One Size Does Not Fit All: Personalized Asthma Treatment for Children and Adults
Case study 1
Five-year old Nikhil (name changed) joined school last year. He suffers frequent attacks of severe wheezing. Since he was one year, he has suffered nose block every night after going to bed. A recent problem he has to contend with is sneezing each morning, soon after waking up.
The pediatrician has prescribed two inhaler medicines for him - one for immediate relief, and another as a 3-month course to prevent frequent attacks. His parents, however, are skeptical about the use of inhalers: they want convincing answers for the following simple questions:
1. What is the illness that Nikhil suffers from?
2. Can he get addicted to inhalers as a solution to his problems?
3. Isn't the use of inhalers abnormal for such a small child?
4. Will it affect his growth in any way?
5. If started, will its use be life-long, and will it lead to some other trouble?
6. Is this illness of Nikhil common for small kids of his age?
7. Is it completely curable?
Case study 2
Renu (name changed) is a 28-year old software professional, who works long hours for a multinational company. She has had mild colds, since her college days.
Of late, she has suffered more frequent colds accompanied by attacks of wheezing; she is unable to climb even a flight of stairs without breathing difficulty.
There is no family history of any allergic disease, nor her personal history of nasal complaints, and food/drug allergy.
Her mother and maternal aunts happen to be obese. She weighs 84 Kg herself, and maybe it is significant that her symptoms became worse, as she started to gain weight. Her parents are concerned about her marriage and future.
Nikhil and Renu, the two patients described above, have one thing in common: they are among the nearly 300 million Indians, who suffer from a lung disease called asthma. Before continuing with their stories, we need to be familiar with the basics of the illness that troubles them.
Common triggers of asthma
The following are the commonly observed triggers of asthma:
• viral and other respiratory infections
• allergies caused by airborne substances such as pollen and spores, certain foods, and medicines
• chronic sinus infections
• obesity and wrong lifestyle
• acidity and gastroesophageal reflux
• hormonal imbalances
• strong smoke and odors including cigarette smoke
• rarely, vigorous exercise
Nowadays, treatment of asthma is quite focused to address the specific condition of a particular patient; the approach stems from the observation 'One Size Does Not Fit All'; hence the following classifications:
Asthma in young children
Asthmatic young children are of two broad groups: (i) those with allergy; (ii) those without allergy (who just wheeze when they get colds; usually, such children are free from asthma, as they grow older).
Asthma in older children and adults
Asthma in this age-group can be more complex, and is generally categorized on the basis of factors like the following:
• Age of onset of asthma
• Presence or absence of allergy
• Hormonal imbalance
• Sensitivity to mold (fungus)
• Allergic to Non-steroidal anti-inflammatory drugs (NSAIDs) (medications generally used for pain, inflammation, and fever)
Based on the individual profile, the degree of severity of asthma is assessed, and case-specific medication is prescribed. Also, treatment of asthma depends on allergy tests to identify associated trigger factors.
Sustained relief from asthma
The following are key factors that ensure sustained relief from asthma:
Regular follow up
Regular follow up includes making periodical visits to the doctor for review, taking prescribed medications as advised, meticulous avoidance of already identified allergens, monitoring symptoms carefully and reporting promptly to your physician unusual ones.
Correct use of inhaler devices
Inhalers are the preferred method of treating asthma at any age for two reasons: (i) the amount of total medication used this way is much smaller than the oral dose; (ii) it reaches the lungs directly.
For example, Bronchodilators like Salbutamol (brand name Asthalin) provide immediate symptomatic relief from cough and wheezing; they are available as tablet, syrup and inhaler medicine. Dosages in oral formulations are in milligrams, whereas inhaler dosages are in micrograms; it is indeed much less!
Once symptoms are under control, steroid inhalers are gradually weaned off. Care is taken to keep away from trigger factors. Asthma can thus be effectively controlled.
Use of incorrect inhalers or administration of incorrect dosage will not produce the desired relief; frequent doses beyond the recommended one will lead ultimately to addiction, and dejection.
Different inhaler and spacer devices are used for different purposes and different patients. Prescription depends on age, compliance and capacity of the patient. You should use the right ones, as per the advice of your doctor. Otherwise, it will be difficult for you to derive optimal benefit from inhaler medication, and avoid side effects.
Regular monitoring of growth of children
Growth of children should be regularly monitored during treatment of asthma triggered by allergens. Appropriate dosage of inhaled medication should actually help children grow better, and have better quality of sleep and overall daytime activity. Any deviation should be reported promptly to your doctor.
Healthy lifestyle and exercise
Maintenance of a healthy lifestyle and regular physical exercise is equally important for sustained relief from asthma.
Case study 1 (Continued)
Nikhil started using regularly the recommended inhalers and his cough stopped at last. Allergy tests revealed that he is afflicted by moderately severe allergy due to house dust mite (HDM).
It is the most common indoor allergen that infests your bedding, carpets and other such areas. It was the trigger of his night-time nose block, and sneezing in the morning. His illness is known as Untreated Allergic Rhinitis, which is a known risk factor for asthma.
Nikhil's parents were taught environmental measures to avoid exposure to house dust mite. A further course of medication including a steroid nasal spray was prescribed for his nasal symptoms.
The parents were advised a regular yearly follow up visit to his allergist until 12 years of age. Also, they were cautioned that environmental measures and the usual courses of medicine during peak humidity season might be found to be ineffective.
In such a case, they were told, 'Immunotherapy' or desensitization to HDM, would be a better option for a more lasting cure for asthma, caused by allergic reaction to house dust mite.
Case study 2 (Continued)
Renu was started initially on moderate-dose inhalers, which were gradually tapered off, as she responded well to the medication. Lab tests revealed that she had a mild deficiency of thyroid hormone.
She was referred to an endocrinologist and a nutritionist as well. She was advised to take a daily low-dose medicine for her low thyroid level. She regularly meets her nutritionist, who closely monitors the quality and quantity of her daily food intake. She opted for swimming four days a week as her preferred workout.
A year is gone, and now Renu is free of her asthma symptoms. She has gradually and steadily lost weight. She feels more energetic and gets sick less often.
Contact your doctor for all further queries and information about asthma!
Article by Dr. Meenakshi Krishnan, Allergy and Asthma Consultant at Kauvery Hospital.