In ancient Indian philosophy, “Breath” (prana) is given the most important status among different functions of human body which sustain life. Even today, a common man identifies life with breathing. Breathing problems are therefore considered very serious. They are potentially fatal and therefore, their treatment is urgent.
I.What you should know about your asthma
- What is breathing?
- Asthma, The Breathing Disorder – Asthma
- Asthma Epidemiology and clinical distribution
- How does asthma present?
- What triggers asthma?
- How to diagnose asthma?
- Asthma management
II.Some Important and Useful Tips
- What are the Do’s and Don’ts
- How do I use an inhaler?
- What do I do in an emergency?
III.Commonly Asked Questions on Asthma
SECTION I. WHAT SHOULD YOU KNOW?
In ancient Indian philosophy, “Breath” (prana) is given the most important status among different functions of human body which sustain life. Even today, a common man identifies life with breathing. Breathing problems are therefore considered very serious. They are potentially fatal and therefore, their treatment is urgent.
Breathing is the movement of air in and out of the lungs. Atmospheric air which contains 20.1% oxygen is taken into the lungs and in a fraction of a second transferred into the blood to be distributed to the whole body with the help of the pumping force of the heart.
As we breathe, air passes through the nose and then into the wind pipe (trachea). The trachea then divides into two branches (bronchi) to supply air to the left and right lungs. Once inside the lung each bronchus again divides into several thousands of branches (bronchioles) to distribute air to 30 crore air sacs. The inside of these bronchioles is lined by a velvety lining (mucosa). These wind tubes are covered from outside with thin strips of muscle which can squeeze the tube when they contract.
- Asthma – What actually Happens?
In Asthma the normally pink and thin mucosa is swollen and red (inflammed), thus reducing the inner diameter of the bronchiole. To make matters worse, the ribbons of muscle around the bronchioles contract and constrict the tubes, referred to as (bronchospasm). To appreciate the difficulty of breathing through these narrowed air passages, one may try to breathe for a 30 seconds through a straw!
Asthma is frequently misunderstood and hence feared. As you learn more about asthma and the management options, it is obvious that a normal life is possible like every one else. Asthma is common and treatable. Furthermore, asthma does not spread from person to person.
Asthma is referred by different names in different regions of India. Symptoms of asthma such as cough and breathlessness are sometimes confused with other diseases such as Chronic Bronchitis and/or Emphysema, a condition which is due to Tobacco Smoking. It is important to differentiate these two common respiratory disorders because Asthma is reversible while Chronic Bronchitis is not.
Asthma is common in all age groups including the children and the elderly. In India, on an average, about 3 to 5 percent of the population suffer from asthma. (4 crore Indians may have Asthma).
Asthma is More Common in children than in adults. Diagnosis of asthma in a child therefore must Not surprise the parents.
Although asthma Commonly Starts in Childhood, it may occur for the first time at any age. Occasionally, the first asthma attack may be reported even in the elderly. Asthma is frequently missed, under recognized and many times under treated in the elderly.
Asthma prevalence is generally equal in males and females. It is said to be more common in boys than girls. Among adults however, Asthma is more common in women than in men.
Asthma can affect anyone regardless of the social status. Many politicians, cinema celebrities, singers, scientists, doctors and even top sportsmen have had Asthma. Their lives are examples to show that asthma can never be a hindrance for success and normal life.
5. WHAT ARE THE SYMPTOMS OF ASTHMA?
There are many different ways in which asthma can present. Some of the common symptoms are: breathlessness, cough, wheezing or whistling sounds, chest tightness, breathlessness/cough. In some patients, these symptoms may occur only after exercise or a common cold.
Cough is usually dry, but some patients may complain of sputum. The sputum is generally white and frothy.
The symptoms are generally episodic. In more severe forms, the patient may remain symptomatic continuously for several weeks or months at times without any relief.
Asthma attack tends to occur more frequently at night or in the early hours of morning. Sleep is frequently disturbed. Patient may develop new symptoms or get worsening of existing complaints with exercise or any other form of physical exertion.
