Asthma is a lung disease that makes it difficult to breathe. You can prevent asthma attacks by carefully changing your environment and avoiding triggers. This week, we bring you an expert from Makerere University Lung Institute to speak to us about measures to prevent asthma.
Show Host: It is a pleasure each time we know that your eyes are on Church of Uganda, Family TV. Thank you so much for loving and watching Church of Uganda, Family TV, and particularly the Health Pot. Remember this programme is brought to you by Makerere University School of Public Health together with Church of Uganda, Family TV with me, Edrine Osteen Mukalazi your host. Remember the whole of this month, even as we head to the end of it we have been looking at Asthma, causes of Asthma, we started with studying Asthma; what Asthma is then we went to the causes and previous Friday we were looking at the treatment.
Today we are here partly to talk about the prevention but also to respond to some of your questions. I am glad that you people are sending in responses, your questions and we are with Dr. Rebecca Nantanda, a researcher from Makerere University Lung Institute. She will partly respond to these questions and also tell us about the prevention of Asthma but before we go into the depth of the topic, I request her to greet us. Dr. Rebecca, we are again excited that you are here with us.
Dr. Rebecca Nantanda: Thank you Edrine and good evening to our viewers. Thank you very much for asking questions and that really shows the interest in the topic and we are happy to respond.
Show Host: Exactly, and the questions are overwhelming. I remember Dr. Christine Nantanda saying that Asthma is a silent killer, very many people are dying but people have no solutions. People don’t know where to go, where to get the right information and the responses show us that this is really true. People are anxiously waiting to know, to listen to information about Asthma and we are glad you are back again to talk about Asthma.
We shall be bringing in the questions of our viewers but I think let us go straight to the prevention. I understand prevention is categorized into two; we want to look at first of all how someone can prevent themselves from getting Asthma and then later on we shall look at how someone can prevent themselves from getting attacks, or how they can prevent their children from getting attacks.
Dr. Rebecca Nantanda: Thank you Edrine. Getting back to the discussion we had about how Asthma develops in people. I remember mentioning that it’s an interaction between your genes and the environment. There are certain things we can do to prevent ourselves from developing Asthma even when we may have the gene and that is something that has to do with the environment.
Show Host: Before you go to the environment, someone asked a question and said, “Is there any test, genetic test that can be done to see whether I am carrying this gene or not?”
Dr. Rebecca Nantanda: Yes, but not those are not the ones that we do in routine clinical care. There are tests that the genes have been identified through the research, so we know specific genes that are responsible for predisposing people to getting Asthma. So, that’s why the researchers are going ahead to see if there are some treatments that are related to the genes that can help people with Asthma. When you come to the clinic, we are not able to test and say for you, you have the genes that is not predisposing to Asthma-that is usually in research setting but getting back to the prevention there are things that I mentioned that we call risk factors, the things that make you get Asthma symptoms even when you have the gene, and those things are in the environment. Things like the air pollution if you are staying in an environment where the air is polluted, there is a lot of smoke either from the cooking within the kitchen or from the environment, factories, from the cars, all those things and once you have the genes, once you inhale those fumes, they start off that reaction because you already have the genes. So, prevention of air pollution in our homes but also in our cities and schools is very important in preventing somebody from manifesting the Asthma symptoms.
Show Host: Yes, because sometimes you look at the traffic congestion and you realize that then cars are parked and that they are fuming out and you are like what can now someone do if maybe there are asthmatic and this is maybe a trigger?
Dr. Rebecca Nantanda: Yes, we usually advise that if you can avoid streets or avoid times when there is flippy traffic and if you are able to close the windows so that you don’t inhale the fumes. Those are some of the things you can do. For the air pollution, it is two ways: if you already have Asthma it can actually make you get an attack but also there are things within the environment I talked about like the allergens, the mold, the pollens, things within our houses that can actually start if you are exposed to them make get Asthma symptoms. So, trying to prevent the development of Asthma gets back to what are those that actually bring about Asthma in the first place, and these are things which are commonly within our environment. There is something I want to mention about Asthma in children, please parents whenever you smoke just know that you are predisposing your child to Asthma. Tobacco smoke is so bad that for example if a pregnant woman lives in a house where there is someone smoking tobacco, the mother can inhale the fumes and affect the unborn baby. So, by the time the unborn baby is born the lungs are damaged, they cannot function very well and such children are at risk of developing asthma symptoms.
