(CNS): According to the The Global Asthma Report 2011, published by The International Union Against Tuberculosis and Lung Disease (The Union) and the International Study of Asthma and Allergies in Childhood (ISAAC): Asthma is the most common chronic disease among children and also affects millions of adults. The burden of asthma has been growing over the past 30 years, particularly in low- and middle-income countries, where a large majority of asthma patients are treated only on an emergency basis – when they arrive at a health care facility with an acute attack of asthma. Part of the problem is that quality-assured asthma inhalers, that are essential to well-managed asthma, are either not available or are prohibitively expensive. Another barrier is that the health services lack the strategy, systems and trained staff for providing good asthma care. The Union urges the international community and countries to make sources of funding rapidly available, so that access to quality-assured essential asthma medicines and asthma care can be scaled up and improve the patients' quality of life, significantly reducing costs for patients and health systems.
The most common symptoms of asthma are cough and breathlessness which are aggravated by exposure to trigger allergens. The bronchi of an asthmatic patient are hyper sensitive. Any contact with a trigger allergen results in their inflammation (producing cough) and spasm (producing breathlessness). Apart from genetic factors, different external factors can trigger asthma—inhaled allergens (pollen, dust mites, animal fur, mould, cigarette smoke, cooking fumes, vehicle exhaust,) and some miscellaneous ones (emotional stress, certain foods, acidity or reflux problem, obesity, changing weather).
The question is how to overcome these obstacles. According to Professor Dr Surya Kant, Head of the Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU), “We have primary, secondary and tertiary prevention methods at our disposal. If one of the parents has asthma then there are 25% chances of the child having it too. If both parents are asthmatic then this increases to 50%. So, primary prevention must begin when the child is in the womb. If the mother is asthmatic then she should become more cautious about her asthma and more regular with the inhaler. Her environment should be clean and not harbour dust mites hidden in carpets, soft toys, cobwebs. The house in which she is living should not be painted/ white washed during that period; else an asthma attack is sure to follow. Smoking by or before a pregnant lady is a crime. Efforts should be made for a normal institutional delivery. A recent study says that caesarean children are more likely to get asthma as compared to those delivered normally, irrespective of the mother being asthmatic or not, perhaps because the vaginal fluids create immunity in the baby's body, providing protection from many diseases, including asthma.”
“Secondary prevention is done so that asthma does not manifest itself in the child. According to Ayurveda (although no scientific study has been done) a child may be given tulsi (basil) leaves and honey –both are anti-allergic-- till the age of 12. The child should be kept away from fast food, cold drinks, and avoid extremes of temperature. If there is nasal allergy it should be treated properly, as it may later change to bronchial asthma.”
However if a person does become asthmatic then it is not the end of a normal life. Tertiary prevention lies in controlling the possible allergen factors, as well as controlling stress, obesity, acidity, stomach disorders, and taking proper medication. The focus of asthma management has shifted from severity based management to control based management. If one uses corticosteroid inhalers (controllers) regularly, and bronchodilators (relievers) in case of an emergency, then asthma can be managed well without any cause for worry. However Christophe Perrin, Coordinator, Asthma Drug Facility, The Union, fears that, “Some patients prefer to get oral treatment as a way to reject the diagnosis of asthma which scares them. For these patients, using inhalers would mean to face the fact that they are asthmatics. When prescribing inhalers instead of tablets, doctors need also to pay an extra-effort to educate their patients to use them properly.”
Dr Surya Kant also advocates jal neti or nasal wash as an added part of treatment. This helps in cleaning the nose and washing off the allergens which may be there. Take lukewarm water to which a pinch of salt is added in a spigot (container with a tube). Let the water enter one nostril through the pipe, and come out of the other nostril. Deep breathing exercises have been found to reduce the severity of attacks in some cases.
A spirometer and peak flow meter are used to diagnose as well as monitor chronic obstructive pulmonary disorders like asthma. A spirometer measures the total volume of air that is inhaled or exhaled while a peak flow meter measures the rate at which air is expelled from the lungs. Dr Surya Kant advises that every asthma patient should possess the portable peak flow meter (which costs only Rs 300) to measure the lung function every day. As the patient blows air into it, a marker slides up a scale to indicate how much air was exhaled. A reading in the green zone means the peak flow is over 80% and the airways are open. Any reading in the yellow zone means that the peak flow is between 50% and 80% and there is risk for a flare-up. A reading in the red zone means that the peak flow is less than 50% and immediate medication is needed. So this lung thermometer is used to forecast and hence manage asthma attacks in advance.
58 years old Anil Gupta (name changed), an insurance agent, has been living with asthma for the past 30 years since 1980. He remembers that, “In 1980 my cold became chronic and eventually turned into asthma. The doctor gave me an inhaler and some tablets to eat. But there was very little relief. Then I met another doctor in 1990, who really helped me manage the disease. He changed my inhaler. Now the frequency of my asthma attacks has reduced considerably, and I lead a normal life. I have to take certain precautions and protect myself from cold, prevent stress and eat a proper diet. But the inhaler is my friend in need. I do not use any tobacco products. My 36 years old son also has this problem of asthma since the last 10 years. But it is under control, and he uses the inhalers as and when needed.”
Dr Karen Bissell, Deputy Coordinator, Asthma Drug Facility, and Deputy Director, Operational Research, at The Union, rightly feels that, “People with asthma should adhere to the medication their doctor has advised and should take corticosteroids regularly as per doctor's advice, and should also avoid triggers of asthma. Cigarette smoke, tobacco smoke and other forms of inhaling tobacco smoke has increased in many countries and that may be the reason for asthma rise in low income countries. People should stay away from cigarette smoke and ideally there should be no body in the family smoking in the vicinity.” (CNS)
Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: [email protected], website: http://www.citizen-news.org)
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