From steroid addiction to stopping medication docs bust asthma myths

Panaji: Mohit was seven years old when he was diagnosed with asthma. He suffered recurrent coughs and colds, chest tightness, and wheezing, and was frequently taken to the doctor. Each time, he was nebulised and put on oral medicines, and the parents were tired of the syrups and antibiotics he was prescribed.

“I went through his records and history and suspected asthma. He had a history of urticaria in his mother from childhood,” said senior paediatrician Dr Sushma Kirtani. “I put him on inhalers and explained to his parents how to use them. After 10 days, he showed improvement. His cough and chest tightness reduced, and there was no more running to hospitals. After a year, his treatment was stopped with specific advice on what to do in the event of any wheezing attack in the future,” she said.

Besides a strong family history being a major cause of asthma, other triggers can range from pollens, dust, smoke, dhup, agarbattis, mites, dry grass, dusting old books, furniture, pets and their fur, to animal dander, and are different for different people.

The Hospicio South Goa District Hospital sees eight to 10 new asthmatic patients, both adults and children, in a month, the majority of whom are from urban areas. The hospital also sees an average of 100 follow-up asthma cases, which rises to 150 during the winter and monsoon seasons when maximum viral infections are seen.

While most asthmatic persons will have symptoms from childhood associated with rhinitis and other allergies, the hospital also sees adult onset of asthma due to sensitisation to some allergens at the workplace or environment later in life. Doctors say inhaler treatment is the mainstay for asthmatic people and is neither addictive nor has any side-effects, and hence should not be stopped without a doctor’s advice once the patient feels better.

Those who end up in emergency are often those who don’t take their inhalers regularly. “It is usually people who are non-compliant with inhalers who come back with bad exacerbation,” said senior chest physician at South Goa District Hospital Dr Govind Desai, adding that the cornerstone of asthma treatment is to continue with inhalers regularly.

“Most inhalers contain corticosteroids but very, very small amounts of it, which when inhaled only act on the respiratory tract without entering the bloodstream and therefore don’t have any major side effects,” he said.

Kirtani said parents are often hesitant to have their children use inhalers, which are the best treatment. “Some deny the diagnosis and feel the child will be branded asthmatic for life. Others themselves reduce their children’s doses as they feel it is too strong and fear their child will be addicted to drugs, which is a myth,” she said.

Once diagnosed with asthma, patients need to learn the proper technique of using the inhaler, says practising pulmonologist and former head of the pulmonary medicine at GMC, Dr Durga Lawande. “If not used correctly, the patient won’t get the desired effect of the medication,” she said.

People usually continue with treatment regularly until they feel better and then stop on their own, leading to a flare-up of asthma. “If we find the person improving, we gradually reduce the dose and bring it down to a minimal maintenance dose to control inflammation in the airways at all times,” she said.

She advises asthmatic persons not to venture outside early morning or late evenings in the winter season when humidity is high, as the cold breeze can immediately cause worsening of symptoms. “One can wear a mask or warm clothes to avoid direct exposure,” she said.