Dr Tahir Saeed, MBBS, DTCD, Pulmonologist, Gulab Devi Chest Hospital Lahore Pakistan and President of Pakistan Chest Society Punjab, answers some critical queries on asthma.
Q: In a polluted country like Pakistan, asthma statistics are harrowing, and will surely get worse. What is asthma, what causes it and what are the current treatments for severe asthma?
A: Asthma is the chronic inflammatory disorder of airways characterized by episodic dyspnoea, wheeze and tightness in the chest; genetically predisposed individuals can experience asthma after coming across specific allergens.
Injectable steroids, (hydrocortisone) nebulization with short acting beta 2 agonists (salbutamol) and oxygen inhalation are required to ease severe asthma.
Q: What are the steps for the diagnosis of asthma?
A: History, clinical examination, peak expiratory flow rate/spirometery, pre and post bronchodilator spirometery, increased IgE levels in the serum and skin allergen test (not widely used).
Q: What are triggers and common foods to avoid?
A: House dust, mites, outdoor pollens, drugs like aspirin, beta blockers, NSAIDs, etc, smoke and cigarette smoking, atmospheric pollution, animals with fur, cats, cockroaches, dogs, sheep etc exercise, emotional stress ,cold infections particularly viral infections of respiratory system
Foods usually have no triggering effect unless there is a history of particular foods that should be avoided. Canned foods are reported to cause asthma symptoms, perhaps due to preservatives included in the cans
Q: What is asthma control and how is it achieved?
A: Asthma can be deemed under control if there are none or less than two daytime symptoms, no night time symptoms, there is no limitation on daily activity including light exercise, pulmonary function tests are close to normal, there are no exacerbations and no adverse effects of medication
Q: Is there any way to stop an asthma attack without medication?
A: Usually attacks are self limiting, avoiding triggers can help avoid attacks and the requirement of medication may be reduced
Q: How many people are affected by this disease?
A: Prevalence of asthma is different in different areas of the world. No authentic study or data is available but about 5% adults in Pakistan are said to be asthmatics; this figure is as high as 17% to 19% in children.
Some questions patients ask their doctor-
Q: What’s the difference between allergies and asthma?
A: Allergens can also cause asthma attacks, allergies may or may not affect air passages, but in case of asthma there is bronchoconstriction, inflammation of the bronchial wall and hypersecretion in response to allergens, so an allergy can occur without the involvement of airways.
Q: I’m 40 and never had asthma. Can I get it as an adult?
A: No age is immune, asthma can occur at any age if you are genetically predisposed but chances are reduced if you have not had asthma symptoms till the age of 40.
Q: So should I worry about the air in my home?
A: The air in rooms should be clean and free of allergens.
Q: Are women more likely to have asthma?
A: Asthma prevalence is higher in younger female children and it’s higher in adult males.
Q: Is there a link between depression and asthma?
A: Emotional stress can initiate an asthma attack.