- Triggers i.e. Factor/s precipitating an attack or causing worsening of symptoms
- Seasonal Change: Most patients experience worsening during the change of seasons, for example between mid February to April and between September and November. This is generally attributed to the heavy load of pollens and dust in the air, besides sudden changes in environmental temperature and humidity. In the crop rich areas, smoke from the burning of dried residues of wheat crop during April and rice straw during September/October can be an important trigger.
- Infections: Almost three out of four patients start with the symptoms of asthma following an episode of common cold, or upper respiratory catarrh due to a viral infection of the upper respiratory tract. Typically, the patient would start with fever, running nose, sneezing and sore throat followed by asthma symptoms.
- Home-dust: Dust mites are small insects not seen by the naked eye. These mites are present and grow in the hot and humid conditions, hidden in the crevices of couches and sofas, carpets, curtains, cushions and bed mattresses. The fecal droppings of the dust mites are allergenic. One gram of dust contains 1000 dust mites and 250,000 fecal droppings. When these fecal droppings are breathed, larger particles are trapped in the nose and finer ones find their way into the lungs. The nose gets the allergy symptoms first, referred to as hay fever, which manifests as runny nose, nasal polyps and watering of eyes. The lower respiratory condition presents as asthma. Cleaning and dusting of rooms and furnishings make these allergens to suspend in air (air borne) which when inhaled by the susceptible individual sensitize and cause asthma attacks. A lot of patients develop symptoms during September/October when people routinely get their houses cleaned and white-washed before the general festival season of Diwali. This is also the time when people in North India take out their warm clothes stored in the closets (which may be dust covered) during the summer months.
- Others: There are several other exposures which can trigger asthma:
- Smoking or exposure to smoking by others i.e. passive smoking or environmental smoking
- Breathing the fumes while cooking/frying foods or the smoker from the combustion of the bio mass cooking fuels
- Strong perfumes and smells like “Bagaar”
- Breathing cold air during cold and foggy weather
- Air pollution (from vehicular traffic and industrial exhausts)
- Fur or feathers from pets, specially cats and dogs
- Fumes, paints, dusts of different grains
Besides the exposures, there could be other factors causing aggravation:
- Physical exertion and exercise
- Emotional disturbances and psychological stress
- Onset of menstrual periods
- Gastro-esophageal reflux (Acid reflux)
- Drugs, such as aspirin, some high blood pressure and heart medicines
Sometimes, a trigger may not be clearly identifiable.
Diagnosis is essentially based on the characteristic history of symptoms of cough, breathlessness and wheezing which occurs in relation to a variety of trigger factors like seasonal changes, exposure to dust etc. However the diagnosis needs to be confirmed by laboratory tests. Your doctor will take a detailed history. He/she will examine for signs of allergies, such as eczema, nasal polyps, sinusitis and will listen for the wheezing sounds from the chest. It is important to remember that
All That Wheezes is Not Asthma; and
All Asthma Does Not Wheeze.
Investigations to confirm asthma and/or other conditions with similar symptoms (which mimic asthma) is therefore necessary to properly manage your condition.
Diagnosis of complications occurring in a patient with a known diagnosis of asthma is important in the overall long-term management.
Remedies for asthma have varied from the folklore practices to the modern therapy. There are innumerable faith healing and miracle treatments offered in different societies. It is important to realize that currently there is permanent cure of asthma. But the natural behaviour of asthma may vary from person to person. At times, spontaneously occurring long periods of relief (remission) may incidentally coincide with some interventions/treatments.
There are two major principles in the management:
- Drugs to control asthma (i.e. Pharmacotherapy)
- Avoidance of trigger factors which aggravate asthma
There are two kinds of drugs for asthma:
- Relievers: drugs which relieve the symptoms of Asthma.
- Controllers or preventers: drugs which actually prevent the process of Asthma
Relievers are used on an “as and when needed” basis when asthma symptoms are present.
The Controllers are used on a regular basis for an extended period of time.
Appropriate and regular use of controllers can control asthma well and decrease the need for the reliever medications. An increasing use of relievers indicates a poor control of asthma.
