronic Disease. He explained this designation was based on a number of factors such as the high incidence of cardiovascular deaths in the area, but is probably mostly due to the health care access issues.
"Asthma is normally more prevalent in urban areas," said Wadi, "because of the problem of air pollution."
Wadi said perhaps the cotton fields and pollens could be a factor in this area's high incidence of asthma as well as the weather. "Hot, humid weather is normally bad for asthma patients," he said. "Also the cold weather is not good."
The first step in helping a patient manage their asthma, according to Wadi, is to educate them and their family about it. "This is a disease without a cure," Wadi said. "They need to know exactly what they are dealing with."
Another key to management is regular follow-ups and communication with a physician. Terry Keck, Missouri Asthma Prevention and Control Program manager, recommends at least one visit every six months.
"Secondly, they have to stick to the regiment the physician has prescribed," Wadi continued. "They need to take their medications on time as prescribed by their physician."
Some good news is as medical research reveals more about the disease, medicines can be even better used to control asthma. Anti-inflammatories, for example, were formerly used just with severe cases. Medical professionals have now learned that these medications are useful for those with mild persistent asthma to prevent asthma attacks from happening.
Watching for signs that the asthma is getting worse and taking immediate action is also important. One useful tool in managing asthma is to use a "peak flow meter" to record and track breathing ability, Wadi said. A minimum air flow baseline number can be established so they know to when to contact their physician.
"Also they should avoid the allergens," Wadi advised. "Avoidance is very important."
Pollens and cat dander are among the worst allergen triggers for asthma, according to Wadi, but there is one both common and easy to avoid: cigarette smoke. "This is really a big trigger - I advise anyone to quit smoking to begin with, but especially if they have asthma. You don't need to smoke if you have asthma." Other triggers include viral infections, cockroaches, dust mites and stress.
A small percentage of people have exercise-induced asthma, "but this is a minor trigger compared with the others," Wadi said. For most people with asthma, "we recommended that they do exercise. It can be very helpful."
Wadi added that it is important to take medications before exercising instead of waiting for symptoms to appear.
Unlike most chronic diseases, asthma afflicts young adults more than old. Most asthma symptoms start at age 4, Wadi said.
Of those polled, young adults ages 18-29 have the highest prevalence of asthma while those age 75 and older have the lowest.
The phone survey used to gather the data did not seek information on those with asthma under age 18, but other data indicates 6.7 percent of Missouri adults live in a household having at least one child with asthma. Shea noted that asthma is the number-one preventable reason for kids missing school.
Not being as common among the elderly, asthma is sometimes overlooked when diagnosing the elderly, Wadi said. "But it can happen in ages 70 and above."