This time of the year, i start seeing more patients with poorly controlled asthma – probably due to the cold winter setting in.
Invariably, i have patients and worried parents trying to get to the bottom of their asthma attack, and what had caused the asthma in the first place. It is a very difficult question to answer sometimes, especially when there are many anecdotal reports documented on Google.
It is true that Asthma risk can be higher if mothers consume certain foods while pregnant. But that does not imply that every Asthma trigger should be engaged when a woman is pregnant. In fact, data from more than 60 000 pregnancies was evaluated specifically looking at the consumption of fish and any resultant protective effect on Childhood Asthma. The results showed that there was no evidence of a protective association of fish and seafood consumption during pregnancy with symptoms of asthma and allergic rhinitis in offspring.
Asthma control in children has serious implications for other areas of health. There were 2 studies recently published that evaluated difficult to control asthma in children, with levels of overweight and obesity. The first study showed a significant association between severe persistent difficult-to-control asthma and obesity and the second study showed that many children with persistent asthma are overweight or obese, have limited opportunity for activity, and experience activity limitations. It is therefore important to assess asthma management in children with a view to weight management as well – children with asthma should have a plan to keep active when their asthma is well managed.
For patients whose asthma is controlled and who have a low risk for future exacerbation, current guidelines recommend gradually stepping down treatment to identify the lowest dose needed to maintain control. A recent article showed that adding Immunotherapy at this stage will assist in managing asthma in patients who are classified as moderate asthmatics. A bit more research is needed here – but it provides some hope when it comes to down-titrating asthma medication.
Remember to assess asthma every 6 months with Spirometry measurements – its the best way to ensure control, in my opinion.
Dr Essack Mitha