Saans hai zindagi!

An Interview with a Doctor:

Increased air pollution is completely damaging our respiratory organs.
The toxic smoke that vehicles throw directly affects our breathing mechanism. Deteriorating environmental situation has aggravated numerous respiratory diseases like Asthma.
There is a sheer requirement to educate masses about this chronic disease so Health, Body & Mind conducts an exclusive interview for enlightening its readers about its causes and cures

By Raana Afzal

Every five out of hundred Pakistanis are asthmatics and the ratio is on a constant increase. During last ten years the rise in asthma patients is 76 percent. According to a study by Asthma Insights Reality in Pakistan (AIRIP), 81 percent asthmatics are not able to help themselves in asthma attacks whereas 99 percent do not care for allergens. This tells the ignorant and unaware attitude of asthmatics towards the problem.

Health, Body & Mind has conducted an exclusive interview with Dr Saleemullah, a Chest Specialist, Abbasi Shaheed Hospital, regarding the ignorance of asthmatics and to aware masses about asthma, its causes, treatments, control and misconceptions.



HB & M: How will you define Asthma for general public?

Dr Saleemullah: Asthma is basically an allergic disorder, which includes inflammation of airways due to environmental allergens. As a result a person suffers from difficulty in breathing, chest tightness, cough and wheezing. These are some basic symptoms that an asthma person has.



HB & M: What are the causes of asthma?

Dr Saleemullah: Asthma is a multifactor disease. Most common cause of Asthma is atopy. It is hereditary. This tendency makes an asthmatic react more to allergens than a normal person. Their airways are sensitive to allergens and a little exposure inflames them.

Then there is non-atopic Asthma. People who suffer with asthma in adult age are non-atopic. Drugs like aspirin and painkillers can cause and aggravate Asthma condition. There are certain viral and bacterial infections that increase its chance.



HB & M: What are the triggers of Asthma?

Dr Saleemullah: Triggers are those that initiate Asthma attack. There are various types of allergens that trigger Asthma attack.

Indoor triggers: dust mites, insects, pets, perfumes, chemicals etc.

Outdoor triggers: pollens, fungi, air pollution, smog, weather changes etc.



HB & M: How are we going to determine the severity of the disease?

Dr Saleemullah: Basically, Asthma is diagnosed through a number of symptoms; difficulty in breathing, chest tightness, cough and wheezing. The symptoms for some diseases are similar to Asthma. In such conditions allergic tests are recommended to see the difference. However, in some patients asthma is so mild that he/she is unable to differentiate or determine the problem. Peak flow meter is used in such condition that describes the severity of asthma. The use of peak flow meter is simply defined by the physician.



HB & M: Can food be a trigger for asthmatics?

Dr Saleemullah: According to the present knowledge there is no such food that can trigger the allergy. However, foods like rice and milk may cause asthma symptoms to appear in some patients but not in all. Food additives that are used for preservation of food can stimulate allergy.



HB & M: What is meant by an Asthma attack?

Dr Saleemullah: Asthma attack is termed as 'Acute Severe Asthma.' A very common sign of such a condition is that a person is unable to speak even a sentence; there is great difficulty in breathing. In our society people under report the problem, which makes the condition more severe. With great difficulties and problems an asthma attack may result in form of death. In acute severe asthma the possibility of death is eight to ten percent.

There is a need to guide people that what they have to do when they face such problem. Do not make a delay in instituting the problem.



HB & M: How asthma can be cured through treatment? Can an asthmatic live a controlled and normal life?

Dr Saleemullah: Unfortunately, there is no cure for the allergy. However, it can be controlled very effectively. 80 percent of patients can control their disease, which means occasionally in years they have an Asthma attack. This control can be achieved by a proper use of your inhaler.



Preventer: This includes steroids. These medicines should be used on regular bases (as prescribed by the physician) by patients to prevent asthma attacks.

