It was difficult for me to live well with asthma. I have always been going to hospital due to asthma attacks even when I use my drugs regularly. But I got relief from asthma attacks when I visited Obafemi Awolowo University Health Centre, Ile-Ife, Osun State, where a consultant family physician educated me on the disease and the best way to use inhaler,” says an asthma outpatient at the Obafemi Awolowo University Teaching Hospital (OAUTH), Chidimma Agwu. Chidimma is one of the 15million Nigerians suffering from asthma, who spend a substantial part of their income on drugs and hospitals bills.
She said: “I have not had any attack that would require me to be rushed to the hospital. I think the cost of asthma drugs should also be reduced to make it affordable to all. The inhaler costs about N4, 000.
Government could make it free for the asthmatics. If we are not paid salary on time, it usually affects me.” In another development, 35-year-old Segun Adebayo, an asthma patient said: “Living with asthma might not be trying but one wouldn’t want to experience its attacks.
You can imagine yourself being pushed into a swimming pool when you do not know how to swim. You can imagine yourself gasping for air, being choked under the water. This will tell you a bit of what it takes to survive an asthma attack.
“To some people, it is more severe and any form of carelessness will be fatal. Inhaler has a way of relaxing the already risen nerves or rather growth in the airways. Asthma has rules that you must obey if you want to live without crises. Some asthma patients smoke cigarette, which is very wrong and against the rules.
“You are meant to keep away from stuffy areas and from smoke. On one occasion that I violated the rules, going to kitchen to fry plantain with red oil, I almost passed out, if not for my friend that helped out. One day, I came back from school, and I was very hungry.
I had travelled and returned with unripe plantain, which eventually got ripe in my house. “Instead of me getting groundnut oil to fry the plantain, I used red oil. I was choked. I couldn’t breathe. I was almost gone, gasping for air. That was a very bad encounter that never repeated itself.
I eventually used my inhaler after I have been pulled out of the kitchen, coughing. That was too careless of me.”
Recounting her experiences also, a mother of four, Mrs. Gladyce Osondu, a caterer, said when she was diagnosed with asthma, she rejected the result and said she would not succumb to the burden of carrying inhaler about. She said: “In one instance, I had been having fever and cough but it got to a point that my husband said I should go for a medical test to determine what the cause of the fever was.
To my greatest surprise, I was diagnosed with asthma, the result, which I rejected. I took to prayers, telling God that there was no trace of asthma in my blood line and I can’t develop one. “I refused to go to hospital or even use inhaler as recommended. I was praying against it because I can’t imagine myself carrying inhaler up and down and people will be sympathising with me.
One day, I was in the house with my children and the attack, which almost claimed my life, came. I couldn’t breathe; I was restless and was losing strength. My children started praying for me and had to call my husband.
“Suddenly, my husband came back and saw what was happening and left to get an inhaler and that settled the matter. But still, when I recovered, I refused to take the inhaler, I said I shouldn’t carry asthma burden and God did it for me.
Today, I do not have asthma symptoms anymore. I do not use inhaler, and I am completely healed. “But then, if not that God is by my side, such attack would have ended my life. Asthma is not a problem when you obey the rules, the doctors told me but I paid deaf ears to that advice. I still bake cakes and other pastries for my clients. I still cook and bake in my kitchen.
Asthma does not have cure, rather control and that is why I resisted it. It was by the grace of God that I came through.”
Of course, the case of the late popular politician, the proponent of ‘political arithmetic,’ Dr. Chuba Okadigbo, Onyi of Onyi, is still on the minds of many Nigerians. He suffered the same fate of suffocation and choking, when he was tear-gassed with other of his party members during one of their electioneering campaigns.
The gas affected his breathing because he was asthmatic, an incident that many said, led to his death.
Asthma will grow by over 100m by 2025
Asthma has been described as one of the most common chronic lung diseases affecting approximately 400 million people worldwide, while about 15million Nigerians are currently living with it.
With increasing urbanisation and adoption of western lifestyle, it is projected that developing countries may have rising incidences of asthma. According to the Nigerian Thoracic Society (NTS), the number of people with asthma will grow by over 100 million by 2025 in the absence of spirited effort to prevent the burden globally, yet it is the most common chronic diseases in children.
