Asthma affects 14% of school children

 

A 2009 study at Mulago Hospital indicates that 14% of school-going children in Uganda suffer from asthma. According to the study, the prevalence of asthma in children aged 6 to 14 years is 12-14%.

 

Citing the study, Gerald Mutungi, the programme manager, noncommunicable diseases at the ministry of health, says asthma among children has increased in places with heavy traffic.

 

“Secondly, a review of records at the Medical Emergency Department of Mulago Hospital revealed that asthma contributed 32% of the medical visits and 18% of the patients needed hospitalisation. In the chest clinic, asthma patients contributed 17% of total visits,” Mutungi adds.

 

Most of the observations were made on patients with severe asthma and the majority had had asthma for a long time. Most people with mild to moderate asthma only seek medical attention when the condition has got out of hand.

 

Implication of asthma

The World Health Organisation estimates the world-wide prevalence of asthma to be 235 million and is on the increase. The impact of asthma on health is difficult to establish because many countries with increasing incidences of the condition do not have accurate data on its magnitude. There have been few national studies on the cost of asthma.

 

Some studies in eight countries found costs that ranged between $49m and $7,000m per annum.

 

Most of the costs are due to hospitalisation and drugs for the treatment of asthma.

 

There are many school days missed by learners due to asthma.

 

Other costs include those as a result of absenteeism from work.

 

The mortality due to asthma is estimated to be 180,000 annually.

 

What is asthma?

When air leaves the nose and enters the lungs, it moves within the lumen of the tubes, which are scattered throughout the lungs.

 

Asthma causes these tubes to be easily irritable, resulting in cough and narrowing of the lumen of the tubes.

 

This results into wheezing and difficult breathing.

 

How does asthma present?

There are three ways in which asthma presents.

 Asthma exacerbation, commonly known as attack.

This is when the lumen of the tubes through which air passes is extensively narrowed. The patients have cough, wheezing and difficult breathing. Such patients require emergency treatment.

 

 Persistent asthma. In this group, there is narrowing of the lumen of the tubes through which air passes although it is not severe.

Such patients still have asthma symptoms.

 Uncontrolled asthma. When asthma patients are undergoing treatment, they should not get coughs, wheezing or difficulty in breathing. However, some get symptoms of asthma despite treatment. Such patients have uncontrolled asthma.

 

What are causes of asthma?

The exact cause of asthma is not known. In most cases, asthma develops as a combination of risk factors, namely:

 Allergies to things like dust, mite, cockroaches, fungi, cats and dogs significantly contribute to attacks in an allergic person.

Environmental risk factors refer to fumes/smells, which are breathed in together with air. Indoor environmental factors such as cigarette smoke, mold, paint odour can contribute to the development or worsening of asthma. 

 

Sulphur dioxide, nitrogen oxide, cold and high humidity are outdoor environmental factors that easily lead to development of asthma.

 

Gender. During childhood, asthma occurs more commonly in boys than girls. At about age of 40 years, more females than males have asthma.

 Family history. Asthma tends to occur frequently among family members in about 60% of cases.

 

Asthma can occur anytime in life, although the development of asthma commonly starts in infancy and childhood. At this stage of life, the natural history of asthma is difficult to describe accurately due to wheezes caused by frequent viral respiratory tract infections.

 

Wheezing in infants may also be due to the fact that the lung tubes through which air passes are very small. The diagnosis of asthma can probably be suspected with confidence from two years.

 

Long-term studies have shown that although asthma symptoms disappear in 30-50% of children during puberty, it often recurs in adulthood. Other studies have also shown that 5-10% of children with asthma develop severe asthma later in life and those with moderate to severe asthma develop long term effects of asthma throughout life.

 

Treatment

“Asthma can be controlled and the patients can lead a normal life. This requires regular and strict adherence to the prescribed medication. The preferred drug for the treatment of asthma is inhaled

(breathed in),” says Dr. William Worodria, a senior consultant (Internal medicine) of Mulago Hospital Complex.

