Inhalers remain the best bet for those battling with asthma —Expert

In this interview by SADE OGUNTOLA, the president of the Nigerian Society of Asthmatics, UCH branch, and a chest physician, Professor Olusoji Ige, says asthma although deadly is treatable and shouldn’t prevent patients from getting involved in different daily activities, including sports, when properly controlled.

WHAT is asthma?

Asthma is one of the world’s most common chronic non-communicable diseases. It is characterised by the chronic inflammation of the inner lining of the airways which becomes swollen and oedematous with mucus plug leading to airways narrowing. This makes the airway hyper-reactive leading to the symptoms of coughing, a whistling sound in the chest (wheezing), shortness of breath and chest tightening. This is a long term disease of the airway that can cause breathing difficulty, thereby making some physical activities challenging or even impossible and can even lead to a life-threatening asthma attack. The tightening of the muscles around the windpipe also adds to the airway obstruction to the lungs. Asthma can affect people of any age, and the symptoms can range from mild to severe.

 

What makes the airways close up therefore limiting oxygen supply to the lungs?

The major problem is the chronic inflammation of the inner lining of the airway leading to oedema and swelling of the cells causing airway hyper reactivity. Asthma triggers vary from person to person. These include indoor allergens, dust mites, cockroach droppings, animal furs and spores from moulds. Outdoor allergens include pollen and environmental air pollution. They all can make the airway hyperactive and then lead to asthma symptoms.

 

What is the prevalence of asthma in Nigeria?

In Nigeria, we have about 10 million people that suffer from asthma and Nigeria ranks highest in Africa with regard to the burden of asthma. But globally, we have 358 million people suffering from asthma and we have about 300,000 deaths annually, although most of these deaths are preventable if asthma is well managed. Globally, 136 million asthma attacks are experienced yearly. Asthma is the most common disease among children worldwide. Fifty nine percent of children/adolescents wake up at night due to asthma with one in five unable to attend school on a full time basis.

People suffer a lot from asthma symptoms because most of the factors that tend to control asthma are not really being addressed, like proper use of inhaler medications. Adherence to medication is very important to prevent life-threatening asthma attacks. Proper health education among those groups is also very important to ensure that they know about the disease, when the asthma symptom is getting worse and how they can reach their doctor so as to prevent mortality. We call it a partnership with their doctor.

 

Experts are saying that there is a rise in cases of asthma in Nigeria. How true is this and what are the factors responsible for it?

Asthma is increasing every year and the number of people with asthma continues to grow. Many people do not use the inhalers but use asthma drugs in tablet forms. Inhalational corticosteroid (ICS) is a cornerstone for management of asthma, but people still don’t know; they still buy tablets. Also, there are so many people that are asthmatic but they don’t know that they have asthma because Nigeria’s health-seeking behaviour is poor and also with mild symptoms. Many of this category of patients are now presenting in health facilities with mild to severe asthma attacks. The adoption of western lifestyle is also a contributory factor. All these account for the increase in the prevalence of asthma in the country.

 

How can I know that I have asthma?

If one has asthma, chest tightness is a cardinal symptom aside from cough, shortness of breath and wheezing. Wheezing tends to betray asthma because the chest will be making a lot of noise and it is always very scary. That is what is called asthma exacerbation. The problem that now tends to happen is that with poor asthma control, there is night time awakening and early morning symptoms due to asthma become prominent features. Another pointer to poor asthma control is the overuse of the reliever or rescue inhaler. Also, physical activities, like going to school for children, participating in sporting activities and going to work will be affected because of poor control of asthma.

What causes asthma?

Asthma occurs due to interplay of the gene and the environment. Also, there are several factors associated with an increased risk of developing this disease. It includes heredity. If the mother is asthmatic, there is one-third possibility of the offspring being asthmatic. If both parents are asthmatic, the risk becomes double. It becomes two thirds. The exposure early in life to environmental factors for asthma in those with genetic predisposition to development of asthma can cause asthma very early in life.

Asthma is also more likely in people who have other allergic conditions such as eczema, conjunctivitis, rhinitis and hay fever. Exposure to environmental allergens can also increase the risk of the disease in an individual. Exposure to allergies, feeding a baby cow milk rather than breast milk also increases the development of allergic diseases and allergic asthma in children with genetic tendency for asthma.

 

What is the difference between asthma and seasonal allergies, given that allergens can trigger asthma?

