Council for asthma education

Despite the means to control asthma effectively, many asthma sufferers in Malaysia are not availing themselves of such strategies, leading to avoidable problems that can range from frequent asthma attacks to even death in certain circumstances. The Asthma Council of Malaysia aims to rectify the situation.
THE fight against asthma is an ongoing battle for all those involved in the management of the disease.
While the asthmatic patient struggles with the frustration of having a disease that disrupts his/her daily activities, doctors also have a tough time convincing the patient to stay on proper treatment.
For doctors such as Dr Zainudin Md Zin, who specialise in the treatment of asthma, progress comes in small, painstaking steps.
The disease itself is hardly the hurdle, as asthma can be controlled through treatment protocols that have been clearly defined by the World Health Organization.
The challenge lies in getting this message across to patients, so that they will not fall prey to misconceptions and outdated beliefs.
“Asthma is a very common disease and is highly prevalent in all parts of the world, including our country,” says Dr Zainudin, a consultant physician and respirologist.
In Malaysia, asthma affects approximately 10-13% of the total population. That’s almost three-and-a-quarter million people suffering from asthma, a large majority of whom are under-treated and living very poor quality lives.
Recognising the need for a focused effort in educating patients, a group of asthma care experts recently got together to form the Asthma Council Malaysia.
“The asthma council dedicates itself to promoting asthma care and education in the country for public and caregivers,” explains Dr Zainudin, who is the chairman of the council.

Asthma in children
Although asthma affects both adults and children, “it is well known that the prevalence in children is much higher than in adults,” says Dr Patrick Chan, a consultant paediatrician and paediatric chest physician.
It is estimated that one in 10 children in Malaysia have asthma. This is a dismal statistic when one considers the impact of the disease on the child’s life.
“Many children with asthma have a lot of symptoms that affect their well-being, their activities and their performance (in school),” says Dr Zainudin. Missing school and sports activities are common occurrences among asthmatic children.
“One must not look only at the (impact on the) child, but also the impact on the entire family,” Dr Patrick points out. When the child’s activities are limited, this affects the parents, siblings and the rest of the family as well.
The greatest problem with asthma in children, he says, stems from the misconceptions that parents and grandparents have about the disease. Most of these misguided beliefs relate to taboos about the child’s diet or activities.
Some parents even believe that the child should not have a bath when the asthma flares up. “When they come to see me a few days later, they will ask me, ‘My child is a bit smelly, can he bathe?’” Dr Patrick laughs as he relates the quirks of his patients and their parents.
In retrospect, these misconceptions may seem amusing, but they underscore the fact there is a serious lack of understanding about the disease. It is especially alarming when these beliefs affect the course of proper treatment, such as when parents do not allow their children to use the inhaler because they worry about addiction.
The one certainty about asthma in children is that it can be treated with good, effective medication – and ironically, this is the most misunderstood, overlooked fact by parents.


Bleak picture
This fact was confirmed by the Asthma Insights & Reality in Asia Pacific (AIRIAP) study, which was conducted in late 2000 to look at the state of patient knowledge, attitudes and behaviour about asthma across the Asia Pacific region.
The results of the study established what most doctors treating asthmatic patients already knew – that a majority of patients were falling far short of treatment goals.
“The study found that asthma patients generally do not perceive their illness as something treatable and they take their disease lightly,” reveals Datin Dr Aziah Ahmad Mahayidin, a senior consultant physician and respiratory physician.
The numbers are grim. The Malaysian part of the survey showed that more than 40% of patients believed their asthma was well-controlled, when in actual fact their symptoms indicated severe, persistent asthma.
Only one-third of patients had been given a lung function test by their doctor, indicating insufficient monitoring of their condition.
Half of all children with asthma missed school; half of all asthma patients had emergency visits to the hospital or clinic; and one-quarter of all asthma patients experienced sleep disturbance once a week.
“The ARIAP study also showed there is a lot of under-treatment of asthma in Malaysia,” says Dr Patrick.
Only 10% of patients are on inhaled corticosteroids, the most effective treatment to prevent symptoms of asthma.
The revelations about patients’ attitudes and knowledge was hardly news to doctors, but the numbers were alarming enough to kick-start some action in Malaysia.

Council in action
Over a year ago, several concerned physicians, including consultant chest physicians, respiratory physicians, consultant paediatricians, general practitioners and pharmacists, got together to look at how the management of asthma among patients in this country could be improved.
The Asthma Council Malaysia (ACM) is the only professional body in the country aimed at raising awareness about asthma and its treatment.
“The ACM mission is to reduce the morbidity and mortality associated with asthma. We do not want to see patients with asthma getting admitted into the hospital and dying of a disease that can be managed with proper treatment,” says Dr Aziah.
The ultimate goal is for all asthma patients in Malaysia to learn to control their disease and enjoy good quality of life.
“One of the roles of ACM is to educate the public to help them understand what the disease is, why it occurs and what they can do to combat it,” says Dr Patrick.
Education for doctors managing the patients should not be neglected either, says Dr Aziah.
Dr Patrick concurs. “ACM will also upgrade knowledge among doctors and GPs through Continuing Medical Education and (dissemination of) guidelines for the treatment of asthma.”
The first feather in ACM’s hat was when it co-organised the World Asthma Day Jogathon with the Malaysian Thoracic Society to commemorate World Asthma Day 2005 in May.
The annual event attracted almost 1,000 participants, both asthmatics and non-asthmatics.
Other activities in the pipeline for the council are a consumer and medical website, educational print materials distributed at clinics and hospitals, as well as TV information spots.
The council looks forward to more activities that will help them achieve their objective, which is to “increase asthma awareness and encouraged shared responsibility between the community, caregivers and healthcare professionals,” says Dr Aziah.

Note: To contact the secretariat of the Asthma Council Malaysia, call Yushiza Yusof at tel: 03-7956 9098; or fax: 7956 2078.
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