Living with asthma: taking control
Swathed in haze, huffing and puffing as you try to make out the silhouettes at the end of the clogged roads, only being able to see crimson glows of vehicles ahead-- it's a typical commute to work here in Dhaka city. Bangladesh, a developing country, where erratic road development works and haphazard constructions of buildings deprive people of clean air, is ranked third most polluted place in the world, according to the World Health Organization's survey as of 2018.
If you are one of the one crore people here (estimate by the National Institute of Diseases of the Chest and Hospital) who struggle to catch their breaths because of dark fumes from automobiles, passive coils of tobacco smoke and smogs of dust around us, the statistics may be of particular alarm to you. Not being able to catch your breath, and finding yourself acutely and uncomfortably coughing, even noticing painful wheezing and fighting a suffocating tightness in your chest is when you are experiencing an asthma attack.
"The narrow passages in the lungs can, more often than not, become inflamed or suffer from the secretion of extra phlegm and/or mucus. This would lead to thicker walls of the lungs and narrower airways," elaborates Dr Tan Aik Hau, senior consultant respiratory physician at Mount Elizabeth Hospital of Singapore. "It's conditions like these that make it difficult for a patient to breathe and result in the diagnosis of asthma."
Narrowed passageways in the lungs are not solely caused by air pollution. In fact, a number of factors contribute to the condition deemed the leading cause of school and work absences.
"While air pollution can certainly worsen the airways, asthma can be caused by a number of reasons, including exposure to any sort of allergen like dust, flowers, wood, sterilising chemicals, or even because of a genetic predisposition. This is specifically why we always ask patients about family history," specifies Dr Tan.
What makes things particularly tricky with asthma is the fact that the symptoms, mainly acute coughing, can often go dismissed. And, so, the question stands; who are the people likely to be affected by asthma without even knowing it?
Quite vaguely, the answer is anyone whose breathing problems do not affect their lifestyle. "A homemaker keeping busy with housework can cough continuously, and barely give it a second thought. But a newscaster reporting on daily news may cough a few times on air for a few days and be pressed to look further into the cause of exhibited symptoms," explains Dr Tan.
The goal, when it comes to an asthmatic patient, is the possibility of a normal lifestyle. "Living well with asthma basically means zero symptoms," verifies Dr Tan. "If the condition is well-controlled, an asthmatic patient can do anything a healthy person sets his heart to," he exclaims.
And so, the light at the end of the tunnel comes in the form of controller and reliever medications which harmonise together to combat symptoms and attacks of asthma.
If vigorous exercise has you out of breath, your symptoms will need an immediate fix. This is when you reach out for a dose of reliever medication, maybe a fast-relief inhaler, designed to provide dramatic respite from the sudden asthma attack. Although reliever medications do not treat or even affect inflammation of the lungs or any other disease causing the asthma itself, what they do achieve is the opening up of the airways in the chest, making it easier for you to catch your breath. The difference is noticed in minutes, and it is particularly helpful to have around in case of overwhelming physical exertions and during emotional or stressful occasions. However, the goal here is minimal to no reliance on reliever medications. And this is exactly where the second group of medications, aka the controllers/preventers come in.
Most asthmatic patients will require a preventer if symptoms are seen quite frequently. "Controller medications work in the background on a regular basis to calm the inflammation of the airways, and therefore, treats asthma so you are less likely to react to triggers," elaborates Dr Tan. "The trick here is to steer clear of the poorly thought-out decision of dismissing controllers at the observation of fewer incurrences of attacks which most patients fail to do," he warns.
The third leg to the stool can be deemed lifestyle choices as staying away from triggers such as allergens, dust, and smoke will also help reducing frequency of asthma attacks and help you make the journey to a healthier life.
In more severe cases of asthma, you may even be prescribed pills or intravenous treatment to help lung inflammation. In life-threatening cases, your trusted physician may also resort to hospitalisation and insertion of breathing tubes down your throat.
With all due measures and guides, hatching an action plan with your physician when it comes to battling asthma is a little less hazy. Next up is the part where you seek medical attention and follow through with your individualised and harmonious combination of medication that will make your life easier, even with asthma. And that is exactly how you take control of the unshakeable disease as if you don't even have it in the first place.
Photo courtesy: Parkway Hospitals Singapore, Dhaka Office