Show host: Aaah…some parents because the bible says men are the heads of the family so they really want to show that they are the heads of the family, now they are smoking and as they are smoking he comes and sits in the sitting room with the cigarette and when all the children are there watching television and inhaling the smoke that he passes out.
Dr. Rebecca Nantanda: I think that is not a smart way of being a family head. If you are a family head, you really want to protect your people, you want to provide for them, you want to make sure they live a good and healthy life. So, again my appeal is that do everything within your power to prevent people from getting certain diseases. Tobacco smoke beyond asthma, there are other so many things besides you yourself, even the people within the environment can actually get diseases just because somebody inhales these smokings. So, if you are a smart house head it means you are going to make sure that they are healthy, you are going to provide for them and if they have symptoms that I talked about make sure they access care.
Show host: Okay...haahaa…not a theoretical head…well, Dr at that very point, someone asked a question and said, “according to Dr. Rebecca’s explanation may be one of us has Asthma but my question is how much does it cost if I want to come at Lung Institute for a normal checkup?” Just, they have not exhibited symptoms but they want to be sure whether they are not asthmatic.
Dr. Rebecca Nantanda: Okay, first of all, it is not that everyone has asthma. We have done some studies in different places in Uganda and we know that at least 2 out of 10 people have asthma symptoms. Unfortunately, over 50% of them do not know until we do a certain test and we tell them you see you have asthma. We do a certain test that can help identify people with asthma at Lung Institute and I want to say that much as we say that we are called Makerere University Lung Institute, we are not situated at Makerere Hill, we are at Mulago Hill within the Medical School. So, when you go within Mulago Hospital, the new Mulago you ask where the Medical School is, and once you reach the Medical School, and ask where the Lung Institute is, you will be able to actually find us. So, our clinic works every day Monday -Friday, we open from 8:00 AM-5:00 PM. It’s a walk-in clinic, you do not have to book appointments, so when you come like somebody who said they want to do a general checkup.
Show Host: Kennedy Mugisha also asked the same question, the location.so, I think the two are covered in one answer.
Dr. Rebecca Nantanda: Yes, maybe I will provide my number at the end of the show so that people may be able to call in and direct them because it may not be easy for some people. So, when you come, first of all, we assess you and there is a specific test we call Spirometry, a technical term but basically, we are measuring the amount of air you are able to breathe in and out that can inform us how well your lungs are functioning and if at all you have asthma. It is a test which I think for now we are able to provide within the Lung Institute, the few other centers are coming up.
It costs One hundred thousand shillings (UGX. Shs 100,000). Of course, it sounds like a lot of money but remember the journey of really making sure that you have the diagnosis-you have a test that really has been done, we put you on the right treatment, and in the long run, you actually save a lot because you no longer be buying medicine here and there all the time, so usually, the first expense can be costly but the savings come on later when you are no longer spending money on inappropriate medication, hospital visits so on and so forth.
Show Host: Well…I think we get back to the prevention, we were still looking at how someone can prevent it… I think what you were explaining was how to prevent someone from getting attacks if they are asthmatic, what else can they do besides expose themselves to the environment? You said most of the triggers are within the environment and what surrounds us? what are the lifestyles someone is asthmatic but they want to go for night clubs, enjoying dancing-can that be actually?
Dr. Rebecca Nantanda: Yeah, of course, it can be a challenge. There is prevention where we are actually preventing someone from getting the asthma symptoms, but if you have been diagnosed with asthma there are things that we teach you to prevent you from getting attacks. The more the attacks you get especially if you are a child and your lungs are still growing the more your lungs are being damaged continually and later on you get other diseases beyond asthma.
It is very important we prevent attacks through making sure that you take the daily medicine once it is prescribed. And in the show during the treatment, I talked about the controllers or preventers and I explained that the medicine is aimed to prevent attacks. Even when you feel fine after the symptoms are gone, remember I said you may feel you are able to play all sports but the lungs inside them have not reached that point where we have controlled the inflammation. Please take your medication.
We usually work as partners to reach a point where we tell you to stop the medication. The number one way of prevention is making sure you take the medication as prescribed for the duration that has been talked about and that can only happen if you are able to keep your appointments and keep taking drugs.
