Asthma

Doctor’s Profile

Dr. Mohammad Asghar (MBBS)

About 10 million people in Pakistan suffer from asthma and visit hospitals every year while 15,000 households have asthma patients. During last few years asthma has taken the shape of an epidemic in Pakistan, prevalence of asthma symptoms in children is between 10 and 20 percent. Children with parents or siblings having allergies have greater chances of suffering from asthma.

What is Asthma?

Q: What is Asthma?

Ans: Asthma is a disorder that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness and coughing. Asthma is a chronic disease characterized by recurrent attacks of breathlessness, cough and wheezing. The first sign of disease is persistent cough. Symptoms may occur several times in a day or week in affected individuals. For some people the symptoms become worse during physical activity or at night. Failures to recognize triggers that lead to a tightened airway can be life threatening and may result in asthma attack, respiratory distress and even death.

What is the connection between asthma and allergies?

Q: What is the connection between asthma and allergies?

Ans: The younger you are when you get asthma, the more likely it is that it has an allergic basis. About 80 percent of children with asthma are allergic and have what we would call extrinsic, or allergic, asthma. There are two parts of asthma. One is the underlying chronic inflammation like inside bronchial tubes, which comes from breathing in things all the time and may not give you any noticeable symptoms, but it’s there all the time. And then, if you’re exposed to something else — a cat, cigarette smoke or perfume, or you get a cold, a viral infection — it may actually make things worse and precipitate obvious symptoms. So there’s the underlying inflammation and the acute triggers. Now, in terms of what causes the underlying inflammation, it’s usually what people are being exposed to and how much there is. So if you have three cats and you sleep with them, the chances are that’s probably the major cause of what’s going on.

What role do genes play?

Q: What role do genes play?

Ans: Asthma and allergies, like most things in life, are hereditary. If you have no allergic parents, then the chance of a child being allergic used to be something around 10 or 15 percent. If you have one parent, it goes to 30 percent. If you have two allergic parents, it goes to 50 percent. So it’s not a complete genetic control, and the genetic control is very complicated. There are genes that control whether you’re allergic to certain substances, and there are genes that determine how much of an allergic reaction you make, and there are genes that control how your bronchial tubes react, etc. The more of those genes you inherit, the more likely it is that you’ll get asthma, and the more likely it is that it’ll be severe and that it’ll occur at an earlier age.

How Common Is Asthma in Children?

Q: How Common Is Asthma in Children?

Ans: Asthma is the leading cause of chronic illness in children. It affects over 9% of children in Pakistan and, for unknown reasons, is steadily increasing. Asthma can begin at any age, even in the very elderly, but most children have their first symptoms by age 5. There are many risk factors for developing childhood asthma. Asthma that starts in childhood often disappears as child grows up, however, if it starts in adult life, it is likely to disappear.

Why Is the Rate of Asthma in Children Increasing?

Q: Why Is the Rate of Asthma in Children Increasing?

Ans: No one really knows the exact reasons why more and more children are developing asthma. Some experts suggest that children spend too much time indoors and are exposed to more and more dust, air pollution, and secondhand smoke. Some suspect that children are not exposed to enough childhood illnesses to direct the attention of their immune system to bacteria and viruses.

What are the common asthma triggers ?

Q: What are the common asthma triggers ?

Ans: Asthma is usually triggered by the following:

  • Animals (pet hair )
  • Dust
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Exercise
  • Pollen
  • Respiratory infections, such as the common cold
  • Stress
  • Tobacco smoke

What are the symptoms?

Q: What are the symptoms?

Ans: Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted. Symptoms include:

  • Cough with or without sputum (phlegm).
  • Pulling in of the skin between the ribs when breathing
  • Shortness of breath that gets worse with exercise or activity

How helpful is allergy testing?

Q: How helpful is allergy testing?

Ans: Allergy testing may be helpful to identify allergens in people with persistent asthma. A stethoscope is used to listen to the lungs. Wheezing or other asthma-related sounds may be heard with the help of a stethoscope. However, lung sounds are usually normal between asthma episodes.


What tests are needed?

Q: What tests are needed?

  • Blood tests
  • Chest x-ray
  • Lung function test

What is the treatment?

Q. What is the treatment? Main treatment is to control airway swelling, and staying away from substances that triggers your symptoms. Long-term control drugs for asthma are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel okay. Inhaled steroids prevent symptoms by preventing airway swelling. These work very well and are almost always the first choice. Long-acting beta-agonist inhalers also help prevent asthma symptoms. These drugs should be used together with an inhaled steroid drug. It may be easier to use an inhaler that contains both drugs.

How can we cure asthma?

Q: Where is Thalassemia treatment available in Pakistan?

Ans: The most alarming factor is that there is no cure for asthma at present though there are some very effective medicines available, which when properly used, can very largely control asthma attacks and allow people to lead a normal life.


Prognosis

Q: Prognosis?

Ans: There are really just three treatments for asthma that everyone should have. The first is environmental control, eliminating any known allergens from the sleep environment. The second is effective drug use — that’s inhaled steroids and anything else you need to keep yourself symptom-free and free of side effects. And the third is that if you’re allergic, especially in children, allergy shots are very beneficial. And the other message is that if you have asthma, you should not be satisfied to be symptomatic all the time. Given available treatments, you should be able to do whatever you want, full functional activities, and be free of side effects and free of symptoms. People should not accept anything less.