Earlyface

In this interview with ARUKAINO
UMUKORO, Paediatrician and
President, Association of Resident
Doctors, Lagos University Teaching
Hospital, Dr. Emeka Ugwu, talks about
the causes and treatment for asthma
What is asthma?
Asthma is a disease condition that
occurs when there is an obstruction of
the airways that carry air to and from
the lungs, or when there is a swelling or
an inflammation of the airways and
hyper-responsiveness. These are
responsible for the symptoms
experienced; the inflammation makes
the airways extremely sensitive to
irritations and increases one’s
vulnerability to an allergic reaction.
What is the prevalence ratio in children?
The prevalence of asthma in children is
about five to 15 per cent. Most of the
time, it is noticed in very early childhood.
Asthma is not just one particular disease
condition; it is like a spectrum, a range
of conditions. There are different types
of severity. Cases of asthma in children
between ages two to six is commonest,
while the least percentage one finds is
between 12 and 16 years, when
majority of them would have outgrown
it. Those who still have asthma at that
teenage age are likely to have it into
adulthood. About 60 per cent of children
with asthma are less than six years; the
remaining 40 per cent will be in children
between seven years to 16 years of age.
What are the symptoms of asthma in
children?
Some of these include, if the child has
difficulty in breathing or shortness of
breath, cough, which is worse at night,
and he doesn’t have fever, then you
know it is not likely to be pneumonia or
an infection, because asthma is not an
infection. Hereditary factor is also
important to know if a child is
susceptible to asthma. For example, if
there is a family history of asthma, that
is, if someone in that family is asthmatic
or has reactive conditions such as
particular allergies, it could lead to
asthma or what is also called hyper-
reactive airway disease. It also depends
on the degree of severity of the asthma.
But the first sign are breathlessness and
cough, and what they call pigeon chest –
the chest may look bloated like that of a
pigeon because of air traffic, the child is
breathing air but can’t breathe it out.
Majority of children outgrow asthma
later in their teenage years.
What triggers asthma attacks?
The more industrialised a place is, the
higher the prevalence of asthma,
because areas with industrial/air
pollution trigger asthma. Also, the more
developed a place is, the more likely they
would have a higher rate of asthma
cases. For example, Lagos would be
expected to have a higher rate of
asthma cases than, say, a village. Also, it
is believed that in cleaner environment,
people are less likely to be exposed to
some germs and things that will
stimulate it.
Effluents from cars and industries have
also been associated with asthma. There
are many possible triggers of asthma,
but as I said earlier, it also depends on
other factors, including hereditary and
the person’s predisposition to allergies
and certain conditions. For example, a
person could be reactive to infections,
virus, bacteria, cigarette smoke, or
certain type of food, drugs, a change in
weather from cold to hot and vice versa.
Some could even react to psychological
factors. So, the person’s lungs will also
tend to react to these factors in the
same range. This lung reaction usually
leads to asthma. Some people can
actually have it without any hereditary
link, but they are in the minority. There is
a relationship between the environment
and nature in the development of
asthma. All these factors are important
predictors of asthma developing in a
child. Asthma is like a spectrum. There
are many other types of reactive states.
What are the first steps to take if a child
has asthma?
There must be a diagnosis first. It
includes the lung function test, as well as
spirometry, where the child is asked to
take in a big breath and then blow as
hard and long as he or she can into a
machine. It is especially used for young
children. There is also the peak flow
metre, used to measure how well air
moves out. There is also the six-minute
walk test. These methods of diagnosis
are definite. After the diagnosis, the
method of treatment can be decided.
There are no blood tests done.
What are the types of treatment available
for asthma patients?
There are several types. A clean
environment is important and asthma
occurs because the child is reacting to
something. So, the first method is what
is called environment manipulation,
where those things the child reacts to
are removed from the environment. For
example, a child with asthma shouldn’t
be exposed to a room with rugs
because of the particles and house dust
in the rug. A carpet is more advisable or
something that is cleaned regularly to be
free of dust. Parents who smoke should
also stop smoking in the house because
it could trigger asthma attacks. So, it is
important to modify the child’s
environment, especially if it is not a
severe case. Also, generators should not
be kept near the windows because of
the smoke and heat from it. Also, the
child can be treated with drugs. The
drugs are two types; the relievers and
preventers. The relievers are those that
work immediately. They are given to the
child to relieve them to help their
airways dilate.
That’s why it is called relievers to relieve
that acute situation. A common drug
used is Ventolin, which is in tablet,
injection and inhaler forms. Its generic
name is Salbutamol. There are other
types of drugs for treatment and there is
an international treatment guideline that
every doctor is supposed to know and
follow its guideline. If it is an emergency,
doctors use oxygen. The preventers are
usually those that work much later. What
they do, as their name suggests, is to
prevent asthma attacks. Many of the
preventers are long active steroids.
These steroids, as well as other anti-
inflammatory drugs, can decrease the
symptoms of asthma. Steroids have
some side effects when it is taken
periodically. Both types -relievers and
preventers – cannot be substituted for
one. The former relieves the immediate
situation so the patient does not die,
while the preventers are supposed to be
given so that the asthma attack does not
happen later. If it is an emergency case,
the doctor would have to admit the
patient and give oxygen and some
injections.
Are there particular steps to manage
asthma condition?
Yes, it depends on the situation. Early
detection and proper treatment helps.
There is what is called partnership in
asthma management. In medicine, we
say self treatment is not good, but this is
encouraged in asthma because it helps a
lot. So, members of the family must be
carried along so that whenever there
are any symptoms, they would know
how to prescribe the drugs to the child
or check the function of their lung and
all that. For example, a three-year-old
might not be able to use an inhaler, so
there is a special device like a pipe,
which the inhaler is pressed into and as
the child breathes in from the pipe, he
inhales the content. Some children are
too young to use inhaler because there
is a coordinated action of inhalation that
the child may not be able to do alone.
How important is early detection and
treatment?
It is very important because if it is not
treated early, asthma could damage the
lungs. Inflammation means there is
redness and swelling in the lungs. So if
the inflammation is not controlled, there
is what is called the remodeling of the
airway. So, the airway could be damaged
permanently if not addressed properly.
So it is important that the child is treated
properly. Asthma can be managed and
treated effectively and the child can
outgrow it.
Should children with asthma be involved
in any form of exercise?
Yes, a child with asthma can be involved
in doing exercises and outdoor
activities, including football and
swimming. That child can even play
professional football. What should be
prevented are those exercises that are
intensive and rigorous and take several
minutes longer than necessary without
a rest period.
What advice would you give to parents?
My advice is that parents shouldn’t panic
when they are told their child has
asthma. Most children, by the age of six,
are likely to outgrow asthma or later in
life during their teenage years from the
age of 13. Up to 90 per cent or nine out
of 10 children will outgrow it by the
time they become teenagers. Asthma is a
chronic disease, but it usually doesn’t kill
people. Deaths resulting from asthma
are less than one per cent. But the major
problem is that people don’t follow up
on treatment, they just go and buy the
inhaler and that’s it.
The child should be taken to the hospital
for regular checkups, say every three to
six months. That would help to ensure
that the child does not suffer many of
the problems resulting from asthma.
Asthma could affect the psychology and
even growth of the child if not properly
managed. But if managed and treated
properly, the child can outgrow it. Again,
the parents should comply with the
drugs prescribed by the doctors. They
should not wait until the child has the
symptoms before they give the
medications. They should also keep
relievers drugs at home.