A breath of fresh air: Relief for asthma patients

In a way, it’s like drowning, gasping and struggling for air, except it’s not too much water that’s the problem — it’s inflamed and swollen airways preventing life-giving air from reaching the lungs. A severe asthma attack is sheer terror for the patient. One survivor of such an episode described it as “internal claustrophobia.”

The characteristic wheezing, coughing, tightness in the chest and the breathlessness that comes and goes in asthma results from an inflammation of the airways, particularly the bronchial tubes in the lungs. Cells lining these airways swell and glue-like mucus is produced. The smooth muscle encircling the airway constricts, resulting in a much narrowed pathway for a breath of air — and hence the wheezing.

A variety of factors can trigger a response by the hyper-responsive airways of the asthmatic person. For some, it’s an allergic reaction to a specific allergen like dust mites, moulds or animal dander; some respond to environmental irritants such as cigarette smoke, high humidity, polluted air or perfumes. A viral infection such as the common cold, exercise or even cold air can also provoke a reaction.

This chronic disease affects appximately 1.5 million Canadians; an estimated 500 die from the illness each year and the galling thing is that at least 80 per cent of those deaths needn’t have happened. Strangely enough, even among asthma sufferers, there’s still a perception that asthma (from the Greek word meaning laborious breathing or panting) is an insignificant ailment. This attitude can be dangerous because under treating the condition can lead to an alarming asthma attack that requires urgent medical care or some permanent loss of lung function. Medications that relieve asthma symptoms include bronchodilators that quickly, though temporarily, open up the narrowed airways, and anti-inflammatory medication in the form of inhaled steroids, to prevent and control chronic inflammation of the airways.

The treatment of asthma has become more refined and effective over the last 20 years. A variety of asthma delivery systems are currently in use, including dry powder inhalers and the popular metered dose inhalers (MDIs), commonly known as “puffers.” These use a propellant to release a measured dose of medication as the patient breathes in.

However, some patients, particularly young children or elderly people, may have difficulty timing the puff of medication and breath intake while using these traditional inhalers. But doctors, patients and caregivers alike are happy with a new disk-shaped inhaler called Diskus, recently introduced to Canada by Glaxo Wellcome.

Diskus delivers an accurate dose of medication from a sealed blister pack into its built-in holding chamber, allowing patients to inhale when they are ready. There’s no need to coordinate operation of a propellant drug delivery device with their breath intake. Not only do patients receive the full dosage of medication, but the built-in dose counter keeps track of the remaining doses.

According to Dr. Charles Chan, senior staff respirologist and incoming Chief of Respirology at the Toronto Hospital, patients “who don’t have the hand and breath coordination required to use traditional inhalers will certainly benefit from Diskus because it’s easier to use.” He also notes “an accurate measure of drug with every dose is something that I really value as a respirologist, because it means my patients are getting optimal asthma therapy.”