Common cough or chronic disease? Episode 68

Monika Rachtan
Hi Monika Rachtan. I would like to welcome you very warmly to the next episode of the Po Pierwsze Pacjent programme. It turns out that up to 4 million people in Poland have asthma symptoms, but control of the disease is only achieved by 20, even up to 10%. Why is this the case? This is what we will be discussing today with Dr Piotr Dąbrowiecki. Good morning, doctor.

Piotr Dąbrowiecki
Welcome. I bow.

Monika Rachtan
Doctor, do we in Poland today have access to effective asthma treatment?

Piotr Dąbrowiecki
As much as possible. Currently in Poland, patients have access to all asthma medicines that are registered in the world and the patient can be treated in full comfort, i.e. according to the level of their disease. Whether it is mild, moderate, severe or severe, difficult-to-treat asthma. In Poland, we have the tools to help this patient to live a normal life, that is, to live without asthma symptoms.

Monika Rachtan
Then why are the figures I mentioned so bad? Because I think we can say that they are bad. 10 20% people in asthma control out of 4 million. It comes out that we have.

Piotr Dąbrowiecki
400,000.

Monika Rachtan
400,000. This is a very small number of patients who achieve disease control.

Piotr Dąbrowiecki
My theory is educational negligence, that is, having good tools to diagnose asthma and to treat asthma, but something is preventing us from achieving those therapeutic effects that we achieve in clinical trials. Because when you look at the clinical trials of these drugs that later enter normal use, patients achieve this. Compliance, that is, the willingness to follow us in this therapy, well, even to 70%. And here, all of a sudden, we find that. we can show a study that, one year after a patient with a chronic disease like asthma has been prescribed an inhaler that cures them of these symptoms, all of a sudden only 10% people continue with the therapy. So something is wrong. Be it.

Monika Rachtan
Are there negligence? Are they negligence on the part of us patients? Because clearly, if you get a prescription for a medicine, we have said many times in this programme that a prescription does not cure. You have to buy that medicine and take it regularly. But maybe the system, Maybe also the doctors are making some mistakes, from which these numbers result?

Piotr Dąbrowiecki
Of course, if it is that bad, there must be mistakes on both sides. That is, we as doctors assume that the patient knows everything. That is, given a certain, small amount of time for the patient, we focus on making a diagnosis and giving the patient that mythical prescription that should be a prescription for health and may not be redeemed. If the patient rejects at all No, I don't have the disease. It rarely happens that way. It is more likely to be the case, and this is also what the research indicates, that the patient buys the medicine, uses it, achieves an effect. That is, having a cough, wheezing, shortness of breath because these are symptoms of asthma, he has no cough, wheezing, shortness of breath and thinks he has cured himself of the disease just like an infection. He took an antibiotic 7 days passed, but you can't be cured of asthma that way. Depending on the level of the disease, if it is mild asthma, and about half of the patients have mild asthma these symptoms don't start after 2 3 days of stopping the medication, sometimes it is a week, two weeks, sometimes after a month another dyspnoea and exacerbation comes and the patient doesn't connect it.

Monika Rachtan
That is, he doesn't realise that it's because he's gone off his medication, his symptoms have returned again and he's not going back on that inhaler. It is, after all, logical that even the doctor wouldn't know that he had done this, he could just get away with it.

Piotr Dąbrowiecki
And it seems to us that this is impossible. That is, by making doctors think it can't be so after all. They do not ask this question. It seems to them that if they have ordered therapy for, say, three months, then the patient has bought the drugs and is using the drugs. Until you ask the question, you don't know. That is, the patient does not often ask. The doctor asks the question: are you sure you are taking your medication regularly? He is, but did you take it today? And yesterday? Well, I forgot yesterday too. When was that? A week ago? So what? Well, it's been a while. Well, somehow. So it is as if I have been educating both doctors and patients for many years that we need to check. So I have this check list in my records. Check if the patient has taken the medicine, check if the patient has taken the medicine correctly, ask the patient if they are worried about something when it comes to the therapy. After all, we use inhaled steroids, the most effective, best drugs, safe drugs. This is what I wanted to emphasise, but patients are still afraid of them.

