Asthma is one of the commonest ailments in Sri Lanka. Recent statistics indicate that the number of patients who suffer from this debilitating chronic disorder is growing at an alarming rate. Asthma has no boundaries . Its victims include young and old, alike. Drastic changes in weather patterns, dust, polluted surroundings and stress , have collectively contributed to this sharp upsurge in asthma, especially, in children. Preventing and controlling an attack can save a life. Today, most hospitals have nebulisers and other non surgical interventions available free of charge, in state hospitals.
However, many people are not aware of such facilities nor are they aware how vital it is to get help. Inhalers are available for children and adults.
Consultant Respiratory and Chest Physician , Jaffna Teaching hospital , Dr Budhika Samarasekera tells us what causes asthma in detail, and offers invaluable advice on how to prevent and control asthma so that patients can lead normal lives.
Excerpts of the interview with the Sunday Observer .
Q. What is bronchial asthma?
A. Bronchial asthma is a disease that occurs due to long term inflammation of the airways.
These airways are the tubes that carry air into our lungs. In bronchial asthma the inflammation causes swelling of these tubes which leads to narrowing them and compromise airflow.
Hence, bronchial asthma causes periodic attacks of cough, wheezing, breathlessness and chest tightness which are known as asthma attacks. Even though there is no permanent cure it can be well controlled to have a normal life.
Jean Baptiste Van Helmont (1579-1644 AD), a physician, chemist and physiologist from Belgium, first said, asthma originates in the pipes of the lungs. Asthma, as an inflammatory disease, was not really recognized until the 1960s when anti-inflammatory medications started being used.
Q. What is the burden of the disease?
A. Even though bronchial asthma is one of the common non communicable diseases, much attention has not been paid to it as for other non communicable diseases, such as, ischemic heart disease and diabetes.
There are about 300 million affected individuals worldwide and prevalence is increasing in many countries including, Sri Lanka. The prevalence of asthma among 5 to 11 year old children in Sri Lanka varies between 13% to 25%. Bronchial asthma is a major cause of school and work absence. Health care expenditure is also very high. Hence, it is considered an economical burden in many countries.
Q. Who gets asthma?
A. Asthma is very common during childhood, but it can affect one at any age. People who have allergies or a parent or family member with asthma are more likely to have the disease.
People who smoke are more prone to get asthma and there is strong evidence that passive smoking (secondhand smoking) plays a role as well. In addition, kids who are exposed to cigarette smoke from people around have a higher chance of developing asthma in early life.
Q. What triggers asthma attacks?
A. Colds and viruses, pets, pollens, house dust mite, extreme weather changes, smoking, food additives and exercise are the common triggers of acute asthma attacks. However, everyone with asthma is different and has a different mix of triggers. Hence, finding out which trigger sets off your symptom is important, to avoid and deal with them.
Q. What are the symptoms of asthma?
A. Cough (especially at night), wheezing, breathlessness and chest tightness are the common symptoms of asthma.
In addition, asthma can be a life threatening illness. You might need emergency treatment if you are too breathless to talk or walk, and if your lips or fingers become blue. These symptoms and signs are features of less oxygen in your blood and you need emergency treatment to open up your airways and get your oxygen levels to normal.
Furthermore, you need to seek medical advice immediately if your rescue inhaler ( Salbutamol) fails to improve your symptoms.
Q. How to diagnose bronchial asthma?
A. It is important to describe your symptoms clearly to your doctor. You may also notice triggering factors of your asthma attacks and health care providers should know all these details to make a good management plan.
Furthermore, they may ask you to do a few tests, such as, lung function test, chest x-ray and peak flow
Lung function test is also called spirometry which can measure your breathing capacity and how well you breathe by inhaling and exhaling into a device called spirometer.
The peak flow meter is a simple device which measures your asthma control. Your doctor may ask you to forcefully exhale into this device to measure your peak flow.
Sometimes your doctor may ask for chest x-ray to rule out any other illness that may cause similar features of bronchial asthma.
Q. What are the other illnesses that have similar symptoms of asthma?
A. Wheezing is also found in respiratory tract infections, chronic obstructive pulmonary disease and several other respiratory conditions. Therefore, it is important to meet a qualified medical practitioner for correct initial diagnosis.
