ASTHMA, ALLERGY, COPD and ILD
Dr. T. Rama Prasad May 7, 2019
The word ASTHMA conjures up the image of a steam engine – huffing and puffing, much like an asthmatic patient. While the steam engine went down into the sunset, asthma is climbing up like a rising sun in tandem with bad lifestyle and environmental degradation.
Globally, ‘Chronic Respiratory Diseases’ are among the leading causes of morbidity and mortality, with ‘Asthma’ (bronchial asthma), 'Allergy' and ‘Chronic Obstructive Pulmonary Disease (COPD) being the most common. Asthma has a case burden of about 358 million across the world. Paradoxically, allergy and asthma are found to be more in the West whose environment is cleaner. Data on the burden of asthma in India has been plagued by inconsistent recording as is the case with other diseases. According to an estimate, the burden of asthma cases in India is about 20 million, with a whopping 487 billion rupees (INR) being spent on treatment per year.
CONFUSING COUSINS Asthma, allergy, COPD, chronic bronchitis, occupational lung diseases, interstitial lung diseases, etc. are related and overlapping disease entities which cause a lot of confusion in the minds of the people and doctors as well due to some common symptoms and clinical signs. The definitions are varied and the diagnostic tools give different verdicts in many cases. Generally, environmental pollution is a common factor in the causation while specific factors like heredity, individual constitution and climate may also play a role.
The‘World Asthma Day’is conducted on the first Tuesday of May to promote awareness and prevention of asthma.
ILLUSIVE CURE
Patients often ask me as to when they would be free from asthma. I refrain from saying that they would when the country is free of pollution and the people live in good lifestyle … lest they would be depressed ! Asthma is arguably the most miserable morbidity outdoing other lung diseases – catching up, in some cases, during childhood and following up to the graveyard.
Very extensive and voluminous research was done, and a plethora of medicines are available today, but with my experience of half-a-century in this field, I may say that we didn’t make much headway to find a permanent solution. Many new and better medicines are introduced but they also have to be taken for indefinite periods. Mostly, once the patients stop medication, the symptoms come back. The same is the case with allergy. Some go for extensive and expensive tests to know the allergen or allergens to which they are specifically allergic to, and to get 'desensitisation' therapy. This also may not mostly work out in practice. Hence the patients switch from one doctor to another hoping for a cure. The patients are tired of taking more or less the same medicines over indefinite periods of time. And the doctors too do not find it satisfying to prescribe more or less the same medicines. However, the faces of pharmaceutical industry may be lit up with impish glee as a whopping amount of 487 billion rupees is being spent by asthmatics in India ! No doubt, the industry is spending colossal amounts on developing new drugs to tackle asthma and allergy, and has already put various new products in the market to mitigate the suffering. Programmed by the manufacturers, the products look scientifically authentic and very promising in the glitter of the glitzy conference halls.
Like in any other ailment where there is no definite cure, a plethora of medicines are inducted into the market, and tall claims are made, also by alternative native systems of medicine.
PREVENTIVE MEDICINE
It is important that ‘preventive’ medicines are to be taken even when there are no symptoms so that the disease would not progress and become permanent. In this context, ‘inhaler’ medicines are very valuable. But in my experience of over 50 years, I found that people are very reluctant and against the use of inhalers due to the misconception that they are “very powerful” and that once they start using them they have to be used forever. And many educated ones fear about the ‘steroids’ in them. In fact, inhalers have less side-effects than tablets as they contain very small quantities of drugs and as the drugs in them do not get into the blood and reach other organs in the body in any significant quantity. As they go directly to the lungs where they are required to act, the dose is small and they don’t affect other organs much. As long back as 2001, I wrote the following in THE NEW INDIAN EXPRESS:
And sadly, most of the patients in India don’t know how to use inhalers properly. It means that they are not only wasting medicines but allowing the disease to progress to irreversible dimensions. In these days of frenetic pace of life, many do not seem to have the time to train the patients patiently to use inhalers properly.
