We have national guidelines for treating Asthma, COPD and Tuberculosis patients

Prof. Dr. Bashir Ahmed

Professor, Respiratory Medicine

National Institute of Disease of the Chest & Hospital

Mohakhali, Dhaka

 

As an eminent Chest Specialist of the country, how do you assess the prevalence of chest diseases in Bangladesh?

I am a Chest diseases specialist working for about 33 years in different hospitals of Bangladesh like Union Health Centres, Upazilla Health Complexes, District Sadar Hospitals, Chest Diseases Clinic, Dhaka Medical College hospital and National Institute of Diseases of the Chest and Hospital. In case of respiratory diseases, we don’t have any definite prevalence study. We have only Asthma & COPD prevalence study. But we have so many other diseases of respiratory system like pneumonia, lung abscess, bronchiectasis, lung cancers, occupational lung diseases and pulmonary TB etc in our society.  As an experienced chest physician, from my observation in different hospitals and private chamber patients, I can say prevalence of chest diseases in our country is not less than 30% among all diseases.

Do you think Bangladesh has all the state-of-the- art facilities to manage chest diseases? Does common people have access to such facilities?

Yes, Bangladesh has all the facilities to manage chest diseases. We have one National Institute of Diseases of the Chest and Hospital, 4 divisional Chest Disease Hospitals, 44 Chest Diseases Clinics, eight -20 bedded Chest Disease Hospitals & respiratory units in some of our medical colleges to treat chest disease patients. Besides, internists are also giving treatment to chest disease patients. We have no post of chest disease specialists in District Sadar Hospitals and in all medical colleges. We have no chest disease specialists to act at Upazilla Hospitals. Due to lack of posts in above hospitals, our people are not getting services from these chest disease specialists. We have national guidelines for treating Asthma, COPD and Tuberculosis patients and we are giving treatment according to these guidelines- which are internationally recognized. By creating posts of chest disease specialist in District Sadar Hospitals and all medical colleges, we can give all facilities of treatment to common people.     

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

In 2007, a study on COPD known as BOLD- BD (Burden of Obstructed Lung Disease in Bangladesh) revealed the prevalence of COPD in general population as 4.32%. Treatment includes advice to quit smoking, immunization against influenza and pneumonia. Other treatment includes, use of long acting bronchodilators in oral and inhalation forms and use of inhaled corticosteroids on the basis of severity. During exacerbation antibiotics and systemic steroid are also given. Rehabilitation programme for COPD patients includes selection of diet, breathing exercise and chest physiotherapy has great importance.

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

Asthma is a chronic inflammory disease and multi-trigger factors includes domestic or occupational allergens (e.g., house dust mite, pollens cockroaches), tobacco smoke, exercise, cold, viral infection, stress etc can trigger the disease. These responses are more likely when asthma is uncontrolled. Some drugs can trigger asthma, e.g., beta- blockers, and (in some patients) aspirin or other NSAIDs. Asthma can be controlled. With modern treatment an Asthma patient can lead a normal life.

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

Asthma is more prevalent in children and young adults (5-21 years). But almost in the young teens (12- 14 years) the prevalence is highest (10.3%). Exact cause is yet to be known. Poor and low socio- economic people are easy victims of asthma and other chest diseases. Garment workers, and people living in overcrowded area are easy victims of asthma and TB. 

What are the challenges in Asthma & COPD care in Bangladesh?

Increasing air pollution, high cost of inhaler drugs, easy availability of tobacco products, superstition regarding these diseases are main challenges. Strong campaign against tobacco is also a challenge.

How life style, pollution and smoking are responsible for triggering the respiratory diseases?

A number of studies have reported associations between air pollution exposures and asthma. For example, researchers have found an association between increased hospital admissions for asthma and particulate matter, an outdoor air pollutant. Air pollution, such as ozone and particle pollution, can make asthma symptoms worse and trigger attacks. Adults and children with asthma are more likely to have symptoms when ozone and particle pollution are in the air. Ozone is often found in smog and particle pollution is often found in haze, smoke, and dust. Ozone is often worst on hot summer days, especially in the afternoons and early evenings. Particle pollution can be bad at any time of year, even in winter. 

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

People living with asthma have to accommodate their long- term condition within the context of their daily life. They may need to remember to use regular medication to keep a supply of inhalers, avoid their triggers where possible, cope with the variability of asthma and the impact of this has on them and their family’s lifestyle. Crucially they have to recognize when their asthma is deteriorating, and make decisions about when to adjust their medication, when to use emergency treatment and when to seek physicians’ help.

 What is the status of Tuberculosis disease in our country?

Bangladesh ranks 6^th in the world TB burden countries. We have achieved a lot of our goal in treatment and control of TB in our country. Now number of smear + ve pulmonary TB patients are 225/ lac and number of total TB patient in one lac are 405. Last year i.e in 2016 total number of TB patients were 223000. Among them pulmonary TB patients were 180000, Smear + ve new pulmonary TB 130000, retreatment smear + ve cases 15000, Smear – ve pulmonary TB 350000. Extra pulmonary TB patients were 43000 and Multidrug Resistant (MDR) TB patients were 800, XDR were TB 10 in number. Amongst pulmonary TB patients, cure rate is 93% and amongst MDR TB patients, cure rate is 73% in our country.

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

Our Pharmaceutical Companies are producing almost all types of drugs for the management of chest diseases. The quality of these drugs are up to the international standard. Only a few drugs for Asthma, MDR and XDR TB treatment are yet to be produced locally.