DR SAMRITI GUPTA
Asthma is a prevalent chronic lung disease, especially affects children. According to the GBDR 2019, India, with over 3.4 crore cases, bears a disproportionate burden of asthma and asthma-related deaths despite having 13% of global cases, highlighting the need for better management.
World Asthma Day, held annually on the first Tuesday in May, aims to raise global awareness. In 2024, themed “Asthma Education Empowers” by GINA, it highlights the importance of educating individuals on managing their condition and seeking timely medical assistance.
Important facts about asthma
What is asthma?
Asthma is a chronic lung disease affecting breathing tubes. It is associated with inflammation and swelling of airways and extra sensitivity to irritants.
What are common symptoms of asthma?
These include dry cough, wheezing, shortness of breath and chest tightness. Symptoms are usually recurrent, episodic, often worse at night or during exercise and reversible with bronchodilators.
Symptoms sometimes worsen with triggers like colds or weather changes which indicates asthma attack. Its manifestations include severe wheezing, relentless coughing, rapid breathing, chest pain, tightened muscles, difficulty talking, anxiety, and pale, sweaty face.
Who are most affected because of asthma?
Asthma is prevalent across all level of society, manifesting from early childhood, with approximately 25% of Indian children experiencing symptoms. Boys are disproportionately affected, with symptoms often emerging before the six year of age.
What causes asthma?
The causes of asthma are complex, likely stemming from hereditary and environmental factors. It is often associated with other allergic conditions, certain respiratory viruses like respiratory syncytial virus (RSV), irritants like tobacco smoke, air pollution, and workplace allergens. While familial predisposition is common, asthma can also occur without family history.
What are asthma triggers?
Certain irritants called triggers can cause asthma symptoms in those who have underlying tendency to have asthma. Some well-known triggers are molds, dust mites, smoke, cockroaches, cats and dog’s fur, tobacco smoke, air pollution, pollens, certain foods, cold drinks, respiratory infections, certain medications, food additives like preservatives and peanuts, emotional upsets, changes in weather and exercise.
Key Issues in Asthma Management
When to seek medical assistance for asthma?
People with recurring asthma symptoms exacerbated by physical activity, emotions, or irritants, leading to physical activity restrictions and school absenteeism, should consult a physician for diagnosis and management.
During severe asthma attacks, unresponsive to home treatment, prompt emergency department visits are crucial for proper care.
What are the treatment options in asthma?
Various treatment formulations are available for asthma, which include oral medications (tablets or syrups), inhalers, or injectables. Inhalation therapy, the cornerstone in asthma management for children, employs two types of inhalers: preventers and relievers.
Preventers, like inhaled corticosteroids, reduce airway inflammation. These are to be taken daily for symptom control even when the child is asymptomatic.
Relievers, such as Salbutamol, swiftly alleviate acute symptoms during attacks but don’t prevent recurrences. Hence, these are reserved for acute episodes and not for daily use.
Address comorbidities like nasal allergy, obesity, acid reflux, or sinusitis to mitigate asthma exacerbations.
What are various inhalers available and what to choose?
Various inhaler devices exist, including dry powdered inhalers, metered dose inhalers (MDIs), and nebulizers. MDIs, particularly with spacers (with added masks in children less than 4 years), are favored due to their portability and ease of use. Spacers enhance medication delivery, especially in children, reducing inhaler side effects. Correct drug selection, dosage, and inhaler technique are vital for effective treatment. Adequate training from the doctor on inhaler use is essential.
Avoid using nebulizers at home due to contamination risk, dosing errors, and maintenance needs. Nebulizers can worsen the child condition during asthma attacks.
Are inhalers very strong medications and habit forming?
Asthma medicines are best inhaled rather than taken by mouth or as an injection. Inhaled medicines go straight to the lungs and give quick relief while using very small doses. They also have fewer side effects as very little medicine reaches other parts of the body. Inhalers are the safest mode of delivering medicines in children with asthma and can be used for long term without any adverse effects or addiction.
Will alternative therapies like Ayurveda, Homeopathy, Yoga, changing food habits, exercise, and fish therapy help children with asthma?
Asthma lacks a cure, but preventive inhalers effectively manage symptoms. Consistent usage is crucial to avoid persistent symptoms and reduce the risk of life-threatening attacks. While Ayurveda and homeopathy lack evidence, yoga, a balanced diet, and breathing exercises offer health benefits. However, fish therapy isn’t recommended for asthma treatment.
Exercise, crucial for children’s growth, is beneficial when coupled with regular preventive inhaler use. Restricting physical activity in asthma should be avoided. Controller and reliever therapy effectively manage exercise-induced symptoms in children.
Preventive strategies
How can the asthma attacks be prevented?
“Maintain awareness. Track your child’s symptoms and triggers using an asthma diary.
“Ensure consistent preventer medication usage, even during symptom-free periods.
” Supervise medication intake and schedule regular doctor check-ups every 3-6 months.
“Implement a personalized asthma action plan and monitor symptoms vigilantly.
“Identify warning signs such as runny nose or coughing.
“Prioritize annual flu vaccinations
“Minimize exposure to triggers whenever possible
How triggers can be taken care of?
“Dust, dander, mites: Use damp mops, cover bedding with dust mite covers, and avoid carpets.
“Molds: Fix water leaks, empty and clean refrigerator and air conditioner drip pans
“Smoke: Avoid smoking indoors, burning incense or candles.
“Pets: Limit contact, keep them out of bedrooms.
“Pollution: Monitor air quality, avoid pollens and harvesting areas.
“Odors: Use unscented products.
“Cockroaches: Store food properly, maintain cleanliness
Is asthma curable? Will a child outgrow asthma?
Asthma is a chronic condition without a definite cure. However, it can be managed effectively with medications. Whether a child outgrows asthma depends on its onset age and severity. Younger children may improve by age 6 without treatment. However, asthma often persists in older children, requiring lifelong management. Adjustments to treatment should be made under a doctor’s guidance. Persistent symptoms are more common in children with severe asthma as they grow older.
Conclusion
Asthma can be managed effectively with regular inhaler use. The affected population benefits from education provided by healthcare professionals and reputable organizations like GINA. Enhanced training for primary healthcare providers is vital for timely treatment initiation and referral. Collaboration among stakeholders is crucial to create supportive environments for individuals with asthma to breathe easy and live freely.
(The writer is Associate Professor, Department of Pediatrics, AIIMS Jammu).