Rabia Mayet | rabiamayet@radioislam.co.za

10 June 2026

7-minute read

Asthma is often seen as a condition that can be managed with a quick puff from an inhaler, but experts say there is much more to the story. While reliever inhalers can provide fast symptom relief, asthma is fundamentally an inflammatory disease that requires ongoing management and proper treatment.

Many people continue to experience frequent symptoms, disturbed sleep, repeated flare-ups, and limitations in their daily activities despite being on treatment. In South Africa, access to specialist care, advanced therapies, and proper diagnosis remains a challenge for many patients, particularly those living with severe asthma.

Dr Dwayne Koot, Medical Manager at Sanofi South Africa explains that asthma is a “chronic airway inflammation disease,” that causes over-sensitivity in the airways. The symptoms include wheezing, a tight chest, shortness of breath and a hacking cough, varying at different times of the day. Unlike other chronic and benign diseases, asthma is variable and reversible. However, if the inflammation is not addressed, it can lead to end-organ damage or irreversible lung function decline. During an attack, the lining of the airways becomes inflamed, the muscles constrict and mucus builds up, causing the asthma sufferer to struggle with breathing.

Asthma affects much more than just our lungs. It affects sleep, concentration, productivity at work, attendance at school, physical activity, and overall quality of life. When you are not breathing properly, every part of your day can be affected.

Children with asthma face unique challenges, affecting their development, schooling, sport, and overall quality of life. They are susceptible to end-organ damage and may never reach their full lung capacity due to remodelling of their airwaves. Breathlessness and wheezing can continue and accumulate over the course of their lives, in terms of their lifestyle activities. Their emotional wellbeing can also be affected, with fear and anxiety building when anticipating the next attack as well stigmatisation from peers and friends. Nighttime waking can lead to tiredness the next day and result in poor performance at school.

Many asthmatics rely heavily on their reliever inhalers, also called ‘rescue’ inhalers, to open up their airways when experiencing symptoms. In recent years there’s been a paradigm shift from relieving the constriction to controlling the inflammation. While reliever or rescue inhalers contain bronchodilators that relieve symptoms, the controller or preventer inhalers contain corticosteroids that address underlying inflammation. According to Dr Koot, your asthma is not truly under control when you’re using your inhaler more than twice a week. Recent studies show that if you rely consistently on your inhaler, you may be at risk of a “life-threatening exacerbation”.

“Asthma is driven by inflammation,” says Dr Koot. Asthma sufferers have a choice to either suppress this inflammation through the use of corticosteroids, or to modulate it with targeted biologics. The latter treatment can culminate in “real control” in assisting with a type of “remission” if the patient is adherent to the treatment, leading to him or her being able to live a life with little to no symptoms.

Distinguishing between oral and inhaled corticosteroids, Dr Koot mentions that inhalers are the “real mainstay” treatment for asthmatics, whereas oral meds have been “relegated to absolute last line of therapy” and due to their bad side-effects, should only be used when nothing else is working.

So, what are some of the common warning signs or red flags that indicate a person’s asthma may be poorly controlled?

• Frequent use of your reliever or rescue pump.
• Disrupted sleep with frequent wakeups from coughing, wheezing and breathlessness.
• Limitations to daily activity like avoiding exercise, missing school or work regularly, or a decline in social activities.
• Daily wheezing and coughing.
• Excessive use of oral steroids.

South Africa scored relatively low when it comes to access to asthma care, despite having excellent guidelines. However, implementation is one of the biggest barriers patients face in receiving appropriate treatment. Access to healthcare is hindered by long waiting times at clinics, transportation, loss of income for time off, medication shortages, difficulty in getting an appointment with a specialist, accessing the newer biologic treatment, misdiagnosis, and the shortage of lung-testing equipment.

Practical steps that can be taken by healthcare providers, policymakers, families, and patients themselves to improve asthma care and outcomes in South Africa:

• Educate yourself on asthma treatment.
• The Allergy Foundation of SA and asthmasa.org have great resources on asthma.
• Asthmatics should be taught to use their inhalers correctly.
• Avoid oral corticosteroids as much as possible.
• Patients should have a written asthma action plan with the medications they are using, how to use them, and what to do in the event of an attack.
• Patients ought to identify their environmental triggers and avoid them.

Worldwide, there are a thousand deaths per day due to asthma, despite the medical profession having a good understanding of what drives the disease. Asthma is something many of us think we understand, but the reality is that there is so much more happening beneath the surface than most people realise. Many sufferers may be living with poorly controlled asthma without even knowing it.

However, according to Dr Koot, asthma is a condition that can often be managed very effectively when it is properly diagnosed and treated. People do not have to simply accept constant symptoms as part of daily life. Managing symptoms and managing the condition itself are not always the same thing. Feeling better in the moment is important, but preventing flare-ups and protecting long term health is equally so.

Because breathing well should never be something we appreciate only when it becomes difficult.

Listen to the full program with Faaiza Munshi and Dr Dwayne Koot here.