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The breathing sickness
ASTHMA, a serious public health problem responsible for staggering healthcare costs, is now on the increase in Pakistan. The morbidity and mortality from bronchial asthma are increasing worldwide. The World Health Organization estimates that up to 150 million people in the world are suffering from asthma.
The understanding of the pathophysiology of asthma has undergone considerable changes in the past few years. This, in turn, has had substantial impact on the treatment of the condition. In this regard, Global Initiative for Asthma (GINA) was created jointly by Who and the National Heart, Lung and Blood Institute (NHLBI) in the United Statess enabling health professionals and public health officials to reduce asthma prevalence, morbidity and mortality.
Asthma management guidelines have been developed by the National Asthma Guideline, derived from international guides such as GINA and the British Thoracic society to assist physicians in treating asthma patients. Some of its objectives include:
1. Increasing awareness of asthma and its public health consequences.
2. Determining causes that lead to an increase in the prevalence of asthma.
3. Studying relationships between asthma and one’s environment.
4. Reducing asthma morbidity and mortality.
5. Improving upon asthma management practices.
6. Improving availability and accessibility of effective asthma therapy.
Recent studies show that practicing doctors do not follow asthma management guidelines. Not only this but also, there is a serious lack of knowledge about asthma medication along with various misconceptions about steroid inhaler therapy.
Side-effects
The burden of illness is borne not only by patients but also by his/her family and society. The symptom of asthma can range from an occasional annoying flare up of breathlessness to frightening episodes in hospital emergency rooms.
Asthma usually begins during childhood. The atopic (allergic) triad is classical wheezing, audible breathing sounds, eczema and seasonal rhinitis (watery nasal discharge) If one parent has asthma the child has a 25 per cent risk of developing asthma, whereas if both parents have asthma the child is at 50 per cent risk of developing the disease.
Sadly, asthma cannot be cured but it can certainly be controlled.
Several management issues are involved in controlling asthma, some of which include:
1. Selecting appropriate medication which differs in each and every case. For instance, if in a patient, exercise is the trigger then he/she will benefit by the use of inhalers which contain B2 agonist. The dose should be taken before one is on his/her way to exercise.
2. Preventing asthma attacks. This simply means controlling the envionment, which may include wearing of face masks or removal of carpets and pets.
3. Avoiding any known triggers. For instance, parents could try to stop smoking if their child has asthma.
4. Educating the patient with respect to the understanding of triggers which may range from dust to weather changes to mold and cockroaches.
5. Monitoring asthma care for long-term control. This is carried out by a small plastic tubing (peak flow meter), by which patient can measure his/her asthma status at home.
6. Following children with frequent exacerbation by peak flow metre measurement. The child should have a peak flow metre at home and parents should call the physician when value starts to drop so that early treatment can be initiated.
The peak expiratory flow rate is a useful tool for clinical assessment and the patient’s self-assessment of asthma. It is also useful to monitor and change therapy and diagnose exacerbation. Patients should establish their personal expiratory flow rates.
This is established after therapy eliminates symptoms. The patient for two-three weeks daily records his/her peak expiratory flow rates in early afternoon with the same metre and thus an average is obtained. Peak expiratory flow rates should be re-calculated every six months to account for growth in children or disease progression. This has three zones.
1. Green zone: this covers minimum symptoms so that patient can participate in normal activities including exercise. In these cases, medication is used less than four times a week.
2. Yellow zone: If (a) one experiences difficulty performing regular activities or exercise and; (b) asthma symptoms are disturbing sleep, medication is used more than three times a week. Yellow also indicates that modification is required in controller medication.
3. Red zone: This refers to severe asthma symptoms requiring medical attention immediately. The symptoms of this zone include (a) excessive coughing; (b) excessive wheezing; (c) extreme tightness in chest; (d) extreme labored breathing; (e) sweating; (f) gasping voice; (g) pale or blue lips or finger nails; (h) anxiety or fear; (i) decreased activity level; and (j) symptoms that do not respond to regular reliever medication, the patient should repeat B2 agonist medication and proceed to the nearest emergency department.
Asthma may not be curable but it can certainly be controlled, given that one takes the necessary precautions and makes significant changes in one’s lifestyle. Undoubtedly, the disease is a menace and can often lead to undesirable and painful symptoms.
However, it is quite possible to maintain a normal life, provided that one is motivated enough to make the required changes.
The writer
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