Breathless

Dr Romi Singla

Is a nagging cough or sneezing bothering you for some time? Have you noticed a recent worsening of your symptoms that include wheezing, shortness of breath, chest tightness, etc.? You could be suffering from bronchial asthma. Bronchial asthma is one of the most common respiratory diseases around the world affecting 1-18 per cent of population all over. Around 74 million in India are suffering from this disease and the number is only rising. Most of the asthmatics are between five and 25 years, with nearly half of the patients being affected before 16 years, although late onset in adulthood is known to occur, especially in women.

What causes asthma?

It is a disease caused by interplay of genetics and environment, which means that one can inherit it from parents.

Asthma is caused by inflammation of the air passage making the airways narrow temporarily, resulting in difficulty in breathing. 

Wheat husk during harvest months, stubble burning, Congress grass, pollen and weeds are some of the most common allergens behind the increase in the number of asthma attacks during the harvesting season in April-May. Stress, viral infections, vitamin D deficiency, extreme exercise and smoke are also known to make asthmatic attacks worse.

Low-birth weight and lack of breast feeding during infancy, obesity are associated with development of asthma later in life. 

Certain medications e.g. anti-hypertensives like ACE inhibitors and beta blockers; aspirin, ibuprofen, naproxen precipitate the symptoms of asthma as do certain occupations e.g. adhesive handlers, vets, textile workers, bakers, millers, farmers, carpenters, hairdressers, milk and egg powder handlers in food production, healthcare and pharmaceutical workers, spray painters and welders.

Why is the prevalence on the rise?

Warm weather is conducive to early and prolonged pollination of trees. With greenhouse effect on Earth, this process is expected to further increase. 

Earlier, most Indians followed a traditional lifestyle and diet that was healthy, wholesome and mostly constituted of locally grown foods. As western culture and foods invaded our life and dictated our lifestyles, it affected the immune system and made us prone to asthma and other allergic diseases. 

Food allergens like sulphites and preservatives added to pickled foods, shrimp, dried fruit, processed potatoes, beer and wine, set off asthma attack. A low intake of antioxidants and omega fatty acids might be another risk factor for asthma. 

Pollution, especially indoor air pollution from dust mites, dusty carpets, incense sticks, curtains, old cars and unplanned urbanisation play a big role in adding to pollution and hence aggravating breathing problem.

Treatment

Asthma is a chronic disease which cannot be cured but can be definitely controlled with inhalers, the best treatment for bronchial asthma. All inhalers are not the same. There are different combinations in varying doses meant for step-wise treatment of both adult and paediatric asthma patients.

Complications

If left untreated or inadequately treated, there may occur fixed remodelling of airways leaving fewer chances of control by inhalers and other medications. Also in long standing, poorly managed cases of asthma, there may occur a fungal infection of the airways, which is further difficult to cure.

Dos and Don’ts 

• Do not get yourself treated from quacks on as-and-when-needed-basis or do self medication with over-the-counter cough syrups and tablets, lest you should land in emergency with severe breathlessness or intractable cough lingering for months.
• If your doctor has put you on inhalers, do not stop treatment after some weeks once you feel better. Almost 80 per cent asthmatics in India are on oral tablets whereas in rest of the world asthma is treated primarily with inhalers.
• Stick to your doctor’s prescription and bring your medications along when you visit your doctor. So that s/he can double-check that you’re taking right dosage of medications and using your inhaler correctly.
• Follow your asthma action plan with your doctor.
• Identify and avoid asthma triggers.
• Monitor your breathing. Regularly measure and record your peak airflow (PEFR) with a home peak flow meter.
• Identify and treat attacks early. When your PEFR measurements decrease, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.
• Get vaccinated for influenza and pneumonia to prevent flu and pneumonia from triggering asthma flare-ups.
• Asthma is closely linked to gastroesophageal reflux; preventing that will help reduce frequency and severity of asthma symptoms.
• Raise the head of your bed by six inches.
• Eat a small meal, at least three to four hours before lying down, and avoid bedtime snacks.
• Maintain a healthy weight.
• Limit consumption of fatty foods, chocolate, peppermint, coffee, tea, cold drinks, ice cream and alcohol. Give up smoking — all of these relax the lower esophageal sphincter. Avoid tomatoes and citrus fruits or juices.
• Wear loose clothes.
• Avoid junk and fried foods. There are allergenic ingredients in the former and bloating and flatulence due to the latter. Both impair asthma control.
• Another condition, chronic rhinosinusitis (CRS) with its severe symptoms of sneezing, post-nasal drip, persistent cough, heaviness of head and face, is directly linked with poor asthma control and hence the two should be treated as a common airway disorder. 
• Effective treatment for allergic rhinitis (hay fever, seasonal or perennial), another common chronic disease affecting 10-20 per cent of the populations, often coexistent with bronchial asthma, may reduce severe asthma attacks, and make the lungs work better.
• Take steps to curb air pollution and greenhouse effect. Plant trees, carpool, switch off the lights when not in use etc.
• Have a bath, change clothes, keep your shoes out, if you have been out for long, as those must have gathered pollen.
• Breathing techniques like pranayam can decrease attacks and use of drugs. These also show significant improvement in the PEFR and are helpful as an adjunct therapy to alleviate asthma symptoms.
• Try to stay stress free, as it is a major asthma trigger.

— The writer is pulmonologist, District Programme Officer, RNTCP, Ropar

from The Tribune http://bit.ly/2UGrUBn
via Today’s News Headlines