Educating the public on Asthma:

Adopting Western lifestyle one cause for Asthma

Dr. Viraj Peramuna writing to the Healtwatch on Asthma, quoting the - ‘Global Burden of Asthma Report 2004’ says that according to this report one cause for the increasing prevalence of Asthma around 300 million in the world at present is the adoption of Western lifestyle by more and more communities in the developing world.

Quoting further on this report which is of health educative value for the readers he goes on:

Asthma is a chronic lung disease characterized by recurrent breathing problems and symptoms such as breathlessness, wheezing, chest tightness, and coughing.

During normal breathing, air flows freely into and out of the lungs. But when asthma is not under control, the airways of the lungs are thick, swollen, and inflamed.

The airways become overly sensitive to environmental changes, and an asthma attack can happen easily.

During an asthma attack, the lining of the airways swells, muscles around the airways tighten, and mucus clogs the tiny airways in the lungs, making breathing difficult.

Asthma symptoms vary from hour to hour, from day to day, from week to week, and over months. They are often worse at night and in the early hours of the morning. The severity of asthma also varies from individual to individual.

Some patients experience occasional symptoms (for example, after strenuous exercise), others have symptoms that interfere somewhat with daily life, and still others have a very severe, relentless disease that almost excludes them from normal school and work activities.

300 million Asthma Affected in the world

The Global Initiative for Asthma will release the Global Burden of Asthma Report, a compilation of published data on the prevalence and impact of asthma around the world.

According to the Report, an estimated 300 million people worldwide now have asthma - striking evidence that asthma is a global health problem that cannot be ignored.

Around the world, asthma affects people of all ethnic groups, socioeconomic levels, and ages. However, asthma often develops during childhood. Indeed, asthma is the chronic disease most commonly causing absence from school.

Moreover, the prevalence of asthma is increasing throughout the world, and the rate appears to increase as communities adopt western lifestyles and become urbanized.

The most striking increases have occurred in Australia, where about one-quarter of children are now diagnosed with asthma.

In the United States, the number of people with asthma more than doubled between 1980 and 1998, from 6.7 million to an estimated 17.3 million. With the projected increase in the proportion of the world’s population that is urban from 45 per cent to 59 per cent in 2025, there is likely to be a marked increase in the number of asthmatics worldwide over the next two decades. It is estimated that there may be an additional 100 million persons with asthma by 2025.

What causes asthma?

The causes of asthma are not well understood, and the rapid increase in asthma prevalence around the world is one of the biggest mysteries in modern medicine. Ten years ago, scientists thought that diesel exhaust and other pollutants might be causing the asthma epidemic.

However, they now believe that the picture is more complex. many scientists are examining the role of genetic factors in causing asthma, and researchers are also looking at how the immune system develops in early life.

The causes of asthma attacks, however, are better understood. People with asthma have chronic inflammation in their lungs, and airways that narrow more easily than those of people without asthma in response to a variety of factors.

The factors that can set off an asthma attack include inhaled allergens (such as dust mites, pollen and cat and dog allergens), tobacco smoke, air pollution, exercise, strong emotional expressions (such as crying or laughing hard), chemical irritants, and certain drugs (aspirin and bata-blockers).

Each person with asthma reacts to a different set of factors, and identification of these factors and how to avoid them is a major step for each individual in learning how to control their disease.

How is asthma diagnosed?

A careful medical history, a physical examination, and tests of lung function provide the information needed to diagnose asthma.

Measurement of lung function is useful both for diagnosis of asthma and to monitor the course of the disease. Such tests include spirometry, which provides an assessment of airflow limitation, and peak flow, which measures the maximum speed at which air can flow out of the lungs.

Spirometry is performed in a health care professional’s office, while peak flow can be tested with portable, plastic peak flow meters ideal for use in home and work settings. Peak flow monitoring provides most patients, together with their health care providers, an effective method to monitor their disease and evaluate their response to therapy.

How is asthma treated?

Asthma cannot be cured but it can be effectively treated.

Treatment of asthma aims at control of the disease, meaning that the person with asthma does not experience asthma symptoms or acute attacks, does not have to use quick-relief medication or visit the emergency room, is able to engage in normal physical activity, including exercise, and has normal lung function.

Control of asthma can be achieved in almost all patients, with no side effects from medications, through the implementation of an effective asthma management program. The GINA program includes a six-point plan:

* Educate patients to develop a partnership in asthma management

* Assess and monitor severity with measures of symptoms and lung function

* Avoid or control factors that cause asthma attacks

* Establish medication plans for long-term management

* Establish plans for managing asthma attacks

* Provide regular follow-up care

Spectacle freedom in eye surgery

Implant eye surgery now possible:

Dr. Dushyantha Wariyapola consultant ophthalmic surgeon (Sri Jayawardenapura General Hospital Kotte.) speaking to the Health Watch on cataract eye surgery said, that what appeared to be an impossibility a few years ago in providing a spectacle free eye surgery in cataract operations has today become a possibility with the development of a new technique and a lens in this field called implant eye surgery where a new lens called (Rester-lens) is implanted in the affected eye replacing the ‘natural lens’, thus enabling the patient to have a life long youthful near and far normal eye vision free of spectacles.