NTS, an umbrella body of all professionals involved in respiratory care, which is committed to regular and continuous update of its members and health workers in management of airways diseases including asthma, said a lot of patients with asthma have died due to usage of alternative therapies that have not been tried.
The Chief Medical Director, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State and President, Nigerian Thoracic Society, Prof. Peters Etete, said asthma is a heterogeneous disease with interplay of the nature and nurture, which is typically characterised by recurring respiratory symptoms such as coughing, wheezing, shortness of breath and chest tightening; the symptoms are variable and can fluctuate for each individual over time. Vitamin ‘D’ deficiency and cigarette smoking during pregnancy lead to asthma in children
According to Etete, several studies have also shown that the environment can have a huge impact on asthma exacerbations, whether from cigarette smoke or pollution within the atmosphere. Similarly, climate change and air pollution have been linked with increasing asthma incidence and exacerbations. Also, low level of maternal Vitamin D, during pregnancy has been linked to asthma in children, while more Vitamin ‘D’ intake has been shown to control symptoms of severe asthma.”
Sequel to these discoveries, the Global Initiative for Asthma (GINA) has decided to institute and organise the World Asthma Day (WAD), an annual event to improve asthma awareness and care around the world. The event, marked yearly since 1998, takes place every first Tuesday in the month of May.
“You Can Control Your Asthma,” being the theme of the concluded WAD, underscores the need for strong patient education that though asthma may not be cured, it can be controlled. Meanwhile, despite the availability of different asthma drugs, a significant number of asthma patients are still limited with their asthma drugs.
While a sizeable number still die from the disease, an estimated 75 per cent of hospital admissions for asthma and 90 per cent of the deaths are avoidable, according to studies. “Nigeria has lost many gifted and illustrious sons and daughters prematurely due to asthma. That underscores the theme of the WAD 2016, ‘You can control your asthma.’ More than 75 per cent of asthmatics do not achieve control and the underlying reason is inadequate education,” Etete added.
A Consultant Physician/Pulmonologist at Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Secretary General, NTS, Dr. Olufemi Adewole, said: “As we have observed, physicians and health workers’ continuing education also plays a significant role in enhancing control.
The Society has equally been involved in community mobilisation and public education on various chest diseases including asthma, emphasising the need for optimal asthma control. “We are also involved in providing continuing medical education on asthma to health care practitioners in different parts of Nigeria.
With increasing urbanisation and uptake of western lifestyle, it is projected that developing countries may have rising incidence of asthma. Patient education should also focus on the appropriate use of controller medications and discourage injudicious use of relievers, which are often abused.”
He continued: “The aim is to access asthma control rather than overreliance on symptoms alone for which most patients with asthma have poor sensitivity of their symptoms. We use this medium to encourage all patients and relatives of individuals with cough and dyspnoea, noisy breathing, and breathlessness that have been recurrent, to report to the nearest health facility for necessary tests. We appreciate our partners and collaborators in this task of ensuring healthy living for all, especially those with lung diseases.”
Ways to prevent asthma and monitor severe attacks
However, Chief Examiner, Faculty of Internal Medicine, West African College of Physicians and Consultant Chest Physician (OAUTH), Prof. Greg Erhabor, noted that severe asthma attack is fatal.
He said chronic inflammation causes an associated increase in airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.
According to him, maternal smoking during pregnancy, widespread use of antibiotics, western diet, parental history of asthma and sensitisation allergies are risk factors, which in most cases, lead to asthma in the newborn but will be prevented if there is change in lifestyle. He explained: “These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.
Severe attacks are common causes of death from asthma and one of the major problems is that, those, who are asthmatic, are not able to recognise the seriousness of their attacks.
“There are a number of pointers that would help in determining whether an attack is severe or not. If these pointers are well understood and monitored by asthmatic patients, less fatality would be recorded. They need to watch out, if there is an increased frequency of night attacks, that is, waking up more than once a night because of wheeze, cough or difficulty in breathing.
“Again, asthma attack is visible when there is an increasing limitation to day-today activities, such as climbing stairs, cooking and other household chores; increased dependent on bronchodilators – drugs that open the airways. For instance, using inhaler, between four and six times a day is a sign of a severe attack.
Another aspect to watch out for is the present of fever, infection of the throat, sinuses and lungs, which may trigger a severe attack. Deterioration of peak flow reading and bluish appearance of the tongue, lips and finger tips are also to be observed.”
