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Breathing is vital for life, and efficient, effortless respiration has never been more difficult than it is today. Instead of the clean countryside, people now live in thickly populated and polluted cities. Fossil fuels (especially the cheaper, more polluting diesel engines) are widely used; our farm produce and processed food is also contaminated with chemicals and allergens.
Eighty to 90 per cent of the population now suffers from some sort of airway malfunction. This is precipitated and aggravated by infections, colds, dust, and exposure to strong smells or cigarette smoke. It is manifested by a non-productive hacking cough, a wheezing sound while breathing, drawing in of the rib cage and a feeling of “air hunger”. Sometimes, once the symptoms set in, they persist even though the precipitating factor has been removed.
Earlier, these symptoms were loosely labelled “asthma” — a word that filled the patient as well as the caretaker with dread. The disease was viewed as a life sentence. Activity was restricted by breathlessness and every change in climate was followed by incapacitating attacks.
Actually, people with these symptoms do not have “asthma”; they have airways that are “hyper-reactive”. When a normal person is exposed to an allergen, he or she coughs once or twice to clear his or her airways. In people with hyper-reactive airways, however, the nose starts watering and violent sneezing occurs in an effort to expel the foreign material. Very soon the airways constrict (instead of relaxing) and the sneezing is followed by wheezing.
Forty or 50 years ago, the medication available to treat these symptoms was taken by mouth, or injected. It had to enter the blood stream from the stomach or muscle. It then eventually reached the nose and lungs. There was often a one-to-three-hour gap before relief was obtained. The person sneezed and wheezed in the interim, losing sleep and productivity. Physical activity appeared out of the question. Eventually the airways stopped responding to the medication. Higher doses had to be used. This produced side effects such as a rapid heartbeat, tremors and sweating. Medication from alternative systems of medicine had their own set of side effects.
Steroids provide immediate relief from these symptoms. Treatment should ideally be for a few days and then tapered off. Many people, enamoured by the dramatic relief, continue to use the steroids on their own, purchasing it over the counter from unscrupulous pharmacies. In other cases, the medical shop itself dispenses the steroid. As relief is immediate, the patient prefers the pharmacist’s treatment. Others take monthly injections of long acting steroids.
But long term use of steroids causes weight gain, a hairy face, precipitates diabetes, weakens bones, and reduces immunity. This causes fractures and frequent infections. It also causes dependence on the medication. The symptoms recur if the steroids are not taken.
Today treatment is more advanced with direct drug delivery systems. The medicine is supplied directly to the nose and lungs as nasal sprays, rotahalers, inhalers or nebulisers. Relief is immediate and side effects are minimal. The medication goes directly to the lungs, acts there, prevents the airways from constricting and holds them open. Inhaled steroids prevent inflammation.
Unfortunately people are often afraid of inhaled treatment. They feel it is habit forming and dangerous, a misconception as the converse is true!
Nasal sprays contain long acting non-absorbed steroids. They stabilise the nasal membrane, reduce swelling and open up clogged nostrils.
Medication delivered directly consists of long or short acting bronchodilators to open up the airways and anti-inflammatory agents to prevent recurrence. Maintenance therapy consists of once or twice a day dose of a long acting bronchodilator with an anti inflammatory non-absorbable steroid. Many athletes need a single dose of short acting bronchodilator 30 minutes before their event. This prevents exercise induced wheezing.
The chances of developing reactive airways disease is increased
• If you have a family history of allergies
• If you are exposed to cow’s milk and processed weaning foods in early childhood
• Recurrent childhood infections (many infections due to H.influensae, pneumococcus and flu can be prevented with timely and adequate immunisation).
• Exposure to cigarette smoke. This is considered the single most important factor. Parents and other relatives who smoke in the house or even outside should stop.
• House mites. The house needs to be cleaned thoroughly every day.
• Food should be sealed and stored. Leftovers attract cockroaches and their dander precipitates attacks.
Child hood “asthma” tends to disappear during teenage years. It can return in adult life.
If you do develop wheezing, consult a physician and get your symptoms under control. It is important to maintain ideal body weight so that abdominal obesity does not decrease lung capacity. The severity of attacks and the interval between them can be reduced if breathing technique is corrected and lung capacity improved by learning and practising yoga, martial arts and swimming.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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