Ayushman Bhava – Asthma

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TOPIC: General Studies 2

• Government policies and interventions for development in various sectors and issues arising out of their design and implementation
• Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions

Facts about asthma

• WHO estimates that 235 million people currently suffer from asthma. Asthma is the most common noncommunicable disease among children. Most deaths occur in older adults. In India alone, over 15 million people suffer from asthma.
• Asthma is a public health problem not just for high-income countries; it occurs in all countries regardless of the level of development. Most asthma-related deaths occur in low- and lower-middle income countries.
• Asthma is under-diagnosed and under-treated. It creates substantial burden to individuals and families and often restricts individuals’ activities for a lifetime.

What is asthma?

Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person.

Asthma attack

During an asthma attack, the lining of the bronchial tubes swells, causing the airways to narrow and reducing the flow of air into and out of the lungs. Recurrent asthma symptoms frequently cause sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism. Asthma has a relatively low fatality rate compared to other chronic diseases.

What triggers an asthma attack?

Although the fundamental causes of asthma are not completely understood, the strongest risk factors for developing asthma are inhaled asthma triggers. These include:

• indoor allergens (for example house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander);
• outdoor allergens (such as pollens and moulds);
• tobacco smoke
• chemical irritants in the workplace
• Old cars and unplanned urbanisation

Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. In some people, asthma can even be triggered by certain medications, such as aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine). Urbanization has also been associated with an increase in asthma, however the exact nature of this relationship is unclear.

It is hereditary: Asthma is hereditary, though the exact gene hasn’t been identified. It is one of the strongest genetic disorders after schizophrenia. Atopy is a collection of genetically transmitted diseases: asthma, allergic rhinitis, eczema, migraine. A family history of any of these ups the risk of developing asthma by five to seven times. The grandmother may have had allergic rhinitis, the mother eczema, while the child may develop asthma.

It can be triggered by stress: Stress may bring on an attack, even if you’ve never had it before, but have a predilection. The smooth muscles of the airways are controlled by the autonomic nervous system (that also controls heartbeat, digestion and other functions that happen ‘automatically’). The hormones released by this system are responsible for causing smooth muscle broncho-constriction. The airways become hypersensitive to even innocuous substances. The main underlying reason is always inflammation. In adults, the stress of a death or separation may trigger it, or even a consistently stressful life.

Food helps: Antioxidants from fruits and vegetables help fortify the body and the airways. They protect the airways from being hypersensitive. In a study, it was found that the airways of healthy individuals were coated with antioxidants, but in asthmatics, antioxidants were significantly depleted.

Asthma is a global priority requiring global action

Governments should

• Include asthma in all their actions resulting from the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020, and the WHO NCD Global Monitoring Framework
• Ensure their country has a coordinated national strategy towards better measurement of the true burden of asthma, improving access to care and improving adherence to asthma management strategies;
• Aim to achieve the UN Strategic Development Goal 3: “ensure healthy lives and promote well-being for all at all ages” to lessen the burden of asthma;
• Ensure that essential asthma medicines are on their country’s Essential Medicines List and ensure that they are free, subsidised or reimbursed;
• Develop and implement insurance schemes which will allow patients to access and buy asthma medicines;
• Strengthen their national policies, such as those to reduce tobacco consumption, encourage healthy eating and reduce exposure to potentially harmful chemicals, smoke and dust;
• Support further research into known asthma triggers and identifying the causes of asthma; commit to research that increases the understanding of asthma, its causes, its costs, and lead to improvements in management;
• Support the acquisition of new standardised data to track the country and global burden of asthma.

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