By Nkiru Odinkemelu
Though an asthma patient, this did not stop Jide Olajumoke from enrolling to serve her Country in the compulsory National Youth Service Corps (NYSC) scheme. She would have opted out, if she knew her dreams would end suddenly, her corpse brought home for burial instead.
According to a report, the late corps member at an orientation camp in Kaiama, Kolokuma-Opokuma local government area of Bayelsa state went to camp with her inhaler and other medications. On the fateful day, the asthma attack that claimed the life of this corps member took place, no one could give significant account of what befell her and the inhaler.
The story of this young woman might be pathetic but it is just one out of the over 150 million people globally that die of asthma annually.
According to Global Initiative for Asthma (GINA), Asthma is a chronic inflammatory disease of the airways in which cells and cellular elements play a role. The chronic airway inflammation is associated with airways hyper-responsiveness (AHR) that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. These episodes are often associated with variable airway obstruction.
According to a study by Global Burden of Disease Study (GBD) undertaken in 2008-2010, about 334 million people are estimated to have the disease, making the disease to rank 14th among major disorders globally in terms of severity and duration of disability, with prevalence still on the rise particularly in developing countries.
Its incidence varies from 5 percent in some countries to as much as 28 per cent in others. In Nigeria, studies carried out suggest that the disease is common and affects up to 10 per cent of the adolescents and adult population, noted the Lagos State Commissioner for Health, Dr. Jide Idris.
An estimate of asthma prevalence in Africa by Davies Adeloye, Kit Yee Chan, Igor Rudan, and Harry Campbell in 1990, 2000, and 2010, showed that in 1990, there was an estimated 34.1 million asthma cases; in 2000, it was estimated to be 41.3 million cases and 119.3 million cases in 2010.
The study further showed that prevalence of asthma were, however, consistently higher among urban than rural dwellers.
Dr. Ayoade Adedokun, Consultant Family Physician with Lagos State University Teaching Hospital (LASUTH) said, “the increase in the prevalence of asthma is not unconnected with urbanisation and industrialisation. Urbanisation rates are projected to grow from current 42 per cent to 59 per cent by 2025 and this will produce a further increase from the 100 million expected increases in the prevalence of asthma for the same period.”
Causes and risk factors
Asthma most commonly develops in early childhood, and more than three-quarters of children who develop asthma symptoms before age 7 no longer have symptoms by age 16. However, asthma can develop at any stage in life, including adulthood.
At the Launch of Guidelines for Asthma Management, experts held that “asthma occurs due to interplay of the gene and environment. Individuals with a family history of asthma or some forms of allergies are more likely to have asthma. It includes allergic rhinitis (hay fever) and allergic conjunctivitis. So, when the genetic predisposition meets with the right environmental conditions or triggers, it can create what is called airway hyper-responsiveness.
A trigger can vary from weather conditions such as thunderstorm, cold, to house dust, pollens, exercises, certain food items, drugs like aspirin and some occupational conditions. For some people, cold water may be the trigger. Some people have experienced asthmatic attack after taking cold water, taking anything cold or exposed to cold weather. It is also known that in certain individuals, cold can trigger airway hyper responsiveness, in which the airway becomes excessively sensitive and may predispose to asthma. However, the mechanism of this is not well understood.
Menstruation and other stressful conditions may induce asthma in some individuals. And so, a patient has to study his own asthma to detect his own allergies.
However, what could be allergic to someone may not be allergic to the other person. Some things may induce allergies, but not necessarily asthma. However, in those that are allergic, they could develop problems ranging from mere sneezing, runny nose, anaphylactic shock, to full blown asthma. So, just as an allergy can trigger an attack, persistent allergy may worsen an attack.
However, there is also the possibility of some individuals becoming less sensitive to these allergies after some time.
On factors that aid development and those that trigger asthma, Dr. Adedokun said, male gender is a risk factor for asthma in children. “In children less than 14 years, asthma is twice as prevalent in boys than girls while female gender is a risk factor in adults; the reason is unknown but it may be due to women’s smaller lung size.”