Reliever: This is particularly for quick relief medication and is used in emergencies.

With two puffs in the morning and two puffs in the night an asthmatic can lead a controlled and normal life. With no:

- Asthma attack

- No emergencies

- No rescue medication

- No sleepless nights

- Can do sports, exercise and any thing else that a normal person can do.

HB & M: How do inhalers are more beneficial for the treatment of asthma?
Dr Saleemullah: Through inhalers the dose of medicine directly affects the airways and lungs as it directly enters the airway passage, whereas tablets revolve in the stomach and blood where it is not required. Through inhalers the medicine directly reaches the required place in appropriate quantity with a considerable effect. Where as tablets circulate in the entire body and does not reach in sufficient quantity.



HB & M: Are there any side effects of steroids?

Dr Saleemullah: There are very negligible side effects of inhaled steroids with no major ones. There is some evidence of effects on bones but the newer generation of inhaled steroids is better. That does not affect much.



HB & M: Combination therapy is now a widely used term for asthma treatment. How will you define this?

Dr Saleemullah: It is the combination of long acting preventer and long acting reliever. A regular treatment through combination therapy gives a complete control on asthma.



HB & M: Why do people prefer tablets for treating asthma? Are they cheaper?

Dr Saleemullah: There are different misconceptions related to inhalers. People think that the use of inhaler makes you addictive. Regarding the cost, this is the way how you look into it. This is the problem particularly related to developing countries and ours in specific. It is a one-time cost. On the basis of per day cost they are not expensive. In our country most of the people are on daily wages. My suggestion is to build inhaler banks in which such people can give their money on daily basis for using the inhaler.



HB & M: Precaution is more important for its treatment or medication?

Dr Saleemullah: It goes side by side. It is like diabetes. A diabetic makes a caution in using sugar as well as have his medicine on daily basis. Similarly, an asthmatic must have to avoid the allergens with a persistent use of preventer.



HB & M: Air pollution is a big problem especially for Karachiites. How can an asthmatic be protected from this?

Dr Saleemullah: Air pollution is more because of increasing vehicles on road. The time you spend on roads has increased. The solution to this problem lies with the government. There is a need of mass traffic system in the city. Every individual is driving his own car. Why not a single vehicle, safe and convenient, can carry and drop the people to their destinies. Secondly all the diesel cars must be changed into CNG ones. However initially it will be difficult but in the long run will be beneficial.



HB & M: Asthma is like a taboo in our society. What do you suggest to change the perceptions of the people?

Dr Saleemullah: Asthma is not as bad as people think. It is atopic through which people think that it is a contagious disease that can be transferred through genes. Although it is heredity but still is not a strong source. Therefore, I think in this regard there is need of education and awareness, which can be spread by media, specialists, and general practitioners.



HB & M: How do you observe the condition of asthmatics in Pakistan?

Dr Saleemullah: Majority of our patients go around very poor asthma control. In my view it is because of different reasons:

* Asthma is a chronic disease that requires a long-term treatment with regular visit to the doctor. Unfortunately the chronic disease patients are reluctant to go to the doctor.

* In between attacks the patient feels too good that one stops the treatment.

* Lack of awareness towards accessible good control of asthma.

* Cannot afford a good form of inhaler.

* Even if have the resources and knowledge, a greater proportion of our nation has attitude of living with disabilities.

HB & M: What is your message for asthma patients?

Dr Saleemullah: Asthma is not a dreadful disease. The problem is it is a chronic. We want cure without care. Remember that Asthma is not a contagious disease and by avoiding the allergens and with the persistent medication it can be controlled completely and an asthmatic can live a normal life.



http://jang.com.pk/thenews/aug2007-w...007/index.html

Asthma

Introduction:

Asthma is a very common long-term condition that affects your airways and breathing. Approximately one adult in 13 is currently being treated for asthma in the UK.

