In the realm of respiratory health, few conditions cast as wide a net of influence as asthma. This condition can affect individuals of all ages, backgrounds, and geographic locations. Its impacts are beyond mere physiological discomfort. This has prompted extensive research and medical attention into asthma. Dr Sarthak Rastogi, Pulmonologist at Jaslok Hospital and Research Center, discussed in detail about Asthma in this interview and explained various aspects of the disease.

Dr Sarthak Rastogi: Asthma is a respiratory condition. It is manifested by a complex interaction of genetic factors and environmental factors, which lead to a chronic condition. In this condition, people experience breathlessness and wheezing and cough. Any age group can be affected, and both sexes are equally affected. The incidence is rising as of now in the last few decades.

What are the signs and symptoms of asthma?

Dr Sarthak Rastogi: The most common symptoms of asthma are prolonged cough, episodes of breathlessness, wheezing or chest congestion or tightness. Some patients have a history of allergies that trigger these symptoms. Some patients tend to have a type of asthma in which there’s just a cough and nothing else. It is called cough variant asthma.

What are the causes of asthma?

Dr Sarthak Rastogi: One of the causes of asthma can be prenatal. There are complex genes which are involved in this, and usually, a patient with asthma tends to have a history of allergies or asthma in the family. Another big factor is the health of a woman during pregnancy. Malnourishment, lack of adequate diet, or lack of adequate weight during pregnancy, can result in an increased risk of asthma in the child. Similarly, a higher intake of sugar or lack of vitamin D, polyunsaturated fatty acids and micronutrients can also increase the risk of this condition in the child. Also, If the mother is asthmatic or has poorly controlled asthma, then again the child may have a higher risk of developing asthma. Complications of eclampsia can also result in a higher risk of a child developing asthma in the future.

Among the post-birth factors are premature birth, a history of chronic or recurrent infections, and exposure to smoke during childhood. Another such factor is indoor fungal growth like moulds. These moulds release airborne spores that can cause allergies and lead to asthma.

Cockroach allergens, indoor animals, like pets, especially cats and birds, can put you at risk of having asthma. One very common thing is childhood respiratory infections. Bacterial infections called mycoplasma put a person more at risk of asthma. Air pollution is another such causal factor, which is now emerging as one of the leading causes of childhood asthma.

Obesity, especially among children and teenagers, can increase the risk of asthma. Another lifestyle habit that can cause asthma is smoking. There are other factors as well that can cause asthma, like baking, living near main roads or highways, etc.

How is asthma treated?

Dr Sarthak Rastogi: The treatment of Asthma is based on the level of severity and control. Depending on your symptoms, their severity and frequency, the doctor will decide the course of your treatment. Usually, it mainly consists of inhalers. A lot of people have reservations about inhalers that they are addictive, but they are not.

A lot of people think that inhalers will make you weak, will make you dependent and that is why they prefer alternative lines of therapies and alternative medicine they approach to. And the fact is if a child takes an inhaler properly and regularly and a growing teenager takes them properly their lung growth is optimal and they tend to grow up better than a person who’s not been given an inhaler during his asthma episodes or to control his asthma episodes.

So it’s very important that we understand inhalers are essential and the backbone of asthma treatment. Apart from inhalers, there are certain therapies oral tablets which are available mainly they are called leukotriene receptor antagonists. So they can be given in conjunction with your inhalers or without them also in some cases but usually it involves one or two oral medicines in combination with the inhaler.

For home-based asthma care, when a person gets sick enough and goes to the hospital there are other treatments but for home-based treatment, these are the main things. An inhaler will change the dosage and the frequency and the types of inhalers will change with the severity of the illness and the control of the disease with time if the disease is getting controlled we can come down on the treatment and similarly if the symptoms are increasing we can go up.

Now if a person comes with seasonal allergies or seasonal asthma exacerbations then we can start the patient on treatment just before the season is going to begin and continue for a month or two after the problematic season is over. Similarly, there are people who present with exercise-induced asthma and that’s mainly in colder countries. For them, we tell them to take regular treatment and plus inhalers before they start their therapy.

Basically, we can tailor the therapy according to the patient’s needs. The patient’s symptoms and other things which depend also on treatment are the patient’s other comorbidities. So a lot of older adults, they tend to have asthma, they tend to have heart disease simultaneously. And these treatments which are given for asthma, interact with heart conditions also in some cases mainly they push up the heart rate and people with complaints of arrhythmias, which is an irregular heartbeat, tend to have a little bit of trouble with these medications.

