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Asthma mysterious

Caught up in the Asthmatic global mystery

A report on the 'Global burden of Asthma' released in Geneva recently describes asthma as one of the biggest mysteries in medical science, whose causes are not yet fully understood, even though the disease has remained one of most chronic diseases affecting human community for decades.

We have received a copy of this report from ex-Medical Administrator Dr. Lucian Jayasuriya for use on this page.

The report states:

A medical mystery

Asthma is one of the most common chronic diseases in the world, with an estimated 300 million sufferers worldwide. The disease ranks high in public and medical professional awareness, yet its causes are not well understood.

In fact, the rapid increase in asthma prevalence around the world in recent decades is one of the biggest mysteries in modern medical science.

Asthma tends to run in families, for example and clearly genetic factors are involved in determining who gets asthma and who doesn't. Yet genetics alone don't tell the whole story. Throughout Southeast Asia, the prevalence of asthma varies among members of different ethnic groups living in the same geographic location, but also among members of the same ethnic group living in different geographic locations.

Scientists also believe that the cause of asthma is connected to the conditions a person is exposed to in early life, particularly those factors that influence how the immune system develops.

One tantalising clue comes from Western Europe, where the lowest asthma prevalences are found among individuals who have lived on a farm in childhood - regardless of where they live as adults.

Finally, asthma is known to be related to other allergic disorders, such as allergic rhinitis and eczema, which have also increased in prevalence over the last few decades.

However, in many parts of the world these diseases haven't increased at precisely the same time. In Taiwan, for example, the increase in asthma occurred before that of allergic rhinitis and eczema.

A disease of development - and a threat to development

Most often, disease eradication goes along with economic development, but asthma is an exception to this rule. The highest rates of asthma are found in some of the world's wealthiest nations such as the UK, Australia and Canada, while the lowest are recorded in developing nations such as Indonesia and Nepal.

In general, wealthy nations have higher rates of asthma than developing nations, although asthma prevalence has been increasing in many developing nations in recent years as these countries industrialise, urbanise and adopt 'western' lifestyles.

Perhaps the best-known example of this phenomenon comes from the former East Germany, where the prevalence of asthma increased rapidly to match that in the former West Germany after reunification in the 1990s.

But in fact, similarly dramatic examples of increasing asthma prevalence have occurred in many other parts of the world. For example, in 1975, researchers could not find a single person with asthma among over 1,000 children and adults in a rural community in the Gambia, West Africa. By 1997, 3 per cent of a rural Gambian population reported current asthma symptoms.

As a result of such stories, asthma is often thought of as a 'disease of development'. More frequently overlooked is the fact that rising asthma prevalence rates also represent a threat to development.

In simplest terms, the economic burden of asthma on families struggling to improve their lot can be severe. For example, in Syria the cost of a year of treatment for a person with moderate persistent asthma is equivalent to the monthly salary of a nurse.

More broadly, the burden of asthma imperils a country's further economic growth when the disease prevents adults from working and children from attending school.

Surveys in Southeast Asia show that 1 in 4 adults with asthma lost time from work over the last year due to their asthma and 1 in 3 children with asthma missed school.

A socio-economic paradox

Is asthma a disease of the poor or a disease of the rich? The answer depends on your vantage point.

In China, for example, asthma is more prevalent in more affluent communities. News stories on asthma in developing countries tend to portray asthma as a disease of the rich - an unexpected negative side effect of development and increasing affluence.

In the UK by contrast asthma disproportionately affects lower socio-economic groups. Asthma is often perceived in wealthier nations as a disease of the inner-city urban poor.

Looking closer, the lower socio-economic groups in wealthy countries are often made up of a disproportionate number of racial and ethnic minorities and immigrants. For example, children of Pacific Islanders born in Australia have twice the rate of asthma as children born in the Pacific Islands.

Similarly, the prevalence of asthma is relatively low in Ethiopia and relatively high in Israel; within Israel, however, the prevalence of asthma is three times higher among adults of Ethiopian origin compared to the general population. In other words, immigrants often can't breathe free.

Understanding the mechanisms behind this socio-economic paradox - why asthma is sometimes a disease of the rich and sometimes a disease of the poor - could help scientists learn more about the causes of asthma. Are there environmental factors common to affluent communities in developing nations, and poorer communities in wealthy nations, that increase a person's risk of developing asthma?

Tracking a time bomb

Over the past several decades, the prevalence of asthma has increased as communities around the world have adopted Western lifestyles and become urbanised. These demographic trends are likely to continue in coming years, with the proportion of the world's population that is urban projected to increase from 45% today to 59% in 2025.

It is estimated that there may be an additional 100 million people with asthma by 2025. In addition, asthma is a chronic disease that frequently develops in childhood, making the increasing burden of asthma around the world likely to continue far into the future.

In short, the Global Burden of Asthma Report documents a time bomb - a burden of disease that threatens to explode in the future.

While an increasing prevalence of asthma is predicted in most regions of the world, the greatest increases in the burden of asthma could come in China or India. Each country has a large population - China is currently the world's most populous nation and India is expected to overtake it by 2050.

And both countries are experiencing unprecedented rates of economic development, with urbanisation, industrialisation and the attendant lifestyle changes that have been associated with increasing asthma prevalence in the past few decades.

An absolute 2% increase in the prevalence of asthma in either country would result in an additional 20 million people with asthma.

Suffering in silence

In many parts of the world, the burden of asthma falls most heavily on the groups that are least able to speak up for themselves - children and the elderly.