Piotr Dąbrowiecki
They are afraid because they have not learnt from us that they are safe and well.

Monika Rachtan
If we have doubts about the use of a treatment regarding safety or precisely the technique of administering a drug, then a conversation with the specialist who diagnoses the disease and the ordination. It may not be possible in the short term when these doubts arise at the very beginning of treatment, because we have an appointment in six months' time, I won't take the medication or I'll forget it for a week. Later on I won't go to that doctor anymore either. And generally it's as if the whole diagnosis has gone to waste and the patient continues to have symptoms. When I have doubts, should I call my GP and make such an educational appointment to let him know that I have been to a specialist, that I have been given these medicines, but I have doubts that the GP will answer my questions.

Piotr Dąbrowiecki
Of course, as much as possible Within the framework of the Polish Cardiac Society or the Polish Lung Association, we educate family doctors precisely on the standards of management in the treatment of asthma, in the diagnosis and treatment of asthma. Ba, a year ago, an agreed consensus was adopted between the PTA, the PHP and the PMR, that is, family doctors, where we defined how to do it, how to diagnose and treat asthma so that it would be effective. So doctors have that information, of course those who want to benefit. Whereas again this education. 25% of GPs have benefited from it. what the standards of therapy are and have read the latest standards for the diagnosis and treatment of asthma. As for specialists, half of the specialists have read and apply yes, half have not read and do not apply.

Monika Rachtan
75% doctors.

Piotr Dąbrowiecki
Family doctors. If we are lucky and come across such an interested GP then of course ok. Looking at what we are also collecting from such a wide field, more or less 20% GPs have entered coordinated care. Presumably these are the ones who have read these standards and it's working pretty well. That is, if a GP in their budget area has this coordinated care, go to them.

Monika Rachtan
Within healthcare. Asthma is one of the disease entities that is recognised and managed. And what additional powers does our primary care physician gain from this coordinated care? What does it mean that he or she gets us into this coordinated care? Will I have less paperwork to fill out? Will I get my medication faster? What real benefits do I have?

Piotr Dąbrowiecki
First of all, the help is in the place where we live most often, i.e. the GP is close by. The specialist is either far away in terms of location or time. In contrast, here I work in such coordinated care. Where do I come in the OPD area? Here I consult 20/30 patients who are referred by their GP, often with suspected asthma, or in turn with asthma already diagnosed, but which, as they say, does not go on treatment. Something is not working there, so the GP wants me to see such a patient and suggest why something might not be working. And at this point the GP, before referring such a patient to me, will often do a chest X-ray. He may do a spiro metric examination and that's it.

Monika Rachtan
And it is.

Piotr Dąbrowiecki
Everything in place. Exactly. I already have such a patient prepared. He has a chest X-ray, he has from the first series. He already has tests done, because the patient can, because the GP can use the money under the entrusted fund to spend on the patient's tests. So I actually come in, already have everything prepared, examine the patient, take a history. And this is where it starts. This is where the next steps start, because I often discover all sorts of difficulties, problems, often in terms of certain beliefs the patient has about therapy, that, for example, a steroid phobia shows up in this patient, which makes treatment impossible, because you can't treat asthma without steroids. And he would like to be treated only with bronchodilators, because he thinks they are effective and steroids cause thrush. Real life. And so often the patient says others make up all sorts of stories about weight, about disorders in various organs that they see appearing after a low dose of steroids, for example. This is impossible.

Monika Rachtan
Doctor, but this leaflet from these steroids is like this. And terrible things are written there. The patient reads it. When he comes home, he doesn't have a doctor at hand again to consult. On the other hand, he goes to websites. Maybe he's on Twitter and there he reads the different opinions of the different people who voice them. Well, how is he not afraid of these steroids? After all, these are the medicines that I have been opening myself lately, and I also remember from my childhood, just when I was being treated for allergy symptoms, that when my mum took out this leaflet, it was so long that it took up the whole table and people were just scared.

