Globally, World Health Organisation (WHO) estimates that 235 million people suffer from asthma. It also indicates that asthma is not just a public health problem for high income countries, but it occurs in all countries regardless of the level of development.
The study further shows that over 80 per cent of asthma deaths occur in low and lower-middle income countries.
In Rwanda, according to the WHO data published in May 2014, asthma deaths reached 267 or 0.39 per cent of total deaths. The age adjusted death rate was 5.62 per 100,000 of the population, ranking Rwanda 80 in the world.
Treatment should be a priority
Prof Joseph Mucumbisti, a pediatrician at King Faisal Hospital, Kigali, and president of Rwanda Heart Foundation, says that with time, the rate of asthma cases can be unpredictable, or even higher in the future if awareness on its treatment and diagnosis isn’t put into effect.
“Asthma is quite a common health issue, it’s part of the non-communicable diseases (NCDs), which can’t be transmitted from one person to another. It’s part of the big four NCDs including cardiovascular diseases, diabetes, cancer and the group of chronic respiratory diseases,” he says.
Therefore, there is need for both medical practitioners and the whole public to be aware of the disease, as well as get the proper treatment required to get rid of it completely.
Mucumbisti explains that, in most cases, asthma tends to continue from childhood to adulthood, that’s if the patient doesn’t get proper treatment and management. However, this can be easily prevented if its cause is treated at a young stage.
“The challenge that we have is that most people tend to dwell on prescribing medicines that are meant to relieve the acute asthma attack,” he says.
He explains that these medicines are in form of inhalers which ensure healing within three to five days. Although this ensures relief, unfortunately, it doesn’t ensure its treatment completely which leads to the inflammation of the disease.
“When this happens, the patient will continue to have asthma even in their entire life. And the longer one has it, the more the impact on their life increases,” he adds.
Mucumbisti, however, notes that as a result of prolonged asthma, one is likely to suffer from chronic diseases of the lungs and the heart, therefore the earlier its detection, the earlier the treatment, thus the prevention of consequences later in life.
Rachna Pande, an internal medicine specialist, says asthma is a chronic inflammatory disease of the airways of lungs. It is characterised by cough with or without expectoration, wheezing, shortness of breath and feeling of tightness in the chest.
According to the WHO report, the fundamental causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways.
What causes Asthma?
Pande says it comes about due to allergies.
“This causes inflammation in the airways of lungs and narrowing of the air tubes resulting in feeling of tightness and shortness of breath. The secretions produced due to inflammation are trapped within the air tubes causing wheezing and productive cough,” she says.
She, however, notes that individuals vary in response to allergens. Some get attacks once in a few weeks or months, while some suffer constantly.
Apart from that, Mucumbisti says that genetic factors also make one prone to asthma.
“A person having a blood relative with asthma has higher chances of developing the disease. Also, smoking during pregnancy makes the baby more vulnerable to asthma,” he says.
Pande explains that some viral or other respiratory infections in childhood can also trigger asthma in those vulnerable to it.
She says that hygiene hypothesis states that children living in very clean environments are more prone to develop asthma, as they lack enough immunity to common infections, because of not being exposed to them as a child.
Also, a child born due to C-section is more vulnerable to asthma as they are not exposed to bacterial flora of vagina during birth, which strengthens immunity.
Factors that provoke asthma
According to Mucumbisti, common asthma provoking agents are exhaust fumes, air pollution, danders, fungal spores, house dust, mites dust, insect droppings, perfumes and drugs like aspirin.
Mental stress is known to induce and aggravate asthma. Diagnosis is made by clinical features and spirometry.
“Producing allergens can be identified by being observant by the individual or allergy tests. In this, a series of potential allergy producing substances are injected subcutaneously in the affected person’s arm and reaction judged after 24 to 48 hours,” says Pande.
She notes that the offending allergen will produce a big flare and wheal and can even provoke an attack, explaining that the prerequisite for this test is that it should be done when the person is symptom free for at least 48 hours and does not need any medication.
Lucie Uwinkesha, an environmental health officer at Kabarore Health Centre in Gatsibo District, says that, asthma symptoms can appear when one is exposed to a trigger.
“A trigger is something you are sensitive to that makes your airways inflamed. This leads to swelling mucous production and narrowing in the airways,” she says.
Uwinkesha adds that common asthma triggers are pollen, chemicals, extreme weather changes, smoke, stress as well as exercises.
How to stay away from allergens
Prevention of asthma mainly consists of avoiding the allergens whenever possible, according to Uwinkesha.
“The best way to prevent an asthma episode or attack is to follow a treatment plan. Also, learning the triggers and avoiding them is essential as far as staying away from asthma is concerned,” she says.
For instance, Uwinkesha says, keeping the nose covered when exposed to dust can help. Mental relaxation is also useful. There is no root cure available.
For the drugs, she points out that they are there to open the blocked tubes (bronchodilators). Drugs such as corticoids, are useful to reduce ongoing inflammation, she said.
In acute attacks, one can use them in inhaled forms (inhaler), whereas in chronic asthma, inhalers can be used two to three times every day. If there’s no response, then one can use tablets.
“In severe attacks, hospitalisation is necessary, whereby oxygen is given along with nebulisation (bronchodilators given with pressure) and injectable corticoids are used,” says Pande.
Severe untreated asthma can lead to respiratory failure and death.
“This is because of the congested nose and tight broncus, coughing and sneezing can occur, especially in the mornings. This mainly happens when one is allergic to dust, particularly from the bedroom environment,” says Mucumbisti.
Mucumbisti further notes that using simple materials like plastics to make a complete cover of the beddings is important as it helps in getting rid of the allergens. Additionally, anti-allergic medication and asthma treatment is as vital.
Olivier Habiyaremye, General practitioner
Staying away from some foods that are likely to cause allergic reactions is essential. Examples of such foods include peanuts, soy, eggs and cow milk. Also, smoking should be avoided as it’s a common trigger and can even cause asthma to rise.
Raymond Awazi, Pediatrician
Getting vaccinated against influenza and pneumonia is important; this is because, if one has influenza infection in the lungs, it can trigger an asthma attack. It can also result in pneumonia as well as other respiratory diseases.
Iba Mayale, Gynecologist
Keeping the house fume-free is another strategy that can keep asthma attacks away. Fumes from gas, wood and even kerosene stoves can irritate the eyes, nose and throat, thus triggering asthma. Proper management is needed if one has asthma to prevent further attacks.
Immaculate Kiza, Medical student - University of Rwanda, College of Science and Medicine
Asthma can also be triggered by the scent in soaps and detergents, therefore, going for those that are unscented can aid in keeping an asthma attack at bay. Additionally, opening the windows and doors daily is ideal as it allows fresh air inside the house.