Often eclipsed by other chronic conditions in news coverage, asthma was recently propelled into the spotlight when Moeneeb Josephs, goalkeeper for Bafana Bafana and Ajax Cape Town, was suspended over the use of his asthma medication.

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Although the matter has since been resolved, it goes to the very core of the way many asthma sufferers are disadvantaged daily.

SA has 5th highest death rate
Asthma affects as many as 300 million people worldwide and kills about 180 000 people each year. Locally, as many as one in ten children suffer from asthma, which makes it one of the country’s most common chronic illness. South Africa has the world’s fifth highest death rate from asthma even though effective therapy is freely available.

Asthma causes recurrent breathing problems and symptoms such as breathlessness, wheezing, chest tightness and coughing. During normal breathing, air flows freely into and out of the lungs.

But when asthma isn’t under control, the airways of the lungs are thick, swollen, and inflamed. The airways become sensitive to environmental changes, and an asthma attack can happen easily.

During an asthma attack, the lining of the airways swells, muscles around the airways tighten, and mucus clogs the tiny airways in the lungs, making breathing difficult.

Although it affects people of all ages, asthma is the chronic disease most commonly causing absence from school.

'The unmet needs of asthma'
The theme for World Asthma Day 2005 is “the unmet needs of asthma”. In a local context this is especially relevant. Asthma is becoming increasingly common in rural areas and lack of access to medical care may mean it’s never diagnosed.

The high cost of medications may mean that although effective treatment exists it may not be accessible. Even the treatment given by doctors may not be consistent with evidence-based guidelines. Specifically, there is substantial under-use of inhaled corticosteroids because of unfounded fears about side effects.

By using asthma pumps appropriately and avoiding triggers of asthma such as smoking, asthmatic people can lead completely normal lives, free from any limitation caused by their asthma.

Contrary to popular belief, people with asthma can also exercise, as evidenced by the achievements of many asthmatic athletes: Moeneeb Josephs, Olympic swimmer Roland Schoeman and Sibusiso Vilane, who in 2003 was the first black African to summit Mount Everest.

Active lifestyle encouraged
It is hoped that these achievements will help encourage people to have an active lifestyle after they’ve been diagnosed with asthma.

In South Africa, asthma is underdiagnosed and many people with asthma symptoms do not realise they have the disease.

The causes of asthma are not well understood, and the rapid increase in asthma prevalence around the world is one of the biggest mysteries in modern medicine.

Ten years ago, scientists believed diesel exhaust and other pollutants might be causing the asthma epidemic. They now know the picture to be more complex. The role of genetic factors in asthma and the development of the immune system is being scrutinised.

What is better understood than in the past, is the cause of asthma attacks. Factors that can set off an attack include inhaled allergens (such as dust mites, pollen, and cat and dog allergens), tobacco smoke, air pollution, exercise, strong emotional expressions (such as crying or laughing hard), chemical irritants, and certain drugs (aspirin and beta-blockers).

Every person with asthma reacts to a different set of factors, and identification of these factors and how to avoid them is a major step for each individual in learning how to control their disease.

Effective management possible
Asthma can’t be cured, but it can be effectively managed.

Treatment of asthma aims at control of the disease, meaning that the person with asthma does not experience asthma symptoms or acute attacks, does not have to use quick-relief medication or visit the emergency room, is able to engage in normal physical activity, including exercise, and has normal lung function.

Control of asthma can be achieved in almost all patients, with no side effects from medications, through the implementation of an effective asthma management programme.

The six-point plan
The GINA (Global Initiative on Asthma) programme includes this six-point plan:

• Educate patients to develop a partnership in asthma management
• Assess and monitor severity with measures of symptoms and lung function
• Avoid or control factors that cause asthma attacks
• Establish medication plans for long-term management
• Establish plans for managing asthma attacks

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