Asthma: We can beat it but not kill it
- World Asthma Day is 3rd May 2016 -

Shobha Shukla *

Asthma is a common chronic non-communicable disease (NCD) that is usually characterised by inflammation of the bronchial tubes or airways of the lungs. 10,000 litres of air and blood pass through our lungs and, as a result, they deliver 350 litres of oxygen every day. If this delivery is hampered in any way it leads to respiratory distress or breathlessness. The episodic onset of respiratory symptoms is called an asthma attack.

During an asthma attack, the bronchial tubes in the lungs become inflamed and narrow, resulting in wheezing, breathlessness, chest tightness and coughing. Even though asthma cannot be cured, we can keep it under control with proper management. The Global Asthma Report 2014, pegs the number of people suffering from this disease worldwide at 334 million.

The report also says that even though asthma is a rare cause of mortality, contributing to less than 1% of all deaths in most countries, it is often a cause of reduced quality of life— not only due to its physical ill effects, but also due to its high economic, burden. It is also a major cause of school and work absence. Further, avoidable asthma deaths are still occurring due to inappropriate management of asthma, including over-reliance on reliever medication rather than preventer medication.

India has an estimated 30 million people with asthma—accounting for nearly 10% of the global burden. During a recent webinar [Watch the webinar recording here: www.bit.ly/apr16-recording ] organised by CNS (Citizen News Service) and The International Union Against Tuberculosis and Lung Disease (The Union), in the lead up to World Asthma Day, Professor Surya Kant, Head, Respiratory Medicine Department, King George Medical University, strongly advocated use of inhaler therapy (as opposed to oral therapy) for management of asthma. He informed that while a reliever inhaler is used to quickly relieve (within few minutes) a bronchial spasm caused by sudden constriction of the airways' muscles, a preventer/controller inhaler has anti-inflammatory properties. It takes 1-3 hours to act, and has a long term effect lasting more than12 hours.

While relievers provide symptomatic relief, they are not meant for regular use. Preventer inhalers should be taken regularly, twice daily, by people living with asthma—irrespective of their status of wellness, advised Dr Surya Kant. If a person is on proper inhalation therapy, he/she can keep this lifelong disease under control forever and lead a very normal and healthy life. But if they are on oral therapy, then they lead a compromised life and mortality rates could also be high.

However, he lamented that in India only 20% of the patients use inhalers while the rest 80% are on oral therapy. Prof Surya Kant also warned against use of alternative medicine to treat asthma. "Till date no medicine other than inhalation therapy is effective for asthma management. Many herbal medicines were used before the advent of inhalation therapy, as there was no proper medication available. But as of now, no herbal, ayurvedic or any other system of medication can manage asthma.

So please do not go for any medication other than preventer inhalation therapy. If a person is on proper inhalation therapy, he/she can lead a very normal and healthy life. But if they are on oral therapy, then mortality rates could be high.

Bronchial asthma is due to interaction between genetic constitution of a person and the environment. If a person is genetically hypersensitive, environmental irritants like air pollution, tobacco smoke, indoor and outdoor allergens, biomass smoke, harmful chemicals in the workplace, as well as cold air, iced drinks and physical exercise can act as potential triggers of asthma attacks and must be avoided by asthma patients as much as possible.

Iced drinks are a big causative factor for asthma in a hot country like India. A study conducted at the Patel Chest Institute, Delhi found that mosquito repellants are also a trigger/causative factor for asthma. Also smells of room fresheners, paints, incense sticks, perfumes etc should also be avoided by those with asthma, warned Dr Surya Kant.

In recent years, Yoga has gained global popularity as a form of exercise with general life-style benefits. Some studies have also investigated the potential of yoga to relieve asthma-related problems. A recent systematic review by Cochrane, has summarised the results of 15 such randomised controlled trials (RCTs) that compared yoga with usual care or no/sham intervention in people with asthma, and reported at least one of the following outcomes: quality of life, asthma symptom score, asthma control, lung function measures, asthma medication usage, and adverse events. Most of these studies had been conducted in India, followed by Europe and the United States. 6 studies looked into the effects of breathing alone during yogic exercises, whilst the other assessed the effects of yoga that included breathing, posture and meditation.

The review authors found moderate-quality evidence in 5 studies that yoga leads to small improvements in quality of life and symptoms in people with asthma. However, evidence about potential adverse effects of yoga and its impact on lung function and medication usage is uncertain, because either the results varied or only a few very small studies reported these outcomes.

As a holistic therapy, yoga might have the potential to relieve both the physical and psychological suffering of people with asthma. However, the review authors warn that while practicing yoga might have some beneficial effect on symptoms and quality of life in people with asthma, RCTs with large sample sizes and high methodological and reporting quality are needed to draw any firm conclusions about the effects of yoga for asthma.

In the aforesaid webinar, that was incidentally organised just one day before the release of the Cochrane review, Dr Surya Kant too had said that, as of now, Yoga exercises might help, but cannot be an alternative to inhalation therapy. Rather Yoga could be an add-on to inhalation therapy.

Prof Surya Kant advocates the 5-D approach for asthma management comprising;
o Doctor—well trained and well informed
o Diagnosis/Differential diagnosis— correct and accurate
o Drug and dosage—appropriate inhaler therapy
o Device—dry powder or multi dose inhaler
o Deliberation—patient education and guidance