Asthma affects the airways, the small tubes that carry air in and out of your lungs. If you have asthma, your airways are sensitive and easily become swollen. When they are irritated they narrow, the muscles around them tighten, and there may be an increase in production of sticky mucus or phlegm. This makes it harder to get enough breath, and causes wheezing, coughing and your chest may feel tight.

Asthma may be very mild, or it can be very severe. Most cases are somewhere in between. Even if your asthma is mild, you should visit the GP regularly to have it monitored. Your GP can then prescribe the treatment most likely to help your symptoms and prevent your asthma from getting worse. An asthma attack can become very serious, if you can't control the symptoms with your treatment regime - you should see your GP or a hospital doctor immediately if this happens.

The cause of asthma is not fully understood. It is partly an allergic condition. There is also a genetic connection between asthma, hay fever and eczema. This suggests that these three conditions can be inherited (they can run in families).

Sometimes certain triggers can bring on symptoms. It's sensible to try to avoid these triggers as much as possible, as they will make your asthma worse. Common triggers include house dust mite, animal fur, pollen, tobacco smoke, cold air, viral and bacterial chest infections.

Symptoms:

Feeling breathless (you may gasp for breath).Your chest may feel tight (like a band tightening around your chest).Wheezing,Coughing, especially at night (this is less common in adults than children).Your symptoms are likely to vary from day to day and are often worse during the night and with exercise.

Symptoms of a severe attack include:

Your symptoms will get worse quickly.It will be difficult to breathe and to talk.Your pulse may race.Your lips and/or your finger nails may turn blue.Your skin may tighten around your chest and neck.Your nostrils may flair as you try and breathe.You should immediately seek medical help if you have symptoms of a severe asthma attack.

Causes:

Asthma does not have a single known cause but there are several factors that may contribute to you having the condition.

These include a genetic predisposition, diet and the environment.

Genes are passed from parents to children and although there is no specific gene that causes asthma, a combination of genes passed from parents to children increases the likelihood of having asthma (also eczema and hay fever).

Attacks can be triggered by,

Breathing in (inhaling) certain allergens (something that causes an allergy), such as pollen or fungal spores, animal fur or house- dust mite droppings. Viral and bacterial chest infections.Exercise, especially when it is cold.Changes in the weather. Fumes given off by cleaning products and solvents in the home including floor cleaners, room fresheners and polish.Tobacco smoke, pollution or vehicle exhaust fumes.Worry and stress.Foods such as nuts and shellfish, or food additives such as tartrazine.If you have an asthma attack your immune system overreacts to a trigger causing the airways to become swollen and inflamed. The muscles in the airways also tighten causing your air passages to get narrower.

Sometimes you may have another asthma attack 6 to 10 hours after breathing in an allergen. This is known as a late reaction.

Diagnosis:

Many adults were first diagnosed with asthma as children.

However a few adults first get asthma as adults, sometimes for the first time in their 50's or 60's. Adults may also get asthma again later in life after having 'grown out' of it as children or teenagers.

If you think you have developed asthma as an adult you should visit your GP, who will ask about your symptoms, examine your chest and listen to your breathing.

The GP will want to rule out other conditions that cause breathing difficulties, such as COPD (chronic obstructive pulmonary disease) or bronchiectasis.

The GP may ask you to use a peak flow meter before and after you inhale (breathe in) a bronchodilator (a medicine that helps to open up your airways). The peak flow meter measures how quickly you can breathe out. If you can breathe better after inhaling the asthma medicine, it usually means that you are diagnosed as having asthma.

A spirometry test is another way of measuring how well your lungs are working. This is linked to a computer and measures how much you breathe out very accurately. This test may be done in your local hospital.

The GP may use a Methacholine challenge test. This is based on the fact that if you have asthma your breathing will get very difficult when you breathe through the chemical methacholine. This effect can be relieved by using an asthma reliever inhaler.

Sometimes the GP will refer you for allergy testing. This involves putting tiny amounts of possible allergens under your skin using a small needle. You are allergic to the things that make your skin red and swollen.