The message is:
Use Controllers (Preventers) regularly and avoid asthma from worsening.
Although doctors prescribe drugs for asthma, asthmatics and their relatives play an important role and can help if they are aware and knowledgeable about Asthma. Appropriate and timely use of emergency drugs, especially the relievers, at home can prevent deterioration of disease as well as expensive hospitalization. Similarly, well-informed asthmatics can regulate the controller drugs at home, either by themselves or with the help of the caregivers.
Treatment for asthma is best administered in the form of inhalers. Contrary to the general belief that inhalers are better reserved for non-responsive or severe asthma, they are used ideally as the first line of therapy.
Use of inhalers for asthma can be compared to using ointments for skin diseases and eye drops for eye condition.
Inhaler medications deliver the drug to the site of the disease. Therefore:
- The effect is almost instantaneous
- Dose required is about one tenth of the tablet or a capsule
- Side effects are negligible.
Fortunately, many of the drugs of both the reliever and controller groups are now available as inhalers.
Some myths about inhalers
- Difficult to understand the proper use
- i.Costs: Although the initial cost of the drug in an inhaler (compared to a tablet) is higher, in the long run an inhaler drug works out to be more economical. Better control of asthma reduces the periods of absence from work or school. Furthermore, all the expensive hospital bills of poorly controlled Asthma are saved.
- ii.Difficulties to use: Proper use of inhalers requires good understanding of the technique. It is especially challenging to the elderly and small children. With time and patience (for both the doctor and the User) proper use of inhalers can be explained well to ensure their effective use.
Incorrect use is the most common reason for poor response to inhalers.
(Refer to Section IIB, ‘Some Useful Tips – How to use an inhaler?)
Types of inhalers
There are two types of inhalers in use.
- Metered Dose Inhalers (MDI)
- Dry Powder Inhalers (DPI)
These drugs are also available as ‘nebulizing solutions’ for use with a nebulizer. Nebulizer is a compressor driven machine that breaks the drug solution into a fine particles of vapour. Nebulization is used for severe attacks when inhalers are difficult to use or in case of children and the elderly who have problems coordinating the use of inhalers.
Metered Dose Inhalers (MDI): An MDI contains drug in a liquid state inside a pressurized canister. With each actuation of the inhaler, a fixed amount of the drug is released in the form of a ‘puff’ containing drug-droplets of uniform size. The released drug is then inhaled deep into the lungs by the user for its effects.
There are three important steps in the use of an inhaler:
- ACTUATION (of inhaler) and RELEASE (of the drug from the canister)
- INHALATION (inspiration) into the lungs
- RETENTION of the drug in the lungs
Actuation, Release and Inhalation require a good understanding and a degree of coordination by the patient to avoid wastage of the drug and ensure its proper delivery into the lungs.
‘Retention’ of the drug requires breath-holding for as long as possible (usually about 6-10 seconds), to allow absorption (of the drugs) into the lungs.
Several methods are used to overcome the problem of coordination. The use of a ‘spacer’ between the inhaler and the mouth is one such device. Many different kinds of spacers are available in the market. The newer ones are more compact than the older ones.
Although a cost is incurred in buying the spacers, better deposition of the drug, increased effectiveness of the medication and ability to use without the coordination seems to be worth the expense.
Dry Powder Inhalers (DPI): A DPI contains the drug in a finely micronized powder form. There are several types of DPIs available in the market. The greatest advantage of DPIs is the ease of use – the drug is released only on inspiration. The steps of Actuation, Release and Inhalation are therefore, much better coordinated and no wastage of drug occurs.
Retention requires breath-holding in both MDI and DPI devices.
Avoiding triggers is as important as the use of drugs. Alterations in living conditions are required to minimize dust, smoke and other allergens in the house. Particular attention must be paid to the bedroom of the patient where about 8-10 hours of the day are spent and contact with dust mites occurs.
Some of the exposures are easy to avoid while others may require major changes.
- Patient should preferably stay away when sweeping, cleaning, white washing or when similar activities are being carried out.
- Replace sweeping of floors and dusting of walls with vacuum cleaning, or at least with wet cleaning (or mopping).