The increase in asthma prevalence in recent decades has occurred among both children and adults, but in some areas has been especially marked among children. For example, in Barbados the prevalence of asthma among the school children has reportedly increased from 1% in 1970 to 15% in 1996.

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Heart disease and driving

by Dr. D.P. Atukorale

It is not advisable for heart patients to drive if they;

(a) have had a heart attack within the last two months;

(b) have angina frequently while driving;

(c) take drugs that cause vertigo (sensations that the body or the world is spinning), fainting, loss of consciousness, lack of alertness or rapid onset of tiredness;

(d) have unexplained periods of syncope (temporary loss of consciousness caused by lack of blood flow to the brain);

(e) have untreated heart block (impaired conduction of electrical current through the heart)

Alcohol interacts with many heart drugs producing reduction in alertness and slowing reaction time.

Driving private vehicles

Apart from the conditions listed above, it is thought to be generally safe for people to drive private vehicles. For example, angina that occurs on strenuous exercise but not in other circumstances is not a bar to driving.

Patients with valvular heart disease

Most people with diseases of the heart valves or with artificial valves are able to continue driving (though not, of course, if they experience fits of disabling giddiness or fainting.

Patients with artificial pacemakers

People with artificial pacemakers (pace setters) are allowed to drive provided that their underlying heart condition is not dangerous; and that the working of the pacemaker is regularly checked (at least one in six months). Driving may be resumed one month after successful implantation of the device.

CABG patients and driving

Patients who have had successful coronary artery bypass surgery (CABG) may return to driving once they have recovered from the operation and it is always advisable for CABG patients to ask their heart surgeons regarding advice about fitness for driving when they come for follow up to the cardiac surgeon.

Heavy vehicle driving

Regulations are more strict and considerably more complicated when driving involves heavy goods, passenger transport and public service vehicles (including taxis and three-wheelers).

Generally speaking, goods and passenger vehicles should not be driven by anyone who has,

(a) any form of angina;

(b) evidence in the ECG of lasting damage from a heart attack;

(c) had more than one heart attack;

(d) dangerous narrowing of vital sections of major coronary arteries (revealed by coronary angiography);

(e) a pacemaker;

(f) significantly enlarged heart (cardiomegaly) confirmed by chest x-ray and 2D - Echo and

(g) seriously raised blood pressure

Medical examinations

For people who drive professionally, yearly medical examinations may be advisable to confirm continued fitness to drive.

Professional drivers who have had angioplasty (PTCA) or coronary artery bypass surgery (CABG) will need to have regular check-ups using exercise ECG (stress testing) 2D-Echo, and if necessary, coronary angiography to confirm that there is adequate supply of blood to the heart muscle.

As a rough guide, driving may be permitted, if yearly checks reveal no symptoms, no ECG signs of inadequate supply of blood supply on exercise testing, no recent heart attack, good pumping performance by the left ventricle (main pumping chamber of the heart) as revealed by a 2D Echo, and coronary artery grafts that show no signs of becoming blocked by atheromatous plaques.

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5s change in Base Hospital, Balapitiya

Base Hospital of Balapitiya has immensely improved under a new development scheme launched by its head consultant obstetrician and gynaecologist Dr. Hemantha Dodampahala based on the Japanese 5s concept.

Daily News staffer Indeewara Thilakaratne who recently visited this hospital with cameraman Ranga Chandraratne has this to say about the hospital's gynaecological unit.

Surrounded by a pleasant view with nicely laid out flower beds and pots, anyone who enters the ward would undoubtedly notice the placard containing the words 'Quality, productivity, care for motherland' which serves as a motto for the ward.

An impressive array of surgical instruments, equipments, medicine and even the furniture is the end result of the 5s concept which is implemented by the new Venereal Obstetric Gynaecologist, Hemantha Dodampahala and his team of doctors.

The unit consists of three sections; Gynaecology ward, Antenatal ward (Where patients admitted before the delivery), Postnatal ward (Where patients admitted after the delivery) could accommodate 120 patients at a time.

Almost every wall of the ward is adored with notices and pictures educating the patients on valuable tips for leading a healthy life.

As you enter the dormitory, one could see the placard which carries the message of the importance of initiating the breast feeding soon after the delivery and guidelines on feeding the child properly under the guidance of the Paediatrician Dr. Damayanthi Hapugala and the team who has been dedicated to care the new born.

It is a dedicated work of a medical consultant who has been known to the people of this country for the past two years through mass media. being one of the highly qualified consultants of the country holding M.D. (Fetomaternal Medicine), M.R.C.O.G. (Member of Royal College Obstetricians and Gynaecologists) - UK, FRCS (Fellow of Royal College of Surgeons) - Edinburgh, MS. (Master of Surgery) in Obstetrics and Gynaecology, he is contended to serve people from rural areas.

The inestimable service of three other consultants namely Paediatrician Damayanthi Hapugala, Surgeon Dhammika Wickramasekara, Physician Chulani Adhikari, District Medical Officer, Athula Piyarathna, all the medical officers and the members of the minor staff made it possible to carry out such a large number of major surgeries that includes Cancer Surgeries; The commendable service rendered and the immense effort by them contributed to keep up the good image of the hospital. All of them want to draw the attention of higher authorities to develop the hospital.

The dwellers of the area are ever thankful to the District Medical Officer, Athula Piyarathne for his indefatigable service that resulted in the overall development of the hospital during his previous tenure.

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