•AN Asthmatic child having her chest checked

BY NGOYA CHANSA –
Developing countries around the world are undergoing an epidemiological transition from communicable or infectious to non-communicable diseases (NCDs), such as cardiovascular disease, chronic respiratory diseases,cancer and diabetes.
These NCDs were responsible for 60 per cent of all deaths globally in 2005, with more than 75 per cent occurring in developing countries.Unhealthy diet, physical inactivity, tobacco and alcohol use are important preventable major risk factors for chronic diseases that are related to lifestyle choices. (Source: WHO Country Office, Zambia Annual Report 2010).
Asthma is a chronic inflammatory disorder of the airways resulting in recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.
It is triggered by cigarette smoking, allergen exposure  such as house dust mites, cockroaches, pollens, mold, animals, occupational allergens. Other triggers are respiratory infections, vigorous exercise, drugs, strong emotion like laughing and crying.
On cigarette smoking, evidence suggests an association between environmental tobacco smoke exposure and exacerbations of asthma among school-aged, older children and adults. Further evidence shows an association between smoking habit and reduction in the efficacy of inhaledglucocorticoids.
According to Dr. Emilia Marsden of Pendleton Family Practice, Asthma in Zambia suggests that there are no clear statistics on the prevalence of asthma in the country.
The 2013 Information record indicate that schools visited in the country during this period showed that the prevalence of Asthma in seven to eight year olds was at five per cent, while in 13 to 14 year olds, the prevalence was at eight per cent.
Statistics in 2013 from the Lusaka Urban District Health Management Team (LUDHMT) recorded 5, 882 asthmatics in five year olds.
Chabula, a mother of four says her son Malumbo Issac (not real name) was a healthy baby when he was born. He rarely got sick.
She recalls that one mid-morning when her son was one and a half years old, he developed a cold.  By 18:00hours, he could not breath and Chabula later took her son to Chilenje clinic. He was examined and given crystapen injection.
lssac was diagnosed with severe pneumonia and referred to the University Teaching Hospital (UTH). At the UTH based on the report from the clinic, he was admitted for the night in the administration ward and treated for severe pneumonia.
One of the doctors suggested further tests saying if it were severe pneumonia he would still have been down.
Just before the age of two, the same attack came back again, a cold accompanied by a running nose. Though it was in the month of September when the weather was very hot, Issac was having difficulties breathing and he had a very heavy cough. In addition, his lips turned blue.
Chabula rushed her son to Chilenje clinic and again the clinical officer diagnosed severe pneumonia. Issac was admitted for two nights.
This time they did not refer him to the UTH instead he was given antibiotics, ventolin drug, one crystapen injection and Ascoril cough mixture. He did stabilise. Chabula, mother to lssac, was advised to take him back to the clinic if it got worse.
“He would get the attacks in a spate of three to four months,” she said.
When he had the next attack the doctors would say it is allergies though the diagnosis was not confirmed. This led to the mother discovering that her son was allergic to eggs, bananas, avocados and fish whether fresh or dried.
“Whenever he eats any of the foods he is allergic to, his chest gets tight and he fails to breathe. Now that he is older he knows what to eat and what to avoid. He is seven years old now and will be eight in September, 2014, “she further narrates.
Chabula recalls a severe attack when her son was four years old. Issac was given some oxygen because he was failing to breath. He started by wheezing, shortness of breathe and coughing for about two days.
She took him back to Chilenje clinic where he was admitted for three days. Again the diagnosis was severe pneumonia and referred to the UTH.
After he was discharged she took him to the UTH where the doctors started their investigations though he was not admitted. A few days after he was discharged from the clinic the attack recurred and they went back.
He was kept at the hospital for the night and discharged the next morning but by evening they returned to the clinic because he was failing to breathe.
This time she says he had a thick mucus discharge whenever he coughed. He was back on oxygen for the night and early the next morning it was removed because he was failing to breathe.
The diagnosis was acute asthma attack after a number of blood tests to rule out sickle cell anemia. Every test they did turned out negative.
She moved to Ndola from Lusaka and even there he was twice admitted for Asthma attacks at the Arthur Davidson Children’s Hospital (ADH).
Doctors said it could be bronchitis and because he is young tends to wear out.
Another doctor, she narrates, suggested he takes ventolin tablets every day.
The last attack she says she took him to Kalewa Barracks clinic in Ndola where he was given an inhaler which was to be used only when he is about to have an attack.
Apart from food allergies she thinks the attacks are triggered by strong scents as well. This is why she avoids triggers like perfumes and deodorants in his presence and all kinds of air fresheners and bath soaps with strong scents. In addition, she monitors his diet as well.
At present, she says it is controlled in that the attacks are not frequent and she rarely rushes him to the hospital. Instead Chabula has continued to give him ventolin and he uses an inhaler only when the attack is about to start and it works.
The difference is that when in full attack it does not work and he goes in respiratory distress.
In that case, a dose of aminophylline is administered where he is given a shot in a vein on the arm every 10 minutes even though he complains that he has headaches afterwards and he vomits”.
Chabula does not give his son antibiotics because she thinks he had far too much of them when he was younger.
“l also  ensure that he wears warm clothing as too much will trigger an attack and less too will trigger an attack so the amount of warm clothes that he wears has to be just right”, narrates Chabula.
Dr. Marsden says “Although there is no cure for Asthma, it can be controlled”.
It is therefore important to know the triggers and avoid them.
Chabula’s advice to the recipients is to use controller medication for chronic symptoms adding that inhaled medication is the way to go.
Reducing patient exposure to triggers improves Asthma control and reduces medication need.
Food allergens must be avoided only if it is clearly demonstrated to cause exacerbations. In children, bacterial sinusitis must be treated with antibiotics.
It is important she advises that in the home for the removal of cockroaches to seal havens, reduce food particles, use cockroach killers and control dampness. Reduce exposure to house dust mites by using bedding encasements.
Wash bed linen twice weekly and reduce humidity level – between 30 per cent and 50 per cent relative humidity.
There must also be a reduction in the exposure to pets. People who are allergic to pets should not have them in the house. At the minimum, do not allow pets in the bedroom.
Dr Marsden’s further advice is reducing exposure to mold. Eliminating mold and the moist conditions that permit mold growth may help prevent asthma exacerbations. ZANIS