As countries observe World Asthma Day on May 2, a Professor of Medicine and Consultant Chest Physician at Obafemi Awolowo University Teaching Hospital, Gregory Erhabor, says the prevalence has been on the rise as a result of increasing air pollution and urbanisation but the death toll has reduced as a result of campaigns from NGOs. In this interview with Rebecca Ejifoma he calls for more availability of Asthma drugs
What is Asthma?
Asthma has its origin from the Greek word, “aázein” means “to pant”. Asthma can best be defined as a disease of the lung that causes narrowing of the airways resulting in the patient being unable to breathe properly. Patients with asthma show the following symptoms: cough, chest tightness, wheeze (noisy breathing) and difficulty in breathing.
These symptoms may occur episodically and in some cases it could be continuous. It often occurs in the night and it is usually stimulated by triggers which include dust, pollens, viral infection, stress, exercise and some drugs among others. Physicians describe what goes on within the respiratory track as inflammation and the results in constriction of the bronchi.
What triggers asthma?
The triggers of asthma have been classified as inducers and inciters.
The inducers are the things that can cause asthma while inciters are things that can cause asthma to flare up. These include: house dust mites are very common in beddings, rugs and furniture. Other examples are: dust, fumes, respiratory tract infections, cold, some drugs called Non-Steroidal Anti-Inflammatory drugs (NSAIDs) like Aspirin, extremes of emotions, stress and certain chemicals.
Who is prone to asthma?
The people most prone are those who have inherited the tendency in form of their genetic makeup. You can know this when you observe that you react adversely to things easily in what is known as allergy or atopy. These individuals tend to have red eyes (allergic conjunctivitis), sore throat (allergic pharyngitis) and catarrh (allergic rhinitis). They could also have adverse reactions to substances like pollens, dust or fumes.
Asthma symptoms usually start in childhood although there are certain variants of asthma that start later in life called adult-onset asthma. When you or someone close to you has these symptoms, encourage them to see the doctor for further evaluation.
Another set of people prone to asthma are those who are exposed to dusty occupations like wood workers, construction or quarry workers or workers with exposure to various chemicals. These occupational exposures can predispose one to develop asthma even if tendency to have asthma is not present, it may as well trigger asthma or make it difficult to control.
How can you tell you have asthma?
Asthma presents with a set of characteristic symptoms: cough, chest tightness, breathlessness and wheeze. In some instances, the only manifestation is cough in what has been termed cough-variant asthma. These symptoms tend to come in episodes which can be seasonal or perennial that is all year round. When you start to experience these symptoms, then you need to visit your doctor.
In Nigeria, these tests are available in most tertiary hospitals and can easily be carried out and are affordable. This is particularly important because most times other diseases can mimic asthma and if the person is not properly diagnosed, that can lead to delayed diagnosis or misdiagnosis with their attendant adverse consequences.
In the world of asthma today, where is Nigeria?
Globally, about 300 million people are currently suffering from asthma. In Nigeria, however, it is estimated to affect 15 million people. This means that almost one in every 15 Nigerians may have the condition.
Sadly, the prevalence has been on the rise as a result of increasing air pollution and urbanisation with the implication that many more people are exposed to polluted air and are thus predisposed to developing asthma.
Experts say asthma only has risk factors rather than causes. Why so?
The cause of asthma is largely unknown, however, two key factors play an important role in determining whether you will develop asthma or not. These are genetic and environmental factors.
Studies have shown that certain genes are associated with those who develop asthma. These genes are passed down from parents to children so you have nothing to do about it. Once you have inherited the tendency, then you are predisposed. That is why it appears that asthma runs in families. We do not know what determines which gene is passed on or why the gene is passed to one offspring and not to another.
In those who have these genes and are exposed to the environmental factors that can cause asthma like dust and the likes, the individual can go ahead and develop asthma. In a nutshell, if you have the tendency and then become exposed to triggers present in the environment, the disease can develop. We often explain that by saying “Genes load the gun, but the environment pulls the trigger.”
