Prof. dr. HADIARTO MANGUNNEGORO, SpP(K): Siloam Asri Hospital Pulmonologist.

Words Prasiddha Gustanto  Photo Arief Suhardiman

THE LINGERING CONDITION THAT ACTUALLY SHOULDN’T BE

About 300 million people around the globe are afflicted by asthma. Those who have the condition, however, are frequently unable to manage it, suffering attacks for years–or even decades–after developing asthma, even though effective medications are widely available.

For Hadiarto Mangunnegoro, a pulmonologist at Siloam Asri Hospital in South Jakarta, this is a great cause for concern.

“Even though asthma medicine has long been discovered, sold around the world and demonstrated to be effective and safe, the percentage of asthmatics who end up being free of complaints is very small, maybe about 20 to 30 percent,” Hadiarto said.

He attributes the low success rate to a mix of fear and ignorance about asthma–as well as to confusion on how it can be treated. J+ sat down with Hadiarto to discuss misconceptions about the disease. Here are excerpts of our interview.

Misconceptions

Asthma medicine only works via inhaling. Doctors can prescribe inhalers, which can be either “relievers” or “controllers” to help to control symptoms, open airways or reduce inflammation.

Relievers, which don’t control but instead help patients overcome attacks, are used for light cases, where patients suffer from two or three asthma attacks a year.

However, these patients still need to use controller inhalers to supplement their treatment.

Controllers, which are for long-term use, contain small doses of steroids that work on a user’s respiratory system.

Proper control of asthma can help patients to minimize their symptoms–and enjoy a better quality of life.

Most of those afflicted, however, don’t properly control their asthma, Hadiarto said: About 80 percent of those who should regularly take asthma medicine do not do so.

“They are afraid of becoming dependent on medication. They’re also afraid of being on asthma medication for long periods of time,” he says. “Strangely, when it comes to high blood pressure or diabetes medicine, they’re fine with taking long-term doses. But for asthma? They don’t.”

One reason has to do with age. Those with conditions like high blood pressure are typically older, so they are already aware of the effects and the dangers of not taking their medicine.

However, asthma most often emerges in children, who don’t feel like they need long-term treatment. They feel slightly out of breath and end up thinking they don’t need long-term medication–even though the problem gets worse with age.

There is also a common belief that inhalers are dangerous. People often ask for tablets or other such medicines as an alternative.

“They prefer medicine that you take orally, even though oral medicine is what often causes side effects. Inhalers are about effectiveness and safety. The use of inhalers means that we can have exact [dosage] measurements. At worse, the side effects are oral ulcers,” Hadiarto said.

While a patient’s asthma might be incurable, it can be controlled through proper medication, living a healthy lifestyle and avoiding asthma triggers, such as smoking, he says. Stress management is also key, as is avoiding air pollution.

Lifestyle changes have helped many asthmatics enjoy years free of attacks, he said. Some even avoid future attacks entirely.

What can be done

Siloam Asri Hospital has its own respiratory department that provides treatment for a wide variety of illnesses, including asthma.

The department uses a list of best practices to determine the way forward, including evaluating the severity of a patient’s asthma, collecting a patient’s medical history, testing lung function, prescribing medications and evaluating a patient’s response as well as checking for allergies and examining other factors such as the presence of sinusitis or runny noses that might prevent asthma from improving.

The process of bringing the disease under control can take up to two years for those with asthma graded light or medium.

In addition to treatment, the hospital offers group exercises for asthmatics, which have been held once every two weeks for the past six months.

At the end of each session, people can join a question-and-answer session with doctors to get feedback on their condition.

Patients measure their breathing rates before and after exercising with a peak flow meter, which monitors a person’s lung capacity, measured in liters per minute.

“One patient may have 250 [liters per minute] on the peak flow meter. Later, after exercising, it can go up to 290. During the Q-and-A session, I can find out that the patient hasn’t actually been properly taking their medication, so I’d tell that patient to work to get that number up to 400,” Hadiarto said.

A Warning on COPDs

Chronic obstructive pulmonary disease, or COPD, refers to a collection of lung diseases characterized by long-term poor airflow, such as chronic bronchitis, emphysema or chronic obstructive airway disease.

“We as a country love to smoke. Smoking is the main cause of lung cancer and COPDs. We have to anticipate the rise of COPDs,” Hadiarto said.

“We know 60 percent of men smoke, and many of them smoke from 6 or 7 years of age. So, we’ll see younger and younger people getting COPDs–and because people are living longer, the ones who smoke will get COPDs. Unlike cancer, COPDs last for a long time.”

Of those who smoke, 40 percent are underprivileged. This is an even bigger cause for concern, he says, adding that COPDs, along with lung cancer and asthma, will become the diseases of the future in Indonesia.

Fortunately, even the worst afflicted can find a way out. He recalls one patients who was suffering from stage four COPD.

“At first, he would constantly go in and out of the hospital. But because he dedicated himself to consistent medication, as far as I know, he hasn’t been back in a hospital for two years,” Hadiarto said. “He may never really go back to normal state without COPD, but at least his quality of life is better.”

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