Professor Guy Marks of University of Sydney, who is also a member of the Board of Directors of International Union Against Tuberculosis and Lung Disease (The Union), shared with Citizen News Service (CNS) some of the challenges that doctors face in diagnosing and treating asthma. "It is often difficult to diagnose it and in particular to decide who needs treatment. Diagnosis requires observation of an individual over time (since asthma is a recurrent problem). Often doctors see a patient only once and it can be difficult to distinguish acute respiratory illness from asthma. Only the latter requires long term treatment. Also, in most countries the main challenge is to enable patients to access (afford) regular treatment with preventer/controller medications", he said, adding that, "There is no long term cure for asthma on the horizon. The best we can hope for in the short-term is better access to, and better targeting of, preventer/controller medications that can reduce the symptoms and disability and, mostly importantly, reduce risk of future poor outcomes (such as hospitalisation, permanent disability and/or premature death)".
Prof Mark's advice to prevent and control asthma in resource poor settings is to 'avoid smoking during pregnancy and around children (prevention); and identify children and adults at risk of poor outcomes of asthma and ensure access to, and regular use of, inhaled corticosteroid medications (control)'.
Asthma in children
Dr Meenu Singh, Head of Pediatric Pulmonology, Asthma and Allergy Clinics at Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, spoke to Citizen News Service (CNS) about asthma in children. Agreeing that asthma in children is on the rise, she also emphasised that asthma is eminently controllable.
She said that, "I would like this message to go out that asthma can be managed by parents and the child with the help of doctors. As much as possible, we should give them preventative medicines, rather than just go for rescue medication that is done in acute cases. It is better to prevent the attack before it occurs and not get into the complications of asthma which would be very expensive to take care of".
Dr Singh rued that in India it is a big challenge to make the doctors practice existing guidelines for management of asthma.
"Many of them would not know what to practice and some of them, even if they know, would rather go for therapies which are in the acute phase as that is more profitable for them. If you start giving prophylaxis to the kids then they will stop coming to the doctors and parents will be able to manage them. The strategy should be to help them get rid of inhalers and it can be done. We should train our children in doing pranayam (a breathing technique) when they are coming out of medication, as in acute cases pranayam may not be effective. In chronic phase we should encourage the children to increase the vital capacity of their lungs in order to take them off the inhalers. 'Neti kriya' (nasal cleansing with warm salty water) is another intervention that can be used to manage childhood nasal allergy which is a prelude to respiratory allergies in later life. Parents are very important stakeholders in evidence based child healthcare, including asthma."
Dr BP Singh, a lung health specialist pointed out that in India asthma in children is often misdiagnosed as TB. This is a matter of great concern as it involves misuse of anti-TB drugs. So, childhood asthma should be dealt with seriously and diagnosed and treated correctly. Dr Singh also echoed the thoughts of Professor Marks on giving children a clean environment to live in. "Indoor air pollution should be minimized and tobacco smoke should be stopped by all means as it is a very important risk factor for triggering asthma attacks. The kitchen must be very well ventilated. If there are pets, they must keep them away from bedroom. The house mattresses contain a lot of dust which exposes asthma patients to mites--the most important cause for allergies. In countries like India, regular sunlight exposure to pillows and mattresses can wipe out these dust mites", he said.
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