On summer challenges of severe asthma patients

Traveling which requires extreme physical effort or bike-riding, mountain climbing and trekking, or extensive hiking, might risk exacerbating the disease and increase the attacks.

By PROF. DAVID SHITRIT
August 18, 2019 09:15
3 minute read.
WATCH OUT for the summer sun

WATCH OUT for the summer sun. (photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)

During the summer, most of us frequent cooling places like the beach or swimming pools, and take advantage of our days off by going on trips, but for many of chronic patients, and specifically asthma and severe asthma patients,  these days can prove to be a difficult challenge.

In Israel, there are some 500,000 asthma patients, 5 percent of them are defined as severe asthma patients. The severity of asthma is defined by the frequency of attacks, their harshness and the reaction to previous medicinal treatments. The severe asthma patient group includes patients who are treated with high dosage of inhaled steroids, or treated with steroids, and they cope with multiple attacks every year, some of which require hospitalization. For these patients, the disease makes routine activities difficult and influences their quality of life. When the disease is imbalanced, they are at risk of developing a respiratory failure which can be life-threatening and requires immediate medical treatment.

However, as long as severe asthma is balanced, it shouldn’t interfere with daily life, and spirit-lifting traveling and adventures are even encouraged. But familiarity with risk-factors and preparing for them in advance is recommended in order to be able to have a full and pleasant experience.

Traveling which requires extreme physical effort or bike-riding, mountain climbing and trekking, or extensive hiking, might risk exacerbating the disease and increase the attacks. Being exposed to extreme weather shifts from hot to cold, areas with high humidity and long-term exposure to strong odors might be important triggers that one should be aware of and prepared for.

It is best to plan a vacation which demands similar physical effort to the one made on a daily basis, and extreme activity is not recommended for those who are not used to it. Nonetheless, one should remember that physical activity contributes to the maintenance and balancing of the disease and so it would be right to include it. Furthermore, it is important to check with the doctor whether the patient should increase the medicinal dosage before going on vacation.

There are two types of inhalers. Preventing inhaler and a relief inhaler. There are combined inhalers which have both capabilities in one inhaler. Either way, it is important to make sure that the relief inhaler is available and close by at any moment and it is recommended to consider whether to take backup inhalers.  Inhaling one breath from the relief inhaler before a strenuous activity or exposure to any possible risk factor can prevent attacks.

Balance is most crucial in treating asthma and therefore the continuity of the medical treatment is of the highest importance. Some insights came to light during the last few years regarding the asthma-formation mechanisms and accordingly specific biological treatments have been developed which allow full control of the disease’s symptoms even with severe patients. It is important to know that a balanced asthma patient can lead almost the same life as a healthy person.

Recently new medications were added that balance the disease for severe asthma patients as well. New biological medications such as mepolizumab (NUCALA) showed efficiency and long term efficacy and safety, and allowed severe asthma patients to have their quality of life back. Reslizumab (CINQAIR) and benralizumab (Fasenra) also act against the protein-antibody IL-5, which is secreted by the immune system. They successfully decrease the eosinophils and significantly ameliorate the disease for patients. They lead to improvement in the disease status, prevent its attacks and reduce the dosage of steroid taken. The new medications have only fews side effects and are considered safe.

Thanks to all existing treatments, taking the treatment regularly combined with avoiding risk factors can bring severe asthma patient to near full function, which includes physical activities and challenging trips.

Prof. David Shitrit head of Pulmonary Department for Meir Medical Center.


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