Healthy lifestyles, clean environments reduce risks for patients | Sunday Observer
Asthma prevalence in Sri Lankan adults is high compared to global data

Healthy lifestyles, clean environments reduce risks for patients

2 May, 2021

In two days time, we will be observing World Asthma Day on May 4 with the focus on uncovering Asthma misconceptions and myths and a call to address them. In Sri Lanka recent studies show a surge in Asthma patients – both adults and children . Many factors have contributed to this unhealthy trend; from outdoor air pollution, caused by vehicular emissions, chemical irritants and indoor pollution such as tobacco smoke, dust mites, bedding, dusty furniture and allergies from household appliances.

The Sunday Observer spoke to Community Family Physician of the Health Ministry, Dr Ramya Premaratne to tell us how asthma is caused and how the risk factors can be reduced .


Q. Asthma is on the rise in Sri Lanka and in the world. It has been said that two studies conducted in Sri Lanka have shown a prevalence rate of about 20 %) that is comparable to western countries. Is this correct?

A. The prevalence of asthma in Sri Lankan adults is high in comparison with global data. A significant percentage of symptomatic individuals deny having asthma and are not on medication.

Q. Any recent study to validate your statement?

A. A multi-centered, cross-sectional study was conducted using an interviewer-administered translated version of the screening questionnaire of the European Community Respiratory Health Survey from June to December 2013 in 7 provinces of Sri Lanka. Subjects were selected randomly from different regions by stratified sampling. The prevalence of asthma was defined as “wheezing in the past 12 months (current wheeze)”, ‘self-reported attack of asthma in the past 12 months’ or ‘current asthma medication use’. In the total population, the prevalence of current wheeze was 23.9%

Q. Yet, in spite of Asthma being a common problem not many persons who have this condition are unaware they have it and don’t know what symptoms they should look for. What are the warning symptoms?

A. wheezing, coughing and chest tightness becoming severe and constant.

  •  being too breathless to eat, speak or sleep.
  •  breathing faster.
  •  a fast heartbeat.
  • drowsiness, confusion, exhaustion or dizziness.
  •  blue lips or fingers.
  •  fainting.

Q. What happens when you get an asthmatic attack and why?

A. During an asthma attack, the lining of the bronchial tubes swell, causing the airways to narrow and reducing the flow of air into and out of the lungs.

Q. What are the trigger factors ?

A. Sinus infections, allergies, pollen, breathing in some chemicals, and acid reflux can also trigger attacks. Physical exercise; some medicines; bad weather, such as thunderstorms or high humidity; breathing in cold, dry air; and some foods, food additives, and fragrances can also trigger an asthma attack

Q. Of these which of them are the most common in Sri Lanka?

A. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as:

  • indoor allergens (for example, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander)
  •  outdoor allergens (such as pollens)
  •  tobacco smoke chemical irritants in the workplace
  •  air pollution.

Q. Any other trigger factors?

A. They can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma: aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine).

Q. Can Asthma be inherited ? What about Rhinitis? Allergies?

A. Inherited genetic makeup predisposes you to having asthma. In fact, it’s thought that three-fifths of all asthma cases are hereditary. According to a CDC report, if a person has a parent with asthma, they are three to six times more likely to develop asthma than someone who does not have a parent with asthma.

Q. What about Rhinitis? Allergies?

A. Asthma and allergic rhinitis are related health conditions. People with allergic rhinitis have a higher chance of going on to develop asthma than people without allergic rhinitis.

Q. Asthma has been described as an occupational and non-occupational hazard. Your comments?

A. Occupational asthma from exposure to a variety of organic and inorganic substances is being increasingly recognised in recent years. Study findings reported associations between asthma and occupational exposures in work place settings where chemical spills, coir dust etc were present.. The degree of hyper reactivity decreased after removal from exposure and increased following re-exposure to the offending agents.

Q. Who are those most at risk? Children? Adults?

A. Asthma is more common in children than adults. Asthma is more common in boys than girls. Currently, there are about 6.2 million children under the age of 18 with asthma.

Q. In the case of very young children who are unable to express their discomfort in words, how do you know they are having a breathing problem?

A. Not all children have the same asthma symptoms. A child may even have different symptoms from one episode to the next. Signs and symptoms of asthma in children include: continuous coughing spells especially during play or exercise, at night, in cold air, or while laughing or crying, Less energy during play Avoiding sports or social activities, Trouble sleeping because of coughing or breathing problems, Rapid breathing, Wheezing, (a whistling sound when breathing in or out), Seesaw motions in their chest (retractions), Difficulty in breathing, Feeling weak or tired, Avoid eating, or grunting while feeding (in infants)

Q. Are there degrees in the severity of the attack of the individual?

A. Yes

Severity of asthma can be detected according to the degrees of the attacks. Daily attacks affect activities – Moderate.

