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| Friday, 20 September 2002 |
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Childhood wheezing and asthma : by Dr. B. J. C. Perera, Consultant Paediatrician, MBBS (Cey) DCH (Cey) DCH (Eng) MD (Paed) FRCP (Edin) FZCP (Lond) FRCPCH (UK)
Here's Dr. Perera's article to the Health Watch. Wheezing and asthma are well known to be the commonest recurrent chest diseases in children. Although the famous cliche "all that wheezes is not asthma" has been around since time immemorial, it is now widely recognised that a vast multitude of childhood wheezers are in fact asthmatic. Globally, some form of wheezing is estimated to affect about 15-20% of all children. There is a wide geographical variation and in some countries like Australia and New Zealand it is as high as 35-40%. Many of the affected children have only a mild form of the disease while some of them have troublesome attacks coming on in episodic fashion. About 1% of children have a serious form of the disease and they are chronically ill with some degree of wheezing almost everyday and marked disturbance in the daily lifestyle. Ordinary coughs and colds or several forms of allergies precipitate a large proportion of the episodes of wheezing. Although many of the attacks are generally successfully treated with excellent recovery as the ultimate outcome, it is an unfortunate fact that still, even in this day and age, some children succumb to the disease. It is also regrettable that on closer evaluation many of these deaths could have been avoided especially if medical assistance had been available at the earliest onset of the fatal attack. Many children who first develop the disease in the first year of life do not continue with wheezing into adolescence and adult live. However, wheezing starting for the first time after the third year of life has a higher chance of persisting into adult stage of life. When a child with wheezing is taken to a doctor, he or she will have to first assess the severity of the disease, treat appropriately and decide on future management. Many children need short term treatment for their acute episodes and a small minority with more persistent and severe disease would need long term continuous therapy. Basically there are two groups of medicines used in the treatment of asthma. The first are a group of drugs loosely referred to as 'relievers'. They are mainly used to treat acute attacks of wheezing and are designed to give relief as soon as possible. The second group are referred to as "preventive drugs" and are used continuously on a long term basis for prevention of recurrences. Only a small proportion of all asthmatics need this type of long drawn out therapy. A very important and most effective form of treatment in all types of asthma is to use the drugs in an inhaled form through the commercially available specialised inhaler devices. These instruments tend to deliver minute doses of the drug directly into the lungs. The inhalers are very useful in the management of asthma and there is no truth in the myth that they are "addictive". Many of the drugs used, especially those used in inhalation form, are quite safe when used in the proper dosages and under medical supervision. There is sufficient evidence that early treatment of the more severely affected children would help in the ultimate improvement in the condition into adult life. On the present state-of-the-art facilities available, childhood asthma cannot be permanently cured by using some magic formulae or some wonder drugs. We could however control the disease very well and help these children to live either normal or near-normal lives. They should be encouraged to take part in all childhood activities and very specially to engage in as many sports as possible. Asthma is not a time-bomb for children and very many of even the most severely affected children do tend to improve with age. The future outlook for all asthmatic children has been greatly improved by the present forms of treatment available and today many doctors approach the problem with a singularly optimistic attitude. =============================== Impacts of asthma Dr. A.T. Munasinghe (Consultant Chest Physician, Chest Clinic, Welisara) on Asthma:
Symptoms of Asthma * Shortness of breath - due to lack of oxygen, a person developing asthma would pant when carrying out job which he / she accomplished with ease in the past. * Chest tightness - constrictive feeling in both sides of the chest * Wheeze - Musical sound on breathing out due to narrowing of the lung tubes. * Cough - Dry cough particularly at night or early morning. Cough on exertion suggest exercise induced asthma. What Causes Asthma?
