Addressing the burden of asthma in Nigeria

Okeoghene Oghenekaro, Nigeria 
(First published in News Agency of Nigeria (NAN), Nigeria on 6th May 2013): Priscilla, a 40-year-old public servant, has been living with asthma for the last 32 years. When Priscilla was first diagnosed of asthma, her grandmother called her an ogbanje because of the way she struggling to breathe. Narrating her story, Priscilla said that growing up was not easy, as she was hospitalised on several occasions. She stressed that she had to consciously avoid cats, dust, fur and feathers, recalling that her contacts with such objects usually triggered asthma attacks.

Priscilla also recollected her harrowing experience while growing up, saying that she was usually isolated because other children avoided her like a leech, thinking that asthma was a contagious disease or some kind of epilepsy.

Besides, Temilade, a secondary school student, said that she could not participate in a lot of school activities because she was asthmatic. She noted that her attacks could be very severe, adding that her condition often scared away some of her peers, particularly whenever she started coughing uncontrollably, gasping for breath.

The two cases aptly exemplify the plight of several other asthmatic children because of the general lack of awareness about the medical condition called asthma. The Global Asthma Report 2011 says that asthma is a serious public health concern because of the fact that it is a chronic respiratory disease which affects not less than 235 million people worldwide.

Christophe Perrin, the Coordinator of Asthma Drug Facility (ADF), International Union Against Tuberculosis and Lung Disease, said that the percentage of adults suffering from asthma had increased appreciably over the years.

Perrin added that the number of children and adolescents suffering from asthma had also increased significantly because more people were now coming forward for health checks for asthma. Dr Yinka Ojugbele, a general physician, said that asthma or bronchial asthma was an allergic condition which affected people’s respiratory system.

He said that the allergy usually affected the airways of lungs, making the conduit to swell and become narrow, leading to wheezing, shortness of breath, chest tightness and coughing. Ojugbele stressed that asthma was usually triggered by certain factors such as rugs, pollens, dust, fur, food and extreme weather conditions, adding that these factors, however, varied from person to person.

``When asthmatic patients are exposed to such things, they have attacks and most of the time, these things are readily available in the house but they could be avoided,’’ he said. Ojugbele explained that there were two categories of asthma, adding that these were extrinsic and atopic asthma. Atopic asthma is common in children, while the intrinsic or non-atopic asthma usually affects adults.

According to the Global Asthma Report 2011, the less frequent causative factors are stress and certain foods, beverages or medicines, while the environmental risk factors include allergens such as dust mites, animal fur, pollen, mould and inhaled irritants like cigarette smoke, cooking fumes, vehicle exhaust fumes, cosmetics and aerosol sprays.

The report shows that the burden of asthma has been growing over the past 30 years, particularly in low- and middle-income countries, while people suffering from asthma were facing increased challenges.

Dr Regina Oladokun, a consultant pediatrician at the University College Hospital (UCH), Ibadan, said that a study indicated that about seven per cent of Nigerian children were suffering from asthma. She noted that due to the societal stigma attached to asthma, many parents often rejected asthma diagnosis for their children, even when presented with results of medical tests confirming it.

Besides, Oladokun noted that many asthma cases involving children in the country were often misdiagnosed in both private and public hospitals ``Many asthma cases are misdiagnosed even by medical practitioners as bronchitis, pneumonia and tuberculosis,’’ she added.

The consultant said that other challenges facing asthma control in Nigeria were the fact that many medical practitioners were not up-to-date in current asthma management procedures. Oladokun also noted that some medical practitioners only attended to acute asthma cases, while refusing to follow up on their patients’ repeated attacks.

Dr Olusoji Ige, the President of the UCH chapter of Nigeria Society for Asthmatics, said that majority of patients did not use inhaled corticosteroids, while others had limited access to such drugs because of the medicines were not affordable. ``The 2011 survey of selected essential asthma medicines revealed that prices of inhaled corticosteroids remained high in many countries, while only a minority of countries had the inhaled corticosteroids on their essential drug list,’’ he added.

On the management of asthma, experts note that even though the condition is not curable; it can be effectively managed with existing medicines. Perrin said that that the International Union Against Tuberculosis and Lung Disease believed that it was very important for countries to have standard guidelines for asthma management.

``The medicine procurement system needs to be functional. Proper prescription of medicines is also important to enable people to know what to use. ``We also need to train more doctors, nurses and health care workers about how to identify, diagnose asthma patients and care for them. ‘’

Perrin added that education must be provided to people as to how to use inhalers and identify asthma symptoms. He said that in managing asthma, there were two groups of medicines that were basically required. ``Most of the people require bronchodilators, which are of course very important medicine but apart from that, what the Union is really trying to push forward in as many countries as possible and also through ADF are inhaled corticosteroids.

``Inhaled corticosteroids are the medicines which would help in healing the lungs of asthma patients because asthma is all about inflammation of the lungs; inhaled corticosteroids are the key medicines that would cure this inflammation. ``However, inhaled corticosteroids are not available in desired quantities in many countries such as India, Nigeria, Kenya, Malawi and Zimbabwe, according to a study we conducted.

``We need to ensure the availability and accessibility of affordable and quality medicines for all people with asthma,’’ Perrin added. Nevertheless, Ojugbele stressed that teachers and parents had vital roles to play in managing asthmatic children. ``Most children with asthma or any other allergic disease tend to keep to themselves a lot because they see themselves as different from other children.

``It is important for their teachers and parents to encourage them; they should give such children the needed psychological and moral support,’’ he said. All the same, experts insist that the best way to prevent asthma attacks is for patients to eat balanced diets, avoid exposure to trigger factors and avoid smoking. They also stress that untreated and poorly managed asthma leads to suffering and diminished lives, also causing disabilities or even deaths.

Okeoghene Oghenekaro, Nigeria  
Citizen News Service - CNS
(First published in News Agency of Nigeria (NAN), Nigeria on 6th May 2013)