The GP may also refer you for a chest X ray or a CT scan to rule out other conditions that can cause similar symptoms to asthma.

Treatment:

Treatment is based on medicines taken through an inhaler to relieve symptoms whilst you are having an asthma attack (Relievers). Also, if necessary, medicines taken through an inhaler to prevent you from developing symptoms (Preventers). If the asthma is still not fully controlled, other medicines may be added on (Add-ons) to the reliever and preventer medicines.

Relievers:

Most adults with asthma use a reliever inhaler (puffer). If you only get symptoms occasionally i.e. less than once a day this is probably the only treatment you will be prescribed.

Salbutamol and terbutaline inhalers are the most common relieving inhalers. They are also known as beta-2 agonists. They deliver a small dose of medicine directly to your lungs, which causes the muscles of your airways to bronchodilate (relax and open up) but do not reduce the inflammation in the airways. They work quickly, but the effect only lasts for a few hours. There are several different brands and types of reliever inhaler. The inhaler is blue or grey in colour.

If exercise brings on your asthma symptoms, then your GP or asthma nurse may recommend that you use a reliever inhaler just before exercise.

Preventers:

If you get asthma symptoms more than 3 times a week or night-time asthma symptoms more than once a week, you will also be prescribed a preventer inhaler. Preventer inhalers reduce inflammation and are used to prevent asthma symptoms, such as shortness of breath and wheezing. They need to be taken regularly, usually twice a day, even when you do not have symptoms.

Most preventer inhalers contain corticosteroids, which are similar to natural hormones produced in your body. There are several kinds but they all work in the same way. They include beclometasone, budesonide, fluticasone and mometasone. The dose of corticosteroid you need, will depend on how often you get symptoms and how bad they are. Preventer inhalers are usually brown, cream, red or orange.

Add-ons:

If your asthma is still not fully controlled, your doctor or asthma nurse may suggest that you try a long-acting beta-2 agonist inhaler e.g. salmeterol or formoterol. This is taken together with your reliever and preventer inhalers.

The longer acting beta-2 agonist inhalers are slow to start working, about 15 to 30 minutes, and so won't treat your symptoms when they happen. However, their effect on the airways last for up to 12 hours. They should help to reduce your asthma symptoms and make you feel and sleep better.

If you do not respond to a longer acting beta-2 agonist inhaler, then your doctor may suggest you take leukotriene antagonist tablets e.g. montelukast or zafirlukast, to help prevent your asthma symptoms. These must again be taken together with your reliever and preventer inhalers.

Or your doctor may suggest you take theophylline tablets. These help keep your airways open, so you can breathe more easily. They work very slowly so you need to continue using your reliever and preventer inhalers.

Steroid tablets:

Steroid tablets may be prescribed as a short course of treatment for one or two weeks if you have a severe asthma attack. They reduce inflammation and improve how well your lungs work. They reduce your symptoms quickly and lessen the chance of you needing to be admitted to hospital.

Nebulisers:

Nebulisers are sometimes used in a hospital or doctor's surgery to give high doses of reliever medicine if you are having a severe attack. They are however no more effective than an inhaler for every day use.

Prevention:

You should try to avoid the factors that may be triggering your asthma. This includes reducing contact with anything that you are allergic to, such as animal hair or pollen. Always wash your hands after touching things that trigger your asthma, especially when stroking pets.

It is also sensible to reduce house dust mite residues where possible, by using mattress covers, vacuum cleaners with allergy filters, and damp dusting. You should ensure that you avoid general irritants such as tobacco smoke where possible.

It is important that you take all prescribed preventive medicines as your doctor or asthma nurse advises, even when you have no symptoms. Also, that you are using your inhalers correctly.

Use a peak flow meter to monitor whether your asthma is getting worse. You should visit your doctor at least once a year for a check-up and to discuss treatment options.

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