How can this disorder be managed?
The good news about asthma is that it is a treatable condition. The goals of asthma management are to prevent or minimise symptoms (control symptoms), prevent or minimise risk of asthma attacks and to ensure that asthma does not limit the patient’s activities.
In treating most medical conditions, we always talk about the non-drug and the drug approach. The management of asthma, however, depends on which type we are talking about. If the individual comes with chronic stable asthma, in other words no immediate dangers or symptoms exist; we advocate that the person tries as much as possible to avoid the identified triggers in themselves. Although, this is difficult to do since most of the things that trigger asthma are present in the environment.
But we advise that the individual study his own asthma and avoid his particular triggers. Drugs are available for the control of asthma. These drugs are better given by inhalation because they go directly into the respiratory track with limited side effects. The drugs are best described as controller or reliever drugs. While controllers are form of inhaled steroids and help prevent attacks, relievers are bronchodilators which help abort asthmatic attacks.
The most important thing is for the patient to have control over his or her asthma and not the other way round. This can be achieved if the asthmatic partners with his or her caregiver to find the best way of achieving good asthma control with the use of monitoring devices such as peak flow metre.
How do we recognise our asthma is getting out of control?
Acute severe asthma is one of the causes of death worldwide and one way of minimising this is recognising when symptoms are out of control. This is usually shown when you have to wake frequently at night, when you need more drugs to control your asthma, when you find it difficult to breathe on mild exercise or when you have been recently hospitalised for asthma.
So, patients are encouraged to monitor their asthma with a peak flow metre. Regular measurement with peak flow metre will help the asthmatic to know when the asthma is getting out of control. If out of control, patients are required to seek urgent medical attention so as to prevent complications.
Prevention they say, is better than cure. How can we prevent asthma?
Prevention of any diseases is usually at various levels. One is primary prevention for the individual who never had the disease and another level is secondary in which those who have had the disease are prevented from developing complications.
Now, for those who are born with the genetic tendency, there is little that can be done. However, we can avoid asthma or prevent it from getting worse if we avoid smoking, undue exposure to irritants at home or at work, use of personal protective devices at work for those whose jobs involve exposure to various irritants and use of cleaner fuels like gas for cooking to avoid indoor pollution, use of tiles rather than carpet in other to avoid exposure to house dust mites.
But for those who have developed the disease, constant use of medications as recommended by their doctors, regular clinic visit, and developing and adhering to an action plan for managing their asthma in partnership with their doctor or care giver will go a long way in preventing complications from the disease.
Asthma awareness is observed annually since awareness is key. Could we then say the number of asthmatic persons in Nigeria has reduced over the years?
The number of asthmatic in Nigeria appears to be increasing due to the increasing urbanisation and air pollution. However, deaths from asthma appear to have reduced compared to previous years. This is as result of increased awareness through avenues such as the world asthma day events and campaigns.
Several NGOs have tried to lend their voice to increase public awareness on asthma. ACCF is an initiative founded over 10 years ago and which has focused on advocacy, education, patient care and research on various aspects of asthma.
I am also happy to announce that the Nigerian Thoracic Society has come up with the national asthma guideline for the management of this condition. This is a great initiative and highly commendable.
Are there measures the government should put in place to contain this scourge?
The government needs to encourage current effort at reducing the burden of asthma through supporting the dissemination of the asthma guideline to every healthcare facility in the country.
They can also make funds available for research in asthma and support the training of healthcare practitioners through sponsorship of local and international trainings. Beyond this, the diagnosis and management of asthma will be greatly enhanced, if government can equip our hospitals with the state-of-the-art equipment for the diagnosis of asthma and other lung conditions.
One of the big setbacks in the management of asthma in this country is the unavailability of drugs. Asthma drugs should be on the essential drug list and highly subsidised and if possible provided free-of-charge as the case of anti-tuberculosis drugs.