He also noted that tobacco smoke from cigarettes, cigars or shisha pipes, is a major trigger of asthma. “Tobacco smoke damage cilia in the airways, allowing dust and mucus to accumulate and obstruct the airways. Asthma sufferers who smoke are likely to experience higher rate of hospitalisation than those who don’t. Also, second hand smoke is a major cause of development of childhood asthma including outdoor and indoor pollution.
“Dust storms reduce air quality and may have adverse effects on health. Small, fine particles can penetrate the lungs and cause serious harm to asthma sufferers. Burning of biomass fuels such as firewood as a source of energy for household needs, is a major contributor to indoor air pollution. This can increase asthma symptoms as most of the smoke particles are small enough to enter the lungs and cause respiratory and heart disease.”
On allergen, he said non-harmful agents, when inhaled, may trigger an immune response to the inhaled substances known as allergens.
“The body produces IgE antibodies designed to recognise specific allergens. When the allergen is inhaled, the IgE antibodies trigger an immune response, causing symptoms of asthma. Indoor and outdoor allergens may trigger asthma symptoms and asthma-like symptoms are commonly observed following sensitisation to: house dust mites, animal dander, cockroaches, aspergillus mould and pollen.”
For those in different industries, occupational sensitizers are estimated to cause 1 in 10 cases of asthma in adults of working age.
For bakers, flour and amylase; in detergent manufacturing- bacillus subtilis enzymes; among farmers- soyabean dust; in food processing, coffee bean dust, tea, egg proteins, and papain. For carpenters and sawmill workers, it is wood dust, shipping workers- grain dust; refinery workers- platinum salts and vanadium; manufactueres- antibiotics, piperazine, methyldopa and salbutamol; in rubber processing- formaldehyde and ethylene diamine; while in plastics industry, it is toluene diisocyanate and acrylates.
Most common symptom of asthma are: recurrent episodes of wheezing – a high-pitched whistling sound heard during breathing, especially when breathing out. However, wheezing is not always the only symptom, asthma can also involve breathlessness, chest tightness or coughing night or early morning. Moreover, not all wheezing and other symptoms mentioned are as a result of asthma. The underlying process includes chronic inflammation of the airways, reversible obstruction of the flow of air in and out of the airways, and the tendency of the airways to over-react to stimuli
Severity of asthma can vary from mild, moderate, severe, to life-threatening. A severe asthma is one whose symptoms of cough, breathlessness, difficulty in breathing and chest tightness persist despite the use of drugs that should relief the condition in the patient.
Severe asthma is a big cause of fatality all over the world. It suggests that the asthma has not been tamed, and that the individual is losing control. It can lead to life threatening asthma, respiratory failure or even death.
So, to guard oneself against the dangers of sever forms of the disease, first, the patient should be aware of things that show that his asthma is getting more severe. The symptoms of asthma that are not controlled include persistent shortness of breath, breathlessness even while lying down, chest tightness, agitation, confusion, or inability to concentrate, persistent coughing and wheezing.
When asthma triggers such as dust, dust mite, pollens, environmental changes like cold and thunder storm easily aggravate asthma, that shows that the condition is not controlled.Again, if an individual who was recently admitted for asthma was not properly treated, such a person also stands a higher risk of developing severe asthmatic attacks.
Older persons can also develop severe asthma because of poor adherence to asthma medications. Over time, the airway changes become more severe due to inadequate treatment. Other factors that can make one prone to severe asthma include poor knowledge about asthma, emotional state, and stressful conditions.
A patient also needs an instrument called a Peak Flow Meter (which is used to monitor asthma control), to determine the severity of your asthma. This meter is to the asthmatic what the sphygmomanometer is to the hypertensive or the glucometer to the diabetic.
