"You shouldn't be careless about asthma"

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Around every third German asthma patient does not have their disease under control. Pulmonologist Dr. In the interview, Sven Böhlandt explains why this is and what fatal consequences poorly adjusted asthma therapy can have.

Dr. med. Sven Böhlandt

Dr. Sven Böhlandt is a specialist in pulmonology. He runs his own practice in Bad Tölz, Bavaria.

Dr. Böhlandt, what happens if asthma patients neglect their therapy?

This can have serious consequences. Asthma is a chronic, inflammatory disease of the airways. If the bronchi are constantly inflamed, the structure of the lungs rebuilds over the long term. For some, drugs no longer work as well. Many also develop a very tough lung secretion that can hardly be coughed up. The disease is therefore more severe overall, which limits the quality of life more.

But there are also negative effects that you immediately feel.

That's right. Of course, untreated or poorly adjusted patients have more complaints. You have to cough more and are less productive. You wake up at night with wheezing noises, get breathless attacks or a real asthma attack.

Why is therapy adherence so low in asthma?

With today's therapies, many patients are symptom-free relatively quickly - happily! But this also leads to them becoming carefree and quickly neglecting their treatment afterwards. However, it is not only the lack of adherence to therapy that is a major problem: the patients are often not properly adjusted from the outset.

So the mistake is with the doctors?

Networking between general practitioners and pulmonologists could certainly be better. I recommend seeing a lung specialist relatively quickly if you suspect asthma. As soon as your therapy is well adjusted, it is enough to see a specialist once a year. Pulmonologists also offer training - because asthmatics often don't know enough about their illness.

What do you learn there?

You learn, for example, how to use the inhaler - this is different for different models and is often done incorrectly. Then of course the medication cannot work properly. You also learn to perform a peak flow measurement yourself at home. This is a simple lung function test with which you can measure the maximum flow velocity of the breathing air with a handy device. If the values ​​drop, this indicates a narrowing of the airways.

This allows patients to adapt their therapy themselves.

Yes, but this should always be discussed with the doctor beforehand. Experienced patients can then, for example, adjust their medication independently during the pollen-free period. You will only take it again when the peak flow value drops. This often happens before the patient feels worse. That is why the measurements are so important. Sometimes certain clinical symptoms also appear that signal to the patient that they need to take their medication again.

Many patients are also afraid of doing more harm than good to themselves with cortisone.

This cortisone fear goes back to the beginnings of cortisone therapy in the 1930s. Back then, patients were given extremely high doses with massive side effects. As with any therapy, side effects can occur with cortisone, but if properly dosed you do not have to worry about taking cortisone under medical supervision. What many do not know: Our body produces cortisone itself anyway. As an asthmatic, I would definitely take cortisone with me if I had to go to a desert island.

Children in particular often have difficulties with long-term medication. One study found that they often feel ashamed about using their inhaler in school.

The most important thing here is educational work. The parents and the attending physician should speak openly with the child about the disease and explain why the therapy is so important. It also helps to build the child's self-confidence.

What about the prognosis for asthma - does the disease always accompany you for a lifetime?

Not necessarily. Primarily, of course, it is already a chronic disease, i.e. long-lasting or lifelong. But children in particular have a good chance of getting rid of their asthma again - if the disease is recognized early and treated consistently. Then it disappears in about 30 percent of patients after puberty, but can sometimes reappear in adulthood. In adults, the disease heals much less often - but at least in five to ten percent of cases.

Ultimately, asthma is now a very treatable disease, in which well-adjusted patients have the same life expectancy as healthy people.

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