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| Sunday, 2 May 2004 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius May 4 is World Asthma Day: When breathing becomes a wheeze.....
Asthma can start at any age, although more commonly in the young. It must be emphasized that asthma is not infectious. Symptoms Symptoms are due to the narrowing of the breathing tubes (bronchi) and are brought about by one or more of the following factors: (a) Contraction of the muscle layer in the walls of the breathing tubes. (b) Swelling of the mucus membrane (or inner lining) of the breathing tubes; (c) Increased secretion of the phlegm (mucus) inside the breathing tubes. The symptoms of asthma consist of periodic attacks of shortness of breath, wheeze and sometimes chest tightness or cough. Cough may be the only symptom particularly in children and usually occurs at night. An acute attack may last for minutes, but symptoms may sometimes persist for several hours or longer, especially if effective treatment is not given in good time. In between attacks the breathing may be normal. Types of asthma Two main types are recognized. Allergic asthma affects people who are abnormally sensitive to common substances, such as house dust, house mite, grass pollen, feathers or animal hair. These substances are known as allergens and contact with them may start an attack of asthma in people who are sensitive to them. This form of asthma usually begins in childhood. The other type, intrinsic asthma which starts in adult life, is not usually associated with any allergies, except perhaps to aspirin. Asthma is related to two other allergic disorders, that is eczema and hay fever, but it is quite common to have one without the others. When two of these conditions occur in the same person, one may worsen while the other becomes better, or both may cause trouble at the same time. There is also an increased risk of development of chronic bronchitis (which is incurable) in heavy smokers. Therefore, patients are strongly advised to stop smoking completely and even to keep away, as far as possible, from smoke arising from cigarettes or cigars of others. Thus, the importance of asthmatic patients giving up smoking cannot be over-emphasized. Asthmatics are also more sensitive to other pollutants in the atmosphere, such as sulphur dioxide. Dust is another common stimulus which causes the narrowing of the air tubes. Asthmatics should be advised to avoid dusty atmospheres (e.g. building sites), as far as possible. Sudden changes in temperature and/or humidity - These are common causes of attacks of asthma, particularly a fall in temperature. Bathing (particularly with cold water) and exposure to cold air such as air conditioning, can bring about attacks in certain patients, since "cold" can cause spasm of air tubes. Such patients are advised to bathe with warm water, preferably around noon and to avoid air conditioned environments as far as possible. Respiratory infections - The majority of infections which cause asthmatic attacks are brought about by viruses, while bacteria are responsible for only a minority of cases. Antibiotics, for example ampicillin, erythromycin etc. which kill or inhibit bacteria, but not viruses, are seldom indicated. These unfortunately seem to be prescribed unnecessarily in many instances. House dust - House dust has been found to contain an insect called a mite. This mite feeds on scales of skin which people shed, particularly in bed. They are therefore mostly found on mattresses, bed clothes and also on furniture, carpets and soft toys. Asthmatic children should not be allowed to cuddle soft toys. It has been found that reducing dust in the bedroom and the home environment helps in ameliorating symptoms, especially at night - This must be done by careful sweeping, dusting and wet mopping by some other person, in the patient's absence. Frequent changes of bed linen, the covering of mattresses and pillows with polythene or plastic, vacuum cleaning of the bed room, bed linen and curtains would also be of help. Foam rubber pillows and mattresses, plastic material rather than fabrics for the curtains, and exclusion of rugs (which gather dust) are also recommended. Drugs and chemicals - Some of the more commonly used drugs such as aspirin and penicillin can precipitate asthmatic attacks. Drugs used in heart disorders and high blood pressure, for example propranalol, and in arthritis, for example indomethacin, can also aggravate asthma in some patients. Therefore, it is of vital importance that the patient must indicate to the doctor that he or she suffers from asthma, even if the present complaint is unrelated to his or her asthma Perfumes can also provoke asthmatic attacks in a few cases. Animals - Cats, and to a lesser extent, dogs and birds, have been found to be responsible for causing attacks of asthma particularly in children. Under no circumstances must pets be allowed into the bedroom of an asthmatic child. Exercise - A few patients, especially children, complain of a troublesome wheeze after exertion, the mechanism being that exercise causes cooling and drying of the airway lining, which brings about narrowing of the breathing tubes. Breathing warm moist air during exertion, such as swimming in warm water, may not bring about exercise induced asthma. Asthmatic patients may therefore be encouraged to swim. Asthma during or after exercise can be prevented by the use of a beta stimulant (eg. salbutamol, terbutaline) or disodium cromoglycate before exercise. Occupational Asthma - Patients suffering from asthma should be advised to avoid such occupations as building where there is excessive dust and also to avoid exposure to cold air such as performing night duty outdoors. Some of the dusts of occupational origin which may induce asthma are - (a) Vegetable dusts such as tea (tea blenders), wood dust (carpenters), cinnamon (cinnamon sorters) and flour/grain (farmers, millers or bakers). (b) Hair, feathers, dung