Israel lacks pulmonologists to treat thousands with asthma, COPD, other lung diseases

Tuesday marked World Asthma Day, but with only about 150 pulmonologists to treat it and hundreds of thousands of patients in need of care, there wasn’t much to celebrate in Israel. The result is long queues when seeing specialists and little availability of lung-function institutes, where tests are performed for diagnosis and treatment.

Against the backdrop of a worldwide increase in asthma cases, mainly in industrialized countries, the awareness day has been held annually since 1998 on the first Tuesday of May.

There are about 340 million asthma patients in the world – children, adults, and elderly – and many more than Israeli specialists can handle easily. Asthma is a chronic lung disease with inflammatory and/or allergic features in the respiratory tract that differ in characteristics and severity from person to person.

The disease presents itself with a narrowing of the tubes that carry air to the lungs – the bronchi – and may be accompanied by secretions of sticky mucus from the walls of the airways that block them and make it difficult to get air in and out of the lungs. It is the most common lung disease.

What are the symptoms?

Symptoms include shortness of breath (difficulty breathing during exertion and even at rest), coughing attacks (dry, or with phlegm), wheezing while breathing (due to the difficulty of air passing through the bronchi during asthma attacks), runny nose, watery eyes, pressure and/or chest pains, significant fatigue, dry mouth, changes in facial skin color, feelings of blur or dizziness, and more.

Despite the common belief that asthma starts in childhood, it can occur at any age. Asthma symptoms often appear in early childhood, but in about a third of the cases, they pass by the age of six. There is no absolute certainty as to why it occurs. On the one hand, the connection to heredity is known (although, to date, no specific gene that causes the disease has been found), and on the other hand, the connection to environmental factors, such as exposure to smoke and air pollution, has been proven.

There are also hundreds of thousands of Israelis – almost all of them smokers or passive smokers exposed to others who exhale the toxins – who suffer from chronic obstructive pulmonary disease (COPD), which makes them feel like they’re breathing under water. Other lung disorders include pulmonary hypertension, lung cancer, and tuberculosis.

Some individuals experience mild asthma, while others experience flare-ups, which are periods of heightened inflammation. Approximately one-fifth of patients experience irregular balance, leading to severe and potentially fatal attacks.

When the muscles around the airways narrow, they tighten, causing more mucus to be produced. The irritants may be dust and various pollutants in the air, active and passive smoking, viral diseases of the respiratory tract, substances that cause allergies (which mainly affect children), pollen from plants, dust mites, pet dander, mold, cockroach excrement, expending considerable effort, obesity, active substances found in medicines (such as ibuprofen), and more.

A World Day dedicated to asthma is needed to raise awareness of the disease and its extent, dispel myths, and improve patients’ quality of life. Among the misconceptions is that sufferers should not exercise, but in fact, it is desirable, because it improves lung function. Studies show that a lack of physical activity increases the risk of an asthma attack. Exercise also relieves difficulty breathing and reduces seizures.

Another myth is that asthma is a psychosomatic disease resulting from psychological conditions. Stress may be one of many triggers, but it isn’t among the causes of the disease.

When patients suffering from shortness of breath, coughing (especially at night), and/or wheezing request a diagnosis by pediatricians or family doctors, they are asked about their family background and if any family members suffer from asthma and/or sensitivities and allergies. Then there is a physical examination, and depending on the doctor’s impression, they may be referred for further testing.

A diagnosis is made with the help of an examination of lung function through a simple, non-invasive test called spirometry. The patient blows air into a spirometer to measure pulmonary function and indicate the probability of asthma or other lung diseases, such as COPD, using different pulmonary indices that check the air flow rates during exhalation. In certain cases, it is necessary to perform various challenge tests (inhalation of substances that cause airway constriction, such as methacholine, or a stress test). Treatment includes bronchodilator inhalers, steroids, or non-steroidal anti-inflammatory preparations.