Get asthma off your chest

‘You can control your asthma” — that was the upbeat message on World Asthma Day 2011, celebrated on May 3.

But South African health experts say the reality is more complex, especially if you come from a poor community and have little access to reliable information.

In 2004, the Global Initiative for Asthma (Gina) reported that one in 10 South Africans suffered from some form of asthma and that the country had the fourth highest asthma death rate in the world among five-to 35-year-olds.

According to Professor Robin Green, from the department of paediatrics and child health at the University of Pretoria, the latest figures suggest that asthma leads to 3 000 to 9 000 deaths a year. In a country where TB and HIV are rife, these statistics might not seem that bad but Green thinks otherwise.

The Western Cape, he says, is an asthma flashpoint, particularly in areas such as Khayelitsha where people have difficulty accessing emergency medical care when they are in the throes of an attack.

“[But] you would probably find that rural South Africa is just as bad,” he says, because detailed asthma statistics for the rest of the country are scarce. But it’s not all bad news.

Asthma medicines are now categorised as essential drugs, which means that state health facilities have to provide them for free. Cape Town paediatrician Dr Shirani Naidoo believes that this signals the government’s commitment to combating the disease. Naidoo also praises the National Asthma Education Programme (Naep) for working with medical practitioners to raise awareness.

Professor Refiloe Masekela, head of paediatric pulmonology at Steve Biko Academic Hospital in Pretoria, says that most doctors have very little time to examine their patients thoroughly. This and a poor working knowledge of asthma lead to “misdiagnosis [of the disease] as lower respiratory tract infections”. Naep is worried that asthma education is not part of the broader community health programmes either.

The Mail & Guardian spoke to four rural-based NGOs in Limpopo and Mpumalanga and none focused on the disease in their outreach programmes. Why? In the current health landscape, asthma awareness is simply not a priority, they say. But a lack of knowledge can prove fatal.

“There is a great deal of misinformation about asthma medications and their complications so people worry that the treatment is worse than the disease,” says Naidoo. It can be equally dangerous to under-estimate the effects of asthma and this is not confined to poorer communities.

In a snap survey of asthmatics from middle-class backgrounds and all in their 20s, the M&G found that none knew that asthma was potentially fatal and most were unaware that, if they were experiencing more than two attacks a week, they might need regular controller treatment and not just the reliever pump generally prescribed by doctors.

Lee Simpson, a 24-year-old candidate attorney, described her first experience of asthma when she was just 15: “My fingers and arm started going numb and there was a crushing sensation on my chest. I couldn’t breathe.”

One of her friends, an asthmatic, lent her his reliever pump. She took a puff and immediately felt better, but the attacks continued. Eventually she consulted a doctor at a state hospital and he gave her a pump of her own. But he didn’t give her much information. Her condition deteriorated and the attacks became so bad that she went to a private doctor.

He explained that she needed preventative medication and prescribed a controller pump she would have to use daily. A month’s worth of preventative medication cost R500 — not a problem while she was covered by her parents’ medical aid.

But when she wasn’t, she stopped the medication. Nobody told her that she could get it for free from a state hospital. Now she knows. She is one of the lucky ones.

For more information, go to the National Asthma Education Programme’s website: This article was first published in the M&G

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Sipho Kings
Sipho Kings is the acting editor-in-chief of the Mail & Guardian

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