1. Dander from the skin, hair or feathers of warm blooded pets, (dogs, cats, birds) 2. House dust mites 3. Cockroaches 4. Pollen from grass, trees and mold 5. Cigarette smokes, Wood dust, Scented products such as hairsprays, cosmetics, strong odours from fresh paint or cooking, automobile fumes. 6. Infections in the upper airways, such as common cold. 7. Showing strong feelings (crying and laughing) 8. Changes in weather and temperatures. Is there a cure for Asthma? No! but it can be well controlled. Poor control would lead to a poor quality of life and even to a sudden death. =============================== Smoking causes male sexual impotence by Manjari Peiris The Action on Smoking and Health (ASH) and the British Medical Association (BMA) estimate that up to 120,000 men in UK in their 30s and 40s are impotent as a direct consequence of smoking. It also says that as this figure does not include with those who had smoked earlier and do not smoke at present, it is likely that this number could have been underestimated. Smoking is a major and avoidable hazard for sexual health. Two of the main side effects of smoking on erective function are acute responses to nicotine, and then immediate improvements on stopping smoking are possible. The authorities advise that labels on cigarette packs and other tobacco products should contain warnings about the threat to men's sexual health. A new directive of the European Union will soon replace the existing directive (89/622/EEC), which indicates the current warnings. Cigarettes sold in Thailand now carry impotence warnings, and the idea is also under consideration in Hong Kong. ASH and the BMA have called for the British Government and the European Union to add the following warnings to labels on cigarettes and tobacco products sold in the UK and EU; Warning: * Smoking causes male sexual impotence A major study in the US found that one in every 13 US men between 20 and 39 is impotent. This number increases with age to roughly in 10 men across the whole adult population. This is equal to two million men in the UK alone. Impotence is linked with a variety of conditions including high cholesterol levels, drugs used to treat high blood pressure and diabetes. However there is strong evidence to show that the effects of all physical aspects are made worse by smoking. Studies suggest that 74% of all cases are due to physical causes. A study of 1290 men who had received treatment for impotence in USA showed that smokers were over twice as likely to become impotent as non-smokers - 56% compared with 21% Cigarette smoking was also linked with a much greater possibility of complete impotence in men with high blood pressure, heart disease and arthritis. Smoking does not therefore, merely add other risk factors, but mix them. There is convincing proof to suggest that impotence indicates more serious basic vascular problems. A study of 4462 Vietnam War veterans between the ages of 31 and 49 revealed on 80% increase in the risk of impotence among smokers compared with men who had never smoked. The study by ASH shows a low level of awareness of the risk of impotence arising from smoking. The survey shows that a considerable 88% majority of smokers (87% of men and 89% of women) do not name smoking as a cause of impotence. ASH and the BMA believe that low level of awareness among smokers makes a compelling case for new warnings on packets of cigarettes and other tobacco products. Medical research links smoking with other areas of male sexual health including reduced volume of ejaculate, lowered sperm count, abnormal sperm shape and impaired sperm mortality. Smoking is also linked to Pyosperima, a condition manifested in swollen tests with excess white blood cells present in ejaculate. There are three main risk factors for impotence. They are smoking, high blood pressure and diabetes. Ian Eardly, Consultant Urologist of St. James Hospital, Leeds says; "It is now clear that smokers are more likely to develop impotence in just the same way that they develop heart disease - if they can stop smoking. There is every chance that they will extend normal sexual function." =============================== Centenarian study team and Health Watch thanks Prof. Colvin Gooneratne of the Colombo Medical Faculty, head of the centenarian study team and Chairman of the Centenarian Friendship Association (Sri Lanka) together with the Health Watch which has been associating with the centenarian study express their profound thanks to all those who helped in numerous ways connected with this week's event of the OPA honouring Sri Lanka's oldest and world's second oldest living centenarian O.T. Engonona from Talpe, Galle. Prof. Gooneratne makes particular mention of the OPA president-elect Architect V. N. C. Gunasekera in accepting the study team proposal to honour the centenarian at the inauguration of the OPA annual sessions. Mrs. Mohini de Silva, wife of late Dr. K. K. W. de Silva from Galle, for bringing the centenarian from Galle to Colombo for the event. Dr. Surinder Bazar, Consultant Cardiac Surgeon Durdans Hospital and the Hospital Management for keeping the centenarian in the hospital for the day and medically attending on her free of charge. Mr. Fari Fouzi of Speed Trade, Havelock Town, Colombo for providing a vintage car to take the centenarian from Durdens to the BMICH for the event and Pradeep Jayewardene of Shell Solar and poorna Health care Trust for donating and fixing solar power lights to the centenarians hut in Galle. - E. Arambewala, Hon. Sec CFA. =============================== Health watch Question Box : Dr. D. P. Atukorale (Consultant Cardiologist) and member of the Health Watch Medical Advisory Panel answers readers queries. How much salt do we need? All of us need salt to live. Amount of the salt in the food is usually measured in milligrams (mg) of sodium and the current recommendation is that an adult has to eat about 2300 mg of sodium per day and we can easily get our requirement from the salt in fresh foods. Most of the Sri Lankans eat more salt than they need and eating too much salt can lead to