ISSN: 1391 - 0531
Sunday, March 11 , 2007
Vol. 41 - No 41

Fighting Asthma: Asian patients to the fore

By Kumudini Hettiarachchi

She is a busy lawyer, running between courts in the Uva region. The mother of two daughters who are both married, life was hectic for Jayaranee Peeris, balancing her home and her work well, until she was struck down by a bout of illness in 1999.

"There was a tightness in my chest, breathing became difficult and I was gasping for breath," says 49-year-old Jayaranee who was rushed to the Badulla Hospital.

Ms. Jayaranee Peeris signing on her support to the coalition in Kuala Lumpur

That was the beginning of a long journey which saw Jayaranee in Kuala Lumpur, Malaysia recently with others like her to reiterate the call for better management and control of asthma through the Asian Asthma Patient Coalition, the first pan-Asia network of asthma patient groups set up several years ago.

"We are dedicated to working together to achieve a better quality of life for patients through asthma control," says Jayaranee.
The Asian Asthma Patient Coalition includes patient group representatives, asthma patients, nurses, social workers and care-givers from Australia, Bangladesh, Hong Kong, Malaysia, Korea, Singapore, Sri Lanka, Taiwan, Thailand and Vietnam.

"Asthma cannot be cured but it can be controlled," stresses Consultant Chest Physician Dr. Kirthi Gunasekera who also took part in the Kuala Lumpur meeting, explaining that though asthma is common it is taken as a part and parcel of life. "It is not identified as an illness. Both patients and doctors don't place enough emphasis on asthma as an illness."

He also points out that there is stigma attached to asthma. Most people are reluctant to admit that they have aduma (panting). They remain house-bound. "Even when we tell a patient that he/she has asthma, they don't want to accept it. There is a high degree of denial," says Dr. Gunasekera who is attached to the Central Chest Clinic in Colombo while also conducting the chest clinic at the Badulla General Hospital.

The Sunday Times learns that with diseases like diabetes and hypertension there is an objective measurement but with asthma there are no specific objective measurements. Asthma can be measured against a scale starting from mild (cold and cough) going into moderate (colds, coughs aggravated by phlegm in the chest) and ending with severe (gasping for breath).

Therefore, recognition of asthma as a long-term illness which requires constant medication is not readily accepted by society. This leads to unwanted deaths and a lot of suffering, says Dr. Gunasekera. The impact of asthma is huge. Children suffering from asthma miss school while adults miss work. If hospitalization is necessary then the whole family is affected not only by the disruption of life but also by the economic problems they would face, having to travel from their homes to the hospital etc.

Dealing with treatment, Dr. Gunasekera says most asthma patients are given temporary relief at hospitals with broncho dilators, which relax the breathing tubes. "This is treating the symptom without addressing the cause," he says comparing it to a malaria patient being given paracetamol to bring the fever down without tackling the malaria itself.

Almost all monthly clinics across the country, even in places such as Kataragama and Sevanagala, are overcrowded. Each caters to about 200-300 asthmatic patients, a majority of whom fall into the "moderate" or "severe" category who swallow tablets to keep going.

Is this good? "If you take tablets everyday, your airways swell up and if the swelling persists you will need medication to halt that, otherwise there is a high risk of death," he says pointing out that inhaled steroids which would control asthma vailable only in leading hospitals.

"What of the needy people in the rural areas? Asthma generally gets bad in the night. Some of them don't even have transport to hospital. These patients need to know that asthma can be controlled. A patient with a very bad attack of asthma, when put on the ventilator would cost the government Rs. 100,000 a day, resources Sri Lanka can ill-afford. If we can prevent a patient getting that bad, through asthma control that would be the answer," he says.

There should be a two-pronged system of tackling asthma which causes much morbidity and economic losses. The first priority would be for the authorities to provide inhaled steroids for patients to control asthma, The Sunday Times learns. "Although they consider it a big investment, the long-term benefit and saving would be immense, because asthma causes much morbidity and loss of working hours for most patients," says Dr. Gunasekera, adding that the second step would be to make asthma patients aware that they need an action plan.

The patient must be able to recognize the pattern of the illness and take the right medication at the right time. "The patient must be educated on when to take normal medication, when to increase it, when emergency measures need to be taken and when to seek hospital treatment, says this chest physician.

And that's just what the Asian Asthma Patient Coalition is attempting to do through its objectives of empowering and educating patients to be proactive in gaining control of their asthma and encouraging health professionals to use recognised and accepted methods of diagnosis, treatment and management of people with asthma.

What is asthma?

It is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early morning.

The lining of the airways becomes inflamed, the muscles of the airways tighten and mucus production increases in the airways.

What causes asthma?

Although the cause has not been fully understood by scientists, asthma can often be diagnosed in members of the same family. Atopic or a strong allergic reaction common with other family members is the most identifiable risk factor.

Exposure to allergens and chemical sensitisers is also a key risk factor since the inflamed airways of asthma sufferers are very sensitive to a wide range of triggers. Some triggers cause immediate asthma symptoms, while others can lead to a gradual development of symptoms.

Common asthma triggers include:

  • Allergens - house dust mites, pets, pollens, mould, some foods.
  • Viral infections - flu.
  • Irritants - cigarette smoke, air pollution, paint fumes.
  • Temperature changes - cold air, sudden drops in temperature.
  • Occupational triggers - wood dust, flour, industrial chemicals, glue.
  • Drugs - aspirins, beta-blocker and other nonsteroidal anti-inflammatory drugs.
  • Emotional stress - anxiety, stress, excitement
  • Food and food additives (less usual) - preservatives, dyes and monosodium glutamate.

Factors that may increase susceptibility to developing asthma

  • Air pollution - indoor and outdoor
  • Respiratory infections
  • Small size at birth
  • Smoking - passive and active. Cigarette smoke contains more than 4,500 compounds and contaminants that can contribute to the development of asthma. Children are especially vulnerable to the effects of passive smoke
  • Gender - prior to the age of 14, the prevalence of asthma is nearly twice as great in boys than in girls.
  • Obesity
  • Diet


Asthma symptoms

Asthma can vary in severity. While some sufferers experience mild occasional symptoms, others can be too breathless to walk. Asthma symptoms can appear and disappear rapidly

  • Recurrent episodes of wheezing - high-pitched whistling sounds when breathing out
  • A troublesome cough, particularly at night or when awakening.
  • Breathing problems during a particular season.
  • Coughing or wheezing after physical activity, including running or other exercise.
  • Coughing or wheezing, or developing chest tightness after exposure to airborne allergens or irritants.
  • Colds that "go to the chest" and take more than 10 days to resolve.
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Copyright 2007 Wijeya Newspapers Ltd.Colombo. Sri Lanka.