Piotr Dąbrowiecki
Well, yes. we operate in an environment and it is somehow arranged. There are leaflets for medicines. These leaflets are actually there to protect the company from like if there's a complication, that the company sort of pays attention to it. But often such complications occur at a rate of 10 in a million or once in a million cases, so at this point it will also be in the leaflet and a particularly suggestible patient will feel that this one in a million is me. So at that point it is difficult for us to reverse it in some way, to turn it around. I often use the argument that I myself have had asthma since I was two years old I have been using medication and I don't look strange, I may have a little bit of hair but it's other factors that have influenced that and this patient starts to get used to it. He asks me about my inhaler so I show the inhaler I use. He says Well are you really taking that? I say well yes, well gosh, well you may have convinced me. So we should. Research shows directly that so-called sick doctors, that is, if the doctor has the same disease as the patient, are more effective in education.

Piotr Dąbrowiecki
Exactly. Perhaps by being more interested, perhaps by the baggage of their own experiences of being involved. That is to say, I have already made some mistakes that I want to protect the patient from now, so that they don't make those mistakes. Perhaps that makes a difference.

Monika Rachtan
Did you become an allergist because you just had asthma and knew how important this control was and wanted to save these patients.

Piotr Dąbrowiecki
Probably yes.

Monika Rachtan
Well, that's what I have too, and showing with examples, with stories of other patients, is some method to tame this disease, to show the patient that indeed asthma is a dangerous disease that significantly affects the quality of life. But proper control of this disease allows you to live a normal life, because people who have, achieve asthma control. They cycle, they go to the mountains, they run. It used to be thought that a person with asthma was to sit in a chair. The best thing to do was to do nothing and just so he wouldn't suffocate. And today, modern medicines allow these patients even with severe asthma to live a normal life.

Piotr Dąbrowiecki
Definitely yes. I remember my own story when, being a little boy dismissed from P.E., I was just a little fat guy who sweated as he went up to the first floor. What changed the moment I got the diagnosis? I started taking an inhaler and started to function normally. So. that perspective sensitises you a little bit to these things. At the moment we know that it is possible to live normally with asthma. That is, except in some special situations, we should not smoke. This is harmful in general, but it is very, very harmful to asthma sufferers. Toxic substances, those that pollute the environment, also harm us as allergy and asthma sufferers. Beyond that, however, physical exercise. You are very welcome. I, as a doctor, have to prepare my patients so that they are able to run a marathon. I have such patients. They run marathons, they have gold medals in swimming. In cycling you can. That is to say, there is already a group of patients who have the disease, who admit they have the disease and at the same time say I take my inhaler, I am able to function normally. This disease does not exclude me from physical activity, it does not exclude me from my profession.

Piotr Dąbrowiecki
I just live life to the full. Just one important thing I have to take medication to protect me from the disease, which means I can breathe normally.

Monika Rachtan
In the treatment of asthma, the technique of taking medication is very important. What is the likelihood that when I go to my primary care physician, or to the allergist or other doctor who is managing my disease? When I ask him about technique, he will pull out an inhaler from the drawer when I don't have mine in my handbag and show me how to take the medicine correctly. Is it a rule that doctors are prepared to educate these patients?

Piotr Dąbrowiecki
In terms of specialists, yes. The research we did that year shows that about 70% of specialists do this regularly and 30% do not. In contrast, this is reversed in the GP, who has to treat everything. Not just asthma, not just diabetes, which means he has a lot of these diseases where he should be the educational expert. So this is 30% of GPs, so we have an opportunity. However, the most important thing is also an appeal to patients. If you have asthma, please show your GP or specialist at your next appointment. When you take your inhaler, see what happens next. You may be making some mistakes that neither you nor your doctor realises are being made.