In addition, working together with the doctor is paramount; the asthmatic needs to have a written health management plan to know when asthma is not controlled and what to do in that instance. All these would help avert problems that may arise when asthma is not controlled.
Asthma in children
Although asthma is a disease that affects both the young and the old, including pregnant women and all races, Dr. Idris said, it is the most chronic disease among children and remains the major cause of school absenteeism.
Adedokun, stressed that several studies have shown that the prevalence of asthma in children in Nigeria ranges from 5.1 per cent to 14.3 per cent, with prevalence rates of about 30 per cent in some areas, as compared to a recent review of asthma in adolescents and adults carried out over a 15 year period (1998-2013) in Nigeria which showed a pooled prevalence of 10.1 per cent.
Common childhood asthma signs and symptoms include: frequent, intermittent coughing, a whistling or wheezing sound when exhaling, shortness of breath, chest congestion or tightness, and chest pain, particularly in younger children
Other signs and symptoms of childhood asthma include: trouble sleeping caused by shortness of breath, coughing or wheezing, bouts of coughing or wheezing that get worse with a respiratory infection, such as a cold or the flu, delayed recovery or bronchitis after respiratory infection, trouble breathing that may limit play or exercise and fatigue, which can be caused by poor sleep.
The experts said asthma signs and symptoms vary from child to child, and may either get worse or better over time. It may be difficult to tell whether a child’s symptoms are caused by asthma or something else because periodic or long-lasting wheezing and other asthma-like symptoms may be caused by infectious bronchitis or another respiratory problem. Therefore it is important to visit a doctor when any or some of these signs are seen in a child for proper investigation and testing.
Asthma in pregnancy
Asthma is said to be one of the most common medical condition encountered in pregnancy. Pregnancy may sure change the course of asthma and asthma may affect the outcome of pregnancy. In one third of patients, their asthma remains the same, in another third, theirs asthma gets worse and in the final third, their asthma improves. Concerns in pregnancy include general management issues and safety data for specific asthma medications.
Overall, good asthma control is essential to protect the mother and the fetus. Risks of uncontrolled asthma in the mother are that she might develop high blood pressure or come down with pre-eclampsia; while for the fetus it could result to perinatal mortality, intrauterine growth retardation and preterm birth and also low birth rate. While more severe asthma is associated with more outcomes.
Although, most asthma drugs have been found to be relatively safe in pregnancy, however, some taken especially in the first trimester have been associated with birth defects of cleft lips and palate and also increase the risk of pre-eclampsia, preterm and low birth weight infants, the experts however affirmed that it was safer for pregnant women to be treated with asthma medications than for them to have symptoms and asthma exacerbations.
Even as asthma is termed one of the commonest chronic diseases of the world, experts believe there is a tendency for reduction asthma deaths in Nigeria if only Nigeria could emulate countries like United States, Canada, United Kingdom and even Kenya which have had reduction in asthma morbidity and mortality by initiating a programme directed at improving quality of asthma care.
According to the World Health Organisation (WHO), the levels of asthma control and health responses in the Africa have been below recommended standards, and these have contributed to the size of the disease burden. Economic analyses in many African settings have shown that direct costs from asthma are usually greater than the indirect costs.
However, indirect costs represent a relatively higher proportion of total costs among paediatric than adult patients. Moreover, the wider economic burden on individuals, families, employers, and society, due to loss of future potential source of livelihood, has also been devastating in many resource-poor settings.
It is believed that many children with asthma in Africa may fail to achieve their full potential if proper management and control measures are not put in place. To avoid the above costs, WHO suggests that education of health care providers and the public is a vital element of the response to the challenge posed by asthma in Africa.
Following these, some team of seasoned physicians, led by Dr. Adedokun came together to champion for the first time in Nigeria, the production of a “Guideline for Asthma Management and Control.”
Speaking on this, Dr. Adedokun said, “the care of asthma is a collective responsibility that should be guided by updated, scientifically proven knowledge and appropriate practices of healthcare workers.”
