Call for better management of asthma
Despite evidence that asthma can be effectively managed, not only is
asthma-related health literacy very low in most settings, but
quality-assured, affordable essential medicines are also very seldom
available.
Inhalers provide almost instant relief and are safe for children
with asthma |
With slow growth in awareness of asthmatic conditions, an increasing
number of children and adults are being diagnosed with asthma. Once
diagnosed, we must ensure that they are educated about asthma, empowered
to live positively with proper management of asthma, in-country
mechanisms are robust enough to ensure uninterrupted supplies of the
required quality-assured affordable essential medicines, healthcare
workers are skilled enough to comprehensively support people who need
care and that aggravating factors or triggers are controlled effectively
where possible.
We do not know yet what exactly causes asthma, but we do know that a
person is more likely to develop asthma if he/she has a family history
of asthma, eczema or allergies. It is likely that this family history,
combined with certain environmental factors, influences whether or not
he/she develops asthma.
Dr Karen Bissell, Deputy Coordinator, Asthma Drug Facility (ADF),
International Union Against Tuberculosis and Lung Disease (The Union),
and a co-author of a 2011 study on pricing, affordability and
availability of asthma medicines and Global Asthma Report 2011 chapters
on asthma and poverty, and the economic burden of asthma, said in an
interview with Citizen News Service - CNS that a small number of
children who get diagnosed with asthma are lucky in the sense that
asthma might go away as they grow up. But most children with asthma will
need lifelong asthma management and care.
Asthma is a lifelong condition and it is possible to live a normal
life with regular asthma management and care.
Christophe Perrin, Pharmacist and Coordinator, Asthma Drug Facility,
International Union Against Tuberculosis and Lung Disease also spoke to
CNS and added that: “The percentage of children and adults which are
reported for asthma over the past years has been increasing
significantly. It is very much linked to the fact that they were not
aware of their asthmatic condition.”
According to the The Global Asthma Report 2011, published by The
Union and the International Study of Asthma and Allergies in Childhood
(ISAAC), asthma is the most common chronic disease among children,
besides affecting millions of adults.
The World Health Organization (WHO) reports that lack of awareness
probably represents the most important barrier to progress in the
diagnosis, treatment and care of individuals with non-communicable
diseases, including 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 in many low income countries.
More allergens
The reason for more and more children developing asthma is not known
with certainty. Some experts suggest that children are being exposed to
more allergens like house dust mites in beddings and carpets, pollens
and moulds, as well as vehicle exhaust and second-hand tobacco smoke,
which trigger or cause the symptoms of cough and breathlessness in
asthma. Others think that a disorder of the immune system, where the
body fails to make enough protective antibodies, may play a role in
causing asthma. And still others believe that not breastfeeding infants
prevent important substances of the immune system from being passed on
to them.
According to Professor (Dr) Surya Kant, Head of the Pulmonary
Medicine Department, King George's Medical University, “If one of the
parents has asthma, then there are 25 percent chances of the child
having it too. If both parents are asthmatic, this increases to 50
percent.
One study says that caesarean-born children are more likely to get
asthma 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.
If the mother is asthmatic, then she should become more cautious
about her asthma during pregnancy. Her environment should be kept clean
and not harbour dust mites hidden in carpets, soft toys or cobwebs.
Smoking by or beside a pregnant woman is a crime.”
Researchers at Imperial College in London found a sharp fall in the
number of children admitted to hospital with severe asthma after
smoke-free legislation was introduced in England in 2007.
The study published in the journal Pediatrics shows a 12 percent drop
in admissions the first year after the law banning smoking in enclosed
public places came into force and a further three percent in each of the
following two years.
The fall was seen among boys and girls of all ages, across wealthy
and deprived neighbourhoods, in cities and in rural areas. Prior to the
ban, the number of children admitted to hospital with severe asthma
attacks was rising by more than two percent a year.
These findings reinforce evidence on the impact of smoke-free
legislation on lung health, especially in case of children who are often
the most innocent victims of second-hand smoke.
Air quality
Another study published online in the European Respiratory Journal
has, for the first time, confirmed scientifically that poor air quality
associated with busy roads can cause (and not merely trigger) asthma in
children. Researchers found that 14 percent of chronic childhood asthma
cases could be attributed to near-road traffic pollution. The results
were comparable, the authors said, to the burden associated with passive
smoking – which the WHO blames on four percent to 18 percent of asthma
cases in children.
