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.

BOOSTER SHOTS: Oddities, musings and news from the health world Asthma pills may work just as well as inhalers in the real world Oral drugs may be as effective as inhaled drugs in relieving asthma symptoms because they are easier to take, suggests a new study. Asthma pills appear to work just as well as inhaled steroids at relieving asthma symptoms in real-life settings, researchers have found, apparently because people prefer swallowing a pill to sticking something up their nose. in one clinical trial, asthma sufferers who took as a first-line therapy the oral medications Singulair or Accolate, each a brand of leukotriene-receptor antagonists, reported as much symptom relief on a quality-of-life survey at two months as those who used an inhaled glucocorticoid, according to a new study published in the new England Journal of Medicine. in a separate trial, patients added one of those drugs or a different type of drug, called a long-acting beta agonist (also an inhaled medication), to their usual regimen of inhaled steroids. again, after two months the researchers found no difference in the regimens’ effectiveness. two years later, the results were similar, researchers noted, if not quite equivalent. even though inhalers have outperformed oral drugs in randomized, controlled studies, the new research compared the two in a more real-world setting: The 650 enrolled patients (ages 12 to 80) were followed for two years, not weeks, and they were responsible for getting their own medications and taking them on schedule. about 65% of patients who took oral drugs as a first-line defense, and 74% who took them as an add-on, stuck with their therapy, compared, respectively, to 41% of those who used an inhaler as a first-line defense and 46% of those who used the beta agonist as an add-on.  An accompanying editorial by two doctors from the Karolinska Institutet in Sweden nicely sums up a possible explanation: “we think this alternative approach works in the real-world setting primarily because it is easier to take a pill once or twice a day than to use an inhaler.” of course, asthma symptoms vary by person, and some treatments work better than others. The Mayo Clinic has a run-down on asthma medications. more study is needed, as the researchers point out. but for some patients it appears that pills may be an option that ultimately helps them to better control their asthma. RELATED: With asthma rates on the rise, here’s how to control symptoms.

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Time: Thursday, May 5th, 2011 at 16:48