Falak Jahan

World Asthma Day is organized annually by the Global Initiative for Asthma to boost the global asthama awareness. Along with the health care professionals and public health officials round the globe, the Global Initiative for Asthma (GINA) is working to reduce asthma prevalence, morbidity, and mortality through evidence based strategies for asthma management, projects, and events such as the annual celebration of World Asthma Day. World Asthma Day takes place on the first Tuesday of may. the theme of this year’s event is “You can Control your Asthma”.

the serious global health disease that affects all age groups, when left uncontrolled, can prove fatal. With an estimated 300 million affected individuals worldwide the prevalence of asthama is increasing because of rapid urbanisation. in Kashmir the number of asthama patients is increasing with gradual industrialisation like cement manufacturing plants and the increase in transportation.

Asthma is the chronic inflammatory disorder of respiratory airways. during an asthama attack the lining of the airways swells, muscles around the airways tighten and mucus clogs the tiny airways in the lungs making breathing difficult. Asthma is characterised by the symptoms like breathlessness, wheezing, chest tightness and coughing. usually the symptoms worsen during the night hours and in the early morning, the severity of asthma also varies from person to person. Asthama is the disease caused by some environmental factors in genetically predisposed allergic patients. now asthama is a fully reversible disease with appropriate treatment.

Asthma can be extrinsic (Allergic) or intrinsic (non allergic), of the two the extrinsic asthama is more common. Asthama is triggered by the host factors and environmental factors. the host factors include genetic makeup, obesity, and gender. Environmental factors include allergens, infections (predominantly viral), occupational sensitizers, tobacco smoke (both active and passive), diet. both indoor allergens (Domestic mites; furred animals like dogs, cats, mice; cockroach allergen, fungi; molds; yeasts) and outdoor allergens (Pollens, fungi, molds, and yeasts) are accountable for the disease. in Kashmir the diet allergens usually constitute tomato, cabbage, cauliflower, milk, eggs, bananas etc. the other triggers include cold air, extreme emotional provocation such as anger or fear, and physical exercise. Even the medications like aspirin and other non-steroid anti inflammatory drugs, and beta-blockers (used to treat high blood pressure, coronary disorders and migraine) can trigger asthma.

While obesity plays its role everywhere, it has also been shown to be a risk factor for asthma. as far as gender is concerned, prior to the age of 14, boys are more susceptible to the disease than the girls. by adulthood the occurrence of asthma is more common in females than in males.

The best way to stay away from the agony of asthma is to avoid exposure to specific allergens one is susceptible to. appropriate management can control the disease and enable people to enjoy a good quality of life. Short-term medications are used to relieve symptoms. People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms. in J&K the immunotherapy is under the focus of intensive research and by the end of this year the treatment will be available. till such therapy is developed for the specific allergens found in Kashmir like the pollen of poplar, prevention efforts along with the medications must be ruled out.

Once a diagnosis of occupational asthma is established, complete avoidance of the relevant exposure is ideally an important component of management. Occupational asthma may persist even several years after removal from exposure to the causative agent, especially when the patient has had symptoms for a long time before termination of exposure. Continued exposure may lead to increasingly severe and potentially fatal asthma exacerbation

The prevention involves prevention of the allergic sensitization or the prevention of asthma in the sensitized people. as sensitization can occur prenatally the antigen avoidance diet is prescribed to the high risk women during the pregnancy. Infants fed with the milk other than breast feeding like the cow milk, soya milk etc., are found more susceptible to the disease. Pure breast feeding during the first months after the birth is associated with lower rates of asthma during childhood.

The persons who is suffering from Rhinites, Sinusites, sleep Apnia,  Gastro Eosophigal Reflux disease are prone to asthama or in other words these diseases lead to asthma soonser or later.

Patients having the history or evidence of rhinitis are more prone to asthma. up to 30% of patients with persistent rhinitis have or develop asthma.

Rhinitis frequently precedes asthma, and shares several common risk factors with asthama like common indoor and outdoor allergens such as house dust mites, animal dander, and, less commonly, pollen affecting the nose and bronchi, occupational sensitizers, and non-specific factors like aspirin. the Allergic Rhinitis and its Impact on Asthma (ARIA) initiative recommends that the presence of asthma must be considered in all patients with rhinitis, and that in planning treatment, both should be considered together.

Sinusitis is a complication of upper respiratory infections, allergic rhinitis, nasal polyps, and other forms of nasal obstruction. both acute and chronic sinusitis can worsen asthma. Nasal polyps associated with asthma and rhinitis, and sometimes with aspirin hypersensitivity, are seen primarily in patients over 40 years old. almost 36% to 96% of aspirin-intolerant patients have polyps, and 29% to 70% of patients with nasal polyps may have asthma.