- Give sufficient exposure of sun and air to the clothes taken out from the closets after storage.
- Keep the bedroom and possibly other places in the house as simple as possible. Furnishing items that are likely to collect dust such as the stuffed toys, curtains, carpets, mattresses (etc.) should be either removed or replaced and covered with easily washable/plastic materials.
- The most important trigger to avoid is the smoke – cigarettes, stove etc. Strong odors of seasoning should be avoided around the asthmatic. Of all the allergens and triggers such as the pollens, dust mite droppings, it is the cigarette and the stove smoke which stay airborne the longest.
Use of maintenance inhaler medications is very important in the overall prevention strategy.
Immunotherapy or use of “allergy injections” have limited role and should be undertaken ONLY on doctor’s advice.
SECTION II. SOME IMPORTANT AND USEFUL TIPS
A: The Do’s and the Don’ts
The Do’s: What should be done.The Don’ts – What must be avoided
- If you develop prolonged cough, breathlessness, wheezing, chest tightness or other respiratory symptoms lasting for more than few days –
Consult your doctor Do not continue to ignore
- If the diagnosis of asthma is established by your doctor –
Accept it as an illness Do not panic
that can be controlled
Asthma is a common illness. You share the illness with some top achievers and celebrities.
- If your symptoms are persistent or recurrent, in spite of the treatment prescribed by your doctor –
Try to look for factors or triggers Do not ignore even minor (listed earlier) in your surroundings or brief exposures
Check your technique of use of inhalers
Triggers are frequently identifiable and potentially avoidable. You might have to make efforts to avoid and plan alternatives.
- If you identify aggravation of your problems in the presence of the following:
- Smoking by you or from those around you
Quit smoking and seek help to quit Do not sit in smokers’ company. Ask them to stop
Your health is more important than the smoking. Your fear of annoying others should not deter you from following a healthy practice. You may humbly remind others that
- Smoking is injurious to your health
- A smoker does not enjoy the freedom of exposing others to smoke.
- House dust on floors, in the carpets, bedding and curtains etc.
- Adopt wet sweeping/mopping Do not do dusting and/or vacuum cleaning of floors sweeping in the presence of an asthmatic
- Use dust proof covers for pillows, Do not allow dust to mattresses, blankets; synthetic collect over furnishings curtains and carpets; – adopt – avoid dampness frequent washing and cleaning
- Pet animals: Either give away your pet or keep Do not handle your it outside your room pet yourself. Keeping well is more important than keeping your pet. You shall have to bear the separation.
- Exercise and sports:Use preventive treatment Do not unduly restrict before any exercise. Exercise exercise just for the fear is the only trigger that you of precipitating asthma do not avoid Allow normal activities and Avoid hard exercise and exercise esp. in children competitive sports, if symptoms worsen. Do not allow asthma to get worsened. Moderation of exercise may be required.
- Foods:If you suspect a food item, Do not generalize as a trigger for asthma, try to restrictions on food items establish a definite relationship. Foods are relatively uncommon causes of asthma exacerbations. Only the patient giving definite history of allergy to a particular food needs to avoid that item. Some examples of food allergies include, peanuts, shrimp and other sea foods and red wine.
- Gastro esophageal reflux i.e. “Hyperacidity” problems:Take early and light dinner at Do not lie or sleep night; reduce weight immediately after a heavy meal. Sleep with head elevated. Seek treatment for reflux Avoid strong spicy foods
- Fumes, paints, strong smells, (perfumes, incense, toiletries) Keep the item/s out of home/ Do not allow the rooms bed room; minimize their use; to get stuffy with the ventilate the rooms adequately vapours and smell of the items. Fresh and clean air in the patient’s environment is always better than smelly, smoky or stale surroundings. While the triggers may not be altogether avoidable, their use and exposure should be minimized.
- Your treatment works better if you know of your drugs and their role:
- Reliever drugs are used for: i. Do not over use relievers as immediate relief from the only method of treatment symptoms. If you need to use them more than twice a week, consult your doctor to introduce or increase your preventive drug.
