DEBUNKING ASTHMA MYTHS AS SA RANKS FIFTH FOR ASTHMA MORTALITY GLOBALLY

South Africa is ranked fifth for asthma mortality in the world and with the nation’s prevalence among the highest globally, the case for better control is clear. 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, Doctor Marlin McKay who practices at the Goldman Medical Centre says as the prevalence in asthma climbs, so too do the myths surrounding the lung disease. He tackles the top ten asthma myths and provides guidance for those who are asthmatics, or those who care for them.

Myth 1: You cannot die from asthma
“For those who don’t believe severe asthma can be a life-threatening illness a wakeup call should be the fact that SA ranks fifth globally for asthma mortality” says Dr McKay. He 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 2: You can never be over reliant on your asthma pump
Dr McKay explains, “Many asthmatic patients use a maintenance inhaler which contains an anti-inflammatory medicine; they also use a symptom reliever inhaler which is blue in colour and contains an item which opens up the airways also known as short-acting beta2 agonists (SABA). 1,2 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 the worsening of symptoms and actually increases the risk of asthma attacks.” 3-6

Myth 3: COVID-19 increases your chances of an asthma attack
Dr McKay explains that 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. 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 4: Asthma medications are habit-forming and dangerous
To debunk this myth, Dr McKay explains that it is important to distinguish between asthma reliever inhalers, “The use of SABA blue inhalers to control asthma symptoms increases the risk of asthma attacks1,8,9. Patients are recommended instead the use of a low dose inhaled corticosteroid (ICS)-formoterol therapy as needed as the preferred reliever therapy across all asthma severities,1”says Dr McKay.

Myth 4: 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 6: 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. From less strenuous options like walking, hiking, golf, to increasing the pace by 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.”

Myth 7: 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 8: Sleep habits are unimportant if you have asthma
The bottom line is, if you are not sleeping well you have less energy and resources to cope with the next day. “Getting a good night’s sleep cannot be understated and there is a lot you can do to help yourself. For example avoid caffeine and strenuous exercise for several hours before bedtime; avoid watching TV or being on a device in bed; only go to bed when you are tired; and sleep for the same amount of hours every night,” says Dr McKay.

Myth 9: An inhaler cancels the effects of smoking with asthma
“The truth about smoking is that it causes irritation and damage to the lungs and will make your asthma worse! Asthmatics have sensitive airways inside their lungs and triggers can cause these airways to narrow – one such tigger is smoking. On top of that, smoking irritates asthma symptoms, and smokers can have more frequent and more severe asthma attacks. Stop smoking,” advises Dr McKay.

Myth 10: 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 e.g. sardines, salmon, orange juice, egg yolks, mushrooms etc) and Vitamin E (almonds, hazelnuts. raw seeds, kale, broccoli etc) play an important role in boosting the immune system.11”

To conclude Dr McKay adds, “Importantly, those living with – or caring for people with asthma, must separate the facts from the myths. 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 https://www.rateyourreliance.com/

Activity ID: ZA-2468 | Expiry Date: Sept 2022

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.
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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.
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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 at: https://www.ipcrg.org/SABA_Reliance_Questionnaire_publication [Last accessed: July 2020].