HAVE you ever felt like a 100 inch mega Wrench is grippingly tightening your chest and your lungs are about to explode and its driving you crazy? You gasp for air, and you feel this tense sensation accompanied by a dry cough and whizzing. You feel dead already and the temptation to sing “Nearer My God To Thee” is so compelling.
Don’t panic as yet, its probably Asthma and all hope is not lost as yet. With earlier diagnosis, proper treatment and management the symptoms could be gone within weeks.
According to the World Health Organisation (WHO), Asthma is the most common chronic disease among children worldwide. Around 235 million people are living with asthma. Over 80 percent of asthma-related deaths occur in low-and lower-middle income countries.
To explore this chronic, respiratory ailment, HealthTimes Editor, Michael Gwarisa (MG) spoke at length to Professor Elopy Sibanda (Prof Sibanda) an expert in Asthma, Allergies and Immunology. He is also the Managing Director for the recently ISO Certified and SADCAS Accredited Twin Palms and GAMMA Allergy and Immunology Laboratory.
MG: Prof could you give us a background on Asthma, its causes and symptoms?
Prof Sibanda: Asthma is a disease of the airways which manifests as shortness of breath, tightness of chests, coughing, particularly coughing during the early hours of night as well as dyspnea, which is difficulty in breathing. Those are the five key features of asthma.
MG: Which age groups are most affected by Asthma?
Prof Sibanda: Asthma can occur at any age and they are certain stakes where it can be more severe than others. For example Asthma in pregnancy differs from Asthma in people who are not pregnant so there are differences.
MG: What are the main causes of Asthma and how does one end up Asthmatic?
Prof Sibanda: Asthma generally runs in families so there is an element where there is an inherited component of the disease. It goes together with other diseases that are called atopic diseases. So people with Asthma may have Hay Fever, may have eczema, sinusitis and others. Those are features of allergic disease. Generally speaking atopic diseases are like a family fruit tree and from that tree any one of the children can pick different allergies and conditions for example in the same family, one can have eczema, one can have sinusitis, and the other Hay fever but all coming from the same tree that gives that predisposition to Asthma.
MG: What allergens are associated with Asthma?
Prof Sibanda: We have realised that there are a number of allergens that are associated to Asthma. They differ from country to country, we have done a bit of work on Asthma in this country and we have realised that the commonest associated allergens is house dust mite, that is followed by pollen, predominantly grass pollen and further down the line we have animal hairs like dogs, cats and so on but they a further down the line. 50 percent of the people will be allergic to house dust mite, 25-30 percent will be allergic to pollen and then the rest there are many other causes like moulds and others.
MG: So how do you identify these allergens and how do you treat Asthma?
Prof Sibanda: When it comes identifying who has asthma and what treatment options we can provide, that is where we come in. This is where we are specialised and certified to the ISO standards. What we do is we attend to a patient who is referred to us by their doctor, we don’t take patients from the streets, and they are all referred to this specialist centre for the investigation and management of the suspected Asthma. We first start by doing the usual clinical work to say could this be Asthma, do you have a family history of Asthma, when did it start and when does it occur. We try and pick up those five features that I referred to. We then go to say are you allergic and what are you allergic to.
MG: Why is it important to identify the allergen?
Prof Sibanda: Identifying one’s allergy is very key. One of the main ways of managing Asthma is by identifying the trigger and to avoid that trigger. For example, if your allergy is to House Dust mite then we advise that it’s not a good to have carpets in your house because they hold mites. If your allergy is to the cat maybe it’s not a good idea to have a cat. If you don’t identify the allergy, it exacerbates the problem, you are continuously exposed so you are defeating the doctors’ treatment procedures, the doctors are giving you medicine but you are still exposed. So you won’t be helping yourself by not knowing what you are allergic to.
