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Breathless

With 200,000 hospital admissions every year, asthma is on the rise in Sri Lanka, but professional care is still in question:


Pic credit - www.jsonline.com

The world is now in the grip of an asthma epidemic that is adversely affecting the young and old alike. No respecter of persons or age, asthma could begin at the very beginning of life if it is genetic related, which means a new born baby could already have asthma when he/she is born. Various other causes like air pollution and life style changes have also been attributed to it. But the actual causes of asthma still remain unknown. Despite several global studies, specialists in the field admit they are still groping in the dark as to what really triggers off the breathlessness and wheezing attacks of this respiratory condition that prevent adults and children leading a healthy and active life.

Globally, there are over 300 million asthma sufferers and it is on the rise in Sri Lanka with a prevalence rate of over 20 percent accounting for over 200,000 admissions and between 750-1000 deaths every year.

In this interview with the Sunday Observer, Dr Kirthi Gunasekera, Consultant Respiratory Physician, Central Chest Clinic and National Hospital, Colombo, talks about asthma, how patients should deal with it and most importantly some of the gaps in identifying and treating the diseases, which require priority attention to improve the quality of life of all asthma patients.

Excerpts...

Q: What is the current status of asthma in Sri Lanka and in the world?

A: Globally, we have now reached the 300 million mark. Two studies conducted in Sri Lanka have shown the rate of prevalence here to be high.

The Issac study (an international study on asthma and allergies) which focused on 7600 children from 400 schools in all 9 provinces, was conducted in 2001 and again in 2013 with a ten year gap.

Dr Kirthi Gunasekera

It showed that about 20 percent of people have asthma, which is high compared to world standards. Of this, the number of severe asthmatics was higher. This co-relates with the high death rates in general in this country which is about 6 per 100,000.

Q: Any other studies related to the increase in respiratory diseases in Sri Lanka?

A: Studies have also shown that we have over 60 percent of persons with allergic rhinitis.

The European Community Respiratory Survey conducted here in three phases included studies of 2000 persons from 7 provinces. In our adult survey, we found that 20 percent adults having symptoms of asthma and 10 percent having a diagnosis of asthma and are now on medication.

Q: What about hospital admissions? Are more asthma patients being admitted now?

A: Present statistics indicate we have about 200,000 admissions for asthma every year.

These figures show that Asthma is one of the main contributory factors for the rising death rates. Besides this, they also co-relate with the increasing usage of asthma drugs. If you look at the number of persons using nebulising facilities, it is obvious that the figures have shot up over the past two decades.

Q: Causes?

A: To be frank, we don’t really know. Maybe environment pollution, which has increased in recent years or changes in lifestyle with more persons adopting unhealthy habits As it is a global phenomenon, there are ongoing studies to come up with the real causes that trigger an attack.

Q: Could stress be a cause?

A: It could be. But here again no study has directly attributed it to asthma.

Q: Could it be genetic? Can a new born have asthma?

A: Yes. If the parents have asthma or has rhinitis or allergic conjunctivitis or exzema, all these conditions could make a new born child more vulnerable to asthma.

But many children have similar conditions to asthma, so they need to be screened and tested by a qualified specialist before they fall into the asthmatics category.

Q: So how does a parent recognise if his /her child has asthma? What are the symptoms?

A: Let me give you five main ways

of identifying asthma in a child:

Not able to engage in his daily activities normally and go to school regularly.

Not able to sleep through the night without getting up and coughing or wheezing.

Coughing and wheezing during the day time.

Have to take extra medication besides their normal medication due to their being unwell.

Or in extreme cases, need to be taken to hospital due to respiratory difficulties.

Any one or two of these symptoms means they have asthma, which is not controlled.

Q: What is the best way to control it?

A: There are several medications. But in my opinion the Inhaled Corticosteroids has been shown as being the most effective way to reduce asthma related mortality and also improve the quality of life of the user.

Q: What happens if an inhaler is used in the wrong way?

A: It could result in aggravating the attack.

Q: Is there a cut-off point?

A: No. It’s not like taking a pill, where you know how many to take. Since it is being puffed into the lungs to open the airways, it is not possible to know how much is going in. The only way to do this is by getting yourself checked at every clinic visit.

Q: How?

A: By doing a lung function test.

Q: Are there special wards for children admitted to the state hospitals for asthma?

A: No. Right now they are kept in normal wards.

Q: What about specialised nurses and pharmacists trained in paediatric asthma?

A: Unfortunately the number is almost nil. That goes for the state sector and even for the private sector.

Q: So as a long experienced physician and specialist in this field, tell us what you believe are some of the most urgent needs for asthma patients in Sri Lankan hospitals.

A: Firstly we should have specialised clinics for asthma in all state hospitals. To man them we need asthma nurses – i.e. nurses trained to deal with young asthma patients, teach them and their parents how an inhaler should be used correctly.

Q: Are there any training programmes for such nurses?

A: No. The Health Ministry should start a course conducted by trained persons as soon as possible as this is the need of the hour.

What is happening now is that untrained nurses and pharmacists in our hospital clinics are instructing patients on how to use inhalers and deal with asthma attacks.

This is a dangerous practice. Training them by qualified persons can help to overcome this problem. If we have trained nurses and pharmacists, specialists like us can have time to conduct these training programmes which should be on going considering the number of asthma patients.

Fourthly, we need more trained Spirometry technicians to measure lung function in persons with respiratory ailments.

At present we don’t have a single trained technician in this field, and very few in the private sector hospitals.

Q: Do you have a message for those with asthma?

A: They must comply with the medication instructions given and take the inhaled corticosteroids correctly when they get a serious attack. When they see their GP for any other medical condition, they should inform him that they have asthma to prevent any new drugs given from having an adverse effect.

Parents of asthmatic children should ensure their children take their medications regularly. Above all, they should let their kinds lead a normal life without being over anxious.


Asthma is…?

It is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early morning.

The lining of the airways becomes inflamed, the muscles of the airways tighten and mucus production increases in the airways.

Causes

Although the cause has not been fully understood by scientists, asthma can often be diagnosed in members of the same family. Atopic or a strong allergic reaction common with other family members is the most identifiable risk factor.

Exposure to allergens and chemical sensitisers is also a key risk factor since the inflamed airways of asthma sufferers are very sensitive to a wide range of triggers. Some triggers cause immediate asthma symptoms, while others can lead to a gradual development of symptoms.

Common asthma triggers:

• Allergens - house dust mites, pets, pollens, mould, some foods.

• Viral infections - flu.

• Irritants - cigarette smoke, air pollution, paint fumes.

• Temperature changes - cold air, sudden drops in temperature.

• Occupational triggers - wood dust, flour, industrial chemicals, glue.

• Drugs - aspirins, beta-blocker and other nonsteroidal anti-inflammatory drugs.

• Emotional stress - anxiety, stress, excitement

• Food and food additives (less usual) - preservatives, dyes and monosodium glutamate.

Factors that may increase susceptibility to developing asthma

• Air pollution - indoor and outdoor

• Respiratory infections

• Small size at birth

• Smoking - passive and active. Cigarette smoke contains

more than 4,500 compounds and contaminants that can

contribute to the development of asthma. Children are

especially vulnerable to the effects of passive smoke

• Gender - prior to the age of 14, the prevalence of asthma

is nearly twice as great in boys than in girls.

• Obesity

• Diet

(from the web )

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