No cure for disease, but management key to survival, say experts
Symptoms include coughing, difficulty in breathing, chest tightness
By Doris Obinna and Ogechukwu Agwu
Asthma is a respiratory condition marked by attacks of spams in the bronchi of the lungs causing difficulty in breathing. It is usually connected to allergic reaction or other forms of sensitivity. It is a chronic lung disease that inflames and narrows the airways in the lungs. It is a long term inflammatory disease of the airways of the lungs. It causes recurring periods of wheezes (a whistling sound when you breathe), chest tightness, shortness of breath and coughing
Experts say ‘asthma is a condition in which airways narrow and swell and produce extra mucus. For some people, asthma is a minor problem and for others it is a major health challenge that interferes with daily activities and may lead to death if not checked..
The American Academy of Allergy Asthma and Immunology, says, “an estimated 300 million people worldwide suffer from asthma with 250,000 annual deaths attributed to the disease. Almost all the deaths are avoidable, it is estimated that the number of people with asthma will grow by more than 100 million by 2025 and 70% of asthmatics have allergies. Asthma is the leading cause of chronic illness in children affecting about 7 million children in the U.S.”
Another survey championed by the World Health Organisation (WHO) estimates the global burden of asthma in adults to be 4.3% with the highest burden in developed countries.
Out of the 300 million people believed to be suffering from asthma worldwide, Nigeria accounts for about 15 million people and for unknown reasons there had been an increase in the cases of asthma in Nigeria. The Nigerian Thoraic Society has projected that about 100 million Nigerians will suffer from asthma in 2025 though the condition is a popular one and irrespective of the major advances in the pathophysiology of the disease, the disease seems to be spreading like wild fire.
For asthmatic patients, this is no good news,bearing in mind that we are approaching the dry season which is characterized by little or no rain, the environment becomes dry thereby raising dust which in turn triggers the symptoms of asthma. It is important that sufferers arm themselves with all the knowledge that they can get and take necessary precaution like wearing face mask when stepping out.
Diagnosis
According to Dr Charles Uzor, diagnosis of asthma is based on the patient’s complaints, clinical examination by the doctor and measurement of the patient’s response to salbutamol medication.
“Unlike other illnesses, test may not be important to establish asthma. In diagnosing asthma; one has to look at several factors that include the history of the illness, clinical exam and response to anti-asthma medications like salbutamol inhaler.”
Looking out for the symptoms, overall health and test results can aid in diagnosing asthma. There are different kinds of test that can help to diagnose asthma such as the lung test and the measure lung test. However, Uzor said these tests aren’t really used to diagnose the condition but to measure the response of a patient to the medications that the patient may be placed on. The two major kinds of lung test that are used to diagnose asthma are the spirometry test and the methacholine challenge tests.
The spirometry test is a simple breathing test that measures how much and how fast you can blow air out of your lungs. It is often used to determine the amount of airway obstruction you have. The methacholine test on the other hand is performed when the spirometry doesn’t clearly establishes a diagnose of your asthma.
Other tests can help determine if you are allergic to specific foods, pollen or other particles. Blood test gives a picture of all over health. Specific tests also measure levels of immunoglobulinE, a key anti-body that is released during an allergic reaction.
Symptoms
Categorically, the symptoms of asthma also known as flare-ups or asthma attacks can be caused by allergic and non-allergic triggers. Allergic triggers such as pet dander, dust, pollen, dust mites, or mold and non-allergic triggers that include smoke, pollution, cold air or changes in weather can result to one experiencing symptoms.
The symptoms include coughing, especially at night, during exercise or when laughing, difficulty in breathing, chest tightness, shortness of breath, wheezing (a whistling or squeaky sound in the chest when breathing especially when exhaling. These symptoms may be worse during exercise, when you have a cold or during times of high stress. Children with asthma may show the same symptoms as adults . In some children chronic cough may be the only symptom.
These symptoms may also vary depending on the type of asthma, there are various types of asthma. They include ; Occupational asthma : This is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job. Childhood asthma as the name implies affects children, leaving an impact on millions of children and their families. In fact, the majority of children and their families who develop asthma do so before the age of five.
There is no cure for asthma, but once it is properly diagnosed and a treatment plan is in place, you will begin to manage your condition and your quality of life will improve. Exercise induced bronchoconstriction (EIB) or exercise induced asthma is the type of asthma that affects the narrowing of the airways in the lungs, this kind of asthma is triggered by strenuous exercise. It causes shortness of breath and wheezing.
Allergic asthma is the type that occurs when an allergy sets off an asthma flare up. Mold, roaches, pollens and pet dander are common allergies but the list can be endless. Food sensitivities may also play a role. There is also another type known as asthma without allergies, this type isn’t triggered by any form of allergies. Usually an upper respiratory infection (cold, flu, and rhinovirus) sets off their asthma. As soon as cold or flu symptoms appear patients are typically prescribed a short course of inhaled corticosteroids for 10-14 days.