He pointed out that the guidelines were aimed at aiding all health personnel, target being mostly doctors in private practice to imbibe current international best practices since it is an open secret that more than half of the population of any state in Nigeria access health from these private medical practitioners among whom the need for updated knowledge about asthma management have been conspicuous.
The guidelines thus take into cognisance theme which include but not limited to: the heterogeneous nature of asthma, emphasis on confirmation of its diagnosis to minimise both under and over treatment, provision of easy assessment tools for patients’ monitoring, appropriate treatment modalities according to current practices, cultural influences on patients and physicians expectations in the course of management amongst others.
He insisted that Nigeria was long overdue for an asthma control guidelines because new knowledge has emerged concerning pathophysiology and pathogenesis of the disease as well as therapeutical options and interventions.
There is need for these guidelines not to end up in shelves like some books have done but that they circulate enough, even up unto rural health managers; it is then that it could be said that the reason for their production was met.
TIPS ON HEALTHY LIVING : Weight loss tips that are evidence-based (3)
By Patience Boulor
People are advised to do all sorts of crazy things, most of which have no evidence behind them.Over the years, however, scientists have found a number of strategies that seem to be effective.
Here are some weight loss tips that are actually evidence-based.
Do aerobic exercise
Doing aerobic exercise (cardio) is an excellent way to burn calories and improve your physical and mental health.
It appears to be particularly effective to lose belly fat, the unhealthy fat that tends to build up around your organs and cause metabolic disease .
One of the worst side effects of dieting, is that it tends to cause muscle loss and metabolic slowdown, often referred to as starvation mode.
The best way to prevent this from happening is to do some sort of resistance exercise, like lifting weights. Studies show that weight lifting can help keep your metabolism high, and prevent you from losing precious muscle mass.
Of course, it’s not just important to lose fat. You also want to make sure that what is beneath looks good. Doing some sort of resistance exercise is critical for that.
Eat more fiber
Fiber is often recommended for the purpose of weight loss. Although the evidence is mixed, some studies show that fiber (especially viscous fiber) can increase satiety and help you control your weight over the long term
Eat more vegetables and fruits
Vegetables and fruits have several properties that make them effective for weight loss.
They contain few calories, but a lot of fiber. They are also rich in water, which gives them a low energy density. They also take a while to chew, and are very filling.
Studies show that people who eat vegetables and fruits tend to weigh less. These foods are also super healthy and nutritious, so eating them is important for all sorts of reasons.
Chew more slowly
It can take a while for the brain to “register” that you’ve had enough to eat. Some studies show that chewing more slowly can help you eat fewer calories and increase the production of hormones linked to weight loss.
Get good sleep
Sleep is highly underrated, but it may be just as important as eating healthy and exercising.
Studies show that poor sleep is one of the strongest risk factors for obesity, being linked to an 89% increased risk of obesity in children, and 55% in adults.
Beat your food addiction
A recent 2014 study of 196,211 individuals found that 19.9% of people fulfil the criteria for food addiction .
If you suffer from overpowering cravings and can’t seem to get your eating under control no matter how hard you try, then you may be a food addict.
In this case, get help. Trying to lose weight without dealing with this problem first is next to impossible.
Eat more protein
Protein is the single most important nutrient when it comes to losing weight.
Eating a high protein diet has been shown to boost metabolism by 80 to 100 calories per day, while helping you feel so satiated that you eat up to 441 fewer calories per day.
One study also showed that protein at 25% of calories reduced obsessive thoughts about food by 60%, while cutting the desire for late night snacking in half .This is the single most important tip in the article.
Simply adding protein to your diet (without restricting anything) is one of the easiest, most effective and most delicious ways to lose weight.
Supplement with whey protein
If you struggle to get enough protein in your diet, taking a supplement can help.
One study showed that replacing part of your calories with whey protein can cause weight loss of about 8 pounds, while increasing lean muscle mass.