Uncontrolled Asthma and Unmet Medical Need [HD]



8 Complications of Uncontrolled Asthma

1. Reduced ability to engage in normal daily activities

According to David Rosenstreich, MD, chief of the division of allergy and immunology at the Montefiore Medical Center in the Bronx, New York, symptoms of asthma like coughing, wheezing, and shortness of breath could cause you to call in sick from work or school, impacting your productivity. Asthma symptoms may also interfere with sleep or prevent you from exercising or engaging in other leisure or social activities, which may affect your overall health and increase your risk for conditions like heart disease and diabetes. A cross-sectional analysis published in March 2019 in NPJ Primary Care Respiratory Medicine found that people who have poorly controlled asthma were more likely to experience work and overall activity impairments than people who have asthma under control.

2. Severe asthma attacks

According to a review published in September 2019 in the journal Advances in Therapy, up to 10 percent of people who have asthma may actually have a severe type that’s difficult to control, which can increase their risk for potentially life-threatening attacks. Anyone who has had a severe asthma attack knows how scary they can be. A severe asthma attack may cause severe breathlessness or wheezing, difficulty speaking, blue lips or fingernails, or other symptoms that don’t improve after taking your rescue medication.

Following your asthma treatment plan should help prevent attacks, though your symptoms may still flare up at times. However, if you’re not sticking with your prescribed treatment, or if it isn’t working well for your asthma, your attacks may be severe enough to cause a trip to the emergency room (ER) or require hospitalization. In fact, a study of people with asthma in the U.S. and U.K. published in April 2019 in the journal BMC Pulmonary Medicine found that those who have a history of severe asthma attacks that require medical attention are roughly twice as likely to visit the ER or need hospital services for their asthma in the future than those who have never experienced severe attacks.

3. Airway remodeling

If you have asthma, your airways become inflamed, which causes them to swell and produce extra mucus. Unless this inflammation is being effectively treated, it can ultimately lead to a permanent narrowing of the bronchial tubes in your lungs, Dr. Rosenstreich says. This so-called “airway remodeling” is irreversible and can affect how well you breathe. Some people may ultimately need to use an assistive device, like an oxygen machine, to breathe.

It’s believed that everyone who has asthma experiences airway modeling to some degree; however, severe airway remodeling is rare. “When inflammation in the lungs isn’t properly controlled by therapy with corticosteroids or bronchodilators, scar tissue can form and the airways are no longer able to open up, even after using an inhaler,” Rosenstreich notes. “It can begin shortly after the onset of asthma, which is why we encourage people to stick to their prescribed therapy.”

4. Side effects of long-term use of certain medications

According to , the side effects associated with corticosteroid and bronchodilator treatment are rare and, in most cases, minor. Although use of inhalers may cause a hoarse voice or fungal infections in your mouth area.

“Side effects are less common with inhaled medications, because the active ingredient stays in the airway or is rapidly metabolized once it gets into the bloodstream,” Rosenstreich explains.

However, with oral corticosteroids, he adds, you may experience side effects such as disturbed sleep, hyperactivity, and increased appetite. Long-term use of oral corticosteroids may increase your risk of infections, high blood sugar, and osteoporosis.

Talk to your doctor if you’re experiencing any side effects — though you should never stop taking asthma medication without your doctor’s approval.

5. Anxiety and depression

As with many chronic diseases, having asthma may increase your risk for anxiety and depression. A study of adults who have asthma in Korea published in the May-June 2019 issue of Asthma and Allergy Proceedings found that those who had asthma were nearly twice as likely to develop depression as those without the condition.

“A condition like asthma can have a significant psychological toll,” Rosenstreich says. If you’re feeling depressed or anxious, talk to your doctor to ensure you get the treatment you need. “Asthma can be a challenge, but it’s treatable,” Rosenstreich notes.

6. Higher risk of developing gastroesophageal reflux disease (GERD).

A review published in December 2013 in the journal  found that approximately 80 percent of people who have asthma report symptoms of GERD, or acid reflux — and it’s more common in those who have hard-to-control asthma than in those whose asthma is well-controlled. Research also indicates that GERD may worsen asthma symptoms and further reduce the effectiveness of treatment, the authors note.

“There’s some evidence that the bronchodilators used to treat asthma may promote acid creation in the stomach and regurgitation in the esophagus,” Rosenstreich adds. If you begin to experience acid reflux, be sure to talk to your doctor.

7. Obstructive sleep apnea (OSA)

The same Scientifica review notes that risk for OSA, which can cause snoring and breathing difficulties during sleep, is almost twice as high among people who have asthma than it is in those without the condition.

8. Pneumonia and other respiratory infections

Asthma itself doesn’t increase your risk for pneumonia or other types of lung infections. However, a study published in December 2013 in the journal Chest found that people who used the highest-strength inhaled corticosteroids to treat asthma were more than twice as likely to be diagnosed with pneumonia or another lower respiratory tract infection than the healthy control subjects. This may be due to the use of inhalers that aren’t properly cleaned, or because the corticosteroids, while reducing inflammation, inhibit some normal immune system function.

“These infections are a concern with the use of any anti-inflammatory,” Rosenstreich says. He adds that people who use inhalers can also experience fungal infections in the mouth. “That’s why it’s important to rinse out your mouth with water or mouthwash after using your inhaler,” he continues.

How to Reduce Your Risk of Complications

In general, working with your doctor can help you find the appropriate treatment to control your asthma symptoms and reduce your risk for these complications. And, once you find a treatment that works for you, it’s important to stick with it.

“Most people with asthma know the importance of staying on prescribed treatment,” Rosenstreich says. “Because if they don’t, they know they’ll see an increase in their symptoms. But your doctor will remind you that symptoms are only the start.






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Date: 18.12.2018, 13:29 / Views: 62241


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