Breathless
With 200,000 hospital admissions every year, asthma
is on the rise in Sri Lanka, but professional care is still in question:
By Carol Aloysius
 |
| 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 dont 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. Its 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 dont 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 )
|
