Do you have a wheezy chest?

By Carol Aloysius

Asthma is still widely prevalent in Sri Lanka. At a media seminar recently, officials from the Health Ministry cited alarming figures of hospital admissions and deaths due to asthma in the country, stating that ten percent of ICU admissions of all adults and 30 percent of admission among children was due to Asthma.

According to the Ministry, asthma was one of the ten reasons for deaths in the country. Health Services Director General, Dr Palitha Mahipala expressing concern over a World Bank study in 2014 which stated there were 2,953 Asthma related deaths , told the media, while there was no need to panic, the disease though incurable, could be controlled with available drugs and nebulisers given free of charge to patients, in all state hospitals. Urging patients to seek early treatment, he said asthma clinics with Consultant Respiratory physicians are available in most leading state hospitals. “Even inhalers are given free of charge, in addition to the drugs”, he said.

The Sunday Observer spoke to an eminent Respiratory physician at the leading National Hospital for respiratory diseases, with several years of experience in the field, for more insights into this debilitating condition that impacts not just the victim, but the family and society as a whole.

Here, Resident Consultant in Respiratory Health, National Hospital for Respiratory Diseases , Welisara, Dr Geethal Perera, discusses the Do’s and Don’ts about asthma and some myths that surround it. .

Excerpts...

Q. Asthma appears to have surged among Lankans in recent years. What is the reason?

A. The apparent increase in numbers could be due to more patients seeking treatment. Asthma used to have a stigma attached to it in society, some years ago, when there was no effective treatment available. Due to the introduction of inhalers and a better understanding of factors precipitating the disease, more people are now accepting the diagnosis and complying with the prescribed treatment.

Q. Who are the age groups most vulnerable to asthma?

A. Asthma is a disease that could affect any age. However, the symptoms are more common among young children, especially those in the preschool age. Some grow out of it late in life. It is not so common in very young children, below 2 or 3 years. However, a persistent wheeze in this age group deserves a visit to a pediatrician.

Q. Is wheezing the same as bronchial asthma? Will a wheezy child be more prone to asthmatic attacks in adulthood?

A. Wheezing is only a symptom of many respiratory illnesses, some of which are more dangerous than asthma. A qualified doctor should be able to detect it early. If there is a doubt, he will request some basic tests or refer the case to a specialist.

Q. Most people who get an asthmatic attack are unable to breathe. Why?

A. In asthmatics due to chronic inflammation, the lumen of the airways tends to be partially obstructed and the walls of the airways are hypersensitive. During an attack, the muscles of the airway go into spasms, obstructing the airways and the lining of the airway starts secreting excess phlegm, obstructing whatever space that is left.

Breathing through this partially obstructed airway is difficult due to the excess resistance, and the patient feels tired early during an activity, compared to a normal person of that age. When the patient breathes in, due to the negative pressure in the lungs, some of the blocked airways open a bit and let some air flow into the deeper parts of the lungs. However, during expiration, the positive pressure in the chest that fall on the walls of those airways makes them collapse. This makes the air that went in during the inspiration to get trapped in the lung. Repetition of this process causes more and more air to get trapped in the chest and ultimately, it is not possible to take more air in, as the chest is already full. The patient then feels tight chested and very distressed.

Q. Is asthma a disease? Is it contagious?

A. Asthma is a disease recognized by the international classification of diseases. It is not contagious. It is inheritable and children can inherit the genes that cause the disease, from parents. However, certain infections that may precipitate an asthma attack in a person with predisposition could be contagious. Therefore, it is useful for certain bad asthmatics to avoid infections. There are certain vaccines that can protect patients with severe asthma from certain infections.

Also it must be remembered that certain infections such as Tuberculosis which could give rise to some of the asthma symptoms could be infectious.

Q. What causes asthma?

A. Predisposition to asthma is hereditary. Susceptible individuals when exposed to various environmental factors develop inflammation of their airways which lead to reversible obstruction of the airways. A majority of Asthmatics are allergic to something or another in their environment. House dust, mite proteins are by far the things that most asthmatics react to. Some other allergens are cockroaches, animals such as cats, certain food, pollen, and organic dust, such as wood dust.

Passive or active smoking in pregnant mothers could increase the chance of children becoming asthmatic. Exposure to certain chemicals such as cleaning liquids or even food additives and colouring could predispose people to asthma.

However, once you have the inflammation, any noxious stimulant could trigger symptoms. These range from strong perfumes to hot spices. Patients with active asthma often experience symptoms in cold environments, with drinks such as king coconut and even certain vegetables. This does not necessarily mean they are allergic to these food items.Some people have exercise induced asthma, where symptoms are triggered by doing exercises.

Q. Can stress be a factor? Or grief?

A. Yes. Asthma is a condition that fluctuates depending on multiple factors. Emotions play an important role in defining our internal environment. Today, even children suffer from stress due to an overload of homework and little play time. Many working people also suffer from stressful situations in their workplaces.

Q. What about extreme climatic changes?

A. Some patients are affected by this. However, if they are on proper medication,they should not be too adversely affected.

Q. Are food allergies a trigger factor?

A.. Food that one is allergic to can give rise to symptoms, even when one is well controlled with a dosage of drugs. However, what you are allergic to is unique to you. So don’t avoid foods that are allergic to other people, e.g. some children are unnecessarily denied nutritious food such as eggs and milk without proper evidence of allergy.

Q. What are the early signs of asthma?

A. Asthma could be remarkably asymptomatic, especially in young people who have a large reserve in lung functions. Symptoms manifest only when the airways are more than 50% obstructed. Symptoms of asthma are quite generic for any respiratory illness. It could be a cough in the middle of the night, or a shortness of breath which varies from time to time.

Q. Is asthma curable?

A. Like many other non-communicable diseases, Asthma is not curable with drugs. However, it could be controlled with medicine and other lifestyle modifications. Some patients, especially children, could grow out of it and after a while may not need specific treatment. It must be remembered that the symptoms may recur later in life with changing circumstances.

Q. Can it be fatal?

A. It can be fatal and Sri Lanka has a comparatively high death rate due to asthma. Most of the deaths could have been avoided if the patients were on proper treatment.

Q. If managed, what are the methods used in Sri Lanka? Drugs? Inhalers?

A. Introduction of steroid inhalers revolutionised the treatment of asthma. We have different types of inhalers in the market, such as, the puff and the dry powder inhalers of various designs, so that patients could be put on the most appropriate device according to individual needs.Using inhalers is safe and accepted worldwide. We also have many drugs available in our hospitals., including nebulizers which are often used in the hospital setup for management of acute attacks. However, certain patients who are unable to use the inhaler could use them at home. You also have oral medications. Oral steroids are very effective. However, their use is discouraged on a regular basis because of the dangerous side effects.

Q. What is your advice to parents of asthmatic children?

A. Most children with asthma can have a normal childhood and participate in activities that other children do, if they are on medication.

‘Protecting’ children is not a way of treating asthma. However, don’t expose children to second hand smoke, artificial food, and house dust collected on toys.