- Preventive drugs are required: ii. Do not stop preventers on regular basis to keep away yourself. They are quite from getting the attacks safe.
- iii. Inhalation is a safe and Do not be afraid of inhalers effective route for both groups Learn to use them properly of drugs. They are neither addictive,nor the drugs for reserve use.
- Inhalers are the preferred Drugs over tablets
- Inhalers are Safe
- Inhalers are Non-addictive
- Inhalers are Effective
- Most inhalers contain similar drugs as in tablets, capsules, syrups and injections of same name, with the added advantage of
-The dose of the drug is very small
-The drug is delivered to the site of the problem – i.e. the lung.
B. How to Use An Inhaler?
Remember that the most important cause of failure of inhalational treatment is a wrong technique employed for inhalation. A good coordinated effort is required at each step of inhalation. There are some variations in the use of metered dose aerosol and dry-powder inhalers available from different manufacturers.
- Carefully read the instructions on the pamphlet supplied with the drug.
- Practice in front of your doctor/asthma educator.
DO NOT HESITATE to ask questions.
- Always rinse your mouth and spit the water after an MDI or DPI is used. Some steroid inhalers can result in hoarseness of voice and fungus growth in the mouth in a small percentage of patients. Rinsing mouth prevents these problems.
The exact steps of M.D.I. use are listed below:
- Remove the mouth piece cover
- Hold the MDI between your thumb at the bottom and index finger on the top of the canister.
- Shake the inhaler well.
- Breathe out through your open mouth
- Place the mouthpiece of the MDI between your teeth or 3 fingerbreadths away from mouth.
- Close your lips and slightly tilt your head backwards.
- g. Start taking a slow and long breath.
- h. When you start inhalation, press the canister down (actuation) to release one dose but DO NOT HOLD YOUR BREATH WHEN YOU RELEASE THE DRUG.
- Continue inhalation to your maximum inspiration.
- Remove the inhaler from your mouth.
- Hold your breath for about 10 seconds or as long as you can.
- Breathe out slowly. This completes one cycle.
If you need another dose, repeat all the steps after a gap of one or two minutes.
The use of a spacer makes the inhalation easier. The spacer is attached with a mouthpiece at one end and an MDI at the other. The drug from the MDI is released in the spacer and inhaled from the other end by the patient. The steps of inhalation remain the same but the ‘h’ is coordinated better.
Inhalation from Dry Powder Inhalers is also easier. There is no difficulty in coordinating between the release of drug and the actual inhalation since the drug is released only during an inspiratory effort.
C. What to Do in an Emergency?
An asthmatic and his/her family are constantly afraid of an impending asthma attack which might occur at odd places and at odd times when medical help may not be easily available.
THEREFORE, it is very important that you educate yourself on the disease and its management plans. Ask your doctor about the steps that should be taken in an emergency situation.
During an attack
- DO NOT PANIC. Panic only aggravates the problem.
- Keep reliever medications with you at all the times. Use reliever inhalers immediately. You can repeat if no relief is obtained. You may take 4 inhalations at first then one every minute up to 12, your hands start shaking or you get relief.
- Pursed Lip Breathing: inhale and then exhale very slowly by puckering your lips into a kissing position. Keep exhaling as long as you can and then start again. This avoids air trapping in your lungs.
- Double the dose of maintenance or controller inhalers.
- Try to seek medical consultation as early as possible. If available, use mobile phone.
SECTION III. FREQUENTLY ASKED QUESTIONS
- A 61-year-old shopkeeper:
- I have never had asthma in the past. How come it started now when I am over 60 years old?
- Asthma can start at any age. Asthma is diagnosed after ruling out other causes of your symptoms.
- Mother of an 8 year old child
- Asthma is generally a disease of the old. My child must have had some allergy.
- But why to label the problem as asthma? It will stigmatize my child.
- It is better to know of correct diagnosis for efficient management. Asthma is a very common problem involving over 4 crore Indians which include about half the children. It is not a stigma at all. People with asthma have achieved the most distinctive positions in their careers and won Olympic medals, Oscar awards and other prestigious National and International prizes.
