60 years ago a therapeutic revolution, enabled millions to breathe freely. In these 60 years, asthma has come a long way from stirring negative thoughts in the mind of patients and society; to a disease that can be easily managed and controlled. Since the beginning of recorded history, difficulty in breathing has been known to all. Diagnoses was also a major concern as ever cough and symptoms of breathlessness were very often ascribed to TB, this was up to the 70s. Limited knowledge and understanding of the disease further complicated the diagnosis.
In the first half of the twentieth century, medicines used in the form of tablets, syrups and injections were used. However, little did they help as living and sometimes nearly dying with asthma: these were the memories of desperate measures, terrified patients and nervous doctors. It was then in the 1950s, cortisone, a natural steroid was used as a treatment for asthma. In 1956, MDI (Metered Dose Inhalers) were introduced and sparked a therapeutic revolution. The device would release the drug directly into the airways in the lungs and thereafter bring fast and safe relief.
It took 6 decades to change the perception towards asthma and inhalation therapy. Impact of asthma on quality of life is far greater than as perceived by the patients and the perception of the disease management is far more controlled in the minds of patients. Increased awareness about inhalation treatment (including non-sufferers) to overcome social stigma; the assurance that inhalation is safe and reliable and to know that asthma can be controlled and thus is not a hindrance in living a full life was the major concern areas.
The therapeutic revolution not just brought the change in solution with new technology but the change in patients (asthmatic) outcome. Modern devices have made it easy for patients to lead a NORMAL-ACTIVE life and the fear of stigma has been taken over by the health habits’ of asthma management.
Speaking on the occasion of World Asthma Day, Dr. Amita Nene, Head of Department – Chest, Bombay Hospital said, “Today inhalation therapy is the mainstay of treatment for asthma. Inhaled medicines are integral to the management of respiratory diseases like asthma. They deliver drugs directly to the lungs and hence act faster and at a lower dose, thereby reducing the risk of side effects. Inhaled medications have been shown to improve disease status, control symptoms, reduce the number and severity of exacerbations and improve quality of life.”
The devices used to deliver medicines to the lungs are as important as the medicines themselves. The various inhaler devices available include the pressurized metered-dose inhalers (MDIs), dry powder inhalers (DPIs) and nebulisers. Approximately 90% of physicians in India reported prescribing inhaler devices to at least 40% of their asthma patients in the first clinic visit.
Although contemporary inhaled therapy for asthma has the potential to control disease, as control is often not achieved in real-life practice in most patients. As per the Asia-Pacific Asthma Insights Management (AP-AIM) Survey, all asthma patients in India are either uncontrolled or party controlled. Poor inhaler technique is a key reason for this poor control.
Many patients find pMDIs difficult to use correctly. Poor hand-breath co-ordination is one of the most commonly reported errors with pMDIs. DPIs are breath-actuated and hence overcome the problem of hand-breath coordination. However, a significant proportion of patients fail to use their DPI correctly as well. One of the common errors made by patients with a DPI is the failure to inhale forcefully and deeply through the device, leading to insufficient drug delivery.
Speaking on the disease management challenges, Dr. Upendra Kinjwadekar, Paediatrician & Pulmonologist, Kamlesh Hospital said, “The key challenges in the management of asthma include improving compliance and developing effective and easy-to-use inhalers. Many patients frequently underutilise their medications or use their inhalers incorrectly, which can be detrimental to maintaining disease control. This can cause them to switch to oral therapy, which can be disastrous.”
Innovation and unique products are giving patients the choice of treatment. And equally improving treatment outcomes through adherence initiatives to advice patients about taking treatment regularly and using inhalers correctly and devising user-friendly diagnostic tools and new inhalation devices to enhance the standard of respiratory care in India.
In these past 60 years, patients not only fought the disease but phobia/ myths associated with it. Increasing public awareness and acceptance of inhalation therapy through mass media and social media has brought more patients into correct treatment.
It is important to remember that “breathing freely starts with talking freely”. Let us welcome the ‘Winds of change’.