Coughs and colds, every parent knows, are an integral part of childhood. So, when two-year-old Muskaan Mittal came down with a cold and fever, and started wheezing one night, her mother Parul, a Gurgaon-based software professional, was not unduly worried. However, Muskaan’s paediatrician saw things a bit differently.
Much to Parul’s consternation, Muskaan was immediately recommended nebulization, which essentially meant she was put on a breathing machine that transformed liquid medicine into a mist that could be inhaled easily. The next three days meant daily trips to the hospital, but all was well eventually.
End of the story? Not really. Four months later, Muskaan started wheezing again. Parul’s reaction was far less complacent this time. She rushed the child to the hospital, and the whole sequence was repeated. Twenty days after the second wheezing episode, the child had a third one. That was when the realization finally dawned on Parul and her husband Alok—their child had asthma.
From Chennai to Chandigarh, the Mittal family’s story, with minor variations, is probably played out in hundreds of households. According to the American Lung Association, more than 350 million people worldwide suffer from asthma, of which around 60 million are Indians. Every year, around 150,000 people around the world die.
Children appear to be particularly vulnerable, and the numbers are increasing. One Bangalore-based study that tracked children treated for asthma for 20 years, between 1979 and 1999, reported a jump from 9% in 1979 to 29.4% in 1999. Urban areas are worse than rural ones, as one 2003 study of 12,000 schoolchildren showed. Says paediatrician Shaguna Mahajan of the Gurgaon-based Shishu Clinic, “I think as much as 25-30% of schoolchildren in Delhi and the National Capital Region (NCR) are wheezing.”
Defining the condition
Studies also provide different figures, depending on their definition of asthma. The symptoms, however, range from mild coughing to breathlessness. The Global Initiative for Asthma defines it as a chronic inflammatory disorder of the airways, in which many cells and elements have roles to play. In an asthma attack, the muscles surrounding the airways become tight and the lining of passages swells, making it difficult for air to go in and out, causing coughing, wheezing (a whistling sound which emanates from the chest) or very fast breathing—these are the classic symptoms. An attack can last from minutes to days, and can become dangerous if the passage is severely restricted. Symptoms may also be worse at night or early morning—the 4am “asthma witching hour”, as some emergency room doctors call it.
While children are the worst sufferers, it can strike anyone, any time. Kanta Gulati, a 66-year-old housewife, did not care much for the cold and smoggy Delhi winters—it induced long bouts of coughing in her every year, leaving her out of breath. Only last year, however, did her doctor diagnose it as asthma.
Causes and triggers
Why does it happen? No one is really sure, although scientists across the world are trying to find out. Genetics seems to play a certain role in predisposing some people to a greater risk. If one is genetically predetermined to have asthma, it can be triggered by breathing in asthma-causing allergens, including automobile emissions, dust mites, tobacco smoke, pet dander and pollens (though pollens are, apparently, not as much of a risk factor in India as they are in the West). Respiratory infections, cold air, stress, and even too much exercise could be the triggers. This is “compounded by the junk that children eat, which exposes them to high amounts of colours, preservatives, sugars and fats”, Dr Mahajan warns.
Treatment for asthma is three-pronged. To begin with, try and avoid known allergens and respiratory irritants such as tobacco smoke or dusty places. There are two basic kinds of medication for treatment. Short-term treatments are taken at the time of the attack, to reduce symptoms. These are usually inhaled steroids with brand names such as Asthalin, Dualon and Beaudesal. They are primarily given through an inhaler to older people and through a nebulizer to the very young. The liquid medicine is put into a machine and the steam with the medication is blown in through a mouthpiece. If the symptoms occur with greater frequency, physicians prefer to put the patient on a long-term medication such as Montair (a Leukotriene inhibitor, a new class of medications for the treatment of persistent asthma) or inhaled steroids which keep air passages open and reduce the incidence of attacks.
The biggest step forward, perhaps, is in accepting that one’s child or loved one has asthma. According to Dr Mahajan, parents in India seem to have a “huge mental block” to asthma and steroids, and need much convincing. Parul Mittal agrees, “Initially, the word steroid scared me so much I would delay treating Muskaan, not realizing that I was making things more difficult.” Many turn to alternative medicines blindly, without checking whether the practitioners they’re consulting are genuine, and are often led astray by quacks in the process. Dr Mahajan says that often parents bring their children to her, saying that the children are doing well through homoeopathy, but have a “classic moon face”, the sign of steroid overuse. She warns that patients should be careful of what they are being given in the name of homoeopathic medicine.
How to control it
While there is no cure yet for the condition, asthma can be controlled. Some studies show that a healthy lifestyle—such as eating fruits and vegetables, and regular light exercise—helps in managing the disease. For the patients, medication simply becomes a routine. Kanta Gulati takes medication as required, when wheezing, to stop the attacks. This works well for her. Muskaan’s mother is vigilant about “dust, smoke, pollens and cold air”, and the child is on daily Montair, along with Seroflo. She has not had an attack in months. Laughing, playing, exploring the world around her, she continues to enjoy the innocent joys of childhood.
• Severe coughing
• Fast breathing
• Tobacco and smoke
• Vehicular emissions
• Pet dander
• Extreme cold
• Too much exercise
• Respiratory infection
HOW TO CONTROL ASTHMA
• Identify the trigger
and avoid it
• Eat health
• Follow the treatment prescribed by the doctor
(Supriya Bezbaruah contributed to this story.)
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