In this interview with ARUKAINO UMUKORO, Paediatrician and President, Association of Resident Doctors, Lagos University Teaching Hospital, Dr. Emeka Ugwu, talks about the causes and treatment for asthma
What is asthma?
Asthma is a disease condition that occurs when there is an obstruction of the airways that carry air to and from the lungs, or when there is a swelling or an inflammation of the airways and hyper-responsiveness. These are responsible for the symptoms experienced; the inflammation makes the airways extremely sensitive to irritations and increases one's vulnerability to an allergic reaction.
What is the prevalence ratio in children?
The prevalence of asthma in children is about five to 15 per cent. Most of the time, it is noticed in very early childhood. Asthma is not just one particular disease condition; it is like a spectrum, a range of conditions. There are different types of severity. Cases of asthma in children between ages two to six is commonest, while the least percentage one finds is between 12 and 16 years, when majority of them would have outgrown it. Those who still have asthma at that teenage age are likely to have it into adulthood. About 60 per cent of children with asthma are less than six years; the remaining 40 per cent will be in children between seven years to 16 years of age.
What are the symptoms of asthma in children?
Some of these include, if the child has difficulty in breathing or shortness of breath, cough, which is worse at night, and he doesn't have fever, then you know it is not likely to be pneumonia or an infection, because asthma is not an infection. Hereditary factor is also important to know if a child is susceptible to asthma. For example, if there is a family history of asthma, that is, if someone in that family is asthmatic or has reactive conditions such as particular allergies, it could lead to asthma or what is also called hyper-reactive airway disease. It also depends on the degree of severity of the asthma. But the first sign are breathlessness and cough, and what they call pigeon chest - the chest may look bloated like that of a pigeon because of air traffic, the child is breathing air but can't breathe it out. Majority of children outgrow asthma later in their teenage years.
What triggers asthma attacks?
The more industrialised a place is, the higher the prevalence of asthma, because areas with industrial/air pollution trigger asthma. Also, the more developed a place is, the more likely they would have a higher rate of asthma cases. For example, Lagos would be expected to have a higher rate of asthma cases than, say, a village. Also, it is believed that in cleaner environment, people are less likely to be exposed to some germs and things that will stimulate it.
Effluents from cars and industries have also been associated with asthma. There are many possible triggers of asthma, but as I said earlier, it also depends on other factors, including hereditary and the person's predisposition to allergies and certain conditions. For example, a person could be reactive to infections, virus, bacteria, cigarette smoke, or certain type of food, drugs, a change in weather from cold to hot and vice versa. Some could even react to psychological factors. So, the person's lungs will also tend to react to these factors in the same range. This lung reaction usually leads to asthma. Some people can actually have it without any hereditary link, but they are in the minority. There is a relationship between the environment and nature in the development of asthma. All these factors are important predictors of asthma developing in a child. Asthma is like a spectrum. There are many other types of reactive states.
What are the first steps to take if a child has asthma?
There must be a diagnosis first. It includes the lung function test, as well as spirometry, where the child is asked to take in a big breath and then blow as hard and long as he or she can into a machine. It is especially used for young children. There is also the peak flow metre, used to measure how well air moves out. There is also the six-minute walk test. These methods of diagnosis are definite. After the diagnosis, the method of treatment can be decided. There are no blood tests done.
What are the types of treatment available for asthma patients?
There are several types. A clean environment is important and asthma occurs because the child is reacting to something. So, the first method is what is called environment manipulation, where those things the child reacts to are removed from the environment. For example, a child with asthma shouldn't be exposed to a room with rugs because of the particles and house dust in the rug. A carpet is more advisable or something that is cleaned regularly to be free of dust. Parents who smoke should also stop smoking in the house because it could trigger asthma attacks. So, it is important to modify the child's environment, especially if it is not a severe case. Also, generators should not be kept near the windows because of the smoke and heat from it. Also, the child can be treated with drugs. The drugs are two types; the relievers and preventers. The relievers are those that work immediately. They are given to the child to relieve them to help their airways dilate.
That's why it is called relievers to relieve that acute situation. A common drug used is Ventolin, which is in tablet, injection and inhaler forms. Its generic name is Salbutamol. There are other types of drugs for treatment and there is an international treatment guideline that every doctor is supposed to know and follow its guideline. If it is an emergency, doctors use oxygen. The preventers are usually those that work much later. What they do, as their name suggests, is to prevent asthma attacks. Many of the preventers are long active steroids. These steroids, as well as other anti-inflammatory drugs, can decrease the symptoms of asthma. Steroids have some side effects when it is taken periodically. Both types -relievers and preventers - cannot be substituted for one. The former relieves the immediate situation so the patient does not die, while the preventers are supposed to be given so that the asthma attack does not happen later. If it is an emergency case, the doctor would have to admit the patient and give oxygen and some injections.
Are there particular steps to manage asthma condition?
Yes, it depends on the situation. Early detection and proper treatment helps. There is what is called partnership in asthma management. In medicine, we say self treatment is not good, but this is encouraged in asthma because it helps a lot. So, members of the family must be carried along so that whenever there are any symptoms, they would know how to prescribe the drugs to the child or check the function of their lung and all that. For example, a three-year-old might not be able to use an inhaler, so there is a special device like a pipe, which the inhaler is pressed into and as the child breathes in from the pipe, he inhales the content. Some children are too young to use inhaler because there is a coordinated action of inhalation that the child may not be able to do alone.
How important is early detection and treatment?
It is very important because if it is not treated early, asthma could damage the lungs. Inflammation means there is redness and swelling in the lungs. So if the inflammation is not controlled, there is what is called the remodeling of the airway. So, the airway could be damaged permanently if not addressed properly. So it is important that the child is treated properly. Asthma can be managed and treated effectively and the child can outgrow it.
Should children with asthma be involved in any form of exercise?
Yes, a child with asthma can be involved in doing exercises and outdoor activities, including football and swimming. That child can even play professional football. What should be prevented are those exercises that are intensive and rigorous and take several minutes longer than necessary without a rest period.
What advice would you give to parents?
My advice is that parents shouldn't panic when they are told their child has asthma. Most children, by the age of six, are likely to outgrow asthma or later in life during their teenage years from the age of 13. Up to 90 per cent or nine out of 10 children will outgrow it by the time they become teenagers. Asthma is a chronic disease, but it usually doesn't kill people. Deaths resulting from asthma are less than one per cent. But the major problem is that people don't follow up on treatment, they just go and buy the inhaler and that's it.
The child should be taken to the hospital for regular checkups, say every three to six months. That would help to ensure that the child does not suffer many of the problems resulting from asthma. Asthma could affect the psychology and even growth of the child if not properly managed. But if managed and treated properly, the child can outgrow it. Again, the parents should comply with the drugs prescribed by the doctors. They should not wait until the child has the symptoms before they give the medications. They should also keep relievers drugs at home.
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