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Asthma still a taboo topic


Published : 29 May 2021 10:45 PM | Updated : 30 May 2021 01:23 AM

Asma Akter (not her real name) was diagnosed with asthma five years ago at the age of 39. Her doctor prescribed her corticosteroid inhaler to take the puff round the year. But she does not take it as she believes her condition is not that severe. She, however, said that every winter she suffers a lot from coughing and shortness of breath.

“Inhaler is for aged persons. My condition is not so severe like an aged person. Better, I am trying to control it in my own way by taking hot water, tea, and lemon drinks and a few tablets,” said housewife Asma, when asked why she was not taking an inhaler. Her husband is a government employee.

Asthma is a major non-communicable disease (NCD), affecting both children and adults. There is no direct known cause of the disease and no cure as well. Corticosteroid inhaler is the best available treatment option. Inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which can be any combination of cough, wheeze, shortness of breath, and chest tightness.

But there are a lot of myths and misconceptions related to the disease that affect the well-being of the patients.

“Still if a girl is diagnosed with asthma, the first thing the parents think is whether they will be able to marry her off. Even they don’t want to take life-saving corticosteroid inhalers, which is the best treatment for asthma due to stigma,” Dr Raj Datta, a medicine specialist in Dhaka, told Bangladesh Post.

“Asthma still remains a taboo subject for many. Even people are so sensitive to the Bangla word ‘hapani’ (asthma) that the moment we tell them you have ‘hapani’ they react saying that no….no….i am fine …my family do not have such problems,” Dr Datta said as the World Asthma Day celebrated on May 5 was themed on ‘uncovering asthma misconceptions’.

“They (people) think it’s a humiliating disease for them,” he said as he diagnoses a lot of asthma patients in his private chambers in and around Dhaka.

There is no recent study about the prevalence of asthma in Bangladesh. An old study of the Asthma Association of Bangladesh suggests that over 5 percent of the people suffer from asthma. Of them, 90 percent do not take modern treatment, so poorly controlled asthma remains a major problem in Bangladesh.

Dr Guy Marks, Professor of Respiratory Medicine, University of New South Wales (UNSW) Australia and President of the International Union Against Tuberculosis and Lung Disease (The Union), at a webinar attended by the journalists of the Asia-Pacific region, said one can die due to asthma.

 “The reason they die is that they don’t take regular steroid treatment. If you can take steroid treatment you are very unlikely to die due to asthma and symptoms are very likely to be well controlled,” he said.

He found that the death rate due to asthma is higher in low and middle-income countries than the rich countries, mainly for three reasons - lack of access to inhaled corticosteroids, lack of access to acute care for exacerbations and more exposure to triggers and exacerbating factors.

“There are many misconceptions about asthma. Many people will tell you what causes asthma. Every one of them proposes a cause for asthma is a misconception because there is no known cause for asthma. There is no clear cut cause for asthma,” said Dr Guy Marks.

He said people with asthma in countries with high levels of air pollution - smoke, traffic related air pollution and industry related air pollution - are quite likely to have more severe attacks and therefore have more risk of death.

He suggested thinking about asthma management from a “multi-dimensional” perspective.

Those include access to drugs, management of other problems such as people particularly older people have other conditions that complicate asthma – smoke related lung disease, obesity and underweight, and training or teaching patients how to look after their asthma perfectly.

“Asthma remains a major problem globally. There is substantial avoidable suffering and death due to asthma which we need to address,” he said, adding that the key message to the people living with asthma is that they need to take modern treatment regularly.

There are two main types of inhaler: bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; and steroids (such as beclometasone), that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death, according to the WHO.

People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.

“In Bangladesh we find patients who think inhalers are the last resort for their treatment, so they tend to hide their condition…but it is actually not correct. It is in fact the primary drug with side effects less than any other oral form of drugs,” said Dr Raj Datta, adding that doctors need to counsel patients to start inhaling steroids and adhere to it.

“We need to talk about asthma and show people that yes I am using an inhaler and I am fine to destroy the myths related to the disease,” he said.