NON-communicable diseases (NCDs) have been rising steadily in Malaysia, drawing attention to our poor lifestyle and eating habits.
With the pandemic, the issue of NCDs has been thrown into the spotlight again, as people with these conditions are prone to severe or even fatal complications from Covid-19.
Around 70 per cent of Covid-19 deaths in Malaysia involved individuals who had NCDs, which is a troubling fact as an estimated 74 per cent of Malaysians are afflicted by these diseases.
Individuals with NCDs not only need to exercise extra caution to avoid a Covid-19 infection but also keep their pre-existing medical conditions under control. Asthma and hypertension are among the most common NCDs in Malaysia.
People who have lung diseases like asthma, chronic obstructive pulmonary disease and even lung cancer, naturally feel more concerned because a disease like Covid-19 affects the lungs. Therefore, they are more susceptible to it, says Pantai Hospital Kuala Lumpur consultant pulmonologist Dr Helmy Haja Mydin.
But it's important to have an understanding of what a disease like asthma really is, he adds.
"In an asthmatic patient, what we see are inflamed or swollen airways. The underlying issue is the same. The airways become inflamed and as a result, there are certain clinical consequences. An asthma attack causes the narrowing of the airways, so breathing becomes affected."
Given the current situation, where people have been advised to not go to hospitals unless absolutely necessary, coupled with movement restrictions, the management of patients with NCDs, including those with asthma, may be affected.
THE HURDLES
Those with NCDs also face unique challenges in this pandemic. Dr Helmy explains that the use of a face mask, for example, can feel suffocating to asthmatic patients and sometimes, that alone can directly or indirectly induce an asthma attack.
"We also have people who are particularly sensitive to certain sanitisers and this can trigger an attack too.
Disinfectants can also potentially trigger an asthma attack. To reduce the risk of triggers, patients may consider requesting a non-asthmatic family member to assist with their house-cleaning and avoid entering any room that is being cleaned.
The type of disinfectants used should also be taken into consideration, preferably ones with hydrogen peroxide (no stronger than three per cent) or ethanol (ethyl alcohol) and which do not contain peroxyacetic acid or peracetic acid.
However, those who have their asthma well-controlled do not have a higher risk of developing complications from Covid-19, says Dr Helmy.
"If you have asthma and it's well-controlled, the risk of you developing severe complications from Covid-19 is the same as anyone else."
To keep it well-controlled, using the right inhaler at the right time with the right technique is crucial, he adds. This has always been important in the management of asthma but even more so now.
Those who have a slightly higher risk of complications from Covid-19 are asthmatic patients who also have other co-morbidities like hypertension, high cholesterol, diabetes and obesity.
DOUBLE THE CONCERN
For those with heart disease and high blood pressure, it's double jeopardy. They are more likely to die from complications of their NCDs and if they get Covid-19, they are more likely to die from complications of it too, says Cardiac Vascular Sentral Kuala Lumpur consultant cardiologist Dr Choo Gim Hooi.
Given the pandemic, patients with NCDs are not going to hospitals as often as they should, or are coming in very late, he adds.
"Many don't come for follow-ups, are not refueling medication, or health facilities may be overwhelmed in caring for Covid-19 patients."
Dr Choo adds that there is concern that patients with cardiovascular disease (CVD) and high blood pressure are not getting the care they need because public hospitals are focusing on Covid-19 patients.
When patients with CVD and hypertension get Covid-19, they tend to get more serious manifestations of the disease, needing respiratory assistance and possibly even dying from it.
The Institute for Clinical Research, a research institute under the National Institutes of Health Malaysia, found that around 55 per cent of Covid-19 fatalities occurred in individuals suffering from high blood pressure.
With prolonged lockdowns, eating and sleeping patterns are affected and physical activity is reduced, further worsening the situation for those with NCDs.
Dr Choo advises hypertensive patients to watch their alcohol intake as too much alcohol causes a spike in blood pressure. They must also keep their weight under control, reduce salt in their diet, eat healthy and exercise.
All these healthy choices must be executed on top of medication. Most high blood pressure patients need some form of medication to control their condition, he adds.
Medications for hypertension do not compromise immunity or make them more susceptible to Covid-19.
"Hypertension is a grave killer and often a silent one if not well-controlled, so know your numbers. Always measure your blood pressure."
The pandemic presents a very challenging situation for hypertensive patients, adds Dr Choo.
They are more likely to succumb to Covid-19 if they get it, so besides social
distancing and wearing masks, they must take their medication and see their doctors regularly. Lastly, protect yourself with the Covid-19 vaccine when it is made available to you.