Lifestyle to blame for rise in asthma cases

An asthma patient uses an inhaler during the launch of the study into asthma at Entebbe Grade A hospital last week. PHOTO by Beatrice Nakibuuka

What you need to know:

Last week on Tuesday, Uganda joined the rest of the world to observe World Asthma Day. The chronic lung disease is still common in Uganda and is one of the top 10 paediatric illnesses that children suffer from in the country. Experts believe that with proper lifestyle management, it is possible to keep asthma under control writes Paul Adude and Beatrice Nakibuuka.

Although it is difficult to obtain recent statistics on asthma in Uganda, some doctors have observed an increase in the rate of asthma that they treat, particularly in recent months. In 2009/2010, Mulago hospital recorded 2,500 cases of asthma. That was an increase of more than 700 cases as the previous two years were recorded at 1,899. Asthma is a medical condition of the airway and the lungs characterised by dry cough, wheezing, difficulty in breathing and breathlessness due to blockage of the airway.

According to a World Bank report, the largest source of air pollution in Uganda is vehicle emissions, followed by burning of fuels such as firewood and charcoal for domestic purposes. Industrial pollutants are next on the list. Air pollution is being blamed for the soaring number of respiratory problems among the Kampala’s residents. Poor air quality can bring on asthma attacks.

Dr Bruce Kirenga, the director of Makerere Lung Institute, at a recent sensitisation workshop said recent research around the world indicated that asthma is on the increase, while in Africa the prevalence rate among adults ranges from four to eight per cent.

He also said in Uganda, between 2013 and 2015, there has been an increment of asthma cases in children compared to adults.

In a research paper titled, factors associated with asthma among under-fives in Mulago hospital, Kampala Uganda: a cross sectional study, Dr Rebecca Nantanda, a lecturer at Makerere University said, “at some point asthma has a history of allergy in the patient, especially those that use gas for cooking and there is need for studies to explore the role of cooking materials and provide information that can be used to design strategies for asthma prevention.”

Research project

The Uganda Medical Research Council (MRU) and Cipla Uganda limited have launched a research into asthma, the research that is meant to find out the causes and ways on how to prevent asthma on Tuesday during the celebrations of the World Asthma Day held at Entebbe Grade A Hospital.

Dr Harriet Mpairwe, the principal investigator on study on asthma among children, working with MRU in an interview with the Daily Monitor stated that “This will be the first research to be done on asthma in the country and to establish its causes and the number of people affected by the condition in the country. This follows a pilot study that was carried out from 2013 – 2014 that looked at 90 children with asthma,” she said.

“The research has began in Entebbe Municipality, and it is meant to investigate why some children get asthma and others do not because worldwide, there is no known cause of asthma,” she says.

She adds that although asthma affects all age groups, the research that MRU is carrying out will be focused on children in the age groups of five to 17 years because the symptoms are more severe among children.
Mutebi Muhammad, the product specialist for respiratory medicine with Cipla Uganda said the prevalence of asthma is growing in Uganda as per research done by the Lung Institute at Mulago hospital.

“As Cipla, in an effort to curb asthma, we have invested a lot in patient education and training, and have also organised respiratory symposiums for doctors interested in respiratory medicine,” he said.
Mutebi further advised people not to be deceived that asthma has a cure and stop taking medication. “Asthma is a long term chronic inflammatory disease that requires taking medication time and again, it is just controlled and not cured” he said.

Symptoms of Asthma
Dry cough that worsens at night and in the morning, wheezing breath, difficulty in breathing and breathlessness. This is due to tightened bronchioles in the lungs; normal bronchioles are supposed to be open to allow free air flow.
However, when a person has asthma, the bronchioles instead become sensitive, narrowed and swollen on the inside with a deposition of mucus so air cannot go in and out of the lungs easily.

How it is contracted
Asthma tends to run in families but it has not yet been proved as a genetic predisposition. Dr Mpairwe stated, “there is no specific known mechanism on how one gets asthma but it is more likely in a family with a history of asthma but we are not sure whether it’s in the genes or environment,” she said.

Numbers
Dr Mpairwe says there are no specific figures of people who suffer from asthma or those who lose their lives to the condition in Uganda since there has never been any research carried out before, however globally she stated that about 350 million people suffer from asthma.

Treatment
She adds that there is no known cure for asthma worldwide and the medicines available only help reduce the symptoms but the problem itself is not cleared. “There are children or adults that have outgrown asthma but we can never declare that they were completely cured because the attacks can reoccur later in life depending on what that person is allergic to.”

After assessment by the clinician to identify whether the child has a mild or severe asthma, Dr Mpairwe says the child may be given Salbutamol relievers that are used for a short time when they get an attack. These help to clear the blocked airway after an attack.

The current international treatment guidelines recommend inhaled medication (inhalers) for asthma patients but they are not readily available in Uganda.

“Most children are being treated with oral tablets since they are cheaper but they come with many side effects like palpitation (shaking of the body) and the heart pounding heavily and at fast rates,” she says.
Mutebi gives hope to the asthma patients that although a cure has not been found, they hope to stop the spread of asthma after the study.

There are no home remedies that treat asthma except for the controllers and relievers after assessment by a clinician. When a person develops an attack, they are given salbutamol inhaler relievers which immediately clear the blockage in the airway. There are daily basis inhalers called controllers. These may include Beclomethasone and Prednisolone that help in the management of the symptoms but do not treat asthma.
“There are herbalists who claim to have herbal medicines that treat asthma but I cannot recommend people to use them because we are not sure what is contained in the medicines,” says Mutebi.

Trigers

An asthma attack is an incident where a child or adult gets severe difficulty in breathing due to contraction of the bronchioles so they gasp for breath. The condition is brought due to the way our bodies react differently to the environment.
Mpairwe notes that a change in weather especially during the cold weather can trigger an asthma attack. When there is a lot of dust, smoke both from cigarettes and any other burnt material, scents from perfumes and flowers, pets and moulds as well as emotions such as excitement, anxiety or sadness.

Experience

Jackline Khainza, 33, has lived with asthma all her life. An inhaler is a must have for her because she is never certain when an attack will kick in. Although her family has tried to make her life comfortable at home, Khainza’s greatest fears are suffering an attack outside the confines of her home. She says at school, it took a lot of efforts for her parents to sensitise the school administration on how to manage her condition.
Unfortunately, they cannot sensitise everyone she comes in contact with say the commuter taxi passengers that meets daily.
According to research, lack of sensitisation in public is one of the hiccups in the fight against asthma.

Expert take
“Most children are being treated with oral tablets since they are cheaper but they come with many side effects like palpitation (shaking of the body) and the heart pounding heavily and at fast rates.”
Dr Harriet Mpairwe, principal investigator on study on asthma among children.

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