EVERY year, since 1994, the world commemorates World Asthma Day and this day was set aside by the Global Initiative of Asthma in collaboration with the World Health Organization (WHO) after the realization that Asthma was a common problem, it was a misunderstood problem and its management was challenging.
By Michael Gwarisa
Back then, there were numerous misconceptions and myths around Asthma by both patients and physicians about what Asthma was all about which made it difficult to deal with as a public health threat. According to data from the World Health Organization, Asthma affected an estimated 262 million people in 2019 and caused 461000 deaths.
The World Health Organization is also a key partner in the discussions around Asthma and Asthma Day and this year, close to 130 countries including Zimbabwe are commemorating this day. The theme for this year’s Asthma Day is “Uncovering Asthma Misconceptions,” and Zimbabwe is joining these commemorations through the Zimbabwe Allergy Society (ZAS) and through the other partners that involved.
Even though studies are still underway to ascertain the extent to which Childhood Asthma is prevalent and also affecting children especially those under the age of five in Zimbabwe, indications are that there has been an upsurge in Asthma related diagnosis in children over the past few years.
To help unpack the Childhood Asthma situation in Zimbabwe, HealthTimes spoke at length to Professor Elopy Sibanda, an Immunologist and Allergies Expert and the Managing Director for the Twin Palms and GAMMA Allergy and Immunology Laboratory.
What Is Asthma?
Prof Sibanda: Asthma is a Chronic airway disease that is characterized by several symptoms which include coughing and the coughing is usually at night. Other symptoms include shortness of breath, whizzing, dyspnea and many other complications but those are the major symptoms of this condition. Its an inflammatory condition of the airwaves and of the lungs. You may want to know what are the causes of inflammation? They are numerous. They are allergic causes and non-allergic causes, environmental causes and idiopathic causes. The allergic causes include the inhalation of dust mites, inhalation of pollen, exposure to animal hair which include your cats and your dogs, and inhalation spows. These being your major inhaled allergen sources that get into the lung, trigger the immune response within the lung to try to fight these inhaled allergen sources and as it tries to fight off, it bruises the lining of the airways, causing inflammation.
There are environmental causes as well, these include air pollution, occupational exposure for those who are working in industries that generate a lot of dust. Those ones can be exposed to the environment which will trigger a reaction, those are some but the list is long.
What is childhood Asthma?
Prof Sibanda: Childhood Asthma is the number of responses that I refereed to occurring to a person which is a child and a child is defined usually as a person under the age of 12 and teenagers between 12 and 15. Any age group of children can have Asthma and Asthma can occur in children as young or younger than one year. The Whole spectrum of zero to 12 years can be affected by Asthma.
Which Age Groups Are Most Prone To Asthma?
Prof Sibanda: You can get Asthma at any age in life. Even children as young as one year can have Asthma. You can have Asthma even in your old age. It can happen at any point and at any time in life.
How Prevalent Is Childhood Asthma in Zimbabwe?
Prof Sibanda: We do not have up to date statistics but we believe it is an increasing problem. Numbers of between 5% and 10% have been mentioned but I am not aware of a concrete figure which focuses on childhood Asthma. We have a colleague at the University of Zimbabwe who is working on Childhood Asthma in Zimbabwe, but once the research is completed, we might know exactly the proportion of people with childhood Asthma.
What challenges are there in dealing with Childhood Asthma?
Prof Sibanda: What makes childhood Asthma difficult is that this is also the age group which is commonly affected by respiratory tract diseases (Upper Respiratory Tract Infection URTI). These infections have symptoms that are very similar to Asthma and may lead to confusion in terms of the diagnosis of the condition in this particular age group.
How Do You Tell Your Child Is Having Asthma or Symptoms Related To Asthma?
Prof Sibanda: In Children below the age of five, the suspicion or diagnosis of Asthma is much more challenging because this is the age group that faces a challenge of URTI. It is easier to tell that my child has Asthma especially in school going children because they will be able to tell you that I feel shortness of breath, I feel tightness in the chest, I whizz and I hear noises in the chest or I cough. The cough in children with Asthma is usually at night and usually in the early hours of the morning after about midnight to 2:00 am, that’s when they wake up coughing. Those children will tell you and it is the doctor who will then try to zero in and say is this coughing is due to infection or due to Asthma and using the usual symptoms of a cough, the whizz, shortness of breath tightness of chest and disruption of sleep the health expert can take further steps.
