Keeping Asthma under Check

Like in other nations, the incidence of asthma in Nigeria is growing with over 15 million persons said to be asthmatic, and about 10,000 losing their lives annually to the ailment. Martins Ifijeh writes that proper management of the illness can help reduce its burden

As studies have shown that the prevalence rate of asthma is increasing across the globe with an estimated 340 million persons already affected worldwide, while around 250,000 die annually due to the scourge, available statistics show that by year 2025, over 400 million people would have been affected by the scourge.

Though it used to be more common in developed countries, there are growing concerns that the prevalence is increasingly affecting people in developing countries, including Nigeria, due to
environmental factors such as urbanisation, industrialisation and adoption of western lifestyle.

A recent report suggests that about 15 million Nigerians are asthmatic or have one respiratory disease or the other, while over 10,000 persons die of the disease in the country yearly; a finding that suggests the disease is now deadlier than the dreaded HIV/AIDs infection in the country.

No wonder experts have raised the alarm that people are dying from asthmatic attacks in the country, a disease that otherwise can be well managed such that the affected persons would lead normal lives, devoid of the pains and stress occasioned by it.

Asthma, a greek word, which originally means panting, is a common chronic inflammatory disease of the airways, characterised by repeated symptoms, reversible airflow obstruction and bronchospasm, with common symptoms being wheezing (breathing with a whistle as a result of obstruction of the airways), coughing, chest tightness, and shortness of breath.

In an interview with THISDAY, a public health expert, Dr. Isaiah Okpebho explained that people still die from it because majority of Nigerians do not know it can be effectively managed with new medical devices and drugs, adding that ignorance was why there were still high mortality rate of the diease in the country.

He stated that although there was no cure for asthma, it can be effectively controlled, hence the need for increased awareness by all stakeholder, so that people will be informed on how to prevent and as well control it. “The high asthma deaths are tragic evidence of uncontrolled asthma and these are mostly preventable if control measures are effectively instituted,” he added.

Explaining how persons affected by asthma can manage the diease, Okpebho said one major step was for them to recognise what triggers their attack and in turn avoid them. Adding that recognising one’s risk factors and avoiding them can go a long way in minimising episodes of the attack. “Parents should also make sure their asthmatic children avoid such triggers, as they may be unable to make informed choices by themselves.

“Asthmatics should not assume they are fine, hence ignoring their drugs or inhalers. Medication should be taken regularly as prescribed. Those who have been given inhalers should use them as prescribed. Even if one has no symptom at all and feel well, he or she still need to take drugs or inhaler every day to help stay well,” he noted.

Adding, he said: “Experience with asthmatic patients have shown that most of them who are supposed to make their inhalers their daily companion and are not doing just that, are people who are either shy of their condition or just assume episodes of the attack would not happen.

“Asthmatic patients who really want to manage their conditions effectively must always inform all the people around them on their status. They should never leave their inhalers or drugs at home, because any unfriendly or polluted environment can trigger an attack,” he noted.

He explained that writing asthma action plan would not be out of place for persons affected. “Those who use written asthma action plan are four times less likely to have an attack that requires emergency hospital treatment. The action plan, filled together with a doctor or health worker, would tell the person what medication to take, when to take them, how to recognise triggers and what to do to get the body back on track.

“Among the several million Nigerians suffering from it, only very few access health facilities for regular reviews. Everyone with asthma should have an asthma review with their doctor at least once a year (every six months for children). This is a good opportunity to check if they are taking the right medication and the correct dose. It’s also a chance to discuss trigger experienced, lifestyle and any other factors that may affect asthma,” he added.

Okpebho also warned that asthmatics must shun certain lifestyle no matter how already deeply-entrenched they have been on the lifestyle or habits. “Asthmatics have no reason to smoke as this would in turn affect their health. Asthmatics who smoke or spend time with people that smoke are risking their lives. Asthma is very deadly and as such, prevention of its attacks must be followed.

“Since children may not know exactly what to do at all times when asthmatic attacks come calling, it is important that schools are educated and empowered to help them. The schools should as well be taught rescue plan in cases of acute episodes of asthma. With this, I believe asthma will no longer be a death sentence,” he explained.

Also on his part, a Medical Officer with Prince Fola Memorial Clinic, Abeokuta, Dr. Abel Babatunde, explained that Nigeria has lost many gifted and illustrious people prematurely due to asthma, adding that lack of education and proper understanding of the disease was a major constraint in reducing the scourge in the country.

“With proper understanding of the disease, many asthmatic Nigerians will realise that their types of job shouldn’t really be what they should be doing,,” adding that, “15 per cent of asthma cases in Nigeria have link with occupational hazards.”

He recommended that asthmatics working inside paint making industries, textile, carpet, pharmaceutical industries, among others must take special care, as they are more at risk of exposure to irritants.

But what causes asthma? Babatunde said the underlying cause was not known, but it’s thought to be due to a combination of genetic and environmental factors, nothing that, people with asthma may have genetic risk factors that make them more susceptible to it, and certain environmental factors, such as exposure to allergens or certain viral infections.

He listed common asthma triggers to include; tobacco smoke, dust mites, air pollution, pollen, mold, respiratory infections, rigorous physical activity, cold air and allergic reactions to some foods.

While noting that most asthmatics who get triggers from tobacco may not necessarily be active smokers, he called on the government to enforce the ban on public smoking, which he said was only on paper and has not been enforced in reality.

It would be noted that in a research conducted at Imperial College, London, it was discovered that there was a sharp fall in the number of children admitted to hospital with severe asthma after smoke-free legislation was introduced in England in 2007.

The study, published in the country’s Journal Pediatrics, shows a 12 per cent drop in admissions the first year after the law banning smoking in enclosed public places came into force and a further three per cent drop in each of the following two years.

Babatunde, while explaining the diagnosis of the disease, said it shows up in different ways, adding that, some people sometimes first discover they have asthma because they have persistent cough or wheeze and shortness of breath that won’t go away.

“It is also difficult for some people to know they have asthma because they think they are just getting frequent colds or other respiratory infections, but in reality, they actually have poorly controlled asthma. In other cases, people are misdiagnosed when they actually don’t have the condition.

“People with obesity can have symptoms that mimic asthma, because extra weight can make the chest stiffer and heavier, which in turn makes breathing more difficult. Also, people with acid reflux or nasal allergies can have symptoms that mimic asthma,” he said.

He said asthma was not curable, but that it could only be managed such that symptoms and even attacks would be reduced to the barest minimum.

According to him, there were two types of medications to treat the disease; quick-relief medications and long-term medications. “Quick-relief medications provide relief from acute asthma symptoms. People with asthma should have a quick-relieve inhaler, as this immediately relaxes the muscles around the airways when applied. Long-term medications are typically taken daily to help prevent symptoms from starting in the first place. A common medication is inhaled corticosteroids, which reduce airways inflammation and make it less sensitive,” he added.

He said it was important that people who take long-term medications do not suddenly stop taking it if they feel well, because symptoms can return. “But people who consistently take their medication end up taking less over the long term because their condition improves, and the dose can be lowered,” he noted.