Women and the challenges of lung health

Sam Banda Jnr, Malawi 
The world on March 8 every year celebrates the International Women's Day which, originally, was known as International Working Women's Day. The focus of the day involves general celebration of respect, appreciation and love towards women for women's political and social achievements. In some countries, however, the political and human rights theme designated by the United Nations runs strong and political and social awareness of the struggles of women worldwide are brought out and examined in a hopeful manner.

The theme for this year is 'A Promise is a Promise: Time for Action to End Violence Against Women'. In Malawi, women led by President Joyce Banda, gathered at the Comesa Hall in Blantyre to commemorate the day.

Besides looking at several other challenges, this day also gives a chance to women to look at other issues affecting them. In 2004, the celebrations run under the theme Women and HIV/Aids.

Apart from HIV/Aids, women – who form the central part of the society, are also victims of lung health which is a prime area that needs to be tackled if women are to live healthier lives.

Lung Diseases

Dr Chen-Yuan Chiang, Director for Department of Lung Health and Non-Communicable Diseases (NCDs), The International Union against Tuberculosis and Lung Disease (The Union), Taiwan, says the most common lung diseases affecting women in Asia and Africa [where Malawi belongs] are lower respiratory tract infection, chronic obstructive pulmonary disease, tuberculosis, and lung cancer. Asthma, he says, is another lunch infection that commonly affects women's life.

But what are the main risk factors for lung disease in women in these settings?

"The main risk factors are smoking, passive exposure to tobacco smoke, atmospheric air pollution, indoor air pollution and poverty," says Chiang adding, that social-economic determinants certainly are associated with increased risk for lung diseases. On whether there are any different possibilities to get lung disease for those that live in rural and urban areas, Chiang says those who are living in urban areas might be more likely to get lung diseases due to higher level of air pollution in cities.

What then can be done in resource-poor settings to protect women from lung diseases related to indoor air pollution?

"Possible interventions include the following, make available alternate, cleaner types of fuel that produce less harmful smoke; Improve access to better stoves used for cooking and heating; improve the quality of the ventilation used for the stoves and provide education for behaviour change," says the NCD expert.

The factors related to indoor air pollution that increase women's risk for lung diseases such as solid fuel smoke according to Chiang are indoor air pollution which mainly comes through cooking and heating. The expert reveals that women who cook at home are more likely to be exposed to combustion of solid fuels during cooking.

Lung Cancer

Interestingly, among women, 20 percent of those who get lung cancer have never smoked. What could possibly be the cause of this?

"Passive exposure to tobacco smoke and indoor air pollution are associated with lung cancer in women," says Chiang. On what is the current situation of vulnerability to cancer or lung cancer compared to men, Chiang says there is no conclusive evidence on this point.

But what precautions do pregnant women have to take when they have lung cancer, is there complications in terms of giving birth?

"Lung cancer tends to occur in the elderly; pregnant women rarely get lung cancer," says Chiang. On whether lung cancer is common in Africa and as an expert, what has been his role in terms of working hand in hand with health personnel in Africa, Chiang says the most important activity in preventing lung cancer is tobacco control and that reducing indoor air pollution might also be helpful.

Chiang advises lung cancer patients to discuss treatment strategy with their doctors stressing that overall five year survival for patients diagnosed with lung cancer is a dismal 14 percent and thus, prevention should get very high priority. On the current lung cancer situation in Malawi especially women, oncologist Leo Masamba says there are not many cases.

"Of the patients I checked out of 11, two were women and this is also the case because many women in the country are non-smokers. Again there are not many smokers in the country as is in other countries because smoking is one of the biggest causes of lung diseases. I would also talk about asbestos, metals, genetic causes and mining," says Masamba.

He notes that mining brings forth several harmful substances and that in the northern region, where they mine uranium chances of people being affected with lung cancer are likely to be high in the next coming years.

"I think something needs to be put in place to critically protect people around the mining area otherwise chances are high. Again, in Malawi the rate of smoking is low and so the duty is to continue encouraging people not to smoke," says Masamba.


Asthma is one of the lung diseases that also affects women and according to Chiang, studies have shown that the disease was under-diagnosed and poorly managed in resource limited settings and that asthma patients, both men and women, living in developing countries have limited access to affordable inhaled corticosteroids, which are essential in asthma control.

This is a disease of the bronchial tubes (the airwaves) that characterised with wheezing, a high pitched whistling sound heard during breathing especially when breathing out. The risk factors that increase women's risk for asthma are passive exposure to tobacco smoke and indoor pollution among others, according to The Global Asthma Report 2011. Chair of the Global Asthma Network Professor Innes Asher says it is important to recognize the impact of asthma on women and ways to lessen it.

"Millions of women in the world struggle to breathe because of asthma and that affect their ability to look after their families and also to stay in paid work. The environment within the home may be a contributing factor – especially tobacco smoke, but also other pollutants like open fire cooking," Asher says.

She adds that policies need to support women having clean air to breathe in all situations. "We know that asthma can be treated by effective medicines, but many women miss out because these medicines are not available or too expensive.

"The Global Asthma Network is striving to make quality-assured essential asthma medicines available and affordable in all countries. Our vision is a world where no-one suffers from asthma," she observes.

Ministry of Health spokesperson Henry Chimbali admitted last year that at times they have not been as consistent in terms of monitoring Non-Communicable Diseases (NCDs) and that they have experienced stock-outs in terms of medication.

"The monitoring for NCD's has not been that consistent for the past years but the current system is now looking into all that. We have a specific programme on NCD where we are collecting data among others to form decisions. We have released the extent of NCD's so more money will be allocated," said Chimbali then.

The International Study of Asthma and Allergies in Childhood (ISAAC) in collaboration with the International Union Against Tuberculosis and Lung Health, has released the report that aims at dedicating to help countries including Malawi identify and address the problem of this disease.

Sam Banda Jnr, Malawi 
Citizen News Service - CNS
(First published in The Daily Times, Malawi on 21st March 2013)