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Asthma can be effectively controlled
Migraine? Don’t get panicky, it’s manageable
Health Notes
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Asthma can be effectively controlled
Asthma poses a major health challenge in India. According to the results of the latest INSEARCH study released in 2010, the pooled prevalence of asthma across 16 different centres spread all over India accounts for about 2 per cent in adults of over 15 years of age. This would imply a rough esti-mate of over 24 million (2.4 crore) patients for a population of about 1.2 bil-lion. Considering the fact that the prevalence is generally higher in children, the overall burden is likely to be more than the estimate. The modalities of treat-ment of asthma have tremendously expanded in the last few decades. The shift from tablets and syrups to inhalation treatments was perhaps the most remarkable step that had happened in the late seventies. Although the inhalational administration of drugs such as “Datura smoking” for symptomatic relief of cough had been practised for several centuries in India, the newer methodology was rather alien and difficult. Identified with habituating drugs in the past, the technique was also considered as somewhat anti-social and unacceptable. Many different forms of ceramic and metallic inhalers had been used in Europe in the Victorian periods. The modern inhalers, however, differed from those in the past in view of their sophistication of technique and pharma-ceutical contents. Inhalation involves direct administration of vapours to the respiratory tract. Hukka, cigarette and bidi smoking also have a similar route of administration. Steam is the most common form of inhalational treatment employed as a home remedy for all coughs and colds. Asthma inhalers ensure the delivery of very fine powder or liquid particles containing the drug or drugs concerned to the disease-site, thereby promoting a local healing effect. On the other hand, the ingestion of a tablet or syrup involves a number of steps before the drugs can reach the site . In comparison to oral method, the inhalation route is rapid in action — the effect starts showing minutes. Moreover, the dose require-ment with inhalers is sever-al folds smaller, usually in micrograms (unlike the tablets, in milligrams). The side-effects of drugs with inhalers are practically nil. Primarily, it is the inhalational therapy which has been singularly respon-sible for good asthma con-trol. Frequently, the patients consider an “inhaler” as a drug, which it is not. It is only a delivery device for the drug. A large variety of devices and drugs are now available as inhalers in the market. The dosage of the drug, usually indicated by a number (100, 150, 200, 250, etc) on the label, points to the weight of the drug (in micrograms) inhaled with each puff. It is also important to know that the dose of the drug, which is actually delivered to the lungs, is even smaller (10 to 40 per cent of the puffed dose). The rest is either wasted or deposited in the mouth and throat. Asthma drugs are classified as either “relievers” or “controllers”. The reliever-inhalers are meant to provide prompt relief from symptoms, but they do little help in disease-control. On the other hand, the controllers are meant to contain the disease and provide long-lasting relief. Controllers are used for maintenance treatment as is required in the cases of hypertension, diabetes and other chronic diseases. Maintenance treatment is required for several weeks or months by patients with seasonal attacks of asthma. The others who develop symptoms more frequently without any seasonal relationship need continued treatment throughout the year. Steroids constitute the essential cornerstone of controller treatment. Stigmatised for their innumerable side-effects, the steroids are feared the most and, therefore, avoided by a large number of patients. Moreover, finding immediate symptom-relief with relievers, a patient tends to rely on them rather than on controllers. This practice is, however, risky and fraught with dangerous consequences. Deaths have been often attributed to the excessive use of reliever-agents, especially when they are used alone without the controller-drugs. Inhalational steroids are generally safe even when used for years. Minor side-effects, mostly local in the throat, are common but avoidable. Prolonged use in heavy dosages can also cause problems such as cataracts in the eyes. Heavy dosages, therefore, must be avoided, especially in the case of children. Additional drugs need to be added if asthma is severe, not properly controlled with inhalational steroids. A large number of other drugs as add-on therapy for asthma are also there. As of today, there is no drug which can substitute the use of steroid inhalers. Allergen-desensitisation for “more permanent control” is a frequently asked question. It has got a very limited place in the overall treatment plan, practically none in adult patients. The newer and innovative techniques or drugs have yet to establish their role in day-to-day-practice. Most importantly, one must learn to live normal life with asthma. Restrictions on food items, games, exercises and other activities are generally unnecessary. Reliance on controlling asthma with pharmacotherapy is advisable rather than avoiding drugs or imposing unnecessary restrictions. Fear of side-effects should not result in the avoidance of drugs which are essential for disease control. The use, however, must be rationalised and audited. We may get additional support in future. The writer is Professor & Head, Department of Pulmonary Medicine,
PGI, Chandigarh.