Monika Rachtan
We encourage you to actually talk to your doctor about this, but also on the internet. Of course, there are educational materials prepared in reliable sources, which show how this inhalation technique should look like. And such sources are also worth using. Among others, the A. The Polish Allergy Society maintains its website, where you can find just such educational content.

Piotr Dąbrowiecki
Definitely yes. Pages of the Polish Geological Society for the Patient. Pages of the Polish Federation of Associations of Asthma, Allergy and COPD Patients. Practical Medicine for the patient. Various sectoral ones. These are just asthma free. That is, there are whether scientific society or patient organisation signature sites where simply. Well it's not cabbage poultices or some other weird therapy, it's just proven knowledge about how to use an inhaler, which is important in the treatment of asthma.

Monika Rachtan
It is in such sources that we should look for reliable, expert-prepared information on our disease. Absolutely. Twitter is not a good place to get expert knowledge. I would just like to remind you that in one of the episodes of our programme, our guest was Maia Mazurkiewicz, a world expert in the fight against disinformation. And we explained to you what disinformation is and why it is created on the Internet, and it also concerns health. Often most often politics, but health in third place. And the actors of disinformation deal not only with topics such as statins, but precisely with steroids. This is also one of their favourite topics, so remember to draw this knowledge from reliable sources. Doctor, but today we talk a lot about the inhaler, and it turns out that the treatment of asthma also includes modern therapies, which are available as part of drug programmes. These are dedicated to patients who fail to control their disease with an inhaler and these prescription drugs. And then the patient is eligible for a drug programme. This is true. What does one have to do? Or what does it take to be a sick person? How sick does one have to be?

Monika Rachtan
How sick do you have to be to qualify for such a programme?

Piotr Dąbrowiecki
What is the easiest way to recognise severe asthma or difficult-to-treat asthma in yourself? If we are taking high doses of inhaled steroids together with other bronchodilators, these are usually two-drug or three-drug preparations that we have to take regularly, and yet we have coughing, breathlessness, waking up at night because of asthma, we cannot tolerate physical exercise or we are taking oral steroids, i.e. drugs in a dose 1000 times higher than the one we take into our lungs. This means that we have a severe form of the disease and, of course, this is influenced by various different situations. Not educated i.e. bad use of the inhaler. That is, I am taking more and more, but because I am taking the wrong one there is no effect. That's one aspect, but often it's a disease with a severe course that makes me have to take more and more. And at this point it is worth reporting this to your GP. Actually, the GP should figure it out, if he is already using high doses of all the drugs and there is no effect He refers you to a specialist. But it is also often the case that the specialist sometimes for different reasons. It's difficult for me to analyse this, but if he doesn't think about it, it's worth asking directly.

Piotr Dąbrowiecki
Doctor, doctor, don't I have severe asthma? After all, I am taking oral steroids. After all, I am using high doses of ground medication and the effect is poor. I have exacerbations all the time, so this is such a patient and for them we have prepared in our outpatient clinics for the treatment of severe asthma, because he works in one of the 60 outpatient clinics for the treatment of severe asthma in Poland. Biological treatment depending on what is the reason that such a severe form appears. Do we, as specialists working in the outpatient clinic, do the so-called hiding phenotype? It sounds very strange, but it consists of trying to discover what is the reason that this disease is so severe.

Monika Rachtan
What tools do you use to determine this?

Piotr Dąbrowiecki
Very simple. A blood morphology with a flare-up, that is, if the patient has too many eo, zoophilic, temporal cells that infiltrate the respiratory system causing swelling of the mucous membrane, excess secretions, bronchospasm activity, then we have treatment against these cells, that is, against it temporally. If a patient has an allergy and for this reason pollen or house dust mite faeces that fall into the nose, into the lungs, cause the same thing again, i.e. swelling of the mucous membrane, excess secretion, bronchospasm, then we have therapy against TH 2, i.e. against allergy, against this syndrome, of symptoms that do not affect only the respiratory system, it is often problems with the upper respiratory tract. Sinusitis, polyps are often atopic dermatitis. So generally there is an allergy with an allergist. I suffer from asthma, or allergic asthma. We also have a preparation that we give and it reverses this adverse t h2 dependent reaction cascade. We also have a medication that we use when the patient has too much IgE class antibodies. Generally looking at the situation whether it is due to allergy or any other cause, and recently we have had those.