For the benefit of Health Watch readers he further elaborated, that ReSTOR implantation could be done even in the very young, safely with no complications. There have been cases where it has been done safely in a six month old baby.

Cataracts are the cause for more than 80 per cent cases of correctable blindness in the country and surgery is the only option. Over the years, a lot of advancements have taken place to make this surgery safer and predictable.

Cataract surgery in itself is fast becoming a speciality with cutting-edge technology specialised intraocular lens or IOL and techniques being made available. Currently, the standard and commonly used IOL in intraocular implant surgery is the monofocal IOL, which provides patient’s distance vision only.

Furthering this ongoing improvement, the latest IOL called AcrySof ReSTOR, which provides cataract surgery patients spectacle freedom in at least 95% of the cases as per various clinical studies.

This lens uses a patented system called “apodised diffractive technology” to improve vision at a range of distances from near, to mid, to far, all in one optical system.

This lens is like two lenses in one-a refractive lens for distant vision, and a diffractive lens for near vision. What is unique about this lens, is its “ability to consistently offer patients multifocality.” Since ReSTOR does not work with muscles of the eye, it is not dependent on a mechanical process or movement of the lens for clear vision.

Further application of this technology would be in the areas of treating patients experiencing loss of near vision, a condition medically termed as presbyopia. It can also be used in cases of young individuals with “high hyperopia or myopia

Picture by Mahinda Vithanachchi

Acute shortage of life-saving drug

Dr. D.P. Athukorala, Senior Consultant Cardiologist, Colombo

There has been an acute shortage of the life-saving drug, Digoxin, in majority of pharmacies in Sri Lanka during the last 2 months as the authorities responsible for importing this drug has forgotten to import in time.

Digoxin which is an extremely cheap drug has been used by cardiologists and other physicians family physicians and general practitioners for treatment of heart failure and abnormal rapid heart rhythm such as atrial fibrillation.

This life saving drug is used by doctors both in all developing and developed countries for about 300 years. I have come across a significant number of patients with severl heart failure and rapid atriae fibrillations as all their attempts to buy this drug have failed and some of these patients had to be hospitalised.

Yesterday I met a heart failure patient who had gone to about 20 pharmacies in Colombo and failed to buy this drug.

It is high time that the drug regulatory authorities take urgent action to our-lift this life-saving drug as soon as possible.

Prevent diabetes:

“Eat Less and Walk More”- Dr Sanjiva Wijesinha

Diabetes may be in our genes but most people won’t develop the disease unless they allow it to do so.

Imprisoned in every fat man a thin one is wildly signalling to be let out

Cyril Vernon Connolly

A couple of months ago I met Professor Abubaker Suleiman, former Director General of Health Services in Malaysia. Before becoming the head of his country’s health department, Prof. Suleiman was a leading nephrologist in Kuala Lumpur.

In the 197 0s, he had been responsible for starting renal dialysis and kidney transplantation programmes in Malaysia.

In the course of the conversation, Prof. Suleiman said that more than half the patients requiring kidney dialysis in Malaysia today are diabetics.

Diabetic nephropathy

In fact the commonest cause of kidney failure in his country - and in most developing countries - is Diabetic Nephropathy. Such damaged kidneys gradually lose their normal ability to get rid of the body’s unwanted chemicals and toxins.

When the kidneys finally fail to perform their function adequately, the patients will need regular dialysis. They have to be connected to an artificial kidney machine, which extracts the toxins from the circulation.

Failure to remove these toxins regularly allows them to accumulate in the blood, leading to death from kidney failure. At present the only alternative to dialysis is a kidney transplant.

The biggest health threat facing Asia in the next decade is not Bird Flu or AIDS but Diabetes. The consequences of diabetic damage - to kidneys as well as hearts - are likely to cause massive problems for populations and health service providers in countries like India. .

Pragmatic approach

A more pragmatic long-term approach is to minimise the number of people who will develop diabetes.

Unfortunately Indians are very susceptible to diabetes. Many still have a mistaken belief that diabetes is caused by eating too much sugar. The truth is that diabetes is in our genes - but most people won’t develop the disease unless they allow it to develop.

Human beings were meant to use up the calories they consume in their food by their daily physical activities. After all, our ancestors started out living in caves, eating the roots and vegetables they foraged for and the flesh that they hunted.

