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Recognising triggers of asthma attacks

Nai’mah suffers from asthma and carries her inhaler wherever she goes. She also keeps it in a handy position in her handbag so she could…

Nai’mah suffers from asthma and carries her inhaler wherever she goes. She also keeps it in a handy position in her handbag so she could easily reach and use it to prevent attacks. “It has helped me a lot,” she said.

The Nigerian Thoracic Society (NTS) estimates that about 15 million people suffer from asthma in Nigeria.

Secretary General of the society, Olanisun Adewole, in a statement said with increasing urbanisation and uptake of western lifestyles in developing countries, the number of people with asthma would grow by more than 100 million by 2025.

He also said the disease was one of the most common chronic lung diseases in children.

Medical experts say asthma attacks are usually periodic and increased hospital visits are observed during the very cold seasons. Asthma is a common long-term lung disease that inflames and narrows the airways, and also causes occasional breathing difficulties.

According to Dr. Ezie Patrick, a physician, asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role.

“The chronic inflammation is associated with a form of airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing particularly at night and in the morning,” he said.

He said the prevalence of asthma has been increasing steadily over the latter part of the century, first in the developed world then in the developing. Current estimates record that asthma affects over 300 million people.

Dr. Patrick added that the socio-economic impact is enormous resulting in lost days from school, or work, unscheduled health care and hospital visits.

The National Heart, Lung and Blood Institute (NHLBI) said asthma affects people of all ages, but it most often starts during childhood.

The institute said young children who often wheeze and have respiratory infections as well as certain other risk factors were at highest risk of developing asthma that continues beyond six years of age.

The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.

“Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It’s not clear whether or how sex and sex hormones play a role in causing asthma. Most, but not all, people who have asthma have allergies.

“Some people develop asthma because of contact with certain chemical irritants or industrial dusts in the workplace. This type of asthma is called occupational asthma,” the institute said.

During an asthma attack, the person may cough, wheeze and have trouble breathing. The symptoms of a minor asthma attack get better with prompt treatment but a severe can become a life-threatening emergency.

According to experts at the American College of Allergy, Asthma and Immunology, during an asthma attack, the muscles that surround the bronchial tubes constrict, narrowing the air passages and making it extremely difficult to breathe. Other common symptoms are wheezing and a rattling sound in the chest.

They said the duration of an attack can vary, depending on what caused it and how long the airways have been inflamed. “Mild episodes may last only a few minutes; more severe ones can last from hours to days. Mild attacks can resolve spontaneously or may require medication; typically a quick-acting inhaler. More severe asthma attacks can be shortened with appropriate treatment,” they said.

Mayo Clinic experts said asthma attack signs and symptoms include:

•           Severe shortness of breath, chest tightness or pain, and coughing or wheezing.

•           Low peak expiratory flow (PEF) readings, if you use a peak flow meter.

•           Symptoms that fail to respond to use of a quick-acting (rescue) inhaler.

They said signs and symptoms of an asthma attack vary from person to person, advising that sufferers should work with their doctors to identify their particular signs and symptoms of worsening asthma — and what to do when they occur.

Dr. Patrick said asthma is usually caused by certain triggers particular to each individual sufferer which could be aerosols, pollen, dust, cold even some exposure to cats, other pets, and moulds.

“These triggers result in an excessive narrowing of the airway in response leading to all the symptoms listed above. However it is important to note that these triggers would have little or no effect in normal individuals. The triggers have particular effect in these individual because of their unique physiology and predisposition to these allergens,” he said.

The doctor said asthma is usually diagnosed in the hospital using a combination of investigations which include:

•           Spirometry which checks the ability of the lungs to expire inhaled air by blowing through a peak flow meter

•           Measurement of allergic status of an individual by using skin prick tests

•           Chest X-ray is also used to identify abnormal patterns in lung presentation

•           Other high technique assessment which involve assessment of the eosinophils, a type of white blood cells in the airway.

The disease can be prevented by avoiding the triggers and aggravating factors, avoiding smoking, and lifestyle modifications such as avoiding sweeping, cooking and working in places where the sufferers are exposed to those triggers.

It can also be prevented through the use of inhalers and other medications prescribed by your doctors appropriately.

The physician said asthma attacks usually present in the hospitals as emergencies as the individual suddenly but progressively find it increasingly difficult to breath.

“The goal of treatment is to ensure immediate relieve of the individual during such attacks by using nebulizers to ensure that the airways are dilated and halting the excessive narrowing. This usually involves the inhalation of medications to bring about relief,” he said.

Other medications such as antibiotics and mast cell stabilizers are administered to ensure that infections are taken care of and repeat episodes are halted.

However, the medical expert added that the mainstay in the management of asthma is the avoidance of the triggers and regular use of inhalers to prevent recurrent attacks.

While asthma can normally be kept under control, it’s still a serious condition that can cause a number of complications, and so it is important to follow treatment plan and not ignore symptoms if they are getting worse.

Badly controlled asthma can cause persistent tiredness, absence from work or school, psychological problems, lung infections like pneumonia, and also cause delays in puberty or growth in children, he said.

The National Heart, Lung, and Blood Institute advised people living with the disease to partner with their doctor to develop an asthma action plan. “This plan will help you know when and how to take your medicines. The plan also will help you identify your asthma triggers and manage your disease if asthma symptoms worsen,” it said.

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