Why thunderstorm can trigger asthmatic attack —Ige

Professor Olusoji Ige

Asthma causes airways to narrow and swell, making it difficult to breathe. President, Nigerian Society for Asthmatics, University College Hospital (UCH) branch, Professor Olusoji Ige, in this interview with Sade Oguntola said the asthmatic experience can range from being a nuisance that can reduce quality of life, lead to absenteeism from school and work, and degenerate to life-threatening attack and ultimately death.

Asthma in Nigeria, what is the situation like?

The incidence of asthma is on the increase in developing countries, Nigeria inclusive, because of many factors such as urbanization, adoption of western lifestyle, exposure to house-dust mite, cockroaches and moulds, and air pollution. Asthma prevalence in Nigeria varies from north to south. On the average, about 10.7 per cent of Nigerians has asthma. About 300 million suffer from asthma globally. There are an estimated 250,000 annual worldwide death from asthma and those deaths occur in those over45 years old and are largely preventable.

Asthma affects all age groups; There is childhood asthma also known as early-onset asthma. The onset of asthma can start early within the first year of age in children. Many people believe that asthma starts from childhood, but adult onset asthma can occur for the first time around the age of 35.

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What can predispose an individual to asthma?

Individuals can be genetically predisposed to asthma. If a mother is asthmatic, there is a one-third probability that her offspring will also be asthmatic. The risk becomes two thirds if both parents are asthmatic.

In addition, there are also environment allergens like air pollution, house-dust mites, cockroaches and moulds that also predispose to asthma. But delaying exposure to these environmental factors can delay the onset of expression of asthma.

A study said that poor inhaler use accounts for poor asthma control in many children (especially adolescent) in developed countries. Is it also an issue in Nigeria?

That is true. Individuals need to be taught the proper use of inhaler medications. Inhaler medication is supposed to go into the windpipe, if it escapes from the nose, asthma symptoms will not be adequately controlled. After prescribing the inhalers, the patients are well educated about proper inhaler use. That is why there should be group discussions like they occur at the meetings of the Asthmatic Society of Nigeria where proper use of inhaler is demonstrated by all the members for adequate control of their symptoms.

An appropriate inhaler technique is key in the management of asthma. All their drugs are inhalational, which goes directly to the windpipe. If the right doses do not get to the right place, then the symptoms will not be controlled.

There are basically two types of inhalers; the preventer medication, which is steroidal preparations and requires to be used on daily basis tends to prevent asthma from worsening. The other one (rescue medication) is just to dilate the windpipe and make the patient to breathe well, since the asthma windpipe narrows during asthma attacks. That is the major principle of controlling asthma.

Asthma is a lifetime disease; people living with the condition will be on medications for as long as possible. But inhaled corticosteroids are very expensive. The under usage of this drug is a reason asthma symptoms worsen and spins out of control.

What are common signs of an uncontrolled asthma?

The indicator for asthma exacerbations (attacks) includes daytime wheezing (symptoms), nighttime awakening; too frequent use of (rescue) inhaler medication that dilates the airway, activity restriction (including exercise), chest tightness and increased visits to the hospital or accident and emergency unit.

Where does weight control come into ensuring good asthma control and improved quality of life in these patients?

People that are big or obese tend to have more asthma symptoms than those who are slim. Also, obese asthmatics tend to experience more heartburn than the slim ones.

Heartburn (Gastroesophageal reflux disease (GERD)) has been linked with asthma. It can worsen and make asthma exacerbation very frequent.

In addition, there are asthma triggers they should also avoid such as dust, pollen, house-dust mite, strong smell, smoke from frying things and vehicle exhausts. They will have to be very careful to know all the things that can precipitate an attack and avoid them. It is also a cornerstone in the management of asthma.

Could persistent cough also be suggestive of asthma exacerbation?

Yes, a persistent cough could also be indicative that the asthma is not well controlled, especially if it disturbs at night. This is called cough-variant asthma. This might be the only symptom experienced by the patient. Asthma is easily recognized when the patient’s chest starts wheezing, with chest tightness, and shortness of breath (difficulty in breathing). There is a tendency to underdiagnose cough-variant asthma. Severe asthma attacks are potentially life-threatening and will lead to death if not attended to promptly by medical experts.

How true is it that thunderstorm can trigger asthma in some individuals, particularly now that we are entering the rainy season?

A thunderstorm is one of the things that can trigger asthma. During a severe thunderstorm, people are frightened, afraid or anxious. That is not a good thing for asthmatics. Certainly, there is an entity called thunderstorm-induced asthma, but it is not very common.

A study claimed that air pollution could be the reason for one in five new cases of kids having asthma in major cities of the world? Why is this so?

That is why we say urbanization is one of the reasons for the increasing prevalence of asthma all over the world. Anything that can go to the windpipe can cause all the problems.  Air pollution is one of the problems that can lead to asthma expression and also aggravate symptoms. This is the same for adult asthmatics.

Based on the theme for 2019 Asthma Day celebration, “STOP for Asthma”, what will be your advice to Nigerians?

The STOP had four letters and each represents things that can be done to stop asthma. The letter S means symptom evaluation; T for test response; O means observe and access; and P is to proceed and adjust treatment.

Those are the four cardinal things that the theme talks about. So, we want to be doing all these, so that the patient will be well managed. That is how we can stop asthma symptoms in our patients.

Is this achievable in Nigeria?

We have to create awareness on this; people need to be educated on the symptoms of asthma and the fact that when they have this disease they need to come for assessment. We have many asthma clubs where patients are properly educated and counselled on the disease and also on proper inhaler techniques.

Also, nurses and doctors in general and private hospitals have to be trained on proper inhaler techniques as well as to update their knowledge on asthma care. If we can do that, then we will be able to stop asthma in line with the theme for this year’s asthma day celebration.