The other ways that we teach you when you come to us on how to prevent asthma is to prevent exposure to the triggers and most of these things are within the environment. For the children, it is either home and if they are school goers, it’s on the way to school or within the school premises. Most of the things that I talked about like the molds, damp areas within the house or dust within the house in the corners do what we call major cleaning often or the windows-that dust is a common trigger, many people ignore it. Cooking is good because we drive our lives from there, we have to eat but it can be dangerous if we cook within the house because the smoke that comes either from the charcoal stove or from the firewood is dangerous once inhaled. We are actually able to teach you and we are able to identify them and be able to reduce the exposure of them.
Show Host: We are right back, thank you our viewers for sticking with us, we have been with people from Makerere University School of Public Health. In the first episode, we had Dr. Shema, we are now with Dr. Rebecca Nantanda taking us through how to prevent asthma. You were telling us about what you tell parents to do. There is a parent here saying “I am Lilian. I am a mother of 2, both of them are asthmatic-in moments of attacks even when I use medicine given to me, my children do not get any better until they are admitted to hospital, what could be the cause? I seriously need help. I am even scared of giving birth to more babies, they may be asthmatic as well.” I think she has had the hardest moment of her life with her children and Dr, what could that be? Could it be that she is not administering these medicines the right way?
Dr. Rebecca Nantanda: The failure to respond when somebody has an attack is either the medicines that they are using is not the correct medicines. Remember I said that there are two types of medicines, we have the reliever which is only used during the attack, and then the controller. If somebody gets an attack, the right medicine to be used is a reliever which is an inhaler.
One thing we don’t know is if she is using the right medicine to relieve the symptoms, but the second thing is how she using it. The problem is that the tubes within the lungs are narrow and therefore you can’t breathe in and out comfortably. That’s why people experience difficulty in breathing and they say they are suffocating.
To give you relief using the reliever medication, we must make sure that the medicine reached the lungs in the right dose. If the children do not have the spacers that means most of the medicine ends in the mouth even though she is using an inhaler. The technique of making the medicine reach the lungs with the right dose is possible if you are using what we call a spacer. It is also possible she has the right medicine but she does not have the spacer but there are some people who have both: you have the right medicine; you have the spacers but how you use the spacer also is important because that is the only way you can make sure the medicine reaches the lungs.
At Lung Institute, we take you through the session on making sure the medicine reaches the lungs. I encourage the mother that if she wants more children, we can find a way through alleviating the anxiety, your distress, the pain, and suffering of the current children are going through so that their symptoms are controlled and then I think that will motivate you to have more children since you will know how to take care of them.
Show Host: Lilian, I think you have heard. Dr. Nantanda, let’s get back to prevention because I believe no parent would like to see their children going through the asthmatic attack. We really want to help them to see that these parents don’t go through what they are going through, or someone may be watching, they are mature but also asthmatic, and maybe they would also want to learn how can they prevent themselves from getting these attacks.
Dr. Rebecca Nantanda: As I mentioned, look at the environment the things within your house, keep your house clean, we have had incidences-you see these carpets, beautiful carpets in the houses they have a lot of dust, they keep a lot of dust. There is something we call the house dust mite, very notorious for causing attacks, so we negotiate with the parents to make changes within their homes. Roll off the carpets and keep them to make sure they clean the house so that there is no dust, if you are cooking within the house get a kitchen or transfer.
There are some parents that have let to go of their nice perfumes because the children or themselves react to the perfumes. There are different modifications which you have to make and at the same time you are taking your medication. Taking your medication alone is not sufficient because you trying to control but the triggers are ongoing, so it is kind of a fight.
Show Host: Looking at the situation where someone asthmatic seated in a taxi and then someone with strong perfumes enters and then the person starts responding to what our President used to call “sneezing out (Okwesyamura)”-they start doing that, could that be a symptom?
Show Host: As a result of asthma?