People can have seasonal allergies without having asthma. Seasonal allergies can be a spectrum of just rhinitis and conjunctivitis. And this can come during the rainy season or during the time when pollen is airborne. But it is quite different from asthma. Asthma means that the windpipe is affected. When the windpipe is affected, there will be narrowing of the windpipe and then all those symptoms like cough, chest tightness, wheezing and shortness of breath. So, asthma is different but its incidence may increase during those seasons.

 

How can individuals live well with asthma?

To live well with asthma means having good asthma control. It means there is no night time awakening, no early morning symptoms, day-to-day activity is not limited, which includes participation in sports. There is also no exacerbation, no frequent visits of the accident and emergency or hospital for admission because of symptoms of asthma.

Asthma control is very important but people tend to underestimate the severity of asthma exacerbation. A proper management of asthma requires a good partnership with one’s doctor to have a proper knowledge of the disease and to identify signs of loss of control or worsening symptoms. This is also very important for regular assessment of the patients and monitoring the degree of control of asthma. When they use their inhaler properly, both the preventer and the rescue inhalers, they can be symptom-free and their activities, including sports, will not be limited by the condition. Of course, they will not have night awakening or early morning asthma symptoms or visit hospitals in an emergency. There would be no absenteeism from work, the children wouldn’t miss school.

Unfortunately, asthma is poorly controlled in Nigeria because people do not access medical care properly and they do not really follow the advice of their doctors. Most of them when they are symptom-free, they become non-drug-compliant thinking that they are okay and free from asthma. That is why we always develop an asthma self-management plan with them. The plan ensures that they identify when the asthma is getting worse and how to increase the dose of their inhalers. When the asthma is getting worse, early visits to the hospital will reduce asthma mortality.

A big challenge is the under-use of inhalers, both preventer and reliever. Many people still use tablets. Nigerians should know that the era of using these tablets for asthma control is gone. Using inhalers ensure that the drugs are deposited in the windpipe and help to make an individual to be symptom-free. Asthma is a windpipe problem and the more symptom-free you are, the more you control your asthma and you live a normal life.

Also, other conditions like obesity, presence of polyps in the nose and infection in the sinus can increase the frequency and severity of asthma symptoms. This is why individuals with poor asthma control need to be assessed properly at the hospital to know the reason why they lost control.

 

Is it possible to outgrow asthma, and is it a contagious condition?

Asthma is not a contagious disease because it occurs due to a gene-environment interaction. So, no one can transmit it to another person. Asthma is the most common disease among children worldwide with 25 to 66 percent of cases continuing to adulthood. The disease condition called bronchiolitis in children tends to present with asthma symptoms, including wheezing. This happens when a virus infects the bronchioles, which are the smallest airways in the lungs. The infection makes the bronchioles swollen and irritated. Mucus collects in these airways, which makes it difficult for air to flow freely in and out of the lungs.

 

Does every asthma patient experience the same symptoms, or can there be variance in the symptoms that individuals experience?

Asthma symptoms in everybody may not be the same, depending on the severity of the asthma. But the four basic symptoms of asthma are difficulty in breathing, chest tightness, coughing and wheezing. Wheezing is the scariest symptom and why many people come to complain in the hospital. An individual with these symptoms that become worse at night and early morning should always suspect asthma. But the use of some diagnostic criteria like peak flow meter and spirometry can help to check if it is asthma (a reversible airway problem).

Pouring water on someone having an asthmatic attack or trying to force the person to drink water or herbal concoction is not helpful. All they require is their reliever (rescue) inhaler. This is why all asthmatic are asked to always keep their inhalers with them, even when they are attack free. It is the rescue medication that can save them in case of an attack. If the inhaler is not with them and they have an attack, the best thing to do is to rush them to the hospital for assistance.

The theme for the 2023 World Asthma Day commemoration is ‘Asthman Care for All’. Our ambition is to ensure all patients living with asthma receive adequate treatment at the right time and in the right setting. Too many patients rely on treatment that relieves symptoms (reliever inhaler) without targeting the underlying cause of inflammation by using inhaled corticosteroid (ICS). Many Nigerians still buy tablets to treat asthma, which is a major challenge.

For patients suffering from more severe asthma, oral corticosteroids (OCS) have been the mainstay of therapy for decades despite mounting evidence that shows over-exposure to OCS can cause serious long-term health risk. Management is therefore long overdue.