Asthma is a major non-communicable disease (NCD), affecting both children and adults. The steep rise in global figures of asthma patients in recent years underlines the fact that the world indeed is in the grip of an Asthma epidemic.
Yet despite its wide prevalence, many people including those with asthma still do not fully understand the disease. Indeed, like many other NCD’s, asthma too is surrounded by myths and misconceptions as well as prejudices which prevent patients from seeking early treatment. This is unfortunate in a country where treatment is available everywhere and is free in state hospitals.
As World Asthma Day is to be observed on March 3, the Sunday Observer spoke to Consultant Respiratory Physician District General Hospital and District Chest Clinic, Trincomalee, Dr. Upul Pathirana to get a better perspective of this widely prevalent health condition which many persons including patients themselves don’t still fully understand thus resulting in aggravating the disease.
Q: As I have just mentioned, most people including readers still do not know what exactly Asthma is and how it is caused. Could you explain to them what Asthma is and what organ/s of the body it is linked to? Is it the lungs? If so why and how?
A: We have two lungs in our body, which oxygenate the blood and remove waste gas, Carbondioxide (CO2) from the blood. To maintain the optimum level of Oxygen (O2) and CO2 in the blood, the required amount of air should reach the alveoli (Alveoli are tiny air sacs connected to the terminal part of the airways). The branched system of airways enables to passage air to the alveoli. The symptoms of asthma are associated with difficulty breathing air out of the lungs due to airway narrowing, airway wall thickening and increased production of phlegm.
Q: What are the symptoms we should look out for? Cough? Wheeze? Shortness of breath and chest tightness – or a combination of any of these?
A: Yes. Above are the cardinal features of asthma, which occurs in isolation or in combination. However, these symptoms vary over time in their occurrence, frequency and intensity.
Q: Which of these is the commonest symptom usually?
A: The patients with asthma usually come out with the symptom of wheezing along with shortness of breathing. You may experience symptoms at night and therefore, sleep disturbances are common among asthma patients.
Q: What are the trigger factors that cause an Asthma attack?
A: Viral infections, allergens (house dust mite, pollen etc), tobacco smoke, stress and exercise can trigger or worsen asthma symptoms. And also, some medications like aspirin, can induce or trigger asthma attacks in some individuals.
Q: Is stress a cause?
A: Stress is a trigger rather than a cause of asthma. If you have asthma, keep an eye on your stress levels - approximately 40 percent of people with asthma tell their doctors that stress triggers their symptoms.
Q: Is smoking a contributory factor?
A: Smoking is harmful to your lungs in many ways. It directly causes an illness called chronic obstructive pulmonary disease (COPD). Smoking is a strong trigger for asthma and therefore, patients who exposed to smoking are more likely to have their asthma is uncontrolled. Inhaling second-hand smoke (also called passive smoke) from another person’s smoking may be even more harmful than smoking yourself.
Q: What about Temperature changes which we are currently experiencing from cold and rainy to hot and humid?
A: The symptoms and triggers are different from person to person. One may have asthma during cold and others in heat.
Q: It is also said that Drugs - aspirins, beta-blocker and other nonsteroidal anti-inflammatory drugs can cause asthma. Your comments?
A: This group of medications can induce asthma or make your asthma is uncontrolled. However, the above group of drugs play a major role in modern medicine, for example, aspirin and beta-blockers in heart attacks. Therefore, if you have asthma, you must tell your doctor during the consultation so that the doctor can use safer alternatives.
Q: Obesity? Many Sri Lankan women, men and children are overweight. Can this be a risk factor for developing asthma?
A: Yes, of course. It is well known that obesity is a risk factor and the development of asthma and asthma may increase the risk of developing obesity. Weight reduction is included in individual asthma management plan of patients with asthma who have obesity and even 5-10 percent reduction in weight improves asthma control.
Q: Respiratory infections?
A: Respiratory infections can precipitate severe asthma attacks which might be life threatening. The infective organisms are usually viruses like influenza and Covid-19 even though rarely bacterial pneumonia.
Q: Can you inherit Asthma? I am told that a new born could be asthmatic if the parents have asthma or suffer from rhinitis or allergic conjunctivitis or eczema? Is this true?
A: Yes, if your family has asthma, you may have the genetic makeup which predispose you to develop asthma. According to the US Center For Disease Control and Prevention (CDC) report, if a person has a parent with asthma, they are three to six times more likely to develop asthma than someone who does not have a parent with asthma.
Q: Gender wise and age wise who are more vulnerable to getting asthma? Why?