But we have a lot of safe inhalers now available which tend to cause fewer cardiac side effects and a person can be managed them. So basically we have to factor in what is the patient’s condition. For an individual patient, we can tailor the therapy according to his level of asthma control, symptoms, trigger factors and comorbidities.

Can asthma be treated using home remedies?

Dr Sarthak Rastogi: So the first thing that we have to understand is asthma is an incurable disease. It can be controlled. Unfortunately, till now we don’t have a cure for asthma. But with proper treatment, we can control asthma to a level where a person can lead a perfectly normal life for decades to come. Considering this, if a person is diagnosed with asthma, I would not recommend for a person go for home remedies only.

Yes, home remedies. If you are trying to eliminate the trigger factors in the house, that’s good. Okay, changing a house or changing your home furniture which has been moulded or which has been sogged by water or infested with moulds or home treatment. But I would not recommend only going with home remedies for a person himself alone. There is no amount of Ayurvedic Kadas or homeopathic medicines which have been shown to reduce asthma.

We have to understand the fact that asthma tends to go into remission for decades also in some cases. A person who’s having severe asthma episodes now or for a few years goes on treatment, their puberty and after that, their symptoms may go into remission for a decade, for two decades or three decades, but sooner or later, the asthma symptoms will come back.

So a lot of these alternative lines of medicine, tend to either claim that their treatment, their treatment can cure asthma and the person takes it and goes into remission and thinks that whatever he has taken has worked, it may not. So and a lot of our asthma, for example, a lot of asthma patients started during COVID time. They started doing Ayurvedic home remedies which they had received on WhatsApp simultaneously they stopped meeting other people. The incidence of normal respiratory viral infections went down, air pollution went down, and they started a little bit of exercising or some other factors improved.

For a lot of asthma patients, especially the young ones, so with Ayurvedic and homeopathic medicines, a lot of my patients were convinced that they improved. And it is more often than not it is a coincidence till factor that they have gone into remission for some other reason. And during these last two years of COVID, it was improved air quality, and lack of interaction which is why they had a lack of other respiratory viruses, which is one of the major reasons for asthma exacerbations.

So they were convinced that whatever they did with home remedies with ginger, lemon and steam inhalation improved their lung function. Now, the only home remedy which may help or home exercises which may help are breathing exercises and asthma to a certain extent. But they cannot control your asthma symptoms, they cannot treat your asthma exacerbation episodes and they cannot cure definitely.

They will be an adjunctive to the therapy, but can never be the main modality of treatment. It should always be a steroid-based inhaler or a steroid-based nebulizer followed by other treatments which have to be the mainstay or the main pillar of asthma treatment. We know that there are a lot of therapies in which people go and they swallow fish or they go for prolonged homeopathic medication. It’s just that the coincidental factor is that patients tend to go into remission for a few years at a stretch that they feel has worked.

A lot of people who move out of Bangalore feel that their asthma has improved and simultaneously they might be taking some alternative line of treatment they feel that has improved more but moving out of Bangalore has caused improvement in their lung function. Now, a lot of our patients with asthma I’m not really sure about it, but a lot of our asthma patients say the pollution and a combination of pollination or pollen is a resultant factor. That their lung function or their asthma gets worse in Bangalore and simultaneously in Delhi during the winter months. People with asthma have a lot of difficulties.

So basically correlation of home remedies with improvement of certain other factors tend to — for them to believe that their asthma is improved. A lot of these times these home remedies sometimes do an alternative line of medicine that is laced with steroids and that steroid in any form, in any oral form can lead to improvement in asthma symptoms and they feel this alternative line of treatment is working and they tend to ignore inhalers.

So as an important message of this interview, I would just like everyone to understand inhalers are designed to directly deliver the drug into your lungs with minimal side effects on the rest of your body. They are not addictive, they will not make you dependent on it, and they will not make your body weak in any form.

In fact, on the contrary, during the growing phases if a person or a pregnant mother takes inhalers it leads to an improvement in lung function and lung growth the person and in the case of pregnancy, it leads to better lung development than lung growth of the fetus or the child inside the mother. That will be my main take-home message from the centre.

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