Piotr Dąbrowiecki
The possibility of using a drug is what is known as 'gumption', a chemical that works. In this last part of patients not yet covered by our therapy, which is asthma that is difficult, difficult to treat, where all other therapies could not be used, because it was a patient without allergies, because it was a patient without no moment and we have antibodies against TSL. P So alarms, lines that. An alarms is a substance that is formed within the respiratory tract that gives a signal attention, alarms, alerts. Exactly. Get to work. This is where something goes wrong and then also all the cells flow into the lungs and as they flow in it gets swollen. It does. It gets bronchospasm and the patient has coughing, wheezing, breathlessness. It reverses that whole system. That is, at the very top of this inflammatory response we hit a point and it causes patients to stop exacerbating, they don't take oral steroids, they start, Their spiro improves. The media start living normally, they run, they cycle, they go to work, they go to school. They just live life to the full.

Monika Rachtan
It's very complicated. These therapies that you doctor a little bit about so do I? Once I have established that I may actually have severe asthma, I have these symptoms. Despite taking my medication regularly I seem to take it well. I try to do this every day. So how do I get to this severe asthma clinic to start this diagnostic pathway? Because I understand that for the patient themselves this is important. What is the cause of the asthma? For the doctor this is very important, because then he can tailor this treatment to the patient. Well, but it is very complicated, so I would like to put myself in the hands of specialists who will give me this therapy that is dedicated to me.

Piotr Dąbrowiecki
Everything is done on the basis of a referral, because this is a method of therapy that is only available on the so-called National Health Fund, because it is a couple of naturally expensive drugs, so I do not know of any private centre that has carried out such therapy. so we have to get a referral from the family doctor to the specialist. If this specialist works in treatment at a severe asthma clinic, well we have, we are already there. But if not, this specialist must refer to another specialist who works in such a severe asthma outpatient clinic. It's a bit complicated, but it's worth it because it looks like a time-consuming procedure. On the other hand, patients come to me who have not been ill for a month, two or a year. This is the interview. Recently there was a 50-year-old man who has been ill since he was two years old, just like me, who is completely mis-medicated, who in his idea of referral to me had severe asthma. On the other hand, I don't know why, but none of the specialists who treated him before discovered that this patient was only treated with bronchodilators, that is, he was taking rescue medication several times a day, which no longer helped him.

Piotr Dąbrowiecki
So yes. He had a severe operation, meaning his bronchi were contracted, it was playing over his lungs. As I examined him, he had symptoms during the day, he had symptoms at night, but he did not have severe asthma. After applying the therapy I prescribed for him after 3 days he texted me. Revelation! That is, he was an educationally neglected patient. Such a patient can be helped by any doctor or family doctor.

Monika Rachtan
A specialist, on the other hand, needs to be educated to be. just needs to be.

Piotr Dąbrowiecki
Educated to educate others. So that is the element. Whereas we ourselves can enforce such education as patients precisely, go to the doctor already with the installer or go to the doctor, already with a list of questions. Yes, because if something is bothering us, i.e. I'm not taking my medication, well, then say you're not taking your medication. That is, don't hide it, because the mechanism is so opposite to what the patient would like. I don't take medication. I have symptoms. I come to the doctor. The doctor increases the dose. I am afraid of the increased dose. I don't take medication. Doctor sees that I have symptoms. He increases the dose. Only good communication between doctor and patient can break this. That is, admitting to the doctor, I don't take because, and that starts the discussion. Of course, there are times when the doctor gets upset, but the consequences are worth it.

Monika Rachtan
Doctor to emotion.

Piotr Dąbrowiecki
Doctor to help myself, because this is my asthma, my dyspnoea, my problems.