- Will he remain asthmatic throughout his life?
- It is true that the disease cannot be eradicated. But the course in an individual patient is highly variable. About a third of children get better or “outgrow” their asthma as the air passages grow during the growth spurts. Your child may get well and remain asymptomatic for a long time. He may persist with the problem and need regular treatment. Sometimes, the disease may also get worse. You should therefore remain watchful and follow the medical advice. In about a third of the cases as the child grows, the asthma gets better or resolves.
- A 25-year-old College student
- I have to wake up almost every night in the early morning hours because of breathlessness and wheezing. I use salbutamol inhaler at that time. Should I continue with the same practice?
- You need preventive treatment with a controller inhaler. The daily night time awakening is an indication that your asthma is under poor control. Treating these symptoms with reliever medication is not appropriate. Generally, if a patient has to use an inhaler more than twice a week or has more than twice a month night time awakenings due to asthma symptoms, controller medications are indicated.
- Is not the inhalational treatment addictive? Do I have to continue all the time?
- Using inhaler treatment is not addictive at all. These are required to continue for better control of asthma. You should not restrict your activities for fear of drugs. If you remain free of symptoms and your doctor’s assessment about your lung function is satisfactory, the treatment can be stepped-down, reduced or even stopped at the opportune time. Stepping up and stepping down of treatment must be done by your doctor.
- Will it interfere with my life and career?
- No. You must not let asthma take over your life. You should be able to lead a normal and active life with appropriate use of controller and reliever medications.
- Should I stop doing my regular exercises?
- Certainly not. You must control your asthma well and continue with exercise and other activities. Of course, it will not be possible to exert and exercise during symptomatic period if the disease is not well controlled.
- What type of exercise will suit me better?
- In general, swimming, gymnastics and yoga are better tolerated. But you can continue with your normal games and other exercises unless there is any aggravation of your asthma.
- Should I avoid any food item?
- Only if you notice that a particular food item is definitely related to your asthma. There is no general restriction on any food item.
- Can I continue smoking?
- Certainly not. You must stop smoking for better control of asthma and a healthy long life. Smoking is the greatest enemy of your lungs. You should avoid even being around other smokers.
- A 22 year-old bride
- I am very worried about my asthma. Will my in-laws accept the problem? Should I continue with my treatment?
- You must continue with the treatment. You should take into confidence your husband and other family members. Asthma must not interfere with your relationship. You should ask your husband (and in-laws) to meet your doctor and clarify doubts. Treatment interruption can cause problems and aggravate asthma.
- Can I enjoy normal relationship with my husband and bear children?
- Yes. There is no reason for you to avoid either marital relationship or pregnancy. The disease is not an infectious condition.
- A 28 year old pregnant lady
- Will asthma affect my pregnancy?
- Uncontrolled asthma can lead to complications. You must continue with treatment throughout your pregnancy.
- Can asthma treatment cause any problem during pregnancy?
- Generally not. Most of inhaler treatment is very safe. In case of an emergency attack, however, a short course of corticosteroids (if required) should be fairly safe.
- How will my asthma behave during pregnancy?
- It is variable. Asthma can remain stable as at present. It can worsen in a small number of pregnant women when the treatment will require alteration. It can also get better in which case the drug dose may actually be stepped down. You should continue to follow the medical advice rendered to you.
- What are the chances of my child suffering from asthma?
- Asthma does have a familial tendency and runs in families. It is possible, but not necessary, that the child will suffer from the problem.
- Can I breast feed my child?
- Yes, you should. Most of asthma treatment is safe during lactation. In fact, there is some evidence to say that the chances of development of asthma are less in children fed on mother’s milk.
- A 70-year-old retired executive
- I have multiple medical problems – hypertension, diabetes and heart disease in addition to asthma. It is quite complicated. What can I do?
- Do not worry too much. It is not uncommon to have several diseases in a single individual. Your doctor can always select the drugs that are compatible with each other and safer in the presence of other diseases. But you do need to be careful. You must tell your doctor about all the medical problems from which you suffer.
