With Christmas and New Year a few days ahead, and the likelihood of a surge in asthma due to excitement and current rainy weather, the Sunday Observer spoke to Consultant Respiratory Physician, District Hospital, Hambantota and Joint Secretary Sri Lanka College of Pulmonologists, Dr Damith Rodrigo to find out how vulnerable persons can minimise risks to asthma attacks during this festive season.
Excerpts.
Q. It has been reported that the number of patients being treated for asthma is on a sharp upward curve, in Sri Lanka at this time around. Do you agree? .
A. Yes, Sri Lanka is a country with one of the highest asthma prevalence especially among Sri Lankan schoolchildren as seen in evidence from the research study ISAAC which found that asthma prevalence is over 10%.
Q The excitement of the Christmas and New Year season ahead and the current drastic weather changes, and air pollution we are now experiencing are said to have collectively contributed to this upward surge in Asthma. Yes or No? How?
Dr Damith Rodrigo
A. Yes. In asthma small airways of our lungs are affected. The small airways of the lungs get narrowed due to swelling of the smooth muscles and increased production of phlegm inside. When these airways are blocked we feel difficulty in breathing the air out of the lungs which results in symptoms like coughing, wheezing, tightening of the chest and difficulty in breathing .
Q. I understand there are certain factors that can trigger an attack ? What are trigger attacks? Who is most vulnerable to them?
A. Certain factors in our environment can cause “asthma triggers” in susceptible persons e.g. cold weather, pollutants in the air can worsen asthma. Additionally, due to the prevailing rainy season various respiratory viral infections like influenza are spreading also triggering asthma in susceptible individuals.
Q. As this is the month many students are about to sit for their exams. could stress be a cause for the current surge in asthma especially among young people? .
A Stress is a common asthma trigger. Studies have shown that when people with asthma are under a lot of stress they have worse asthma control and more flare-ups.
Q. Bronchial asthma and asthma – is there a difference in these two conditions – or are they one and the same condition?
A. They are the same. Bronchial means related to bronchi or the “airways”. In asthma, it is the small airways of the lung that are affected, hence the correct medical term should be “Bronchial asthma”.
Q. How do you diagnose bronchial asthma ? Are there tests? If so, what are they?
A. Diagnosis of asthma is usually done based on clinical symptoms. Cough, wheezing shortness of breath and chest tightness are the four cardinal symptoms of asthma. These symptoms can occur in isolation or in tandem and they usually show “diurnal” variation. This means these symptoms usually get worse towards the night time. The most serious attacks of asthma occur towards the late night and very early morning (2 am to 6 am) as this is the time when the environment temperature is very low and the tone of the bronchial muscles are at the maximum level.
The diagnosis of asthma is confirmed by doing a lung function test or spirometry test, where the patient is asked to breath out to a machine called a spirometer. Spirometry tests are available in most respiratory treatment units islandwide.
Q. Are there other illnesses that have similar symptoms of asthma ? I was told that wheezing is also found in respiratory tract infections, chronic obstructive pulmonary disease and several other respiratory conditions. True or false?
A. True. There are a lot of other illnesses that can mimic asthma as they share common symptoms. For instance patients with heart failure can present with shortness of breath and can be wrongly diagnosed as asthma. On the other hand cough is in fact a common respiratory symptom that can be seen in common respiratory infections. Wheezing can transiently occur in lower respiratory tract infections especially in small children and can present as asthma. Chronic cough and difficulty in breathing can be seen in most of the patients who are suffering from Chronic Obstructive Pulmonary Disease which is quite a different disease entity to asthma. Therefore a thorough clinical evaluation is important before confirming the diagnosis of asthma.
Q. What about House Dust Mites (HDM) and fungal moulds in damp walls which are commonly seen in Sri Lanka. Dog hair and cat hair of household pets, pollens, respiratory infections, and certain allergens in food that we eat and fragrances, chemicals used in detergents, hair dye that people use also can trigger serious asthma attacks
A. House Dust Mites (HDM) and fungal moulds in damp walls are two common asthma triggers commonly seen in Sri Lanka. Other factors that can also act as triggers are dog hair and cat hair of household pets, pollen, respiratory infections and certain allergens in food that we eat and fragrances, chemicals used in detergents, hair dye that people use also can trigger serious asthma attacks.
Q. Can exercise cause an attack?
A. Yes, exercise is also known to trigger asthma in certain individuals and it is labelled as exercise induced asthma”
Q. Strong emotions?
A. Yes.. Strong emotions such as anger can also trigger asthma attacks.
Q. Inhaling toxic fumes from vehicular traffic – aren’t they a hazard for those with asthma ?
A. Yes. Absolutely true. Research confirms that traffic pollution plays a role in the development of asthma that goes beyond just triggering symptoms especially in childhood asthma.