Q. Can asthma be treated and what are the treatment options?
A. For both, children and adults, asthma can be well controlled with medication given by an inhaler.
In the case of an acute asthma attack the airways can be opened by using medications through an inhaler. These inhalers are called rescue or reliever inhalers. The blue Salbutamol inhaler is an example of rescue inhaler.
In addition, most asthma patients are on steroid inhalers to prevent the inflammation of the airways. These inhalers are called preventer inhalers and the doses of steroid are smaller in these. Side effects are minimal when you use these inhalers, compared to oral tablets.
If the asthma is not well controlled with inhalers it is important to check the inhaler technique. It is the responsibility of the prescribing doctors to check inhaler techniques of their patients.
Q. Can frequent asthma attacks damage the lungs?
A. Frequent asthma attacks will cause narrowing and scarring of the airways. This is known as airway remodeling and will lead to a narrower airway that compromise airflow. Hence, airway remodeling can cause more frequent attacks and worsening symptoms.
Q. How to prevent frequent asthma attacks?
A. All patients with asthma have to take medications as prescribed by the doctor. Preventer inhalers play a major role in preventing inflammation of the airways and frequent asthma attacks. Also, they need to meet the healthcare provider and correct the inhaler techniques if symptoms are not under control.
It is important to identify and avoid triggering factors that stimulate the airways. In Sri Lanka, dust and air pollution play a major role as triggers of asthma. Therefore, it is important to have a dust free environment to prevent acute attacks. In a dusty and polluted environment, people with asthma need to wear a mask.
All people with bronchial asthma are advised to stop active and passive (second hand) smoking. This will help to prevent other respiratory diseases as well. Smoking is a leading cause of chronic obstructive pulmonary disease and lung cancers in the world.
Respiratory tract infections can also trigger asthma attacks. So, it is important to meet your doctor to adjust asthma medications. In many developed countries all asthma patients are vaccinated with the Flu vaccine to prevent complications.
Q. Are inhaler habits forming and becoming addictive?
A. Inhalers are the safest method of delivering steroids into your lungs. They are not habit forming and side effects are very much less than oral steroids. Long term oral steroids can cause reduced bone density (osteoporosis) ,weight gain and diabetes mellitus. Hence, inhalers are the best option to prevent asthma attack.
Q. What is the role of antibiotics in the management of asthma?
A. Antibiotics have no place in the treatment of asthma, unless there is co-existing bacterial infection. However, most asthma attacks are triggered by viral infections and can be managed without antibiotic. Misuse of antibiotics and over the counter supply leads to antibiotic resistance, and this has become a serious health hazard.
Q. Are Asthma medications safe in pregnancy?
A. A moderate to severe asthma attack is a risk for both, mother and baby. In pregnancy asthma should be well controlled. Most medications including inhalers are safe in pregnancy.
Q. Can people with asthma do exercise and sports?
A. This is a very frequently asked question, especially, by parents. It is true, some people with asthma find that exercise triggers asthma attacks. If you get asthma attacks only with exercise and not at any other times there is a higher possibility of exercise induced asthma. However, if your asthma is under control you can still do exercise.
For individuals with exercise induced asthma, it is important to do warm up and warm down before and after exertion.
In addition, they could get a bronchodilator (relieving inhaler) before exercise.
On the other hand, regular exercise is good for individuals with asthma in several ways, such as, improving the working capacity of lungs, boosting the immune system and supporting the immune system.
There are some world class athletes and sportsmen living with asthma. If asthma is under control you can choose any sport.
Q. What are the complications of asthma?
A. Although asthma can be kept well under control, it is a serious illness that can lead to life threatening attacks, and several other immediate and long term complications.
Life threatening attacks can be complicated by respiratory failure and death. In addition, acute asthma may be associated with chest infection and lead to pneumonia.
Air leaks from the lungs can occur as a complication of acute asthma and this condition is called pneumothorax. It is important to follow a good treatment plan and not ignore your symptoms if they are getting worse.
Furthermore, badly controlled asthma can cause long term issues, such as, persistent tiredness, stress, anxiety and depression. In children, there may be delays in growth or puberty.