Asthma has emerged as a major disease in developed and developing nations. As per WHO, around 150 million people are asthmatic worldwide, with India reporting 15-20 million cases, 10-15% of them being five to 11-year-olds.
It isn’t clear why some get asthma and others don’t. It’s probably due to a combination of environmental and genetic factors. Exposure to irritant allergens trigger asthma. Asthma triggers differ from person to person and can include airborne substances such as pollen, dust mites, pet dander or particles of cockroach waste, respiratory infections, physical activity, cold air, smoke, medication like beta blockers, aspirin, ibuprofen and naproxen, strong emotions and stress, sulfites and food preservatives. Gastro-esophageal reflux disease (GERD), in which stomach acids back up into your throat, can also trigger asthma.
Asthma is becoming common among children and it is tricky to recognise it. The airways in infants are narrow and any cold or infection can cause inflammation and further narrow down the airways.
Common symptoms are lingering cough or sudden and severe shortness of breath. Night coughing, wheezing or whistling sound during breathing, fast breathing that causes the skin around the ribs or neck to pull in tightly and also colds that settle in the chest. Symptoms may worsen when the child is around triggers like air irritants.
Measures to be taken:
We use different inhalers depending on the severity and response of patients. Each of them carries long-term side effects and must be used in prescribed limits. Salbutamol is the short acting B2 agonist (SABA) and the most frequently used inhaler. Formoterol and Salmeterol are long acting B2 agonist (lABA) used for moderate and severe asthma control. long-term and repeated use without consulting a doctor and without controller and prophylaxis medication can increase asthma complications like exacerbation, cardiac arrhythmia and hypertension.
Inhaled steroids are the main component of asthma therapy. They give relief and prevent attacks. Since their discovery, asthma care has improved. So far, no adverse effects have emerged in adults when given in control. They do not cause degeneration of respiratory passageway, cancer, diabetes, or high blood pressure. Nevertheless, there are some side effects when steroids are used in high doses by adults and even as usual dose in children. Risk of fungal infection in the oral cavity increases because of local deposition of the drug. This can be minimised by rinsing the mouth with water after inhaling the steroid spray. Rinsing removes the residue. Also, using spacer tube with inhalers can result in increase delivery in the airway and less deposition in the oral cavity. Children's bones are sensitive to steroids. High doses can predispose children to cataracts, glaucoma, weakened immune system, increased incidence of infections and thinning of the skin and bones.
A management plan with doctor inputs is best. There are four major components to this:
Outdoor pollution needs Government strategies to cut dust, vehicular and industrial pollution. Avoid going outdoors if the level of pollution is high and use mask.
To reduce indoor pollution
( The writer is hod, pulmonology & sleep disorders, fortis hospital, New Delhi)