Help, I Can’t Breathe…

More and more people today are complaining thus, be it summer, monsoon or winter. And it’s not surprising ; the global incidence of asthma is steadily rising. In India, between 5 and 25 per cent of the population is affected. The wide variation is because statistics are difficult to come by. There is very little unbiased documentation about the true incidence of asthma using instruments and lung function tests...…...click & see
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Asthma — now called reactive airways disease — tends to run in families prone to allergy. Some members wheeze, some sneeze while others may have itchy, red skin lesions. Wheezing may be present all the year round with varying degrees of severity. Attacks may also come and go, precipitated by cigarette smoke, chemicals in the air (mosquito repellents, room fresheners), infections (particularly viral), medication (aspirin, ibubrufen) or food additives (dyes, preservatives), with symptom-free intervals…..click & see

Air enters the body through the main air vessels — the bronchi, which branch out into the lungs as bronchioles. If they are irritated, they secrete mucous which narrows them. In normal people, the bronchioles relax when this occurs so a slight cough expels the obstructing plugs of mucous. In allergic people, the bronchioles constrict further, trapping the mucous and causing a feeling of suffocation…..click & see

Symptoms usually start with a tight feeling around the chest and a cough. But there is no sputum, the cough is ineffective and fails to relieve the feeling of breathlessness and suffocation. More severe, hacking and ineffective cough then sets in.

Doctors do not like to tell a patient or a parent that there is “wheezing” — the latter tend to equate it with asthma and fear chronic lifetime debility. Others confuse it with tuberculosis or primary complex. Neither is true. Wheezing is treatable and the person can lead a normal life.

The mainstay of treatment is bronchodilators, which open up the narrowed bronchi. If a direct delivery system is used, the drug goes straight into the lungs. Nebulisers, inhalers and rotahalors are freely available and efficient. Nebulisers require electricity to work and are not portable. Inhalers and rotahalors can be carried around. Inhalers, unlike rotahalors, require a certain amount of breathing co-ordination to be affective. In young children and the elderly, they become efficient only when combined with a spacer and facemask.

For an acute attack, salbutamol is usually sufficient. If there are repeated attacks, interfering with sleep at night, long-term treatment is needed. There are long-acting medications like salmeterol. When delivered to the lungs, it opens up the airways. This must be combined with a steroid like fluticosone. It prevents the local inflammatory reaction, decreases mucous secretion and helps keep the airways open.

Tablets and syrups do work eventually to control wheezing. They need to reach the stomach, get absorbed, reach the blood and eventually the lungs. They are more likely to produce side effects like nausea, vomiting and tremors. The onset of action is also slow.

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Some lifestyle modifications may help to control the disease. Obesity contributes to the severity and frequency of attacks. The “pot belly” reduces the capacity of the lungs, as it tends to push them upwards. The BMI (body mass index) — weight divided by the height in metre squared — must be as close to 23 as possible.

Aerobic exercises like fast walking, jogging, swimming, skipping or stair climbing improve lung function and capacity.

Avoid known allergens that are likely to precipitate attacks. It may be airborne chemicals, like those in mosquito mats, coils and liquids. These should not be used anywhere in the house, as the smoke tends to permeate easily. Some allergens may be present in food or medication. If an attack seems to be precipitated by ingestion of a particular substance, it’s better to avoid it than search for a cure. Desensitisation is offered in some clinics but it’s a laborious and expensive process.

Stop smoking and as far as possible stay away from smokers.

People with reactive airways have poor breathing technique. This can be improved with exercises taught by physiotherapists and yoga teachers. Videos are available on the Internet. Proper breathing techniques go a long way towards improving lung capacity and reducing the duration, frequency and severity of attacks.

Hand-held devices called spirometers are available to measure the amount of air you breathe in and out. These are inexpensive. By documenting the readings daily, it is possible to anticipate an attack and take prophylactic action.

Always use the nebuliser, inhaler or rotahalor as directed. Sometimes a single dose at night may prevent lung damage and keep the lung capacity at a satisfactory level.

Source:The Telegraph ( Kolkata, India)

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