Good News for Those of Us Who Have Mild Asthma
334 million people worldwide have asthma. About 25 million of them are here in the United States. Luckily, the majority, some 60%, have only mild asthma, sometimes referred to as "intermittent." I'm one of those who have mild asthma. I've never received emergency care or needed to be hospitalized because of my asthma. In fact, I wasn't even diagnosed until I was in my twenties (when my symptoms worsened for a while).
I've always felt as though I was lucky not to be "like most people with asthma." I'm talking about people who struggle to maintain consistent asthma control and frequently need emergency care and changes in their treatment plan. Turns out most asthmatics are like me.
The people who most research is aimed at, and rightly so, are these less stable folks, even though they represent only 40% of all asthmatics. Even so, they probably represent the lion's share of health care expenditures for asthma.
Remember, asthma is a chronic condition for which there is no cure. But, asthma control is something most people with asthma should be able to attain, even those with moderate to severe asthma.
However, the fact that most people with asthma only have mild or intermittent asthma is not the good news I referred to in my headline. In fact, a recent study found that 90% of people who have mild asthma never progress to a more severe form of the disease. Isn't that great?
Most of us with mild asthma are treated either with just a short-acting, rescue inhaler (usually albuterol) or a low-dose inhaled steroid maintenance inhaler. I've been on both in the past, but currently only require an occasional puff or two of my rescue inhaler, usually when exercising.
Details of the Study
A group of researchers in British Columbia, Canada decided to examine the disease course in people in their area with mild asthma over the long term. Here are some key points:
- Administrative health data was gathered for 70,829 patients with mild asthma in British Columbia
- 62% were women; 38% were men
- Time period examined was between January 1997 and December 2012
- All participants were adolescents and young adults with newly diagnosed mild asthma
Although most people with mild asthma remain fairly stable, some don't, for previously poorly understood reasons. Researchers aimed to fill in the gaps of knowledge on this issue with this study.
Each year, for 15 years, the patients were once again classified as to their asthma severity: mild/dormant, moderate, or severe. This ranking was dependent on the level of asthma treatment they received and how many asthma attacks they had.
Researchers found that most of the people who started as mild asthma stayed there. Only 1 in 10 advanced to another, less stable and more severe stage. They also found that there were 4 main reasons why people progressed:
- They managed their frequent symptoms with a rescue inhaler, rather than an inhaled steroid. When you need to use a rescue inhaler more than twice a week, or your symptoms wake you up at night more than twice a month, chances are it's time for a maintenance, or controller medicine. Those are signs that your asthma is not under control.
- They were older adults. In general, older adults with asthma tend to have poorer control of their symptoms. It is also more likely to be serious and disabling.
- They had other disease conditions besides asthma. Any time that your body is battling more than one health challenge, the chances for asthma control diminish. This is especially true if it's another respiratory condition, such as COPD. The chances of having 1 or 2 other co-morbid conditions also rises with age, so in that case, both factors #2 and #3 may be in play.
- If they were on an inhaled steroid, it tended to be a low-dose single med inhaler. The other option for asthma controller treatment is a combination inhaler that contains both a steroid, as well as a long-acting bronchodilator. People that were on the combination inhaler from the outset were less likely to progress.
Mild asthma tends to remain fairly stable over time. However, now that we understand more about why certain people progress and become less stable, while others don't, we can take steps to help them. Both asthma patients and their health care professionals should pay attention to changes in the level of control. When control slips, the treatment plan will need to change, in order to prevent further decline of respiratory function. As a patient, never be afraid to advocate for yourself!
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