LIVING WITH ASTHMA: PRACTICAL TIPS FOR BREATHING EASIER IN PAKISTAN

Five major respiratory diseases; asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pneumonia, and tuberculosis, have contributed to 20% of global mortality According to Global Asthma report 2022, Pakistan is 5th most populated country with 221 million population. The report also says that approximately 4.3% population is suspected to suffer from Asthma. Two types of asthma are observed in Pakistan; Seasonal Asthma and Occupational asthma. Seasonal Asthma is most common having various indoor and outdoor allergens as triggered factors.

What is Asthma?

Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to narrowing and obstruction of the bronchus and bronchioles. It is characterized by recurrent episodes of breathlessness, wheezing, chest tightness, cough, and sputum production. It is typically caused by a long-term exposure to irritating gases or particulate matter, most often from cigarette smoke.

Asthma Triggers in Pakistan.

In Pakistan, some of the common triggers for asthma are as follows:

1. Seasonal pollen– particularly from male paper mulberry trees
2. Airborne allergens– indoor and outdoor allergens

Environmental Pollution

Occupational Hazards-work environments
Lifestyle changes– increased urbanization and changes in diet or activities.
Indoor air quality– tobacco smoke etc.
Respiratory Infections-viral infections exacerbate asthma
Cold air
Emotional stress-fear, anger, physical exercise.

How is Asthma Diagnosed?

Chest radiography (chest X-ray) and chest computed tomography (CT) are the primary imaging methods to diagnose asthmatic and COPD. CT and magnetic resonance imaging (MRI) are used to evaluate pulmonary structure and function. Spirometry is the test to determine lung function and diagnose lung disease. It involves a deep breath and forcefully breathing out (exhaling) into a tube connected to a spirometer. A spirometer measures the amount of air taken in and out of the lung and the time is taken and thus determined how quickly you exhale the air.

MANAGING ASTHMA ATTACKS

Three-step approach is opted to prevent and control asthma symptoms.

Follow asthma action plan from your health care team. It has three parts with color codes: Green, Yellow, Red
Home lung Tests- Lung Function test.

Following devices can be used to measure how well your lungs are working. This is called a lung function test.

Peak Flow Meter
Spirometer

Keep an asthma diary every day to keep track of your symptoms and helps you share accurate information with your health care team. Record the following information:

For pharmacological therapy

The Global Initiative for Asthma (GINA) strategy is widely followed in Pakistan. The recommended medicines include;

inhaled corticosteroids,
β2-agonists,
muscarinic antagonists,
leukotriene modifiers,
biologics

Despite availability of GINA recommended medicines, asthma still remains underdiagnosed and undertreated. Following treatment plan is adopted for managing asthma.

USING INHALER PROPERLY

Right use of inhaler is the fundamental step in delivering medicine to the lungs otherwise most of the medicine remains in lugs. Using a metered-dose inhaler (MDI) seems simple. Unless one use it properly. If you have a spacer, use it. It helps get more medicine into your airways.

Getting Ready

See the instructions that came with your inhaler for when and how to prime the inhaler.

Take the cap off.
Look inside the mouthpiece and make sure there is nothing in it.
Shake the inhaler hard 10 to 15 times before each use.
Breathe out all the way. Try to push out as much air as you can.

Breathe in Slowly

Hold the inhaler with the mouthpiece down. Place your lips around the mouthpiece so that you form a tight seal.
As you start to slowly breathe in through your mouth, press down on the inhaler one time.
Keep breathing in slowly, as deeply as you can.

Hold Your Breath

Take the inhaler out of your mouth. If you can, hold your breath as you slowly count to 10. This lets the medicine reach deep into your lungs.
Pucker your lips and breathe out slowly through your mouth.
If you are using inhaled, quick-relief medicine (beta-agonists), wait 1 to 2 minutes before you take your next puff. You do not need to wait between puffs for other medicines.
Put the cap back on the mouthpiece and make sure it is firmly closed.
After using your inhaler, rinse your mouth with water, gargle, and spit. Do not swallow the water. This helps reduce side effects from your medicine.

Keep Your Inhaler Clean

Remove the metal canister from the L-shaped plastic mouthpiece.
Rinse only the mouthpiece and cap in warm water.
Let them air-dry overnight.
In the morning, put the canister back inside. Put the cap on.
Do not rinse any other parts.

Replacing Your Inhaler

Many inhalers come with counters on the canister. Keep an eye on the counter and replace the inhaler before you run out of medicine.

Do not put your canister in water to see if it is empty. This does not work.

Bring your inhaler to your clinic appointments. Your health care provider can make sure you are using it the right way.

Storing Your Inhaler

Store your inhaler at room temperature.

AIR POLLUTION AND ASTHMA

Air pollution can cause and even worsen asthma and other lung diseases leading to increased hospital visits, and can cause early death. Air pollution is contamination of the air with substances that harm human health or the environment. i.e. gases, chemicals, or small particles in the air.

Small airborne particles, found in haze, smoke, soot, and airborne dust can lead to serious air quality problems. These include dust, pollen, mold, combustion particles, compounds, metals, smoke and soot, emissions, Ozone (O3) Nitrogen dioxide (NO2), Sulfur dioxide (SO2), Carbon monoxide (CO), Methane (CH4). Breathing in air pollution can cause, breathing problems, Asthma attacks and Worsened asthma symptoms, Decreased lung growth in kids, Reduced lung function, Hospital visits, Adverse birth outcomes (such as preterm birth, low birth weight, stillbirth), Early death

FINDING ALLERGIST IN PAKISTAN

Allergy testing is also done in many big hospitals of Pakistan. The allergy is diagnosed through many ways, e.g. blood test, by injections and sometimes by medicines. Different institutes in Pakistan are offering allergy testing like Agha khan university hospital, National institute of health IDC. Information about best allergist is also available on different social media groups. Finding good allergist in your area is not a big deal now.

Allergist are doctors who specialize in treatment and management of allergic conditions.

Clinical immunology practitioner or allergy specialists work for the treatment of asthma and other factors that triggers the allergies. Top Allergy or asthma experts in Pakistan has increased to a great extent in the last decade. Allergists in Pakistan have now many facilities and they have invented many machines and equipment to diagnose the allergy. The best allergy treatment in Pakistan is done in the city of Islamabad. Dr Shahid Abbas is a well-known clinical allergy specialist in Islamabad. Dr Wasim Ali and Dr Asif Ali are also well-known allergist and researcher Agha khan university hospital also offers allergy treatment.

ASTHMA GUIDELINES

The Allergy and Asthma Institute Pakistan (AAIP), is involved in research and training for academics and clinical practice in field of asthma. The AAIP is currently engaged in research on asthma, respiratory allergies and other chronic respiratory diseases (CRDs) in Pakistan, in collaboration with the National Institute of Health Research Global Health Research Unit on Respiratory Health (RESPIRE), based at the Usher Institute, University of Edinburgh, UK.

The Pakistan Chest Society produces updated guidelines for asthma periodically, and focuses both on physician’s training and patient education. Public health education campaigns, educational videos are launched on social media for this purpose. Many tertiary care institutions have dedicated asthma clinics, and conduct trainings, seminar and educational activities in addition to providing state-of-the-art clinical services.

AUTHOR: SAHAR IFTIKHAR