These days we live in houses, and consume more than we need to of fried and sweet foods and sugary carbonated drinks (with or without cocaine derivatives). We walk very little and we all put on weight as we get older, especially around our waists.

The prevalence of obesity in our population is far too high and since being overweight and obese is one of the surest risk factors for developing diabetes, doctors have even coined a new word, Diabesity, to describe the new disease that is affecting the world.

Putting on weight and not exercising our muscles is a sure way to bring on diabetes as we get older. Having diabetes is not simply a question of taking tablets and pretending to avoid sweet foods at parties.

Diabetes is a damaging disease that makes one six times more likely to get a heart attack and puts one at risk of kidney failure.

Good precaution

It is a good precaution to get yourself checked for diabetes once a year, especially if you are over forty, overweight or your stomach protrudes over your belt. All that is needed is a simple blood test.

If you find that you haven’t yet got the disease, now is a good time to start taking steps, literally and metaphorically. to prevent yourself getting it.

The simplest rule to follow is to “Eat Less and Walk More”.

The writer is a surgeon and family physician based in Australia.

Courtesy - The Hindu

Green tea extract may boost cancer-fighting enzymes

Healthy subjects who received daily caffeine-free green tea extract capsules had an increased production of detoxification enzymes, which may provide some cancer-fighting benefits, study findings show.

“Concentrated green tea extract could be beneficial to those who are deficient in the detoxification enzyme and shouldn’t be harmful for those who have adequate detoxification enzyme,” lead investigator Dr. H.-H. Sherry Chow, of the University of Arizona, Tucson, told Reuters Health.

Genetic and environmental factors cause people to have varying levels of glutathione S-transferase (GST) enzymes.

These enzymes may play a crucial role in helping the body defend against toxic and cancer-causing compounds, note Chow and colleagues.

Previous laboratory and animal studies found that green tea compounds, antioxidants called “catechins,” activate these GST enzymes. Therefore, Chow’s team investigated the effect that concentrated compounds from green tea would have on GST enzymes levels in 42 healthy adults.

Their findings are published in the medical journal Cancer Epidemiology, Biomarkers and Prevention.

For four weeks prior to the study, the non-smoking volunteers refrained from drinking green tea, taking supplements, or eating foods known to contain epigallocatechin gallate, a potential cancer-fighting antioxidant.

Over the next 4 weeks the volunteers took four capsules, each containing 200 mg of epigallocatechin gallate, every morning prior to eating. This provided the equivalent amount of epigallocatechin gallate obtained from drinking 8 to 16 cups of green tea daily, Chow said.

The researchers found that the detoxifying GST enzymes increased by 80 percent in the study participants with the lowest GST levels at the start of the study. Participants with medium or high GST levels had either no increase or a slight increase in GST levels.

SOURCE: Cancer Epidemio logy, Biomarkers and Prevention, August 2007

Menopause may be to blame for weight gain in older women: study

As if the hot flashes and insomnia of menopause weren’t bad enough, now comes word that menopause can make you fat.

The declining estrogen levels associated with “the change” can interfere with metabolic processes leading to weight gain, US researchers said Monday, confirming what many women already knew.

The findings seem to support a link between the female sex hormone estrogen and regulation of obesity, especially the dangerous accumulation of abdominal fat linked to heart disease, diabetes and cancer, the study’s authors said.

“The accumulation of abdominal fat puts both men and women at heightened risk of cardiovascular disease, diabetes and insulin resistance,” said Deborah Clegg, assistant professor of psychiatry at the University of Cincinnati Academic Health Center in Ohio.

“Women are protected from these negative consequences as long as they carry their weight in their hips and saddlebags. But when they go through menopause and the body fat shifts to the abdomen, they have to start battling all of these medical complications,” she added.

In experiments on rats, Clegg showed that when they cut off the estrogen supply to a part of the brain that is central to energy regulation, the rats quickly developed an impaired tolerance to glucose and a sizable weight gain, even when they took in the same amount of calories.

What’s more, the excess weight went straight to their middle sections, creating an increase in visceral fat.

The findings suggest that estrogen receptors in the ventromedial nucleus, a region of the hypothalamus, plays an essential role in controlling energy balance, body fat distribution and normal body weight.

The hypothalamus controls body temperature, hunger and thirst.

By identifying critical brain regions that determine where body fat is distributed, Clegg’s findings may help scientists formulate “designer” hormone replacement therapies to better manage and manipulate estrogen levels.

“If we could target those critical regions and estrogen receptors associated with weight gain and energy expenditure, we could perhaps design therapies that help women sidestep many of the complications brought on by the onset of menopause,” she said.

Clegg presented her study in Boston at the 234th national meeting of the American Chemical Society.