HEALTHWATCH
Chronic but manageable
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World Asthma Day is observed on May 3 to create awareness about this disease and its control. Dr. R. NARASIMHAN
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CONTROL ASTHMA: Patients can lead active, productive lives; given proper treatment. Photo: K.R. DEEPAK
BRONCHIAL asthma is a complex disease with a very wide spectrum of severity in clinical presentation. A global increase in asthma has occurred in recent decades. In many areas, the rise of asthma has been seen as communities become urbanised. With the projected increase in the urban proportion of the world's population from 45 per cent to 59 per cent in 2035, the increase in asthma is likely to continue. It is estimated that there may be an additional 100 million persons with asthma by 2025. Asthma accounts for about one in 250 deaths worldwide. The theme of World Asthma Day 2005 (May 3) will be "The Unmet Needs of Asthma".
Surprising results
In India it is estimated that about 20 million suffer from asthma and out of this only about three to four million get proper treatment in the form of inhalers and steroid inhalers.
To address this, the Respiratory Research Foundation with 512 asthmatics conducted a study. Surprisingly, it was found that most people, even among the educated, had reservations about using inhaler therapy. Only about 30 per cent used inhalers as advised. About 42 per cent used it on a "need" basis, while 10 per cent did not use it at all since they felt that it was addictive and bad for the heart.
Being a chronic disease with no cure but excellent control options, it requires a continuous patient-physician participation and collaboration in treatment.
The availability of guidelines with physicians and specialists alone is not sufficient to give optimum care for the patient.
The last two decades have seen intense efforts to standardise treatment options for out-patient management of asthma. Yet management of asthma has been far from satisfactory.
The World Asthma Day is an attempt to bridge the gap between the patient and physician. It is important that the patient knows that asthma is only a controllable disease, inhaled medications are the best modes of delivery and that steroid inhalers are safe. The doctor should be aware that newer methods are available to deal with asthma. Since asthma is not an important topic in undergraduate classes, most peripheral physicians are unaware of the latest methods of controlling asthma. The result: asthma continues to be under diagnosed and under treated.
More than 40 guidelines are available to treat asthma, which are formed after taking into account clinical evidence, local knowledge, attitudes and practices, socio-economic factors and cultural factors. Yet, despite their widespread dissemination, adherence to them, both by patients and physicians, is low. There is no guarantee that the guidelines will be read and still less that they will be practised. Many physicians see these guidelines as an intrusion on their right to prescribe medicine of their choice. Patients who are used to a certain medication may feel their experience in managing asthma is better than a physician's experience.
Many do not realise that the dividing line between "experience" and "bias" is thin and often blurred.
Causes
Some are common to all sufferers, while others vary. Some causes or triggers are
Viral infections like colds or flu
Allergens, usually from pollen, pet fur or dust mites
Exercising in cold weather
Emotional reactions like excitement, fear or anger
Irritants like smoke or other kinds of air pollution
Smoking
Weather changes
Additives to food like artificial food colouring, or specific food allergies
Medications
Symptoms
The signs of asthma may not be constant. The main signs are: breathlessness,a tight feeling in the chest a wheezing sound during breathing or coughing.
These can appear while exercising or at night. When the symptoms become severe, rapidly and suddenly, it is called an asthma attack. There may be more trouble with breathing during an attack. Some people get used to the symptoms and do not realise that they can breathe more easily after treatment.
Signs of a severe/dangerous attack:
Symptoms that worsen rapidlyand do not improve even after using bronchodilators (medicines that open the airway).
Symptoms that do not improve or return even after using medication.
Difficulty in talking due to breathlessness
Why breathlessness?
Airways become inflamed (red, swollen and narrower) causing the various symptoms since the airflow to and from the lungs is restricted. The airways become restricted because: the lining of the airways is inflamed; more mucus (phlegm) may be produced and block the airways; The muscles in the walls of the airways tighten.
Management of asthma depends on the correct use of medications to control and prevent asthma. Some people stop taking medication because they're feeling better. Increasing use of the bronchodilator during an attack will not help because it will not treat the inflammation. This may lead to an a life-threatening attack.
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