2023-05-02 13:18:11
02 May 2023
4 million people suffer from asthma in France. While highly effective drugs are available to control this chronic respiratory disease, it kills 900 people every year. How, then, to explain such a figure? On the occasion of World Asthma Day, we asked the question to Pr. Gilles Garcia, pulmonologist, president of the Asthma and Allergies Association.
Each year, in France, asthma kills 900 people. How is this possible when we have all the necessary drugs?
Prof. Gilles Garcia : In France, in 2023, even if we are an industrialized country and all the drugs are perfectly accessible, 60% of the 4 million asthmatics in the country suffer from insufficiently controlled asthma. That is, symptoms are always present in these people. The severity and frequency of these symptoms can put them in a danger zone, with a life-threatening risk in the long term.
What is “insufficiently controlled” asthma?
Prof. Gilles Garcia : It is estimated at two symptoms per week and two recourses per week to emergency treatment, such as Ventolin (a bronchodilator used against the abnormal contraction of the walls of the bronchi, editor’s note). These symptoms include coughing, sputum, chest tightness, shortness of breath in the efforts of daily living and nocturnal awakenings. The latter is really to be considered as a dark orange flag, it is anything but banal.
So the deaths are not due to a sudden and brutal asthma attack, without warning signs?
Prof. Gilles Garcia : We often imagine an asthmatic who is well and who, for such and such a reason – an allergen, a virus – has a cataclysmic asthma attack that leads to death. But in most cases, it doesn’t happen that way. It is about a quantity of daily symptoms, which are expressed in an insidious way. These symptoms eventually become invisible to the patient. He gets used to them and tolerates them. He then encounters a slightly more risky situation than usual (allergic reaction, viral infection, etc.) which will put him in vital danger.
Plea for more therapeutic education
Is this called asthma exacerbation? Is this what endangers the lives of patients?
Prof. Gilles Garcia : Yes. This is an asthma attack. Little by little, the asthma gets worse. We are obliged to increase the amount of emergency treatment, to modify the background treatment with the use of more cortisone. In France, we still speak too often of bronchitis, we must banish this term which does not reflect reality. Because, the risk is there, in these asthma attacks which are not supported and which endanger the patient. The deaths mainly concern people who have had asthma for months, an asthma underestimated either by the patient or by the doctors.
Patients are not sufficiently informed, in your opinion, about this disease?
Prof. Gilles Garcia : Yes because they think they can manage it but they suffer from it. Nothing is done without the patient who must be voluntary, but he must also be properly accompanied and informed by his doctor. He must have all the information to identify the symptoms and know how to react. It’s called therapeutic education, and we know it works. People who benefit from it have fewer exacerbations, take less cortisone, go to the emergency room less. But therapeutic education unfortunately remains very hypothetical in France. However, each patient should be able to benefit from it regularly.
Lifelong treatment
Can asthma be cured?
Prof. Gilles Garcia : Unfortunately no. It is a chronic disease on which research is advancing, especially for vaccines, but for the moment there is no cure. You have to take your treatment for life, even when you are better. If you don’t take it, you’re bound to be overtaken by your asthma. The background treatment is low-dose cortisone, which only passes into the bronchi. With compliance with this treatment, 80 to 90% of patients are doing very well and leading a completely normal life, practicing all the sporting activities they wish to practice.
A final word on the number of asthmatics, more than 4 million in France, and this trend has been steadily increasing in recent decades. For what ?
Prof. Gilles Garcia : In the 1960s, 2% of the population was asthmatic, maybe less. Today, we are at 8%, probably not far from 10% among those under 20 years old. Asthma is the most common chronic disease in France, it is a disease that has exploded over the past 50 years in all industrialized countries. The Western way of life has clearly favored the emergence of disease and allergies. With more than 60,000 hospitalizations per year in France, school absenteeism, professional absenteeism and sick leaves, it is a disease whose cost is very heavy for society.
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