Monika Rachtan
Today we talk a lot about the technique of administering the drug. I am wondering. I don't know if your doctor is going to get into it, if you have an inhaler with you and could show me.

Piotr Dąbrowiecki
In the car.

Monika Rachtan
In the car. Well, that's a pity. Will have to cut that question out then. But ok, well. They say we can take a pause. And could we come? Yeah, yeah, ok, then we'll send the doctor to the car, yeah? Well, if the doctor came and brought it, then I would show.

Piotr Dąbrowiecki
I just don't know if it won't be some kind of formula for advertising something.

Monika Rachtan
We can only hide the question. The doctor says probably.

Piotr Dąbrowiecki
He didn't want to do that. As a rule I try not to do things like that. I'm sure my wife shouts at me.

Monika Rachtan
Okay, okay, that wasn't the question. Let's keep flying. Yes, Cuts. Okay. You mentioned that biologic drugs are administered extra-intestinally. So how?

Piotr Dąbrowiecki
Are they administered subcutaneously? Simply an injection of the drug administered by varying. The frequency of administration of these drugs varies. Most often it is once a month. There are preparations that we give every fortnight. There are preparations that we give once every two months, but the standard time from administration to administration is about 30 days.

Monika Rachtan
Does the patient then have to come again to this asthma clinic? Can this medication administration take place in the primary care physician's office?

Piotr Dąbrowiecki
Can it even take place in the patient's home? Because in most European countries under this kind of home admin, patients simply take these medicines at home because they are very safe. They do it themselves. The reality in our country is that the first three times the patient has to get it at my clinic, because I have to teach the patient, I have to see if they have side effects. It hasn't happened to us, and we have more than 120 patients in our outpatient clinic and there have been no side effects, so it is very safe to use this therapy. Also, this patient has to show us that he is able to do himself. So, as a rule, on the third visit he administers himself in front of us. And then on the fourth visit we are able to give him one or two packs to take home. This is when we usually connect with the patient. On the day of administration, he tells us what is happening to him. And so it goes. So at the moment we have freed up some of these patients from having to travel, because sometimes it's a kilometre and sometimes it's two hundred kilometres to the centre, depending on where someone lives.

Piotr Dąbrowiecki
So for some it was a problem. We also have a patient coming to us that week from Sandomierz. This is already some energy expenditure for such a patient. She has to block the whole day to come to the outpatient clinic. But she can, of course, every once in a while do it herself at home, so at this point it is a good idea. Particularly as it is very safe and there is no, no worry that the patient will harm himself, for example, by using the medicine inappropriately, because he knows how to administer it. Those who don't know how don't get it.

Monika Rachtan
In Poland, we have 60 centres for the treatment of severe asthma. Probably the majority of patients would like to go there at once, in order not to go through this path from one specialist to another. Is there such a map somewhere on the pages of the Polish Cardiac Society? Or maybe there is a list of centres on the website of the National Health Fund, so that you don't have to wander around various outpatient clinics to find your way to a doctor.

Piotr Dąbrowiecki
Of course, there is a list on the website of the National Health Fund. There is a list on the website of the Polish Archaeological Society, on the website of our Federation of Asthma, Allergy and COPD Associations. There is a list where the patient can simply look up and see where there is a biological treatment clinic close to home that deals with this.

Monika Rachtan
The doctor has been treating asthma patients for many years. Is there a story that moves you, doctor? Just a patient who was treated ineffectively, who had asthma symptoms all the time, came to your doctor or to a colleague and received this effective treatment. And it changed his life 180 degrees.

