COLUMN – Asthma –– will happen but can be treated
Asthma sufferers make up more than a quarter of the people being rushed to the emergency unit of the Queen Elizabeth hospital every year, but careful self-management by patients and by family could reduce that number.
And while health officials concede that emergency prevention is easier said than done, owing to a number of factors, vital health care services will continue to be in demand by those whose breathing conditions have deteriorated so low
that urgent priority must be given.
“Asthma is an acute unchronic lower respiratory condition resulting in hyperactive airways and inflammation in the lungs. The condition frequently exists along with other atopic and allergy-type disorders, including sinusitis, atopic eczema, and allergic conjunctivitis,” explained Senior Medical Officer of Health Dr Kenneth George.
“The prevalence in the school-aged population of Barbados is estimated to be 16 per cent [but] . . . may be even higher in certain age groups, particularly the six-to-seven age group, where the prevalence rises to almost 19 per cent.”
Dr George on Tuesday shared a discussion forum with allergist and immunologist Dr Vincent Hutchinson as the Asthma Association of Barbados observed its 25th anniversary and World Asthma Day.
Dr George further said: “Asthma disproportionally affects infants, children and adolescents when compared to adults and is associated with several environmental triggers [substances that provoke allergies], including animal dander, the house dust mite, indiscriminate burning, and possibly the Saharan
“On average a stark 23 per cent of emergency visits to the Accident & Emergency Unit is accounted for by asthma, which approximates to 10,000, sometimes as high as 12,000, visits annually to the Queen Elizabeth Hospital for asthma . . . . Our average annual visits to the Accident and Emergency Unit is about 45,000 visits per year.”
He explained that asthma was an equal opportunity disease, affecting all countries, in all income groups and all levels of development, but most asthma-related deaths occurred in low and middle income countries.
The World Health Organization estimates that 235 million people currently suffer from asthma, which is recognized as the most common chronic non-communicable disease in children.
WHO places Barbados in the middle of world standings with the disease at a rate of 1.4 persons affected per 1,000 people. The lowest world rate is 0.3 per 1,000 people, and the highest 2.8 per 1,000.
“Asthma morbidity and mortality can be reduced and eliminated by the appropriate care and support,” Dr George contends.
One way to reduce the rush of Barbadians to the QEH with breathing problems is to observe the Caribbean Asthma Guidelines, which Dr George said “form the basis for prevention and control of asthma. It involves individuals understanding their disease, knowing their triggers, what to do in emergency and understanding preventative measures”.
“The World Health Organization has identified three strategies for good asthma management: one, surveillance; two, primary prevention; and three, improved access to cost-effective intervention, including pharmaceuticals.”
But Dr Hutchinson, president of the Caribbean-American Medical Scientific Association (CAMSA), said that passing on information to parents, family and other caregivers on primary prevention for the asthma patient was not an easy task.
He said that a common mistake of the medical practitioner was in thinking the asthma sufferer was the number one concern of the family.
“As the physician or nurse, you think the child has asthma and this is a priority; it may not be. It may be financial, housing, it may be their own health problems as well; so they really have to balance how much effort is put into focusing on the child.
“You have to deal with the parents first. The parents are under stress; so they would not be able to provide the care that you want them to provide for the child . . . . You need to examine the parents first to make sure they themselves confront that which control their lives.”
Dr Hutchinson points to another area of common mistake by the professionals.
“When a child comes to the emergency and is sick, you try to educate them [parents], when they come into the hospital, and you try to take the mothers aside to try to educate them.
“It doesn’t work.
“When a child is sick in the emergency room, adults don’t hear anything in the emergency room.
“The best place to do this would be when the patient, or the family is available at their individual time, to sit down with you away from all the stresses.
“So we figure that the best place to do the intervention is in the household . . . and then all the services are provided through the home.”
He said the community health worker visiting the home could point out common conditions that could be triggers for an asthma attack: “household dust, that invisible dust; you look for evidence of moulds on the walls, ceilings, kitchens; we ask about tobacco exposure; we look for unrepaired holes in walls”.
Then the human factor comes into play, when at the first sign of recovery the prescribed treatment is abandoned.
“It is very difficult to tell a person with asthma to take medication when they’re feeling well, but . . . even though you’re feeling well, the underlying problem with asthma is inflammation. So if you don’t treat the inflammation, when you become exposed to triggers in an environment –– it could be smoke.
“Take medication around the clock,” Dr Hutchinson advised.
When preventative measures are not applied, or for some other reason fail, alertness is a key factor in a patient’s and family action plan.
Dr Hutchinson said: “It is very important to recognize a person who is sick very quickly. Asthma can turn around very quickly; so you can go from having a mild attack to a severe attack within minutes . . . . [It’s] very important that the patient or family recognizes when symptoms are worsening and when they need to get to the emergency room.”
He said the affliction of asthma was all-consuming for a nation because those without the disease, and who had no close family members affected, were still touched by the domino effect of the ailment.
“Recognition of asthma as a national public health issue is important, not only to asthmatics alone; everyone in your community.
“Asthma is a big burden on everyone; not only on the family, but on the country as a whole. A lot of days of work are lost because of asthma. When the child doesn’t go to school and both parents are working, somebody has to take care of the child.
“So one parent has to leave work to take care of the child; so there is a tremendous burden on the family in terms of income.”