They avoid efforts and sports. Those who suffer from it also fear trips to the countryside. Let’s talk about asthma sufferers, ua chronic airways disease that affects 300 million people worldwide, of which over 4 and a half in Italy. Patients who have very low therapeutic adherence. According to data from Iqvia, a provider of information and technologies in the health sector, in 2020 only 26 per cent of those with asthma followed the prescribed therapies. If you look at the data by age group, it turns out that the under 40s have carefully followed the treatment in 17 percent of cases while the over 60s reach 31 percent. This is for mild and moderate asthma, while for severe asthma (which affects about 8 percent of asthmatics) there are therapies based on biological drugs, in addition to inhalation ones, for which greater adherence. The problem, therefore, mainly concerns mild and moderate asthma.
An underestimated problem
One of the reasons behind the inconstancy in care to be sought in the attitude of the patients themselves: Young people, above all, do not willingly accept the idea of being sick and having to be treated – comments Sergio Harari, director of the Department of Medical Sciences, San Giuseppe MultiMedica Hospital in Milan and professor of Internal Medicine at the State University di Milano – the point that in the case of mild asthma, having no symptoms other than respiratory crises, people believe they are well and therefore do not consider it necessary to constantly follow the therapy. But il asthma treatment should not only be carried out on call during attacks, but for as long as the doctor deems appropriate, often for life.
Excess to avoid
In other cases it may happen that inhalation therapy (based on inhalation of cortisones associated with bronchodilators) is used excessively when needed. If three or four “as needed” administrations per week are exceeded – underlines Gianenrico Senna, allergist and president of Siaic, Italian Society of Allergy, Asthma and Clinical Immunology – it means that the disease is not being adequately controlled. The pandemic may have increased adherence, albeit slightly, but it is still far from a conscious management of this disease.
Treatments
The patient does not give the inhalation therapy the same dignity as the pill treatment – explains Francesca Puggioni, pulmonologist at the Personalized Medicine Center for Asthma and Allergies and head of the ImmunoCenter clinical-organizational section in Humanitas Milan – because the person must provide all the information to treat himself in an aware way: what type of asthma he suffers from, what he can do therapy. Cortisone and bronchodilators taken by inhalation, in fact, not only cancel the symptoms of the respiratory crisis, but also have a preventive role.
Continuous inflammation
An asthma that is not treated properly over time can promote the so-called mechanism of remodeling – continues the expert – the walls of the bronchi, constantly inflamed, thicken so much that they change shape: the bronchus becomes “hyperplastic” and progressively closes. At the age of 50-60, a person may have impaired respiratory function, precisely because he did not treat his asthma properly as a young man.
Adapt to the disease
I patients tend to view this condition as a momentary disturbance and neglect the long-term effects. They believe they don’t have to take medications constantly because they have no obvious symptoms, but in reality those who manage their asthma poorly live their lives in a very limited way. And it falls into the so-called deconditioning syndrome: the patient with asthma, in order not to have attacks, stops making certain efforts, attending environments where irritants or allergens may be present, playing sports. He prefers to limit his quality of life rather than take the drugs that would allow him to live it fully. The goal of personalized treatment, in fact, is to allow a normal life to be led, without deprivation.
Dangers
Also because of mild, uncontrolled and untreated asthma, one can die. An Italian study published in 2016 on World Allergy Organization Journal analyzed a series of asthma deaths that occurred between 2013 and 2015 in Italy: 24 cases of which 17 only in Veneto. The latter were between 10 and 40 years old, and they were all atopic subjects (ie with a predisposition to develop allergies). None of the patients were on regular therapy, but according to medical records, 13 of them were advised to take short-acting beta-agonists (SABAs) and courses of inhaled cortisone. Asthma can never be underestimated. If you suspect you have this disorder you should speak to your doctor. It may also be useful to contact patient associations such as FederAsma and Respiriamo Insieme, which can help manage the disease.
June 23, 2021 (change June 23, 2021 | 15:58)
© REPRODUCTION RESERVED