Mild asthma could still lead to fatal attack

But doctors say such cases are rare and sufferers need not avoid exercise

By Salma Khalik , Melissa Pang, The Straits Times, 16 May 2012

A MILD asthmatic who has been symptom-free for years could still get a sudden attack that is fatal.

But since such fatal attacks are rare, doctors say those who have their asthma well under control need not avoid anything, including exercise.

Asthma is in the headlines after Defence Minister Ng Eng Hen revealed in Parliament on Monday that one in five servicemen in the Singapore Armed Forces (SAF) suffers from it, but his condition is usually mild - mild enough for most sufferers to be considered combat-fit.

He was speaking in response to a question on pre-enlistment medical screening after a spate of deaths of SAF servicemen. Among those who died was a full-time national serviceman who collapsed while taking part in a training exercise involving smoke grenades. It is still not clear if he had had an asthma attack.

Nationwide, about one in five young children suffers from asthma, but the number goes down to about one in 20 as they get older. The National Health Survey 2010 found 3.9 per cent of people aged 18 to 69 suffer from asthma. The prevalence is higher among young adults aged 18 to 29, at 5.2 per cent.

Asthma is a chronic inflammatory disease of the airways. Its symptoms include wheezing or noisy breathing, and a recurrent cough. About 70 per cent of the children suffer from mild asthma, defined as being well in between attacks which are infrequent.

Associate Professor Anne Goh, a senior respiratory physician at KK Women's and Children's Hospital (KKH), said: 'Children do not outgrow their asthma. But many will have fewer symptoms when they are beyond the age of six to seven.'

But Prof Goh also pointed out that the national numbers may not reflect the true picture of asthma prevalence, since the figures are based on questionnaires, and people sometimes think a child who wheezes must have asthma.

'Many children wheeze with viral infections but do not have asthma. Many adults may have asthma but may not have been diagnosed with it, or may not know it until they are exposed to a trigger,' she explained.

Triggers include allergens such as dust mites, pollen, tobacco smoke, and even stress.

Such a trigger, she added, could cause someone with mild asthma to 'suddenly get a severe attack which could be fatal'.

Too much exercise could also trigger an attack, but there would be symptoms such as shortness of breath and coughing, said Dr Chan Tiong Beng, a respiratory physician in private practice.

These warn the asthmatic to stop, unlike allergen-induced attacks that can come without warning, he added.

It is therefore important for NSmen who suffer from asthma to be aware of the signs and recognise when their condition is worsening.

Dr Chan said someone suffering from mild asthma would get no more than two night attacks a month. This happens when they wake up in the middle of the night coughing or feeling breathless. Night attacks are used to gauge the severity of their condition as there are fewer triggers than in the day.

Those with moderate or severe asthma need to take regular medication to decrease the chances of airway inflammation, he said.

Freelance video editor Rudi Osman, 27, was diagnosed with asthma when he was four. He was hospitalised three times as a child as his asthma attacks were severe. But his condition improved as he reached adulthood.

He was classified as combat-fit when he enlisted for national service in 2004.

During his basic military training stint, he suffered from three minor attacks. Two were triggered by dust as he was carrying out some assigned cleaning chores, and the third occurred during exercise.

'I made my allergy known so I was assigned more administrative work. I was never in a situation where I was forced to continue to exercise when I felt unwell,' he said.

According to the World Health Organisation, about 180,000 people die of asthma each year, mostly in low and lower- middle income countries.

It said asthma is both under-diagnosed and under-treated. Left untreated, asthma can cause permanent damage to the lungs.