of animals, birds/poultry (animal and poultry workers). (c) Isocyanates (Adhesive workers, rubber workers, vehicle sprayers, print or polyurethane foam workers). (d) Epoxy Resins (Paint or plastic workers). N.B. - Inhalation of cotton dust (in textile workers) can cause a condition called Byssinosis which can resemble asthma. Psychological factors - Emotional stress at home, school or work place can aggravate asthma. Conflicts with others, separation from loved ones, divorce between parents, alcoholism in the family and bereavement are some of the situations that are known to increase symptoms in asthmatics. Foods - Some of the foods that can trigger attacks in certain asthmatic patients are cow's milk, eggs, nuts, tomatoes, shell fish, pineapple, alcoholic beverages and cordials. It is important to note that many patients suffering from asthma can consume some or all of these without having symptoms. It is usual for symptoms to occur within a few hours of taking the offending food, so that patients can generally identify such food. Pollen - Pollen of some flowers and grasses can also precipitate attacks of asthma at certain times of the year. Treatment Drugs - Drugs that stimulate the sympathetic nervous system fall into two categories: 'Selective' drugs (Beta two stimulants) which cause little or no stimulation of the heart and are safe for long use. Non-selective/partially selective drugs. These are now regarded as being less suitable and less safe for use than drugs of the previous group, as they are more likely to cause irregularities of the heart and other side effects when used for a long period. Drugs used to treat asthma may be given by one of several routes: 1) inhalation 2) orally 3) injection 4) nebulizer which is used for severe attacks. by Dr. J. H. L. Cooray and Dr. P. N. B. Wijekoon from A Layman's guide to Bronchial asthma ###### Childhood asthma by Dr. B.J.C. Perera, Paediatrician, LRH Asthma is the most common recurrent respiratory disease in childhood. The incidence varies widely around the globe ranging from 2-38 per cent in different countries. On the most recent evidence the occurrence is around 30-35 per cent in Sri Lanka.
Any severe attack of asthma could be potentially lethal but a very large proportion of the fatalities are preventable. Thus medical attention should not be delayed especially if the acute episode is unusual or responding poorly to the child's usual medications. 'Reliever drugs' are used to treat acute attacks and 'preventive drugs' are used to avert acute episodes and disturbance of the normal life-style of the child. These drugs are safe when used properly, in recommended dosage under medical supervision. Many drugs have to be administered by inhalation using special devices. These inhalers are quite safe and easy to use when children are properly trained on the devices. They are not addictive. There is no 'perfect cure' for childhood asthma but the disease can be very well controlled using the presently available medications. The ultimate aim of treatment is to allow the child to live a normal or near-normal life without any significant disturbance to the normal life-style and growing up processes. There is no reason why asthmatic children, when properly treated, could not take part in games, even competitive sports. Symptoms A dry cough usually at night ###### Asthma update The Health Education Bureau of the Ministry of Health has organised several activities to commemorate World Asthma Day on May 4, 2004. A Respiratory Disease Study Group website for both general public and medical profession - www.asthmasrilanka.com will be launched, followed by a Poster Exhibition which will be held on June 22 and 23 at the Lionel Wendt. The poster exhibition will be on from 8.30 to 8.00 p.m. on both days. The purpose is to increase the awareness of general public with regard to asthma. This is the first time an exhibition of this kind is held in Sri Lanka. This unique exhibition will offer the following services: a) Check your peak flow rate to assess whether you are asthmatic or not b) Inhaler and Device techniques checked free of charge. Asthma Society membership forms will also be available at the counters. In addition it will conduct a School Health Quiz 2004 on asthma. This will be held at the BMICH on the 30th of June 2004. It will start at 10.00 and end at 2.00 p.m. The first 50 schools will be selected this year. It will be held in all 3 languages. The quiz is a team event where 6 students from each school will be assigned a table. The quiz master will announce the question and each school will have to answer in the answer sheet provided. There will be 10 questions of 6 rounds. At the end of each round the question papers will be collected and corrected. The results of each round will be announced at the end of each round. The winners will be awarded the Winning trophy along with a cash award of Rs. 10,000 and the runners-up will be awarded the runners-up trophy along with a cash award of Rs. 7,500. All participants will be given certificates. For The Medical Profession the Health Education Bureau has organised its 3rd Symposium on November 21 this year. ***** Problems in managing Asthma by Dr. Bandu Gunasena, Consultant Chest Physician Galle Most patients are still unaware about proper management. The most important management strategy of bronchial asthma is the usage of inhaled corticosteroids along with some adjuvant inhalers (long acting beta agonists). But inhaled corticosteroids are still not freely available in government hospitals. Patients should have free access to these drugs through government hospitals via well established asthma clinics having reasonably adequate infrastructure and trained man power. Stigma against steroids should be removed from general public as well as from some health-care personnel. Inhaled steroids should be available free of charge in hospitals and the issue of drugs has to be done by people trained in asthma