A recent (2019) publication in the 'British Medical Journal (BMJ)' noted that 'Metered Dose Inhalers (MDI)' contain the propellent gas 'Hydrofluoroalkane (HFA)' which is a potent 'Greenhouse gas', and that this gas is not present in the alternative inhaler called 'Dry Powder Inhaler (DPI)'. This raised the question as to whether DPI is to be preferred. Excessive 'Greenhouse gases' lead to 'Global warming' and its deleterious effects on environment. But the amount released by inhalers is insignificant (0.1%). Unhesitatingly, one may use whatever inhaler is prescribed by the doctor.
CAUSATIVE FACTORS
While in many cases there is an overlap of asthma and COPD, there are ‘pure’ cases of COPD where it is a progressive disease despite treatment. Many of them end up in ‘chronic respiratory failure’ necessitating indefinite oxygen supply through ‘home oxygen machines’. The causes for COPD are mostly chronic smoking and air pollution which are also associated with lung cancer.
PREVENTION
The morbidity, mortality and the economic burden of asthma and COPD can be decreased by providing access to preventive care, early treatment and use of primary health care instead of running to emergency departments at a late stage. More focus is to be put on adherence to treatment by the patient, and adherence to rational guidelines of treatment by doctors (https://www.ncbi.nlm.nih.gov/pubmed/25948888?dopt=Abstract).
Generic barriers to better health such as environmental pollution, smoking, recklessness to health issues, poor infrastructure, poor nutrition, illiteracy, unawareness to public health, etc. are to be addressed.
INTERSTITIAL LUNG DISEASE (ILD)
Interstitial lung disease (ILD) is an umbrella term used for a large group of diseases that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. Lung damage from ILDs is often irreversible and gets worse over time. Many people with ILD have trouble in breathing and a cough that does not go away. In more severe cases, complications can be life-threatening and include high blood pressure in the lungs, right heart failure, and respiratory failure (the lungs do not deliver enough oxygen to the body). The condition, which is part of a group of disorders known collectively as interstitial lung disease, causes inflammation and scarring of the lung tissue. The average survival for people with this type is currently 3 to 5 years . It can be longer with certain medications and depending on its course. People with other types of interstitial lung disease, like sarcoidosis, can live much longer.
Even so, in some cases, the causes are never found. Disorders without a known cause are grouped together under the label of idiopathic interstitial pneumonias, the most common and deadly of which is idiopathic pulmonary fibrosis (IPF). While there are not formal categories of IPF, doctors and patients sometimes think of IPF in four different stages depending on symptoms and treatment needs. IPF can be a scary diagnosis, but it's not a death sentence. IPF progresses differently for everyone. Some live with the disease for many years.
Interstitial Lung Disease (ILD) - American Lung Association
https://www.lung.org › lung-health-diseases › interstitial-l...
https://www.lung.org › lung-health-diseases › interstitial-l...
New drug significantly slows progression of fatal lung disease
https://www.uhs.nhs.uk › Newsandpublications › Latestnews
https://www.uhs.nhs.uk › Newsandpublications › Latestnews
Interstitial Lung Disease: Symptoms, Causes, Tests
https://my.clevelandclinic.org › health › diseases › 178...
https://my.clevelandclinic.org › health › diseases › 178...
Interstitial lung disease - Symptoms and causes - Mayo Clinic
https://www.mayoclinic.org › syc-20353108
https://www.mayoclinic.org › syc-20353108
Interstitial Lung Disease: Life Expectancy, Treatment, and Types
https://www.healthline.com › health › interstitial-lung-dise...
https://www.healthline.com › health › interstitial-lung-dise...
Dr. T. Rama Prasad,
'PAY WHAT YOU CAN’ Clinic, Perundurai, Erode Dt., TN, India.
Former Medical Superintendent (Special), RTS & IRT Perundurai Medical College and Research Centre, Perundurai.
Nice information sir. Would you say the role of Pranayama in recovering of Asthma?
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