Dr. Rebecca Nantanda: It could be. Some people have allergies of the nose and that can be a symptom. There are so many people that have asthma and they also have allergies of the nose. Now the good news is if you are on treatment and you stop overreacting to some of those triggers, you still have to make sure you reduce to the exposure. If you are on medication, you may be in the accompany of someone who has strong perfumes but still do not end up in another tap because the inflammation is controlled, and that is the beauty of making sure that you have medication and you are taking it correctly because eventually, the attacks disappear and even take you off the medication. So, again one of the ways of preventing those things is making sure you have medication.
Show Host: I am looking at a situation these days it is a little cold and coldness is one of the triggers to attacks, what can an asthmatic person do? Someone will take it as an excuse that “You know when I bath, I might get an asthmatic attack”
Dr. Rebecca Nantanda: It is true. For some people, cold water or just a cold environment is a trigger for an attack. Again, there are some people where this maybe not be a problem. First of all, we let you know that you have to prevent yourself from getting cold, we usually inform you that when you see the clouds changing, just get your sweaters before it starts raining. The moment it gets cold the reaction starts.
Prevention means you keep warm all the time, there are some people where we have had to go an extra mile-the parents are a bit innovative; they say in the morning maybe I make sure she /he bathes cold water or maybe I make sure I wipe or bathe or just halfway and then I make sure she is warm, things just like that. Once you are working with the parents or if there are adolescents, we can actually find out something that works out for each individual because everybody has different situations, so we discuss with you within your environment what can you change, what can you do differently so that you prevent or avoid exposure to triggers.
Show Host: Someone can tell you, “when I bathe with warm water, then my body becomes cold immediately.”
Dr. Rebecca Nantanda: No… Ideally when you bathe. you should wipe. Once you wipe your self then the body keeps warm.
Show Host: Well, I think we get back to this question as well. “Thanks for the show, I find hardship in breathing when it rains but I also have severe back pain. From these talks I am afraid I might be having asthma, what can I do?” Is back pain associated with Asthma because she says in the first place she has hardship in breathing and then back pain?
Dr. Rebecca Nantanda: Probably not, but could be associated with what goes on when somebody gets asthma. Many people when they are having that suffocation when they can’t breathe, they tend to bend forward to try and breathe better. It is just one of it, actually if one comes in the way they set in the chair tells us how bad the attack is, So, probably that person is constantly getting those repeated attacks, and most times they have to take a posture that is really bending forward, we know that if you are not upright you get back problems, so it could be associated.
I also remember I said that one of the symptoms of an attack of asthma is when you have chest pain. I do not know whether she is talking about a backache or she is really feeling chest pain. If she is really feeling pain within the back, where the lungs are then really that could be the cause of asthma. The best thing could be that she gets care, she gets assessed properly then we find out whether she has asthma. If there is something else associated, that is also treated. By the end of the day she gets a quality life.
Show Host: Someone is greeting us in the name of Jesus and is saying, “Dr. Christine Shema talked about the substitution of inhalers with drugs, who qualifies for these drugs because I think I have overused the inhalers?” And in the same development, someone also asked about the effect of the inhalers on the body, so you can wrap up the two altogether.
Dr. Rebecca Nantanda: So first of all, inhalers do not cause any damage once we teach you how to use them. You don’t have to use them for the rest of your life. The problem comes in if you are not using the right inhaler. If you are not using the controller the one that prevents attacks, you end up using only relievers and you tend to overuse and reach a time when even when you use that reliever, it’s no longer working because the lungs are damaged, so it is important to have the correct medication. So, there is nothing like I have overused the inhalers if they are being used correctly.
At what point do I stop using the inhaler? That is an assessment that we do as the patients and providers and determine that now you can stop using the inhalers. Alternative medicines, occasionally we may give tablets, especially to children but we do an assessment, there are many things we consider: is it that cost, will you be able to understand and make sure that the technique we are teaching you is okay. So, we assess you as an individual and see what is really best for you and as I mentioned actually the best option is inhalers.
Show Host: Thank you so much, Dr Nantanda. As we wrap up the whole topic that has taken us through the whole month, what is your last message to our viewers out there on asthma?
Dr. Rebecca Nantanda: First of all, I want to thank the viewers for really listening in and the questions that they have asked. I want to encourage our viewers that if you find your child with those symptoms that we mentioned, please make sure that you take the child for an assessment. There is the medicine that can help children with asthma live a normal life so that they are like any other children, they can realize their potential, can get the grades we are looking for and they can practice their talents or sports or games.
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