Gastroesophageal Reflux is also associated with asthama. Medical management should be given for the relief of reflux symptoms as it is often effective. Patients may be advised to eat smaller, more frequent meals; avoid food or drink between meals and especially at bedtime; avoid fatty meals, alcohol, theophylline, and oral beta2-agonists; and elevate the head of the bed.

Although asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.

Enlightened Treatment

To stay away from the allergens that cause asthama and taking the medications for the inflammation of the respiratory airways was the only way out to deal with asthma. But now with the help of immunotherapy you can enjoy your life with no need to control the disease after treatment, as it gets fully cured.

The World Allergy Organisation along with American College of Allergy Asthama, and Applied Immunology and Indian Academy of Allergy Asthama and Applied Immunology has approved the specific therapy for curing asthma. Dr. Ghulam Hassan is the pioneer to start curing asthama patients in J&K with this therapy. Dr.Ghulam Hassan is the consultant at department of medicine, Government medical college and associated SMHS hospitals, Srinagar Kashmir. Recently Dr. Ghulam Hassan completed his fellowship training in “Allergy” and Diploma in “Allergy and Asthama” through American Academy of Allergy Asthama and Immunology at Christian Medical College Vellore India. Besides, he is the member of American College of Allergy Asthama and Immunology as well as Indian Academy of Allergy. he has also published research papers.

Dr. Ghulam Hassan says “America has developed some specific vaccines and drugs which halt or alter the allergic process in the body. in order to develop specific vaccines and drugs for some allergens that are specific to our state like the pollen of poplar, the American College of Allergy Asthama and Applied Immunology and Indian Academy of Allergy Asthma and Applied Immunology are helping out. the vaccines for such Kashmir specific allergens are to be created and I have taken the initiative to introduce this therapy in our state”

Immunotherapy decrease sensitivity to allergens and leads to lasting relief of allergy symptoms even after treatment is stopped. this makes it a cost-effective, beneficial treatment approach. Allergy shots work like a vaccine, the particular allergen is injected into the body and the gradual increase in the dose develops immunity or tolerance to the allergen. “This therapy turns an asthma patient into a normal person within 3-5 years, and with further research this duration will shrink” Dr. Ghulam Hassan said. “When compared with the symptoms and ailments caused by asthama, the risk involved in using this therapy is quit negligible” Dr. Ghulam Hassan added.

Fewer older cancer patients are given treatment with the decline starting at the age of 50 (Posed by models)

Elderly people are being denied cancer surgery because NHS doctors are reluctant to operate on them, according to a study.

It found the number of people treated for breast cancer falls by a third over the age of 60.

Meanwhile only two per cent of patients over the age of 80 have surgery for six of the top 13 cancers.

Researchers said workers in the NHS often believed performing surgery on elderly patients was inappropriate and said this attitude was one of the key reasons for the decline in operations.

The biggest drop in operations is seen in the over-7ps but the study found a decline across all forms of cancer treatment is evident from the age of 50.

Dr Mick Peake, lead clinician at the National Cancer Intelligence Network which carried out the study said: ‘While this isn’t intrinsically surprising, the drop in some cancers begins in age groups as young as the 50s. this is a cause for concern.

‘And, crucially, it raises questions about the underlying reasons for these variations and, in turn, what can be done to reduce them.

‘Inevitably, there may be reasons for variations by age and geography that are not directly related to the quality of care in our hospitals.

‘Such reasons may include the stage of the disease at diagnosis, late presentation by patients with symptoms, patients – especially older ones – choosing not to have surgery, different numbers of patients with other illnesses which mean surgery would be ill-advised.

‘But because complete data on these factors is not available, the report can’t attribute any of the variation to them, highlighting the importance of NCIN’s ongoing work in improving the information collected about cancer patients.

‘Despite all these caveats, the new facts and figures suggest that some parts of the country may have different rates compared to other regions.

‘This report provides the basis for further analyses to try and understand what the underlying causes of these differences are.

Dr Mick Peake: ‘While this isn?t intrinsically surprising, the drop in some cancers begins in age groups as young as the 50s. this is a cause for concern.’

‘This is a good basis for cancer networks to examine why they might have lower surgery rates than their neighbours. so publishing this type of analysis could actually help to make things better.’

The study found that ‘There was evidence of small but significant decreases in the proportion of patients receiving a major resection (organ or tumour removal) in the more deprived socio-economic groups and also of variation in surgical rates between cancer networks.’

Less than 16 per cent of people with cancers of the oesophagus, stomach, bladder, prostate, lung, pancreas and liver had a record of a major resection. with liver cancer only six per cent had surgery before a drop to two per cent for all of these cancers for the over 80s.

Over the age of 40 and until someone reaches 80 the drop in the number of people receiving surgery for cancer of the ovaries was 56 per cent, kidney 49 per cent and cervical 48 per cent.

