“In all respects of diagnosis & management of Asthma in Bangladesh, we do not lag behind the developed countries

Prof. Dr. Md. Ali Hossain

National Institute of Diseases

of the Chest and Hospital,

Mohakhali, Dhaka

 Would you please tell us about the prevalence of COPD in Bangladesh and its management?

Asthma is a one of the most common chronic conditions affecting both children and adults. In Bangladesh about 7 million people (5.2% of total Population) are suffering from asthma (First National Prevalence Study/1999). Among them 5.86% are adult and 7.3% are children. But, day by day numbers of patients are increasing. Study done in 2010 shows 11.6 million people suffering from asthma.

 Management of Asthma

Management of asthma include treatment of acute asthmatic episodes and control of chronic symptoms, including nocturnal and exercised induced asthmatic symptoms. Pharmacologic management includes the use of preventers such as Inhaled corticosteroids, Inhaled cromulyn or Nedocromil, Long acting bronchodilators, Theophylline, Leukotriene modifier, and recent strategies such as the use of Anti IgE antibodies (Omalizumab) immunotherapy and bronchial thermoplasty. Prevention and control of asthma risk factors are the important tools of asthma management.

 What are the factors that trigger Asthma? Is it curable?

Asthma is a multifactorial disease. Genetic, environmental, social, emotional factors are responsible for developing asthma.

1. Environmental: Allergens
2. Outdoor allergens (pollens, molds or fungus)
3. Indoor allergens (House dust Mite, Dander, molds, insects-cockroach, hairy doll)

• Food allergens (beef, prawn, hilsha and other shell fishes, sea food, eggs, cow’s milk, vegetables, nuts and food additives)

1. Irritants

Tobacco smoke, wood smoke, strong odors, perfumes and spray, cosmetics, paints, air pollutants, toxic gases from vehicles and factories

1. Upper Airways Infections:

Viral infections, recurrent common cold.

1. Exercise
2. Certain Drugs

B-Blockers, aspirin, NSAIDs.

 

Is it curable? Actually asthma is not curable, but would be in remission. If an asthma patient get all the preventer drugs regularly and avoid risk factors, he or she will be free from asthma symptoms, and even, can maintain his/her normal life with  or without minimum drugs.

 Compared to developed countries, do we have all the facilities for treatment of Asthma patient?

Management of asthma done in Bangladesh is same as in other parts of the world. The basic principle of management of asthma is:

1. Avoidance of risk factors
2. Use of preventer drugs regularly

• Use of reliever drugs as required basis

1. Use of recent drugs (Anti IgE anti-bodies)

 A few years back, we were a bit behind the developed countries in the management of asthma. But for the last 3-4 years, because of excellent growth of our pharmaceutical companies, we acquired all the latest medicine required to control asthma and we have got well equipped laboratory facilities to diagnose asthma from other diseases. So, in all respects of diagnosis and management of asthma in Bangladesh, we do not lag behind the developed countries.

  Do we have any specialized hospital to treat patients?

Yes, In Dhaka, National Institute of the diseases of the chest and hospital and National Asthma center is mother organization for treatment of asthma patients. Also in periphery in all medical college we have got well equipped respiratory unit to render services for asthma patients. Respiratory specialist in all these respiratory unit are quite competent enough to combat asthma attack among the asthmatics.

 Is there any research work going on Asthma in Bangladesh?

Yes, a lot of research is going on in Bangladesh, especially in NIDCH. All the doctors who are in MD (Chest Diseases) course are involved in research activities. All research papers are of high standard and published in national and international journals.

 Which group or segments of people are more vulnerable to this disease and why?

Asthma is a global burden, prevalence is increasing day by day. Paediatric population are more vulnerable for developing asthma due to:

 

1. Early exposure to environmental pollutants such as, particulate matter, ozone concentration, sulphur dioxide etc.
2. Recurrent respiratory tract infections i.e. Respiratory syncytial virus, Rhinovirus.

• Overcrowded population

1. Low birth weight baby
2. Maternal smoking habit
3. Indiscriminate use of antibiotics in early age

• Family h/o asthma and atopy

 What advice you have for Asthma patients to enable them to lead normal life?

Living with asthma can be challenging, but if one pays full attention, he can lead an active, healthy normal life. For these, Asthma patients will be able:

1. To learn about the natural h/o disease, trigger factors, management plan of exacerbations and self-management plan.
2. To learn how to monitor his asthma severity by recording peak flow with peak flow meter

• To learn regular use of preventer drugs and rescue medications during exacerbations

1. To learn life style modifications and environmental changes care

 Do you think our local pharma companies are manufacturing all the necessary drugs for remedy of Asthma? What about quality of these drugs?

Yes, all necessary drugs are manufactured by local pharmaceuticals companies in our country for remedy of asthma. These drugs are in good quality and available throughout the country. Compared to other countries, these are cheaper.

 What role of Govt. or NGO or Media can play in building awareness about Asthma?

Asthma is a non-curable but easily controllable disease. So, awareness about the disease is very important. Early diagnosis and treatment can help near total control. In all sector, Govt., NGO or media can play an important role for asthma awareness. Such as:

1. can formulate law against use of tobacco
2. Health insurance card for all patients

• Development of echo-friendly housing for homeless people

1. Asthma education topics in primary books
2. Development of residential and industrial town in different places
3. Organizing regular seminar, symposium about asthma

• Print and Electronic Media can show how to use asthma medication
• To overcome of fear about inhaler.