Dr B.P. Singh, a renowned lung health specialist, says that in India,
asthma in children is often misdiagnosed as tuberculosis. This is a
matter of great concern as it involves misuse of anti-tubercular drugs.
So, childhood asthma should be dealt with seriously and diagnosed and
treated correctly.
Dr Singh insists on giving children a clean environment to live in.
“Indoor air pollution should be minimised and environmental tobacco
smoke should be stopped by all means as it is a very important risk
factor for triggering asthma attacks. If a person is allergic, then
pollen, dust, fumes and strong perfumes should be avoided. The kitchen
must be very well ventilated. If pets are there, they must keep them
away from bedrooms. The house mattresses contain a lot of dust which
expose asthma patients to mites - the most important cause for
allergies. In countries like India, regular sunlight exposure to pillows
and mattresses can wipe out these dust mites.”
However, if a person does become asthmatic, then the disease can be
effectively controlled, if not cured. The focus of asthma management has
shifted from severity-based management to control-based management. A
person living with asthma can also lead a very normal life and this
message should be conveyed to them properly. The treatment of asthma is
cheap in comparison to the disability caused by it. If one uses
corticosteroid inhalers (controllers/preventers) regularly, and
bronchodilators (relievers) in case of an emergency, then asthma can be
managed well without any cause for worry.
Controller therapy
Dr Singh says, “In case of children, once the diagnosis is complete,
I would suggest taking controller therapy regularly. Current inhaled
corticosteroids provide almost instant relief and are safe for children.
They do not cause side effects as the drugs reach the lungs directly and
are not absorbed in systemic circulation as compared to oral drugs and
injections which get absorbed in the other organs of the body too like
the liver, kidney, and heart and can cause side effects.
“Regarding the diet of asthmatic kids, parents very often do not
allow the child to eat curd, ice-cream and rice as they think that such
food would worsen their asthma. But these foods can be taken by such
children without any problem. The most important thing is that they
should use the inhaler regularly.”
Perrin from The Union also stressed to CNS: “Most of the people
demand bronchodilators which are of course very important medicine, but
beside that what The Union is really trying to push forward in as many
countries as possible and also through the ADF are inhaled
corticosteroids. Inhaled corticosteroids are the medicines which would
help in healing of the lungs of asthma patients because asthma is about
inflammation of the lungs and the inhaled corticosteroids are the key
medicines to cure this inflammation. Inhaled corticosteroids were not
available as desired in many countries such as India, Nigeria, Kenya,
Malawi or Zimbabwe.”Perrin added: “Education must be provided to people
on how to use the inhalers and on checking the symptoms. They should
have the knowledge and they should know when they have their warning
sign. If something is out of control, they must know what to do. They
should know when they have to go to the healthcare facilities for help.
Having a chronic patient with asthma, knowing how to manage their own
asthma, is very important to keep people out of the hospital wards.”
Protective effect
In fact, a study in Phase Three of ISAAC explored the impact of the
intake of types of food on asthma and confirmed that a potential
protective effect on severe asthma in adolescents and children was
associated with the consumption of fruit three times or more per week.
At the same time, an increased risk of severe asthma in adolescents
and children was associated with the consumption of fast food three
times or more per week. If the association between fast foods and the
symptom prevalence of asthma is causal, then these findings have a major
public health significance, keeping in mind the rising consumption of
fast foods globally.
Another ISAAC Phase Three study was conducted on 76,164 children aged
6-7 years (from 29 centres and 17 countries) and 201,370 adolescents
aged 13-14 years (from 73 centres and 35 countries) to examine the
relationship between potential risk factors, such as body mass index
categories (underweight, overweight and obesity), vigorous physical
activity and television viewing and the symptoms of asthma (and also
rhino conjunctivitis and eczema).
The study confirmed the association between overweight and obesity
(but not underweight) and symptoms of asthma. Vigorous physical activity
was positively associated with symptoms of asthma, in adolescents, but
not in children. Viewing television for five or more hours per day was
associated with an increased risk of symptoms of asthma in adolescents
as well as children.
So, till a permanent cure for asthma is found, the least we can do as
adults is to protect the health of our children by letting them breathe
clean air devoid of tobacco smoke and vehicular exhaust; giving them
healthy (and not fast) food to eat; encouraging more physical activities
and less of television watching; and if need be, learn ourselves and
train our children to manage asthma effectively.
Courtesy: CNS/Asian Tribune
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