Asthma: Managing Chronic Airways Disease in the Philippines

Asthma affects millions of Filipinos, from children to adults, impacting daily activities, school performance, and work productivity. While asthma cannot be cured, it can be effectively controlled, allowing people with the condition to live active, normal lives. Understanding your asthma—its triggers, symptoms, and treatment—is the first step toward better control.

What is Asthma?

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways (bronchial tubes) that carry air to and from the lungs. In people with asthma, these airways are sensitive and react strongly to certain triggers, causing:

Inflammation: The airway lining becomes swollen and produces extra mucus.

Bronchoconstriction: The muscles around the airways tighten, further narrowing the air passages.

Hyperresponsiveness: The airways overreact to triggers that wouldn't affect people without asthma.

These changes make it difficult for air to move in and out of the lungs, causing the characteristic symptoms of asthma: wheezing, coughing, shortness of breath, and chest tightness.

The Asthma Spectrum

Asthma varies widely in severity and pattern:

Intermittent Asthma: Symptoms occur less than twice a week, with brief flare-ups.

Mild Persistent Asthma: Symptoms occur more than twice a week but not daily.

Moderate Persistent Asthma: Daily symptoms that affect activity.

Severe Persistent Asthma: Continuous symptoms that severely limit activity.

Understanding your asthma severity helps guide treatment decisions.

Common Asthma Triggers in the Philippines

Identifying and avoiding triggers is a cornerstone of asthma management. Common triggers in the Philippine context include:

Environmental Allergens:

Dust mites: Thrive in the warm, humid Philippine climate and are found in bedding, upholstered furniture, and carpets
Cockroach droppings: Common in Philippine homes
Mold: Flourishes in humid conditions
Pollen: From grasses, trees, and weeds
Pet dander: From dogs, cats, and other furry animals

Air Quality Issues:

Vehicle emissions, especially in Metro Manila and urban areas
Industrial pollution
Cigarette smoke (including secondhand smoke)
Burning of garbage and agricultural waste
Cooking smoke from traditional stoves

Weather and Environment:

Sudden weather changes
High humidity
Air conditioning (cold air and poorly maintained filters)
Strong winds carrying allergens

Other Triggers:

Respiratory infections (colds, flu)
Exercise, especially in cold or dry air
Strong emotions (laughing, crying, stress)
Certain medications
Food preservatives and additives
Strong odors (perfumes, cleaning products)

Recognizing Asthma Symptoms

Asthma symptoms can range from mild to severe:

Early Warning Signs:

Frequent coughing, especially at night
Feeling tired or weak during exercise
Wheezing or coughing after exercise
Decreased or changed lung function on a peak flow meter
Signs of cold or allergies

Active Symptoms:

Wheezing (a whistling sound, usually when exhaling)
Coughing that may be worse at night or early morning
Shortness of breath
Chest tightness or pain
Difficulty sleeping due to breathing problems

Severe Attack Warning Signs (Emergency):

Severe shortness of breath where you can't speak in full sentences
Straining chest muscles to breathe
Bluish color in lips or fingernails
Little or no improvement after using quick-relief inhaler
Peak flow readings less than 50% of personal best

Asthma Medications: Understanding Your Options

Asthma medications fall into two main categories:

Quick-Relief (Rescue) Medications:
These provide rapid relief during asthma attacks:

Short-acting beta-agonists (SABAs): Salbutamol (Ventolin) is the most common, relaxing airway muscles within minutes
Taken via inhaler or nebulizer
Should not be needed more than twice a week if asthma is well-controlled
Always carry your rescue inhaler

Long-Term Controller Medications:
These reduce inflammation and prevent symptoms:

Inhaled corticosteroids (ICS): The most effective controllers, reducing airway inflammation
Long-acting beta-agonists (LABAs): Often combined with ICS for better control
Leukotriene modifiers: Oral medications that block inflammatory chemicals
Combination inhalers: Contain both ICS and LABA for convenience
Must be taken daily, even when feeling well

Proper Inhaler Technique

Many asthma patients don't use their inhalers correctly, reducing medication effectiveness. Key points:

For Metered-Dose Inhalers (MDIs):

Shake the inhaler well
Breathe out completely
Place the mouthpiece in your mouth and seal your lips around it
As you begin to breathe in slowly, press down on the inhaler
Continue breathing in slowly and deeply
Hold your breath for 10 seconds if possible
Wait 30-60 seconds before the next puff if needed

Consider using a spacer (a plastic chamber that attaches to the inhaler) to improve medication delivery, especially for children.

Creating an Asthma Action Plan

Work with your doctor to create a written asthma action plan that includes:

Green Zone (Doing Well):

No symptoms
Can do usual activities
Continue regular medications

Yellow Zone (Caution):

Symptoms present (coughing, wheezing, chest tightness)
Waking up at night due to symptoms
Can do some but not all usual activities
Take quick-relief medication and increase controller medications as directed

Red Zone (Medical Alert):

Very short of breath
Quick-relief medications not helping
Cannot do usual activities
Symptoms getting worse
Seek emergency care immediately

Living Well with Asthma

Environmental Control:

Encase mattresses and pillows in allergen-proof covers
Wash bedding weekly in hot water
Keep humidity below 50% with dehumidifiers or air conditioning
Remove carpets if possible, especially in bedrooms
Keep pets out of bedrooms
Don't allow smoking in your home or car
Use air purifiers with HEPA filters

Healthy Habits:

Exercise regularly (with proper warm-up and possibly pre-treatment)
Maintain a healthy weight
Avoid known triggers
Get vaccinated against flu annually
Practice good hand hygiene to prevent respiratory infections
Manage stress through relaxation techniques

Monitoring:

Use a peak flow meter to track lung function
Keep an asthma diary noting symptoms, triggers, and medication use
Attend regular check-ups with your doctor

Asthma in Children

Asthma is the most common chronic disease in Filipino children. Special considerations include:

Many children "outgrow" asthma symptoms, but the condition may return in adulthood
Proper inhaler technique is challenging for young children—spacers and nebulizers are often necessary
School staff should be informed about the child's asthma action plan
Children should participate in physical activities with appropriate precautions
Parents should learn to recognize early warning signs

Asthma should not limit a child's activities or potential. With proper management, children with asthma can participate fully in school and sports.

The Goal: Asthma Control

Well-controlled asthma means:

Minimal or no symptoms
No nighttime awakening
No limitation on activities
Minimal use of rescue inhaler
Normal or near-normal lung function
No asthma attacks

If your asthma isn't meeting these goals, talk to your doctor about adjusting your treatment plan. Asthma control is achievable for almost everyone with the right approach.