 

He adds that there are two main types of asthma drugs, namely: relievers because they relieve symptoms of asthma quickly and controllers, which prevent “development of abnormalities” (inflammation) in the airway.

 

Real life experience: My battle against the condition

 

During my Senior Six vacation in 1999, I used to suffer from a dry irritant cough that always woke me up in the wee hours of the night. I decided to visit the clinic one morning. The doctor examined me and the fi rst question he posed was:“Do you have any history of asthma in your family?” I replied in the negative. I asked him whether he meant I was asthmatic. “Yes,” he said. I was shocked.

 

The doctor wrote a prescription and off to the treatment room I went. It was the fi rst time I was being injected through the veins. 

The best I did was to scream.

After getting medication, I went home. At 8:00pm, I started coughing persistently, vomiting and breathing with diffi culty. My parents rushed me to the clinic. This time, I was admitted and given injection upon injection. I was discharged after some days.

 

Interestingly, each time I suffered an attack and was given an injection, I would feel better. This made me stop taking my medication. However, one day, my condition worsened and I was rushed to the clinic.

 

All the treatment I was given could not work. The doctor referred us to Mulago Hospital, but I did not heed his call.

 

I took aminophylline drugs and felt better.

 

In 2000, I joined Makerere University and was assigned to a room on Level 5 at Mary Stuart Hall. This meant that to get to my room, I would have to climb several stairs. Fortunately, in 2000, I did not suffer any attack. I felt I had recovered, so I did not see the need to go to Mulago Hospital.

 

In 2001 when I joined second year, I was moved to Level 7. Two weeks into my second year, I started experiencing a dry irritating cough whenever it clocked 11:00pm. I could tell I was getting the attacks again.

 

This time, I visited a doctor in Bwaise. Each time I was unwell, I would be injected with adrenaline.

However, my situation only got worse.

Whenever I returned from lectures, I would fi rst sit on the stairs, pondering how I would get to my room. Being an evening student, I would skip both breakfast and lunch as they required me to climb the many stairs back to my room. I would only leave my room at 5:00pm to attend lectures. This went on until I completed my second year.

 

In 2003 while in my third year, I moved to the annex, where there were only about eight stairs drugs. Each time I was unwell, I would call my elder brother who was also a student at Makerere. He would come with a friend, who was pursuing a bachelor’s degree in medicine, to inject me.

 

Sometimes, I would be too weak to do any chores. At such times, my elder sister would come by and help me. Interestingly, each time my sister was around me, I would feel fi ne. The moment she would break the news that she was leaving, I would suffer an attack. Knowing the dire consequences of her departure, my sister started cooking up lies when she had to leave. When she did not return, I would conclude that she had left. With time, I got used to being alone.

 

Other times I would not move 10 steps without resting. This made attending lectures difficult.

During times like this, I would read from my bed, thanks to coursemates, who would bring me notes and update me whenever any courseworks or tests were due. Sometimes, I would hire a motorcycle to take me to CCE Hall (about 600 to 700 metres), where my institute was located.

 

One Friday night while my sister was around, I suffered an attack that almost took my life. Panting, I asked her to fetch a basin of water and pour it over me, thinking it would relieve me. She did exactly as I told her, but I instead became unconscious. I had spare adrenaline vials with syringes in my room, but the annex gate was closed. One of the students jumped over the wall to access the main Mary Stuart Hall to find a student who knew how to inject people. 

 

Thankfully, I regained consciousness after the injection.

The next day, my father took me to the clinic in Bwaise. While there, we were referred to Dr. Nwang Okot of Mulago Hospital. We went to Mulago to see him. After examining me, he prescribed drugs that could relieve me of my condition, although they were expensive.

 

After the treatment, my condition stabilised and I could attend all my lectures.

 

Before, I could not sit through a lecture for more than 15 minutes. I completed my studies and graduated in 2003.