hypertension in people who are salt sensitive. It is common knowledge that hypertension increases your risk of strokes (brain attacks) heart attacks and kidney disease. If you are already suffering from hypertension, eating too much salt may make the hypertension worse. If you have a strong family history of hypertension it is advisable for you to reduce salt consumption. In the West high blood pressure affects almost a third of the people who are over the age of 50 years and hypertension is called a "silent killer" and majority of Sri Lankans suffering from hypertension do not know that they have hypertension as routine medical checks are not done by majority of Sri Lankans. In the West almost 50 percent of people over the age of 70 years have hypertension. Elderly people are more sensitive to changes in salt intake than your people. Other ways to lower blood pressure If you are overweight reduce the excessive weight. Be physically active, limit alcohol intake and start healthy eating habits by eating mainly plant based foods such as bread, cereal, rice pasta, vegetables, fruits, legumes (peas, beans and lentils) and moderate amounts of lean meat, paultry, fish, reduced fat dairy products, monounsaturated oils (olive oil) and polyunsaturated oils such as gingili oil. Does everybody need to restrict salt intake This question is of pressing importance for public health purposes. One side are the USA. The National Heart, Lung and Blood Institute (a branch of National Institutes of Health), the National High Blood Pressure Education Programme and academic experts on hypertension who have long held that it is important to restrict dietary salt for the purpose of reducing the incidence of hypertension in USA. On the other side is the Salt Institute, the rich and powerful manufacturers of processed food (virtually all processed food contain huge amounts of salt) and the academic experts on hypertension whose careers have been based on funding from these sources. These experts cite scores of scientific studies bolstering their arguments that high salt diet has little to do with hypertension and that salt restriction is dangerous. Both camps are entrenched and well armed. The bottom line is that salt metabolism and its effects on hypertension are extremely complex. Reading the medical literature on salt is like reading the Bible; you will be able to find something in these to support it. New studies on salt and hypertension A new study conducted at Indiana University of School of Medicine suggests that it is not the hypertension produced by salt that is the most important cause of health problems, instead it is the whether the individual is salt sensitive or not that matters. For people who are salt sensitive, the risk of dying from cardiovascular problems is increased with dietary salt, whether or not they are hypertensive. People who are salt sensitive experience an exaggerated blood pressure elevation when they are given a salt load. Salt sensitivity is a risk factor for developing hypertension. Many salt sensitive people are in fact not hypertensive to all. The Indiana study suggests that it is not hypertension that causes early death in salt sensitive people. It is the salt sensitivity itself. That is, in these individuals high dietary salt causes cardiovascular disease even if their blood pressure remain normal. Dr. Aviv from the University of Medicine and Dentistry of New Jersey says that salt increases the reactivity of the platelets. He says that high dietary salt intake leads to cardiovascular events like stroke and heart attacks and kidney disease directly in the absence of hypertension. What should we do about our dietary salt In view of the above latest information it would be seen prudent to reduce our salt intake to a reasonable and practical degree especially if you have risk factors for heart disease and stroke such as smoking, obesity, diabetes and hyperlipidaemia (high cholesterol and triglycerides in blood). Practical tips for reducing salt intake You can cut down your salt consumption by avoiding processed foods such as processed meats, commercial potato chips, sausages, crisps, high salt pastries, cutlets, rolls, pizza, cheese bits, salted nuts such as roasted peanuts, salted gram and roasted cashewnuts and "papadam". Sell your salt shaker. Never add salt at the table. Check the labels of condiments and conventional foods many of which are loaded with salt e.g. sauces, canned fish, canned vegetable, dry fish, "seenisambol", pickles, "katta-sambol". So to flavour foods used freshly ground pepper, fresh or dried herbs, vinegar, lemon juice, fresh mustard (made from powdered mustard) and fresh garlic or garlic powder. Try making your own sauces, pickles and chutneys without adding salt. Potassium chloride is another product used as a salt alternative but before using potassium chloride you must consult your family physician. You must avoid salt in cooking and this includes salt, onion salt, celery salt, garlic salt, beef and chicken cubes, gravy powder, soup cubes, "Lunudehi" and sprats. Use acidic flavours such as vinegar, fruits juices such as lime and lemon, tamarind and pineapple juices, curry spices such as cumin, cardamon, cinnamom, ginger, turmeric, chillies, clove, coriander pepper and mustard. When you start taking a slow salt diet during the first few days foods taste bland and after about a month, taste will be quite acceptable. If you have trouble reduce your salt gradually in a stepwise fashion until your taste buds get used to other flavours. Problems with reducing salt intake People with kidney disease or those taking medication such as lithium or diuretics like frusemide, should consult their family physician before changing the amount of salt they eat. Pregnant mothers should consult their obstetricians before making any changes in salt intake. Misconceptions about taking extra salt Some people believe that in hot weather or when exercising or after heavy sweating, you have to take extra salt. This is not correct. Your body makes automatic adjustments by making sweat less salty and passing less