- Shall I live long enough in spite of my asthma? I have so many responsibilities and works to do.
- Asthma can be controlled if regular treatment is continued. But you have to be disciplined and seek regular medical advice. There is no reason for you to unduly worry or get depressed about the unforeseen future.
- I have to travel frequently. What precautions should I take?
- You need not restrict your travel. Treatment must be continued at all times. You should also keep an ‘information card’ in your pocket about your disease/s and treatment in case of an emergency arising in situations new to you.
- A 58 year old housewife
- I just cannot use an inhaler. Instead, can I use tablets?
- Inhaler treatment should not be substituted for this reason. Use of dry powder inhalers is not difficult. You need to patiently listen to your doctor, follow the instructions carefully and practise. Using inhalers is easy to learn.
- Can I continue with my hormone replacement therapy?
- Yes you can, if you are already on Hormone Replacement Therapy. There is no contraindication or interaction.
- A 40 year old farmer from Punjab
- I have got asthma since childhood. I have heard of a “fish medicine” practised in Hyderabad. Does it completely cure asthma?
- “Fish medicine” is one of the several treatment practices adopted by different people on either hearsay or some misplaced belief. Currently, there are no valid scientific data in terms of controlled clinical trials to prove that “fish-medicine” is effective. In the absence of such scientific criteria, there is no reason to believe that this treatment can even control, or cure asthma. Factually speaking, any agent used for the treatment of a disease should be considered as a drug and should abide by the legal rules of the land.
- Does the same hold true for the ‘natural spring water’ being used in Himachal Pradesh to cure asthma?
- Yes, it does. Any relief from such unproven remedies is only incidental. Occasionally, spontaneous relief from asthma can occur even without any such treatment.
- Can I wait for spontaneous relief to occur than seeking treatment?
- No, you must not. You must control your problems with proven, scientific remedies. There is no guarantee of a spontaneous cure.
- A 32 year old computer analyst
- I have been frequently prescribed corticosteroids by my doctor. I am very scared of their side effects.
- It is true that corticosteroids have multiple side effects especially when given for long periods. But you must not develop a phobia of corticosteroids. They are very useful and life saving drugs when used according to the well laid scientific principles. Short courses of corticosteroids are essential to control acute episodes and exacerbations. Avoiding or delaying steroids during such attacks can only aggravate the problems. It is much better to terminate the acute attack with treatment including steroids prescribed by your doctor than prolonging the problem.
- Can the steroid inhalers be similarly used for short periods during acute attack?
- Generally no. The steroid inhalers are required to be used for maintenance treatment. Their long term use is fairly safe and cannot be equated with steroids taken orally.
- A 48 year old Principal of a school
- Several students of my school have got asthma. I wonder if anything is wrong in the surroundings here?
- Asthma is a very common problem in even the most advanced and developed countries. While the particular surroundings of your school may have some role to play, it is generally not the major cause of asthma in children. If the percentage of asthmatic children in your school is significantly more than in other schools of your city, you should certainly attempt to identify the precipitating factor/s.
- What precautions are necessary for us in the school to handle an asthma attack in a child?
- You must educate the teachers of your school, the children and their parents in handling a medical emergency. Insist upon the parents about the need of regularity and compliance of medical treatment prescribed by the doctor for a particular child. Take help of medical teachers or doctors for essential, minimum medical trouble-shooting. Panic must be avoided at all costs. Keep some essential drugs and contact numbers of doctors and hospitals handy in the school.
- Asthmatic children get stigmatized in the school. They therefore, tend to avoid their treatment with inhalers.
- This is rather unfortunate and based on false belief. Everyone needs to be educated on this important issue. Neither asthma nor its treatment with inhalers are stigmas at all. Asthma is common like many other medical and surgical problems. It is completely compatible with a normal life span and quality of life.
Do not get scared.
Do not feel ashamed of asthma.
There are many other harmful things which can be gainfully avoided, such as Tobacco Smoking and addictive drugs – but not Inhalers required for controlling a medical problem.
We hope this information is helpful to you in understanding your condition better. We wish you a normal and healthy life!