Continuous limited physical activity- Severe persistent

Q. Is it a lifelong (chronic) condition?

A. Yes. Asthma is a lifelong, or chronic breathing problem. It cannot be cured, but it can be prevented and controlled.

Q. If detected early is asthma curable?

A. There’s no cure for asthma. However, it’s a highly treatable disease.

Q. How is asthma treated?

A. The right medications for you depend on a number of things such as age and symptoms. Preventive, long-term control medications reduce the swelling (inflammation) in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary.

Long-term asthma control medications, generally taken daily keep asthma under control on a day-to-day basis and make it less likely you’ll have an asthma attack. Types of long-term control medications include:

A metered-dose inhaler, which uses a small aerosol canister to push out a short burst of medication through a plastic mouthpiece. A dry powder inhaler, which releases the medicine only when you take a deep breath.

There are two main types of Inhalers used to treat asthma:

Long-term control medications such as inhaled corticosteroids are the most important medications used to keep asthma under control.

Quick-relief inhalers contain a fast-acting medication such as salbutamol.

Q. Is treatment tailored to the age and physical and mental health condition of the person?

A. Asthma management issues will vary from person to person. Tailoring can address relevant cultural, social, environmental, and psychological factors, as well as attitudes and health conditions.

Patients with severe asthma or COPD have often a suboptimal symptom control due to inadequate treatment. A better understanding of pathogenetic mechanisms, phenotypes, endotypes and the new technologies available in the fields of molecular biology and immuno genetics have made it possible to synthesize specific monoclonal antibodies virtually able to interact with any target antigen, or to open a way for new therapeutic target options.

At present, the only biologic drug availabl e in clinical practice is omalizum ab. To overcome the limits of omalizumab, t he research has focused on new monoclonal antibodies presenting higher avidity for IgE (e.g. ligelizumab and lumiximab) and ability to interact also with low affinity IgE receptor (FcRII). At present, many new biological drugs with different mechanisms of action and targets are matter of research.

It is very important to identify the asthmatic phenotype in order to select the most appropriate drug for the individual patient.

The most promising agent s are targeted against cytokines of Th2 pattern and related receptors, such as IL-2 (daclizumab) and IL-13 ( lebrikizu mab) or IL-5 in patients with hypereosinophilia (mepoliz um ab, resliz umab and benralizu mab).

Other interesting drugs have as a target TNF-or its soluble receptor (infliximab, golimumab and etanercept) or IL- 1 (canakinumab), a cytokine with an important systemic proinflammatory action. Finally, the discovery of increased levels of C5a in the airways of asthmatic patients has led to the synthesise of a specific monoclonal antibody (eculizumab).

Help should come from the identific ation of biomarkers that can guide in choosing the best treatment for the individual patient, such as IgE for omalizumab or periostin for lebrikizumab.

Keywords: Asthma, Cytokines, COPD, Inflammation, Monoclonal antibodies

Q. Can those with asthma marry, have children, work, and lead an active life?

A. Yes. With treatment, most people with asthma can live normal lives; marry have children and. lead an active life. Appropriate management of asthma can enable people to enjoy a good quality of life.

Q. Asthma is also linked to air pollution. Tell us how air pollution is linked to the recent surge in asthma in Sri Lanka and its impact on adults and children .

A. Research suggests that asthma and exposure to air pollution are linked. Air pollution contains harmful substances which can be toxic to the respiratory tract. Prenatal exposure to air pollution has been shown to increase the risk of wheezing and asthma development in children

Q. Chemicals that leak toxic poisons to the air. Can they cause asthma?

A. Yes. Many types of gases—such as Chlorine, Sulfur dioxide, Hydrogen sulfide, Nitrogen dioxide, and Ammonia—may suddenly be released during industrial accidents and may severely irritate the lungs. Gases such as chlorine and ammonia easily dissolve and immediately irritate the mouth, nose, and throat. The parts deep inside the lungs are affected only when the gas is inhaled deeply.

A common household exposure occurs when a person use household cleansers with Ammonia, that irritant gas chloramine is released. Such gases can cause inflammation of the small airways (bronchiolitis) or lead to fluid accumulation in the lungs (pulmonary oedema). Chemicals used to make paints, varnishes, adhesives, laminates are also toxic substances.

Q. Your message to readers on preventing and reducing the complications of asthma?

A. My message is a change in Lifestyle modification. This is a must to reduce the risk of asthma. In addition avoidance of triggers which I have already mentioned is a key component of improving control and preventing attacks. Smokers must remember that even inhalation of cigarette smoke (passive smoke) may trigger asthmatic attacks.

Exercise and Yoga can also improve the quality of life and symptoms in people with asthma. Finally, improving people’s knowledge about asthma is an important component of managing asthma School-based asthma self-management interventions, which attempt to improve knowledge of asthma, its triggers and the importance of regular practitioner review, may reduce hospital admissions and emergency care unit visits.