salt in the urine. It is very unlikely that you will ever need extra salt unless advised by your family physician. ***** Long term use of clopidogrel Q: D. M. Koralege from Homagama - I have been using clopidogrel for a long time on doctors advice. I am afraid of side effects. Could you advice me on this. Reply: Clopidogrel which is an inhibitor of platelet aggregation is superior to aspirin and long term administration of clopidogrel to patients with atherosclerotic vascular disease has been proved to be more effective than aspirin, in reducing the combined risk of ischaemic stroke, myocardial infarction or vascular death. The risk of causing neutropenia (low blood neutrophil count) is less when compared to aspirin. In patients who have undergone coronary angioplasty treatment with a combination of clopidogrel and aspirin reduces the risk of cardiovascular death and heart attacks by 31 per cent (Cure Trial). Therefore it is advisable for you to follow the instructions of your cardiologist and continue taking clopidogrel and aspirin. Your cardiologist will regularly instruct you to do white cell counts and watch for neutropencia which is a rare side-effect of aspirin and clopidogrel. =============================== Cholesterol lowering drugs - mortality Q: G. C. de Silva, attorney-at-law from Pannipitiya says "I am under treatment for ischaemic heart condition with the following drugs after seeing the annexed lab reports ordered by my cardiologist: 1. Isosorbide dimitrate 10mg twice a day; In a recent Health Watch page there was a reply item that patients treated with cholesterol lowering drugs had a higher mortality when compared to those not treated with drugs. Your worthy advice will enlighten patients treated with cholesterol lowering drugs. My lipid profile is as follows "Serum cholesterol 164mg/dl, serum triglycerides 137mg/dl, HDL-C (Good cholesterol) 38 mg/dl, LDL-C (bad cholesterol 90 mg/dl and cholesterol /HDL-C ratio 4.3." Reply: There has been some misunderstanding of my reply to a Health Watch reader who has asked about treatment of her husband who is 73 years of age with cholesterol lowering drugs. (Health Watch DN - 09.08.2002). In my reply I have mentioned that "most physicians do not treat patients over the age of 70 years with cholesterol lowering drugs" as patients treated with cholesterol lowering drugs when compared to those not treated with drugs. If you are below 70 years, you dont have to worry, as your cardiologist has given the best treatment for you. With your cardiologists prescription, your total cholesterol, your triglycerides and LDL have come down. According to Honolulu Heart Programme where 3572 patients whose ages ranged from 71 to 93 years were followed up for 20 years and there was an increased mortality in elderly people with low cholesterol and it was shown that long term persistence of low cholesterol concentration increases the risk of death (Lancet August 2001). With regard to your lipid profile your HDL cholesterol is too low and your cholesterol/HDL ratio is too high. To increase your HDL-C (good cholesterol) it is advisable for you to (a) stop smoking if you are a smoker; (b) Take regular exercises such as brisk walking, bicycling or swimming for about 45 minutes per day for at least 4 days a week. (c) Consume olive oil, cashew nuts and avocado which are very rich in monounsaturated fats which are known to raise the level of HDL-C. Once the HDL-C level goes up the total cholesterol/HDL rates will come back to normal. Many physicians how believe that low HDL cholesterol is a worse risk factor for heart attacks than high LDL cholesterol. In Sri Lanka there are some GPs who are influenced by multinational drug firms and prescribe very powerful statins to patients with mild hyperlipidaemia without first trying the effect of exercises, low fat low cholesterol diet, control of obesity and life style changes. Recently I met a heart patient with LDL cholesterol of 40 mg/dl as a result of his G.P. using the latest statin for a cholesterol reading of 240 mg/dl. On stopping the statin and starting the patient on low fat, low cholesterol diet exercise and life style changes his lipid profile came back to normal. Doctors have to use common sense when they treat healthy people with potent drugs like stations which have many side effects. Cholesterol metabolism and haemostatic mechanisms differ in the elderly and greater quantities of drugs accumulate in their blood and they may have poor renal function. Therefore doctors treating hyperlipidaemia in the elderly must think twice before prescribing potent and powerful cholesterol lowering drugs such as statins. It is advisable to treat these elderly people with nonpharmacological methods before trying them on powerful drugs such as statins. =============================== Heart Walk on September 29 Dr. A. T. W. P. Jayawardena has informed heath Watch that this year's Heart Walk, organised by the Sri Lanka Heart Association will be held on Sunday, September 29. A special feature of the walk will be the participation of several by-pass operated heart patients in the walk which will be from Alfred Place to Wellawatte. More details of the walk are being finalised, he informs. |
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It
is an unfortunate fact that still even in this day an age some children
die of Asthma. It is also regrettable that on closer evaluation many of
these deaths could have been avoided specially if medical assistance had
been available at the earliest onset of the attack.
Asthma
is a chronic lung disease which results in narrowing the lung tubes. The
narrowing could be episodic or progressive. The latter could be compared
with a process of corrosion. The tubes are hypersensitive and react
excessively to stimuli, such as germs, cigarette smoke, house hold dust,
pollen, cold air etc.
Hereditary
and environmental causes. A family history of asthma or other allergies
like rhinitis or eczema would increase the risk. Environmental factors
involving occupational exposures, are increasing daily. Common triggers
for asthma includes.