care depending on the patient's need to minimize wastage. Advanced respiratory medicine is still not fully operational in main hospitals. Uninterrupted supply of inhaled corticosteroids is important to make sure that the patients are well controlled and maintained so that they do not get admitted to hospitals and they live a near normal life. Government hospitals still lack infrastructures to manage asthma properly. No social security system for needy patients. ***** Problems faced by the Sri Lankan asthmatic by Dr. Kirthi Gunesekera * Difficulty in diagnosis, because of denial by patients. * Many patients deny they have asthma because of the stigma attached to the disease. * Under-diagnosis * Under treatment of diagnosed patients. * Reluctance of patients to use preventive drugs via inhalers as and vs. drugs and nebulizers. Nebulising should be the last resort to relieve muscle spasms temporarily, while drugs have several adverse effects. Preventive drugs are safe and encourage annual lifestyle. * Many doctors do not recognise symptoms such as regular coughs and colds because of their lack of awareness and absence of easy diagnostic tools. * In Sri Lanka there are several diseases that mimic asthma eg. smoker's cough. This delays accurate diagnosis. * Lack of basic essential drug, such as inhaled steroids. The latter is cost effective and prevents morbidity and mortality. The question is, why is there step motherly treatment given to asthma patients as compared to the facilities given to patients with heart disease, diabetes, kidney problems and cancer, when a free uninterrupted supply of inhaled corticosteroids can bring very positive results in the thousands of asthma patients in this country/ Local risk factors The following are risk factors for causing asthma, from the ISAC study on Asthma conducted in Sri Lanka. * Straw roofs, clay walls, uncemented floors. * Animals such as dogs and cats kept as pets as well as domesticated cattle can cause asthma. * Smoking. If there is a smoker in the house a child can easily become an asthmatic patient by inhaling smoke fumes. * Fumes from keresone lamps and firewood hearths. Some myths and facts Myth: Bathing is bad for a child with a wheeze. Fact: This can be prevented by the use of preventive drugs via inhalers. Myth: Drinking cool drinks and certain foods like pineapple can bring on an attack. Fact: This depends on the child. Some children will not react adversely, while others may react badly. Myth: Asthma can be cured. Fact: Asthma cannot be cured as at present. But it can be controlled very well if managed properly. Myth: If you cure eczema you can get asthma. Fact: The pre-disposition of a patient to eczema reflects a patient's ectopic nature (i.e. tendency to be allergic) and therefore the child at anytime can have hay fever, simisitis, asthma or itchy eyes which are all inter linked to each other. ###### Journalists Awards for Excellence in reporting on Reproductive Health - 2003 The Health Education Bureau of the Ministry of Health, Nutrition and Welfare in collaboration with UNFPA has called for entries from those who have contributed to the print and electronic media on Reproductive Health issues during the year 2003 for the Annual Journalist Award on R. H. The National Media Forum has decided to present three separate awards for Print/Radio/Television. The main purpose of this annual award scheme is to recognise professionalism and reward those who have excelled and shown enthusiasm during a particular year on the issues concerning Reproductive Health. The scheme is open to journalists from newspapers, broadcasting and television stations of all three languages in Sri Lanka. The following criteria should be adhered by all entrants. * Contestants could apply personally but the relevant institutions has to endorsed them as professional journalists (either full time/part time/freelance) * Should certify that the activities are his/her own. * Should be items printed/broadcast/telecast over media during the year 2003 (Jan. 1st - Dec. 31st) * Contents themselves should produce their productions/ newspaper clippings by Registered Post or delivered personally to Director, Health Education Bureau, No. 2, Kynsey Road, Colombo 08. Entries for the contest close by 12.00 Noon on 15th May 2004. Persons attached to Health Ministry or its branches inclusive of Provincial Health Ministries and Departments are not eligible to apply. The journalists who have won the national award once, is not eligible to apply for 3 years from the year of award. Besides the main award the annual journalists on RH there will be 10 other special awards or commendations if deemed fit by the judges. Recipients of awards will be picked by an independent panel of eminent judges from amongst the media and health recommended by the National Forum of Journalists on RH, an advisory body to the Health Education Bureau on media activities on RH. Presentation of awards will be made at a ceremony to be held to coincide with the World Population Day - 11th July. For further details contact: Director, Health Education Bureau, No. 2, Kynsey Road, Colombo 08. |
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Bronchial asthma may be explained, in simple terms, as an illness where
there are repeated attacks of difficulty in breathing and/or cough which
may be accompanied by a wheeze.
Asthma is mild in the majority of children and only about 1-2 per cent
has a very serious form of the disease. In the Asian region about 2-8 per
cent of children of the 13-14 year age group have severe attacks of
wheezing. In the natural course of the disease about a quarter of all
asthmatic children grow up to be adult asthmatics. Those who develop
wheezing in the first 2 years of life are more prone to grow out of it
during adult life but those who develop symptoms after the 3rd year are
more likely to have persistence of asthma into adult life. Girls are more
prone to carry the disease over to adult life.
