EDITORIAL |
https://doi.org/10.4103/ijrc.ijrc_64_19 |
Challenges with Present Symptom Control and Risk Reduction of Future Exacerbations in Asthma: Indian Patients' Perspectives
Departments of Critical Care Medicine and 1Anaesthesia, Mazumdar Shaw Medical Center, Narayana Hrudayalaya, Bengaluru, Karnataka, India
E-mail: dr.harishmm@rocketmail.com
How to cite this article: Harish MM, Ramya BM. Challenges with present symptom control and risk reduction of future exacerbations in asthma: Indian patients' perspectives. Indian J Respir Care 2020;9:129-30.
Received: 13-12-2019
Revised: 29-01-2020
Accepted: 25-02-2020
Published: 05-06-2020
Overall, about 4% of the global population were reported to be suffering from asthma in 2017.[1,2] Its prevalence is increasing and may represent the tip of the iceberg.[3] Even when efficient therapeutic options, national and global guidelines are available, many remain symptomatic.[4,5] As a result, there is increased utility of health-care resources across intensive care, emergency room, and hospital.[6] Multidisciplinary coordinated therapy of any chronic disease can improve the long-term patient outcomes, better health-care professional and personal satisfaction, and reduced cost burden on healthcare.[7] As regards asthma management, interprofessional communication, self-care, and a good patient-physician relationship are promising strategies to reduce symptoms, hospitalization and to improve the overall quality of care.
According to health-care data, problems in the proper treatment of asthma can be related to the patient (lack of trust in the treating physician), to the doctor (lack of time or good infrastructure), and to diagnostic errors (other diseases that may mimic asthma).[8,9] Asthmatics may receive limited multidisciplinary care and there may be a lack of interest among the patients in the care of their disease. Studies should be planned to understand the perception of asthmatic patients regarding self-therapy protocols.
Other than the patients themselves, the main people who have a role in the management of asthma are general practitioners and specialists (pulmonologists, physicians, and intensive care physicians). They have a role in its diagnosis, treatment, follow-up, and patient education. The clinical pharmacist, family physician, and occupational therapists also have a small role in asthma management.
Often neglected in the care of asthmatics is educating the close family members and relatives of the patients about the signs and symptoms, precipitating factors, and immediate therapy. It is important to educate them about some preventive strategies that they can easily understand and supportive measures, they could provide their family members suffering from asthma. In developing countries such as India, majority of the asthmatics do not even know the basic aspects of their disease and tend to be casual or negligent.
Very rarely, a few educated patients understand their illness and become more autonomous in their care. An important factor that determines the relationship between asthmatics and care providers is the severity of the disease and its clinical phase. In the community, the general practitioners act as first responders in patients without severe manifestations, and an emergency physician acts as a first responder if the patient presents with acute severe manifestation such as “status asthmaticus.”
Clinical pharmacists, respiratory therapists, and physiotherapists are other caregivers and involved in patient education. When the patient is severely ill and admitted to the intensive care unit (ICU) for mechanical ventilation and other organ support, an intensivist plays a significant role during the phase of weaning from the ICU care. The ICU team can have a significant impact on the patients' self-esteem, understanding of self-care, and immediate troubleshooting. Overall patients' behavior reflects the therapy he has received for asthma at different stages. In developing countries, many patients were unaware and uncertain about the diagnosis of asthma for a long time. Spirometry may not always help in diagnosis, prognosis, and follow-up.[10]
Many rural, uneducated, and low socio-economic category patients get consultation only during acute exacerbation of symptoms and tend to discontinue long-term care and follow-up in the symptom-free periods.[11] This discontinuous care leads to a lack of awareness about self-care and results in poor long-term outcomes.
A physician and patient-integrated approach are very important to asthma therapy, wherein knowledge of self-care and follow-up is an important aspect. In India, some self-care educational activities may be seen in some private or public sector hospitals, however, patients rarely access such programs. Self-management programs may not be successful unless the media gets involved in creating this awareness.
Despite the proven benefit of reducing emergency care, hospitalization and improving the overall quality of life,[12] the nonavailability of protocols for patient care pathways lead to lacunae in the diagnosis and timely treatment of needy patients. Lack of proper communication between individuals can escalate the problem, poor control of disease, and impact patient's economic and social growth.
Many patients in developing countries prefer oral medications as compared to inhalational therapy.[13] Evidence suggests the compliance with inhalers and inhaled medications is very poor.[14,15] Some patients, even when they have inhaler and inhaled medications, were not able to use it in an optimal way to have maximum benefit. This demonstrated the lacunae from health-care providers in motivating and educating the patients appropriately. Other factors which hinder their use may be simple forgetfulness or possibly, cultural beliefs that these devices are unsafe, addictive, difficult to use.[16]
In conclusion, an in-depth knowledge should be provided to the asthma patients in relation to their severity of illness, nature of medications, comorbidities, and troubleshooting during exacerbations, explained to them in their own language to encourage self-care and improve the long-term outcomes.
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