Treatment
There is no cure for asthma, but symptoms can be controlled with effective asthma treatment and management. This involves taking your medications as directed and learning to avoid triggers like dust and pollen that cause your asthma symptoms. Your allergist will prescribe the best medications for your condition and provide you with specific instructions for using them.
“The medications are usually inhalers containing steroid and/or salbutamol. Asthma can be a tricky illness to manage, I strictly advise against self medication, your doctor will have to decide for you,” he said.
The medications could be controlled medications and inhaled corticosteroids that are taken daily or combinations inhalers which contain corticosteriods in addition to long-acting beta agonist (LABA). LABAs are symptoms controllers that are helpful in opening the airways. However, care should be greatly exercised as this kind of medications carries risks.
In some cases, quick-relief or rescue medications can be administered to quickly relax and open the airways and relieve symptoms during an asthma flare-up or taken before exercising if prescribed. Rescue medications are not meant to take the place of controller medications, if you find yourself dependent on this kind of medications they should see a doctor.
In case of severe symptoms, oral and intravenous corticosteroids may be required to combat the flare-ups. This form of medications may result to serious side effects if depended as a long term treatment.
According to Dr Gabriel Omonaiye, Medical Director, God’s Goal Hospital, Ojo, Lagos, “asthma is an inflammatory disease of the airways that is due to the narrowing of the airways following the contraction of bronchial muscle, increased mucous secretions, and blockage of the bronchioles.
“It is usually recurrent and the pathological constriction of the bronchioles either completely or partially. The symptomatology complex is that of difficulty with breathing (laboured breathing)-dyspnea, audible wheeze, chest tightness, coughs, which is often at night. It is often due to interplay between environmental factors and numerous vulnerability genes.
“Hence, the prevalence of asthma is on the increase may be due to the increasing environmental pollution. The associated mortality rate has increased over the years.”
Omonaiye noted that the common triggers for asthmatic attacks are many. These include; allergens such as insects like cockroach, pets, dust, flower pollens, feathers, poultry droppings. Perfumes, insecticides, paints, smoke from generating sets, cigarette smoking, cold environment, exercise, emotional disturbances, and anger are known precipitating factors.
“For some asthmatics, the crisis could be from coryza and respiratory tract infection that could be of bacterial or viral (respiratory syncytial virus). Certain drugs like aspirin; Beta-blockers may be the culprits in certain people.
Highlighting the factors linked to asthma, he said, low dietary vitamins C and E, young maternal age, poor maternal nutrition, prematurity, low birth weight and lack of breastfeeding. The presence of other allergic disorders such as vernal conjunctivitis and hay fever carries further risk.
Omonaiye said asthma can be classified as childhood onset and adult onset. Asthma is classified into four groups: mild intermittent, mild persistent, moderate persistent and severe persistent.
“Patients with the severe disease suffer nocturnal awakenings, fast breathing (tachypnea), fast heart rate (tachycardia), inability to speak, visible effort to breathe, prolonged exploratory phase of breathing, pursed lips, pulsus paradoxus, cyanosis and altered consciousness. The chest may be clinically silent. Respiratory failure may supervene and death may result.
“The management involves adequate health education on preventive measures by avoiding the precipitants. Oral inhalers are quite good in aborting some attacks. Drug treatment is an indispensable part of the management. Oxygen therapy is a compulsory component in some cases. Some people with childhood onset asthma may “out grow” it. One third of pregnant asthmatic women, improve during pregnancy, one third is unaffected by pregnancy, while the remaining one third deteriorates.
“Reporting late to the doctor for the treatment of an asthmatic crisis is one of the major causes of mortality. Some of the patients overtime become over confident in their own ability to treat themselves and may seek doctor’s help rather late with disastrous consequences.
“Finally you need to further emphasise the importance of prompt treatment during an attack. Many people think of how to avoid spending money on adequate care and unnecessarily endangering their lives,” he cautioned.”
According to a report by the National Institute of Health (NIH), poorly controlled asthma may lead to severe, life-threatening attack and permanent lung damage. Asthma is not contagious. While its causes are still unknown, researchers have determined that asthma can be caused by both hereditary (inherited) and environmental factors.
“Whether or not you have a family tendency to develop asthma, you might have developed asthma by being exposed to one or more of your personal “triggers.” Occasionally, people who hold certain types of jobs will come in contact with triggers in the workplace that cause asthma episodes.
“When you have asthma, your symptoms can vary from time to time and situation to situation. It can be difficult to know when changes in your symptoms are normal, and when they might mean trouble. That is why it is recommended that patients work with their doctor to create a written asthma plan.
“Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will: prevent chronic and troublesome symptoms, such as cough and shortness of breath, reduce your need for quick-relief medicines. Also, help you maintain good lung function, let you maintain your normal activity level and sleep through the night and prevent asthma attacks that could result in an emergency room visit or hospital stay.
“To control asthma, partner your doctor to manage the disease or your child’s asthma. Children aged 10 or older, and younger children who are able should take an active role in their asthma care.”
Meanwhile, taking an active role to control your its involves; working with your doctor to treat other conditions that can interfere with asthma management. Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle.
Talk with your doctor about medicines that can help you stay active. And working with your doctor and other health care providers to create and follow an asthma action plan.
“An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed, ” an expert advised.
Research also shows that asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or “rescue,” medicines relieve asthma symptoms that may flare up.
“The initial treatment will depend on the severity of the asthma. Follow-up asthma treatment will depend on how well the asthma action plan is controlling the symptoms and preventing asthma attacks.”
“However, the level of asthma control can vary over time and with changes in the home, school, or work environments. These changes can alter how often the person is exposed to the factors that can worsen the asthma. At this point, there may need to increase the medicine if the asthma doesn’t stay under control.
“On the other hand, if the asthma is well controlled for several months, then, there may be decrease in medicine. These adjustments to the medicine will help maintain the best control possible with the least amount of medicine necessary.
“Asthma treatment for certain groups of people such as children, pregnant women, or those for whom exercise brings on asthma symptoms will be adjusted to meet their special needs,” he said.
Signs of B12 deficiency in women
By Chinenye Molokwu
Women have a much more difficult time absorbing vitamin B12 into their systems than men. In fact, recent studies show that after women reach 40, their chances to have a vitamin B12 deficiency will even increase. Additional studies even show that anywhere from four to six percent of women in this age group have or will develop medical issues directly related to a lack of vitamin B12.
Fatigue
Studies show that ongoing fatigue is typically one of the first signs of a vitamin B12 deficiency in women.
Our bodies rely heavily on B12, to continue to produce much-needed red blood cells. These ever – important cells send and distribute oxygen to all of the body’s organs. When the body does not have the adequate amount of oxygen in its blood cells, it can cause people to continuously fight the feeling of fatigue, even if they are consistently getting a good nights sleep.
Dizziness
Feeling dizzy or even a bit wobbly are strong signs of a medical issue when a woman may be experiencing a deficiency in the vitamin B12. Some people can become dizzy simply by standing up or walking up a short fight of steps.
These symptoms can prove to be quite dangerous, often causing severe falls that may lead to even more serious injuries, as a direct result..
Pins and needles
Lots of people tend to experience the sensation of pins and needles when sitting cross – legged or when resting on an arm behind their head, often referred to as the particular body part in question “falling asleep”.
These types of situations are all considered to be completely normal and natural. However, when a person consistently begins to have strange sensations throughout his/her body with no obvious cause, almost like electrified pinches and pressures, then it could very well be a sign of a B12 vitamin deficiency.
Memory loss
I think everyone has probably experienced a little bit of forgetfulness from time to time, especially when a person may be tired or under a lot of undue stress or anxiety. We have all definitely looked for our cell phones while we were talking on them, or searched frantically for our heads.
However, when common forgetfulness may become the norm more than an occasional occurrence, it could definitely be a sign of a B12 deficiency.
Pale skin
Sure…some people just have lighter complexions than other. Plus, there are certainly other factors that can come into play, such as whether a person is ever out in the sunlight, or they reside in a basement apartment. However, pale skin can be a common symptom that a person may not be getting the proper amount of vitamin B12, whether in their diet or through supplements.
Anxiety
Many people can experience anxiety, often culminating in mood swings and even depression. If there is a calculated reason behind this, such as a strong fear of being laid off from a job, or a family member has a major surgery coming up, then an individual experiencing temporary anxiety may just hope that the symptoms lessen over time. However, if a person seems to experience signs of anxiety for no good reason, then the answer may be in a lack of vitamin B12.
Vision problems
Sometimes people may experience vision problems, including seeing spots, having blurry vision, catching shadows in the corners of their eyes and even seeing double. Issues with vision can be caused by a lot of varying factors, like lack of sleep, problems with contact lenses or eyeglasses and even staring at a computer screen or watching television for too long.
However, issues that are causing impaired vision of any kind could also be directly related to a lack of vitamin B12 that may have gone unnoticed for a while..
Decrease in muscle strength
We may all have a day or two where we seem to be physically dragging, and even merely thinking about going to the gym for even a mild, low-impact workout is definitely not on the schedule for the afternoon
However, sometimes, these feelings of muscle tiredness do not fade over the course of a few days, and we can still only lift 20 pounds, when we are used to lifting 65 pounds on a good day. When these muscles issues seem to hang around, a B12 vitamin deficiency could definitely be the culprit.