Treating an asthmatic

Asthma is a chronic condition that affects airways (tubes that carry air in and out of the lungs).

Asthma causes the lining of the airways to swell, mucus accumulates, and surrounding muscles tighten, and this reduces air flow to the lungs. Asthma is mainly an allergic condition but non-allergic asthma also occurs.

According to Dr Anne Irungu, a paediatric chest specialist, the cause of asthma is not well known but it is thought to have a genetic basis and exposure to certain environments can trigger the symptoms.

There is no cure for asthma. However, with early diagnosis, right treatment and strict adherence to doctor’s instructions, the symptoms can be well controlled.

Dear doc,

Why is asthma common in childhood and who else is at a risk of developing asthma?

Gitobu

Dear Gitobu,

Asthma is the most common chronic non-communicable disease in childhood. The reason for this is not well known and research is ongoing on the rise and cause of this rate. Asthma can affect people of different ages, though it mostly starts in childhood. The risk factors of developing asthma include a familial history of asthma or allergic disease like eczema, personal history of another allergic condition, a twin with asthma, and living in poor air quality areas that are polluted. Dust, fumes from cars, strong scents like perfumes, upper respiratory infections and allergy to certain foods can trigger asthma. In addition, obese people, people who smoke and persons residing in urban areas are at risk of developing asthma.

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Dear doc,

Does wheezing always mean a person has asthma and what are other symptoms of asthma?

Nyagah

Dear Nyagah,

No. Not all wheezing is associated with asthma and it is thus important to see a doctor for accurate diagnosis if you experience this. Asthma is characterised by shortness of breath, wheezing (a whistling sound coming from the chest when one breathes), and a cough especially at night and in the early morning. A cough without a fever can occur during different situations like while playing or doing an exercise, in cold environments or when the weather changes. Older children may experience chest tightness/pain. The severity of these symptoms may vary in different people.

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Dear doc,

Can a child pass asthma to other siblings and what are the chances of a child outgrowing asthma?

Jesma

Dear Jesma,

Asthma is inheritable through the parents who have an allergy or asthma. But it is not a contagious or communicable disease thus cannot be transmitted to siblings. Asthma is a chronic disease thus the symptoms may ease for a while after medication and control measures are taken but it is not completely ‘outgrown’.

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Dear doc,

What triggers asthma attacks?

Noel

Dear Noel,

Usually, people with asthma are overly sensitive to certain things which do not affect other people without the condition. Asthma attacks can be triggered by various things such as cold air, intense emotions of sadness or happiness, upper respiratory infections like flu and common cold, second-hand tobacco smoke, allergens like dust, pollen, cockroach droppings or food additives. Indoor cooking fuels like charcoal jikos or even clean fuels like gas/electricity, mold in damp areas of the house and some medications like aspirin can also trigger an asthma attack.

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Dear doc,

What is the treatment for asthma and are there times when one can stay without using medication?

Edith

Dear Edith,

The treatment of asthma involves use of inhaler medication for quick relief of symptoms and to prevent further or worsening of symptoms. Other medications are anti-allergy medicines or drugs used to treat other conditions that commonly occur with asthma like reflux. Once controlled and symptom free for over 3 months, medications can be stopped or reduced in number and dosage with close follow-up to watch for recurrence of symptoms.

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Dear doc,

When is an inhaler recommended, how does it work and how should it be used?

Walter

Dear Walter,

An inhaler is a medication in the form of a pressurised container that when pumped it sprays particles of the drug directly into the lungs in small but very effective dosage that minimises the side effects of the medication. There are two types of inhaler medications. One is used for quick relief of active symptoms and normally in a blue and white casing. The other type is a preventer medication that is used to stop further or worsening of the symptoms and can be in different forms including discs and tube shaped casings.

Inhalers for quick relief are used as often as needed in a day to relieve active symptoms. Two to four puffs of the inhaler can be given 15-20 min apart up to three cycles in an hour and many cycles in a day. If this occurs the child should be brought to hospital for a review as it shows their symptoms are out of control.

Preventer inhaler medications are used once or twice daily to control symptoms of asthma with a goal of achieving full control in three months and follow-up done to assess level of control and modify the treatment as needed.

KNOW YOUR BODY 

How to cope with asthma

Asthma is a chronic condition that requires continuous care. For this reason, it may pose a big challenge to the members of the family who may feel worried and stressed about what to do. The following can help in making life easier while living with an asthmatic at the same time keeping them healthy and safe;

To cope with asthma, the asthmatic child must first be well controlled. Use of medications and adhering to the treatment is very crucial.

The treatment is to enable the patient to enjoy every level of activity that a child without their condition has e.g. swimming or sporting activities they love doing.

Use of asthma diaries to document symptoms and assess level of control is necessary in all asthma patients. It also helps the patient and their parent or caregivers to get involved in their management and predict their triggers.

Have all the necessary medications readily available. For example, quick relief inhalers, for administering when the patient has active symptoms.

Have a peak flow meter at your home. This is a gadget that measures how an asthmatic person is breathing as compared to their normal breathing.

Take control measures. Each asthmatic person has their own asthma triggers. What affects one person may not necessarily affect the other. It is therefore important to identify triggers in the environment and avoid them.

This can be achieved by dust proofing the home, eradicating cockroach infestations, taking measures to avoid pollen inhalation, getting rid of mould in the house, avoiding food and drug allergens that are known to cause symptoms and stopping cigarette smoking by household members.

Talk to a doctor about the appropriate exercises and sports and whether an inhaler should be used before engaging in such activities. Take caution when there are conditions that can trigger asthma, for example during cold or dusty days.

If possible have meals prepared at home instead of going for processed foods. Some food additives can trigger asthma hence when you cook at home you are able to avoid them. Encourage healthy eating habits and prepare balanced meals to prevent overweight or obesity.

Advocacy groups can give support to both patients and their families. Locally the Kenya association of Prevention of TB and lung diseases (KAPTLD) has an asthma advocacy programme.

In case of an asthmatic attack, do the following;

•  If you suspect a person is having an attack, look out for any signs of speaking or breathing difficulties, coughing, wheezing, distress, and grey-blue tinge to the finger nails, earlobes and lips.

•  Start by reassuring the person and request him or her to breathe slowly and deeply. This helps the person control his or her breathing.

•  Help the person use their inhaler immediately to help ease the attack.

•  Sit the person down in a position that is comfortable (preferably upright). Loosen any tight clothing.

•  If the attack does not improve in a few minutes, it could be severe. Have the person take one or two puffs of the inhaler in every two minutes. Continue this until the person has had ten puffs.

•  If it is a first attack or it is severe and worsening, call for medical attention.

•  Help the person to continue using the inhaler as you wait for help. Continue to check on the pulse, breathing, and response level.

•  If the symptoms improve, have the person take a rest.