Q. Tobacco smoking has been cited as one of the biggest culprits in triggering asthma. Do you agree?
A. Yes indeed. When a person inhales tobacco smoke, irritating substances settle in the moist lining of the airways. These substances can cause an attack in a person who has asthma
In addition, tobacco smoke damages tiny hair-like structures in the airways called cilia. Normally, cilia sweep dust and mucus out of the airways. Tobacco smoke damages cilia so they are unable to work, allowing dust and mucus to accumulate in the airways which causes narrowing of these airways resulting in asthma attacks.
Q. Does that include passive smokers – those who don’t smoke, but are constantly in close contact with actual smokers?
A. Smoking of all types, especially tobacco smoke even if the exposure is second hand (passive smoking), can trigger asthma, especially in children and babies. Breathing just a small amount of secondhand smoke can cause a severe asthma attack. According to the CDC (Centre for Disease Control and Prevention in the US) secondhand smoke contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer. If you have asthma, it’s important that you avoid exposure to secondhand smoke.
Q. Many low budget homes continue to use the open hearth in closed kitchens for cooking. How harmful is this practice for especially older persons with compromised immune systems ?
A. Firewood smoke that comes from open hearths in closed kitchens in lower and middle class house settings in this part of the world is the main reason for indoor air pollution. This has led to an increase in the number of chronic respiratory diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD) cases especially in women.
Q. Gender wise and age wise who are those most vulnerable to asthma? Why?
A. Asthma is more common in females than in males. Global asthma prevalence in females is around 10.8 % where it is 6.5 % in males. Asthma is more common in children than in adults.
Q. If detected and treated early can asthma be cured?
A. There is no permanent cure for asthma. But it doesn’t mean that one should suffer from this illness. If diagnosed early and started on proper medication asthma can be controlled well and deaths due to asthma can be prevented and quality of life of patients with this disease can be significantly improved.
Q. Can it be managed if chronic ? How?
A. Asthma is a chronic inflammatory disease. It is this chronic inflammation that occurs inside these airways that leads to increased phlegm production and narrowing of airways to cause asthma attacks. We should provide “anti inflammatory” medications to counteract this inflammation. Nowadays asthma can be simply managed with long term inhaler medications containing inhaled corticosteroids prescribed by your physician which contain these anti-inflammatory properties which also acts as the “preventer” medications. However, we use inhaled bronchodilator medications like inhaled salbutamol to dilate the airways to give the patient’s immediate relief and these are called “reliever” medications.
Q. Can children with asthma also use these inhalers? Isn’t there a danger of overuse?
A. Inhalers are quite safe to be used in all age groups including very small children. They contain very small amounts of inhaled corticosteroids or bronchodilator medications that directly go and act on the patients lower airways in lungs and the absorption of these medications to the patient’s own blood stream is negligible. On the other hand if you are to use oral medications that you swallow as pills they get absorbed into the blood and only a small amount will act on the lungs causing a lot of other adverse effects on other organs. Therefore, using inhalers is quite safe. However some patients fear to be started on inhalers thinking that they get used to it or get addicted. This is a total myth.
Q. Can frequent attacks of asthma damage the lungs permanently? If so, how?
A. Frequent asthma attacks due to poor asthma management can lead to airway remodeling. Airway remodeling is a serious condition that happens when asthma is untreated or poorly managed.
The lungs become scarred, asthma medicines do not work as well and less air is able to move through your airways. This is why proper control of your asthma is important.
Q. Gaps you see in the delivery of quality care for asthma patients in Sri Lanka?
A. Current gaps in asthma care in Sri Lanka which I see include inequity in care discrepancies between different socioeconomic groups, especially in rural areas . Lack of access and affordability of recommended inhaled medication especially during this economic crisis where government supply of inhaler medications are also not up to the mark. The other main issue I see are the misconceptions among our people with regard to the disease and especially its treatment including the fear of inhaler medications.
Q. How would you like to close them with the available hi technology now available?
A. Educating the public regarding the disease and its treatment is important.
Q. Your word of advice to all our readers out there who are susceptible to asthma attacks ?
A. Asthma is a completely controllable disease and with proper controller medication one can lead a normal and active quality life. Remember asthma is a chronic disease and treatments are also long term. One should not be afraid of using inhalers and if you follow your medication you might even reach disease remission and lead a normal active life.