Piotr Dąbrowiecki
This is the kind of story I have in my mind all the time. It is the story of a lady to whom I came as an emergency physician, because I had worked in the emergency medical system for several years, she just happened to have asthma, a severe exacerbation, and having already had several years of education in schools for asthmatic patients, I simply invited this patient to the training we were organising at the time at the Institute of Tuberculosis and Lung Diseases in Płocka Street. I didn't believe that she would come, after all it was so many of these patients. It was still a time then, early 2000s, where these asthma patients actually called the ambulance a lot, because there was no effective treatment either. Especially patients would fall asleep heavily. So it was that once, twice during the duty period we always went to such a patient. So I didn't believe that a bach would come. Two months later, there he is. So we've been friends ever since and after we've been friends for a while, I said it's changed her life. She is currently able to sing professionally, which means she leads a choir, she sings having asthma, severe asthma. She is already on biological treatment.

Piotr Dąbrowiecki
And this is an example that it is possible, that it is possible to realise a dream, that being an allergist, and a sympathiser since childhood, because that is what she is at a certain point, even if the asthma is difficult and severe. It is possible if you just use the latest developments, medical knowledge, but also get involved yourself. She has changed her life. There was also a steroid and medication phobia, because she sang like this. And what do steroids do? Sometimes they affect the voice, they lower the timbre of the voice, can cause such drugs, can cause hoarseness. This is already a problem for the person singing. We changed the drugs so that there is no hoarseness. So it's all possible, There just has to be communication and there has to be a willingness on the part of both the patient and the doctor.

Monika Rachtan
Is such training for patients still organised in our country? Is it possible to come and meet the doctor?

Piotr Dąbrowiecki
Unfortunately, the pandemic here has impacted negatively on training and we are not currently doing such training. We just do them online. We often do webinars for patients, which you can simply attend. These are free webinars whether as a patient federation or as the Polish Allergy Society. So there are things like that happening. We've also recorded a little bit of material like we do now, for example, educational material, where the patient can just go to the website or the federation or the PTA or practical medicine at their leisure and see. I have a problem. I think these drugs are harming me. I go to the treatment tab and there some head is explaining to me what is really going on there, what I should be concerned about and what is just fake news that I should ignore. There are sites like that. We are considering whether to go back to stationary meetings, but we still haven't made that decision. Probably because of lack of time and also because frankly online more people attend such meetings because it can be done from a big room or you can leave work for 15 minutes to or on holiday.

Piotr Dąbrowiecki
From all over the world. Sometimes people log on to such training courses and there they greet us from England or Thailand, for example.

Monika Rachtan
Recently, the first symptoms of asthma, especially allergy-related asthma, can appear as early as childhood. What can parents do to prevent this allergy from turning into asthma in adulthood?

Piotr Dąbrowiecki
First of all, make a diagnosis. That is, if little Johnny or little Anna has a cough, wheezing, shortness of breath, we do not delay. Of course, it could be an infection, because some children, for example, start to get ill when going to kindergarten and it could also be an asthma infection. So it is worth doing all the diagnostics, doing allergy tests. And it is not true that we have to wait until some mythical moment of 3-5 years. If we suspect an allergy in a child, we can then do tests whether the child is one, two or whatever age they are. That is, we do the tests, we try to get a straight answer from the treating doctor, could it be asthma? If so, can I get asthma medication? If yes, how are these medications used? If I do get the medication then at the next meeting I show if my child is using the medication well, as it is from last week. Experience with parents of a 4 year old who has been using asthma medication? Not using an extension tube for a 4 year old? Such a medicine as PMT. That is, such an inhaler archi isolated is not able to coordinate. They pee there.

Piotr Dąbrowiecki
There was something going on in that throat. Were there any complications in the form of thrush? The moment they changed to administering this medicine into a tube and the child breathed through a mask, the symptoms passed. So we always show whether this child is able, whether this adult is able to use these medicines. And so the asthma story begins. If we treat the symptoms well, half of the children are observed like that. At least they stop having symptoms. For various reasons adolescence, good treatment not quite correct diagnosis. Sometimes this happens. On the other hand, because these medications are not able to harm us, so we don't commit Better to recognise asthma than in a person with asthma. Not to recognise it. Why? Because a child's lungs are developing up to the age of 7 8 years. The capacity of the alveoli increases And now this sensitive period between 3 and 6 7 years of age, where often we do not yet make a diagnosis, but we wait. These are chronic infections, chronic infections, but ten times a year, without fever, responding well to steroids. Admittedly, there is clearly doubt, i.e. it is asthma, which has not yet received a diagnosis.