The difference between the number of patients from poor areas being treated compared to the more affluent was surprisingly narrow with the largest difference being cervical cancer – 10 per cent. however this did not take into account treatment in the private sector.

Adams IV for News The specialist: Dr. Michael A. Palese on kidney cancer

The director of minimally invasive surgery in the Department of Urology at the Mount Sinai Medical Center, Dr. Michael A. Palese specializes in robotic, laparoscopic and endoscopic surgery for kidney cancer. he has performed more than 2,000 minimally invasive kidney procedures.Who’s at riskKidney cancer was diagnosed in over 58,000 Americans in 2010.”Typically it affects more men than women, and last year there were over 13,000 deaths from kidney cancer,” says Palese. “About 1 in 70 Americans will ­potentially develop kidney cancer,” he says. The average age of diagnosis is 64, but kidney cancer can affect all age groups.While there is a genetic component to kidney cancer, the biggest risk factor is smoking. “Obesity, hypertension and long-term dialysis are additional risk factors, as are occupational and chemical exposure to things like asbestos, cadmium, certain organic solvents and certain herbicides,” says Palese.Signs and symptomsKidney cancer exhibits a trademark cluster of symptoms. “The classic triad for kidney cancer is blood in the urine, pain and a flank mass, which people might feel as a bulge in their side,” says Dr. Palese.”Fortunately, we are detecting kidney cancer at a much earlier stage today,” he says. Most cases are being diagnosed by ultrasound, MRI or CAT scan. Often these were done for another diagnostic reason.There is no blood test for kidney cancer or recommended routine screening, like colonoscopy for colon cancer.”Blood in the urine is the main marker,” says Palese. “Secondary signs include weight loss, fever, fatigue, night sweats and other changes in laboratory values, such as increased liver function tests and increases in the red blood cell count.”Traditional treatmentEarly diagnosis is the key to fighting kidney cancer. “If we catch the cancer when it is still localized, the five-year survival rate is over 90%,” says Palese. “If it has spread to lymph nodes, it is about 60%.” if the cancer has metastasized, the survival rate drops to 10%.Kidney cancer is one of the few cancers that does not respond to chemotherapy or radiation, so surgery is the number one option. “We usually don’t biopsy kidney cancer, because there is a high false negative rate,” says Dr. Palese. “So the treatment of choice is to remove the tumor and get a clear margin.” in the past, surgeons would remove the whole kidney, but now the goal is to remove only the tumor through a partial resection, and leave the rest of the healthy kidney behind.Traditionally, kidney surgery has always been done through an open approach, which meant a large incision, longer hospitalization and longer recovery for the patient. Attempts were made to improve this by performing laparoscopic, or “keyhole,” surgery. but laparoscopic partial nephrectomy is a very complicated procedure, and only experienced surgeons could perform it. “With the introduction of robotic surgery,” says Palese, “many tumors which were previously thought to be unresectable as a partial nephrectomy can now be done. Thanks to this new minimally invasive technique, people have less pain and blood loss, and get back on their feet quicker.”Kidney cancer can recur after surgery, so patients must remain on surveillance for the rest of their lives. “It is very important that you follow up with your doctor regularly after kidney cancer surgery,” says Palese.Research breakthroughsRobotic kidney surgery is a new ­procedure that has become increasingly common since it was first introduced in 2005.”Robotic kidney surgery is for people with localized kidney cancer,” says Dr. Palese. “Our goal is to remove the tumor and leave behind the rest of the healthy kidney, which will increase quality of life and decrease problems associated with loss of a whole kidney.” The technical name for the surgery is robotic partial nephrectomy.in the past five years, even more treatment options for late-stage kidney cancer patients have evolved. “There are five new targeted therapies that affect specific proteins involved in the spread of the kidney cancer,” Dr. Palese. “These can reduce replication and prolong survival rates.” Several more targeted drugs are also on the horizon. “Like robotic surgery, we’re just using these targeted therapies in the last five years, so our statistics are rapidly changing,” says Palese. “A whole new world in kidney cancer treatment has opened up.”Questions for your doctorAs with any surgery, be sure to ask your doctor, “What risks are associated with surgery?” in addition, it’s important to find an experienced surgeon, so ask “How many of these surgeries have you done?” Robotic surgery is still a new technique, and Dr. Palese advises patients to seek out an expert. “It’s a tool, so it’s only as good as the surgeon using it.”What you can doGet informed.The web has sites that provide a great deal of information on kidney cancer. use a reliable source like the American Cancer Society (cancer.org), the American Urological Association (auanet.org), the Kidney Cancer Association (kidneycancer.org) or the National Cancer Institute (cancer.gov).Don’t ignore blood in the urine.Go see a doctor immediately. “Blood in the urine calls for a workup,” says Dr. Michael A. Palese.Surveillance is vital.If you have a family history of kidney cancer and kidney disease, make a plan with your doctor to monitor your health.