Identity of the trigger to the Allergen is critical and we do that here. It is done at three levels. We test first, we offer skin pre-testing, we do blood tests and we are the only laboratory in the country and I think in Southern Africa which offers what is called Molecular resolve diagnostic testing where we use an instrument called Isac which will tell you not that you are allergic to eggs but that within the egg, you are allergic to a certain component so that I can say to you, you are allergic to eggs, but if its boiled eggs you are fine. Or you are allergic to fresh milk and not sour milk, that way, people will know the specific components they are allergic to.
MG: Could you take us through a brief of the Asthma treatment process?
Prof Sibanda: Having done tests for allergies and all, we then ask the next question, has Asthma caused any damage to you. That we do in our lung function test laboratory where we measure one’s lung volumes and say a man of such and such a height, age, race and ethnicity is expected to have X litres of Air in your lungs. We measure how much you have and then once we measure how much you have , we try to see how you respond to the treatment we would have administered. So we offer treatment through Nebulisation and measure again. That tells us two things, first, that you have Asthma particularly if the variation is about 10 percent. Secondly, it can be reversed using the medication that we would have administered. Once we have done that, we then have a reference point, you came with 60 percent capacity in January 2020, our aim is the get you to 80-90 percent capacity and we aim to achieve that in a given certain time frame. That time frame varies with age, the younger children we get quicker, as people grow older lungs are stiffer and we don’t hit the target as quick as we like to. Each age group has its own targets in terms of achieving the lung function values. When you achieve those lung function values, you do not have symptoms, Asthma is there in you but it’s well-controlled, it doesn’t bother you.
MG: Is it possible for a person to have Asthma but know it or the Asthma does not manifest its symptoms?
Prof Sibanda: It is very possible, Asthma manifests when your lung volumes hits a critical barrier. Your lung volume should fall below about 60 percent before you know that you have Asthma, Many people are Asymptomatic but what I am emphasising is that if you do have Asthma, we can take you to a stage where you don’t have to care or worry anymore, the label is there but symptoms are not there. Whether you have a label or not, what bothers an individual is that shortness of breath, coughing at night and tightness of the chest. We can remove that and we can time it to say this will be gone in about 12 weeks or 16 weeks. We now know what you are allergic to and you have gotten rid of the trigger (cat, carp et) is no longer there, now we are giving medication to remodel the lungs so that they can re-adapt back to near as normal as possible. Sometimes In children we really overshoot even to 100 but in adults we are happy with 80 and 90 percent. In adults, we prefer to see people earlier when the symptoms are easily reversible.
MG: What are the treatment options available for Asthma?
Prof Sibanda: There are only two treatment options available and one is the preventer, the other one is a reliever. The reliever is the one you get when you have an asthma attack, that is when you use an inhaled reliever or nebulised reliever. It gives you relief but you may need to use it in another hour and can be used more than 20 times a day. Our objective however is to prevent the attacks so we want to use a preventer. A preventer is used on a daily basis twice or three times a day depending on the dosing and severity of the diseases. If you are on a preventer and you have used it continuously for 15 days, you will not have an attack and you will not need the reliever. These are called inhaled glucocorticosteroids and they come as an inhaler.
MG: How critical is patient education in Asthma management?
Prof Sibanda: Patient education is key in Asthma. A patient needs to understand first what it is he/she is dealing with. The patient needs to understand that it is indeed Asthma because not all that Whizzes is Asthma. It is very important for us to know this is Asthma. At times it could be diesel exhaust emissions which are very small particles that can hit the lungs and clog them, creating symptoms which are Asthma like. The treatment is completely different from Asthma. So that distinction is important and the distinction is being missed by people.
MG: And lastly Prof, religious leaders are on the habit of telling their congregants and followers that Asthma is spiritual and caused by demons. What is your take on that?
Prof Sibanda: Asthma is purely science and what those people are talking about is purely fiction. It’s clearly a scientifically proven diseases that you can also scientifically reverse. Point is that people when they get short of breath unexpectedly, they can find all sorts of explanations. The reason you are gasping for breath is that your capacity is now at 30 or 40 percent when it should be 100 percent and then there is a flu on top of it. It’s not because of anything apart from lung volume.