Piotr Dąbrowiecki
So if we treat this little patient well, his lungs will develop properly and he will not be a respiratory invalid. On the other hand, if we don't recognise and only treat the stock, because an antibiotic, sometimes a drug in an onion somethingtam somethingtam, then his lungs will not have 300 million alveoli, but two hundred. It doesn't prevent him from being active, it doesn't prevent him from living. But patients with severe asthma and post-HP, or chronic surgical lung disease, are recruited from this group. So if we have such a toddler, the sooner the diagnosis is made, the better. If we have a toddler with allergies, and we can treat him, i.e. apply a therapy, the only therapy that is able to get him out of the clutches of allergy, then let's do it. Why? Because the use of therapy means that in people with allergic rhinitis, asthma does not start. People with mild asthma do not develop severe asthma. That is to say, it is worthwhile to treat optimally against, automatically and to use all possible means of prevention, including desensitisation.

Monika Rachtan
If this treatment is given to a child of, say, four years old, when this normal lung development has already occurred, do we have a 10 year old. Is it possible that this treatment?

Piotr Dąbrowiecki
God, what is that? Sorry, but it's an alarm clock. I'm the one who turned it off, but the alarm clock is. I'm sorry. Again.

Speaker 3
Excuse me. Okay.

Monika Rachtan
If we give treatment to such a four-year-old and it turns out that the child is developing normally, the lungs have developed normally, the symptoms have disappeared. We have a ten-year-old, already a youngster, is there a chance that this treatment will just be automatically discontinued in this child?

Speaker 3
It all depends.

Piotr Dąbrowiecki
Current asthma treatment standards tell us that if a patient has symptoms infrequently, i.e. once a month, once a fortnight, once a week, we can treat him simply symptomatically. We give him a steroid with a bronchodilator when he needs it and that is ok. You have symptoms, you take, but not a short-acting drug, such as it is, or just a steroid alone with a bronchodilator, so I dilate the bronchi, I act against the cough, it's against the breathlessness, but at the same time I give an anti-inflammatory drug in there, which treats the cause of why these symptoms happened, and after some time this patient stops using the inhaler, because he doesn't have symptoms. Sometimes a year, sometimes two, sometimes three. So we talk about such a remission of the disease. And such a remission can last for a very long time. It all depends on what happens in that person's adult life, whether they start smoking tobacco. If the symptoms return so quickly. Where does he live? If he lives on the main thoroughfare of the city, the symptoms return quite quickly, because exposure to nitrogen oxides on particulate matter increases the risk of the patient's asthma symptoms returning.

Piotr Dąbrowiecki
Did he feel his allergy? Because if not, well, subsequent seasons of sensitisation to grasses, to birch, can beat so severely. The lungs and the immune system of the lungs, that there will be an expression of these symptoms in adulthood. And there are patients who don't wake up until around 50-60 years of age and this disease returns. So at the moment we think that we can't cure the patient, that asthma is a bit like that. It's like, I don't know, it's our affliction that tells us to be careful about certain things, not to smoke, to live in a clean atmosphere, not to come into contact with an allergen. If we live with the disease like that, we can live 100 years in complete comfort. If we make some mistakes, unfortunately this asthma comes back and starts to bother us.

Monika Rachtan
I hope that in today's conversation we have convinced you that it is worth seeing your doctor when you identify asthma symptoms. Let me remind you that 4 million Poles may have asthma and only 2 million 300 thousand have a diagnosis. The doctor is looking for that one million seven hundred thousand patients whom he can and wants to treat effectively. We encourage you to visit your doctor. Thank you very much, doctor.

Speaker 3
Thank you very much.

Monika Rachtan
My guest and your guest was Dr Piotr Dabrowa. This was the One Patient programme. My name is Monika Radwan and thank you very much for your attention.