The Asthma in this age group is usually not associated with environmental factors, although environmental factors such as smoking can increase the risk. If one or more close family members of a child has Asthma, it increases the likelihood of Asthma in the child. You don’t stop there, what you want to do with children under five is see if they are allergic to given environments. In our country, these children can be allergic to things like house dust mites, cockroaches, pollen from grass and trees and it helps us to understand what time of the year the child has these symptoms.
A tool has been generated to try and help us simplify the understanding or suspicion of Asthma. This is called the Asthma control test and there is an adult Asthma control test and there is also a childhood asthma control test and this covers the symptoms I have mentioned in children in ages of between about 4, 5 to 12 and that is fairly sensitive and will be able to raise a clear suspicion that this child might have asthma. It’s a tool that can be used by parents and teachers as well as healthcare workers.
What Is Asthma Not Associated With?
Prof Sibanda: Asthma is not commonly associated with fever. If a child has a temperature and is coughing, then Asthma is not your first suspicion.
Is There A vaccine For Asthma?
Prof Sibanda: There is no vaccine for Asthma. However, you can perform what is called specific immunotherapy which when given to a person, a child with Asthma will improve the tolerance to the allergen source that is triggering the condition. This specific immunotherapy is administered through an injection so it can be said there is an injection or there is a vaccine but medically, we say it is desensitization of an allergen specific immunotherapy. That is available if we have identified the allergen that is causing the problem in a given child. However, its not everybody that can be desensitized but many of the people that are allergic to house dust mites, pollen and molds can be offered specific immunotherapy and that tends to improve the symptoms by increasing the tolerance of the children to the allergen source that is implicated.
Are There Inhalers That Are Specifically Made For Children Under The Age Of 5?
Prof Sibanda: Yes, the inhalers are available. They may not be of specific sizes or children but we do have inhalers. The inhalers are two broad groups, one of them are the preventers and others are relievers. The relievers include Salbutamol this will give you relief in a very short period of time, and must be used when a child has an Asthmatic attack but this drug does not prevent an attack. There are inhalers that do prevent an attack and these are called glucocorticosteroids. These have to be used for a longer period and they tend to be more expensive and unfortunately, many parents will get any remedy that they can afford and hope it will work, it will work to relieve but you can keep on relieving Asthma 10 times a day when you could put a child on a course of preventer to prevent the attacks for a longer period of time. Inhalers are recommended in Children and there are two types of inhalers, the emergency reliever and the long-term preventer. We encourage the use of long-term preventers once we confirm that this child has Asthma and use relievers when you have to relieve.
Misconceptions Around Asthma:
Prof Sibanda: There are many misconceptions on Asthma and each country has its own specific ones and in Zimbabwe we have our own. Some of these misconceptions are that Asthma is a childhood disease. It is not, it can occur at any age. Others say Asthma if for the elderly, that is not true, Asthma can occur at any age. Some say Asthma will go away, yes it can but it is not an issue that it will always go away. There is also a misconception that Asthma should be treated only when there is an acute attack. No, it has to be treated continuously. There is a misconception that it is inherited. That is partly true and partly false. There are people who have Asthma that runs in the family and there are people who do not have Asthma that runs in the family.
What To Do If You Suspect Your Child Has Asthma?
Prof Sibanda: Your first port of call is your health worker and that health worker could be your local nurse, your local doctors, your General Practitioner or it can be your specialist doctor who will be able to say I suspect this is Asthma. In people under the ages 4 or 5, it’s easy to confuse an infection with Asthma. Asthma is chronic and an infection is acute. An infection needs treatment there and then. A practitioner will be able to say this is an infection and institute treatment without delay. The chronic condition that Asthma is, its diagnosis is associated with delays. Now within the facilities where we work, they listen to you, do test in order to clinch a diagnosis of Asthma. We suspect that many people walking may be Asthmatic when they are not. So if they are suspicions from the health fraternity, we can offer services.
