Treatment Strategies: Reshaping the Concept of Asthma Management

By Awa Sowe 


Asthma is a chronic (long-term) condition that affects the airways in the lungs. The airways are tubes that carry air in and out of your lungs. If you have asthma, the airways can become inflamed and narrowed at times. This makes it harder for air to flow out of your airways when you breathe out. 
About 1 in 13 people in the Africa has asthma, according to the Centers for Disease Control and Prevention It affects people of all ages and often starts during childhood. Certain things can set off or worsen asthma symptoms, such as pollen, exercise, viral infections, or cold air. These are called asthma triggers. When symptoms get worse, it is called an asthma attack.
There is no cure for asthma, but treatment and an asthma action plan can help you manage it. The plan may include monitoring, avoiding triggers, and using medicines.
According to World Health Organization(WHO) Asthma is a major non-communicable disease (NCD), affecting both children and adults, and is the most common chronic disease among children.Inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which can be any combination of cough, wheeze, and shortness of breath and chest tightness.
Asthma affected an estimated 262 million people in 2019 and caused 455 000 deaths.Inhaled medication can control asthma symptoms and allow people with asthma to live a normal, active life. Avoiding asthma triggers can also help to reduce asthma symptoms. Most asthma-related deaths occur in low- and lower-middle-income countries, where under-diagnosis and under-treatment is a challenge.
Mrs Sainabou Njie Cham is Senior Nurse at Kanifing Hospital. In this interview, she affirmed that asthma is a long-term condition affecting children and adults. She explained that the air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, shortness of breath and chest tightness.
 “These symptoms are intermittent and are often worse at night or during exercise. She went on to explained that, Other common triggers can make asthma symptoms worse. Triggers vary from person to person, but can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps and perfume.
Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries. He added that People with under-treated asthma can suffer sleep disturbance, tiredness during the day, and poor concentration. Asthma sufferers and their families may miss school and work, with financial impact on the family and wider community.
“If symptoms are severe, people with asthma may need to receive emergency health care and they may be admitted to hospital for treatment and monitoring. In the most severe cases, asthma can lead to death,” she noted. 
On the cases, Mrs Cham mentioned that many factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause.Asthma is more likely if other family members also have asthma – particularly a close relative, such as a parent or sibling, Asthma is more likely in people who have other allergic conditions, such as eczema and rhinitis (hay fever).Urbanization is associated with increased asthma prevalence, probably due to multiple lifestyle factors.Events in early life affect the developing lungs and can increase the risk of asthma. These include low birth weight, prematurity, exposure to tobacco smoke and other sources of air pollution, as well as viral respiratory infections
Exposure to a range of environmental allergens and irritants are also thought to increase the risk of asthma, including indoor and outdoor air pollution, house dust mites, moulds, and occupational exposure to chemicals, fumes or dust.Children and adults who are overweight or obese are at a greater risk of asthma.
According to Cham, Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life. There are two main types of inhaler, bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; 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.
In addition, she added that people with asthma may need to use their inhalers every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available. Adding that, it can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. 
Using a spacer device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. Mrs Cham added that a spacer is a plastic container with a mouthpiece or mask at one end and a hole for the inhaler in the other. A homemade spacer, made from a 500ml plastic bottle, can be as effective as a commercially manufactured inhaler. 
“Access to inhalers is a problem in many countries. In 2021, bronchodilators were available in public primary health care facilities in half of low- and low-middle income countries, and steroid inhalers available in one third”.  she noted 
She also highlighted that people with asthma and their families need education to understand more about their asthma, their treatment, triggers to avoid, and how to manage their symptoms at home. It is also important to raise community awareness to reduce the myths and stigma associated with asthma in some settings.
An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. Cham explained that, these attack happens in the body’s airways, which are the paths that carry air to the lungs. 
“As the air moves through the lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in the lungs swell and the airways shrink Less air gets in and out of the lungs, and mucous that your body makes clogs up the airways”. She narrated 
An asthma attack can happen when you are exposed to “asthma triggers.” Ones asthma triggers can be very different from someone else’s asthma triggers. She added that, one needs to Know his/her triggers and learn how to avoid them. 
“Watch out for an attack when you can’t avoid your triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, smoke from burning wood or grass, and infections like flu.” she explained 
In conclusion, she said one can control his/her asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following doctor’s advice. When asthma is control, you will not have symptoms such as wheezing or coughing,you will sleep better,you won’t miss work or school,you can take part in all physical activities, andyou won’t have to often go to the hospital.
Haddy Jagne, a season banker at Eco-Bank Gambia said she had asthma since childhood, and for years, she needed steroids to control it. “I began getting biologics about 18 months ago, and it’s been just wonderful,” she said. 
She went on: “Before, when I was taking steroids, I would occasionally have breathing problems and had to rush to the hospital”.
Ms Jagne urged people to go for regularly check-ups for early detection and to go through the treatment processes.  
Asthma is a lifelong condition, but symptoms can be manage by avoiding asthma triggers and taking medications consistently, quick-relief medicines to treat immediate symptoms as well as long-term control medicines to keep your asthma in check.