5.4 million people in the UK receive treatment for asthma, which equates to one-in-12 adults and one-in-11 children nationwide. Of these asthma patients, a huge number suffer from allergies which can trigger an asthmatic attack and exacerbate pre-existing symptoms – positioning them at the forefront of possible danger when a lack of awareness or planning comes into play. Shuaib Nasser, Consultant in Asthma and Allergic Disease at Cambridge University Hospitals NHS Foundation Trust, depicts why we must elevate patients’ understanding of potential triggers, and ensure that they’re prepared.
Allergic asthma accounts for up to 90 per cent of cases in children and young adults, and 50 per cent in adults. Many children do ‘grow out of’ their condition, yet, while the triggers that more commonly affect younger sufferers are food allergy and hay fever, among older sufferers there are different triggers to watch out for, of which infection can be a common one. These figures put the UK at one of the worst countries in Europe in terms of asthma rates, and data from Asthma UK shows that more people are suffering from attacks than five years ago.
Having their Say
In a new, real-world evidence study conducted on behalf of the British Society for Allergy and Clinical Immunology, in which 5,003 respondents took part, UK asthma sufferers were asked whether they were aware of their asthma triggers, with the aim to discover whether a better knowledge could help patients manage their condition. This study was a retrospective, non-interventional assessment of self-reported symptoms, in which participants completed an internet-based questionnaire and responses were collected electronically using a bespoke media platform.
The research showed that despite NICE guidance advising healthcare professionals to use ‘IgE tests to identify triggers once a formal diagnosis of asthma has been made’, over half of respondents didn’t know what triggered their asthma, and almost 70 per cent had never been tested for allergies. 97 per cent of respondents, however, believed that a better understanding of their triggers could help them to manage their asthma. Of those who had been found to have allergic triggers, 92 per cent said that they had taken steps to reduce their exposure to their triggers and had benefitted as a result. Furthermore, two-thirds of respondents said that they didn’t have a personalised asthma action plan (PAAP) despite NICE guidelines advising GPs to prescribe an ‘asthma self-management programme, comprising a written personalised action plan’ and a further third reported that they didn’t attend an annual asthma review. 70 per cent of respondents reported fluctuations in the severity of their asthma over the course of the year. This suggests that identification of triggers in these patients may help to improve control. Common allergic triggers, at this time of year, in particular, include grass pollen as the most prevalent, as well as birch pollen. If symptoms are more severe during winter months, this could suggest a house dust mite or pet allergy. Other allergic triggers include fungal moulds (e.g. Aspergillus, Alternaria, and Cladosporium) or food.
The Importance of Empowerment
If an asthma sufferer suspects that their asthma has an allergic trigger, it’s important to advise them to begin to monitor their symptoms for potential triggers. Should they begin to document a pattern in the severity of their asthma, and this could be as simple as noticing a change in certain seasons, when travelling abroad, at home vs the office, or when visiting certain friends, then they should bring this up at their annual review. IgE testing can help to confirm or exclude suspected triggers and improve management of asthma using avoidance strategies.
Helping a patient to understand their triggers can empower them with new-found freedom to choose how they manage their asthma. For example, if an asthma sufferer is discovered to have pet dander as an allergic trigger, they can choose to make lifestyle adaptations to reduce contact with their own cat or dog, or pets belonging to others. This does not necessarily mean getting rid of their pet, however, actions such as regularly vacuuming and not allowing the pet in bedrooms, or on furniture, can have a substantial effect.
Encouraging asthma sufferers to take an interest in their condition is key and they are most often enthusiastic when it comes to learning about how they can play a role. Asking questions about their own health and how their actions affect symptoms leads to raised awareness of a patient’s personal circumstances. In turn, this could inspire a desire to take control, self-manage, and reduce exposure to triggers through the use of achievable steps. A PAAP is just one example of how patients can be helped in managing a condition that, in some cases, can be life-threatening.
The cost of asthma to the National Health Service is £1.1 billion, of which over £660 million is spent on prescription drugs. Empowering asthma sufferers to monitor their own condition could lower the chances of attack, and in some case may allow reduced dosage of prescription medicines while maintaining better asthma control. Identification of individual asthma phenotypes and identification of triggers will give every asthma sufferer a deeper understanding of their own asthma, and in the longer-term improve compliance and more appropriate use of inhalers and other asthma medications.
It’s important to remember that asthma is a serious condition, from which around three people every day die. Research carried out by Asthma UK has shown that around every 10 seconds, someone in the UK has an asthma attack, and one-in-11 people don’t believe that asthma can kill. Evidence from this real-world study shows that too few asthma sufferers have their allergies and other non-allergic triggers identified. We should encourage those who take care of asthma sufferers to ensure that everyone with asthma has a PAAP listing personal triggers identified through careful history-taking and blood tests if required.
About the Author
Shuaib Nasser is a Consultant in Asthma and Allergic Disease at Cambridge University Hospitals NHS Foundation Trust. His work on thunderstorm asthma, drug allergy and asthma deaths has improved patient care and led to a DH-funded national enquiry into asthma deaths. He set up and chaired the British Society for Allergy and Clinical Immunology (BSACI) Standards of Care Committee until 2012 and his efforts led to the publication of National Allergy Guidelines. He was a member of the Resuscitation Council Working Group that published guidelines on the management of anaphylaxis. He sat on the Royal College of Physicians National Review of Asthma Deaths Steering Group and chaired the NICE Drug Allergy Guideline. In 2011, he was awarded the William Frankland BSACI award for outstanding services to allergy. He served as President of BSACI from 2015-to-2018.