A: Asthma predominantly occurs in boys in childhood, with a male-to-female ratio of 2:1 until puberty. Asthma prevalence is greater in females after puberty, and the majority of adult-onset cases diagnosed in persons older than 40 years occur in females. Boys are more likely than girls to experience a decrease in symptoms by late adolescence.
Q: The World Health Organization describes Asthma as the most common chronic disease among children. So how does a parent recognize if his /her child has asthma? What are the symptoms? I’m told there are five main ways to check if your child has asthma.
A: You may suspect your child has asthma when you notice the following symptoms:
Coughing that is constant, is intermittent or seems linked to physical activity
Wheezing or whistling sounds when your child breathes out
Shortness of breath or rapid breathing Complaints of chest tightness
Repeated episodes of suspected bronchitis or pneumonia
If he shows these symptoms, take your child to see the doctor as early treatment of asthma in children prevent severe asthma attacks and long-term consequences in addition to symptom control.
Q: Is there a difference between adult asthma and childhood asthma? Can young children with asthma get over the disease faster than adults?
A: Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality.
Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
Q: What is the best way to prevent asthma and reduce risks of asthma attacks?
A: The best way to prevent asthma attacks are to identify the possible triggers so that you can avoid or minimise exposure to those. You must take your medications as prescribed. Your doctor prescribes medications known as asthma preventers such as inhaled corticosteroids. Track your asthma and recognise early signs that it may be getting worse, and you can have an action plan from your doctor to know what to do when your asthma is getting worse.
Q: Treatment –wise how do you treat a patient admitted with a breathing problem?
A: Good clinical evaluation supplemented by simple testings will establish the diagnosis of your breathing problem in majority of cases. The treatment is directed to the underlying diagnosis and your doctor will individualise the treatment plan so that it best suited to you.
Q: According to the World Health Organisation’s latest data Asthma affected an estimated 262 million people in 2019 and caused 461000 deaths. How does Sri Lanka rank in comparison to these global figures?
A: To quote the WHO data published in 2018, Asthma Deaths in Sri Lanka reached 6,248 or 4.92 percent of total deaths. In comparison to global figures, Sri Lanka still has higher mortality rates in asthma related deaths.
Q: The theme for 2022 World Asthma Day is ‘Uncovering Asthma Misconceptions’. What is its significance to Sri Lanka? What are the most common myths that we need to debunk regarding asthma, especially childhood asthma ?
A: Asthma is a treatable disease and patients can have near normal life with effective asthma treatment. Some myths behind asthma in Sri Lanka challenge us to achieve this target. Asthma medications used commonly to prevent asthma attacks and relieve symptoms are formulated in inhalers. All the inhalers in the market are in the form of either dry powder (capsules) or pressurised metered dose inhalers (puffers). These inhalers are easy to use and have very minimal side effect profile compared to pills which we take through the mouth and then get absorbed into the blood to deliver into lungs. Most patients unfortunately think in the opposite way making a resistant environment to prescribe inhalers.
Q: Asthma medications are habit forming, dangerous and lose their effectiveness over time is another Myth. -True or false?
A: This is absolutely false. Asthma medications do not lose its effectiveness over time and it is vice versa in real life, where doctors reduce the dose of drugs over time provided that asthma is well controlled. The first three years of symptom onset is the crucial period as beyond this period, lung starts permanent changes within the airways. These permeant changes are prevented by asthma medications. With early treatment, you can go ahead with very low dose of medication without any danger and it reduces health care associated cost too.
Q: Another belief is that people with asthma should not exercise, play sports or participate in gym class – Myth or fact?
A: It is a myth. If you feel breathless during or after exercise, it means your asthma is not well-controlled. We encourage exercise for patient with asthma to improve lung functions.
Q: Asthma is only a childhood disease and is usually outgrown. Is this a myth or fact?
A: It is Yes and No. Childhood asthma may outgrow or persist into adulthood.
Q: If you aren’t wheezing, it isn’t asthma –True or false?
A: False as wheezing is only a one symptom of asthma. Patients can present with other symptoms as described above without experiencing wheezing.
Q: Your message to the public on reducing asthma risks on the eve of World Asthma Day?
A: Asthma is a treatable disease and the treatments are available everywhere in the country. You should seek medical advice early and comply with the treatment.
Correct inhaler technique is the cornerstone for optimum drug delivery to the target site within the respiratory system.
Non-compliance and incorrect technique waste your money also. You can bring your inhalers whenever you seek medical advice so that we can make sure that the prescribed medication is delivered to your lungs..