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Short of breath?

PHOTO: N. SRIDHARAN

EXERCISE HELPS Walking helps everyone, including asthmatics, keep fit

We can’t guess how the Akkriti Bhatia case will play out. But the story of this young girl who died of asphyxia — inability to breathe in acute asthma — is a wake-up call. Could it have been prevented? Do we know enough about asthma?

According to Asthma Foundation of India News, India has one of the largest concentrations of asthmatics in the world. “The incidence of asthma has increased dramatically in the last 20 years,” says paediatrician Dr. Priya Chandrasekhar. “Delhi will be the asthmatic capital of the world by 2020. Symptoms could occur in 60 per cent of children under one year, 50 per cent in the one to five age group.”

What is asthma? “A chronic respiratory disease that produces intermittent symptoms,” says Dr. Raj B. Singh, Chief Respiratory Physician, Apollo Hospital and Managing Trustee, Chest Foundation of India.

“The hallmark is bronchial inflammation. You’ll see non-specific cough with sputum, periodic tightness of chest with breathlessness.” Among infants and toddlers, says Dr. Priya, “it’s nocturnal, with persistent cough, cough following exercise, wheezing, gastro-oesophagal reflux, shortness of breath, refusal to feed.”

Reasons? Asthma is partly inherited. Chances of the child getting it are high if one or both parents have it, says Dr. Priya. The major triggers of asthma attacks however, are environmental.

“Cigarette smoking worsens asthma,” says Dr. Raj. “So do air pollution, mosquito coil/indoor smoke and chemical spray. Children born to women who smoked during pregnancy are more likely to develop asthma.”

Viral infection is real bad news for asthmatics. Food supplements and additives like colouring agents too can trigger the disease. But “severe reactions caused by food allergies should not be confused with an asthma episode,” warns Dr. Raj.

“People with one allergic disease can have asthma as well. Indians avoid food perceived to “cool” the body such as cucumber, tomato and citrus fruit. In allopathy there’s no evidence these have an adverse effect on asthma.” He mentions the “hygiene hypothesis”: Our immune mechanism protects us from developing the disease, while in sterile societies the incidence is higher.

“Asthma is high among Indian children born in western countries,” said Dr. Priya. She includes food as a probable trigger. “Around 20 per cent of children have food-related asthma.”

Though asthma is not caused by cold environment, “I see more cases in winter,” says Dr. S. Balasubramanian at Childs Trust Hospital. “Maybe because cold air causes narrowing of bronchial tubes. Adolescents are prone to attacks during menstrual periods, exams and summer camps in mountains.”

Doctors worry about poor diagnosis. “A six-year-old had cough, breathlessness after playing and climbing stairs,” says Dr. Priya. “The parents took it for weakness and modified his diet. He got worse.” Doctors mistake symptoms for infection and treat it with antibiotics, and occasionally with TB drugs, says Dr. Raj.

“Symptoms may be intermittent, but the disease is present between symptoms. Unless people recognise this, treatment will be sporadic and insufficient. Asthma remains uncontrolled in patients not on regular medication. The commonest mistake is to confuse symptoms with the disease and treat symptoms alone.”

There’s also the stigma factor. Dr. Bala points out, “Adolescents are known for poor treatment of any condition; it is psychological. Parents fear the label.”

What’s needed is an asthma treatment plan. Once the disease is confirmed through a spirometry test, patients/parents should be told of its implications. “Apart from drugs, treatment should include height-weight management, change in environment at home,” says Dr. Priya. “Hydrate the child, keep him cool, have food control. Incidence will come down dramatically.” For teens the prescription is minimising stress, no smoking, healthy eating, pulmonary function test before mountain treks, inhaler in hand, says Dr. Bala.

“The most effective and safe method of controlling this is regular and adequate doses of inhaled cortico-steroids,” says Dr. Raj. Unfortunately misconceptions regarding steroids and use of inhalers keep patients from using inhalers regularly. In India only two per cent of the people with asthma are on inhaled steroids.

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