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Migraine? Don’t get panicky, it’s manageable
There is a varied etiology of migraine which includes reasons like dietary indiscretion, upsetting of the daily routine, suppression of biological urges, facing stressful conditions, exposure to heat and indulging in overwork, resulting in improper sleep and rest. Migraine is also attributed to a number of other factors like allergies to a particular food and smell, acidity, nutritional deficiencies and metabolic disturbances. Many women complain of migraine around the period of menstruation, the type of which usually gets cured naturally after menopause. According to the modern view, cerebral vasoconstriction and later dilation, which is triggered by any of the reasons mentioned above, is responsible for the pain and other associated symptoms of migraine. It is generally seen that the majority of patients who suffer from migraine are very sensitive, methodical and more or less have a rigid and perfectionist type of personality traits. Clinically, an attack of migraine has certain peculiar symptoms and many times its premonitory signs appear hours or days before the actual episode. Though each patient has his or her own indications of an impending attack, the actual phase of migraine is preceded by certain symptoms like difficulty in speaking, feeling of weakness and flashing of various types of lights in the visual field. Some patients become irritable, anxious or depressed as they experience heightened sensitivity to light and noise, and feel excessive thirst or craving for a particular type of food. The average duration of the exact attack of migraine varies from one or two hours to one or two days. It starts with shooting pain in the head which initially increases in intensity and then slowly wanes. Mostly this phase of migraine is accompanied by nausea, vomiting and many other physical and psychological symptoms. During the episode patients feel relief in an area which is away from fast light and is quiet and noise-free. The attack leaves the patients in varied conditions as some patients feel exhausted and sleepy whereas others feel light and active. The management and prevention of migraine largely depends on the patient’s ability to identify and mollify the exciting factor of the disease. If the reasons are dietary, it is advisable that the patient should exclude that particular food item and always opt for timely meals which are light and easily digestible. Those patients who get migraine after following an improper “dincharya” and are not getting proper rest should set their daily routine in order and avoid late night engagements. As a home remedy, taking fresh coconut water during the attack controls nausea and vomiting and replenishes the lost energy. During the attack taking a snuff of the powder of dry ginger (sonth) or vacha (Acorus calamus) lessens the intensity and duration of the episode of migraine. Similarly, tea like concoction made of tulsi, cardamom and clove also has mild analgesic and refreshing effect. Taking twice a day one to two gm of dry powder of well-known psychotropic herbs of brahmi, jatamansi and shankhpushpi in equal quantity helps control anxiety and reduce stress levels generally associated with chronic migraine. Proper treatment of migraine requires careful study not only of the pattern of the migraine and but also of the personality of the patient. The approach in selecting the medicine largely depends on these two factors. The common management of all patients of migraine is to advise them to adopt a balanced lifestyle which includes following a proper daily routine and taking up stress-busting measures like morning or evening walk, exercise and yoga, and doing regular breathing workouts like pranayam. The writer is a Ludhiana-based senior ayurvedic consultant and Guru at the Rashtriya Ayurveda Vidyapeeth.
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Health Notes
Washington: Scientists have identified the mutation that underlies a rare, inherited accelerated-aging disease and provides key insight into normal human aging. The study highlights the importance of a cellular structure called the “nuclear envelope” in the process of aging. “Aging is a very complex process which affects most biological functions of an organism but whose molecular basis remains largely unknown,” says Dr. Carlos López-Otín from the University of Oviedo in Spain. “Over the last few years, our knowledge of the molecular mechanisms underlying human aging has benefited from studies of premature-aging syndromes, such as Hutchinson-Gilford Progeria syndrome, that cause the early development of characteristics normally associated with advanced age,” he added. —
ANI
Losing a night’s rest burns 135 calories
London: US scientists have discovered that going without sleep for a night uses the same amount of energy as a two-mile walk. A study at Colorado’s Sleep and Chronobiology Laboratory found that losing a night’s rest burns 135 calories — like eating two slices of bread or drinking a glass of milk. However, sleep deprivation is not a way to lose weight. It actually means we store more energy while asleep than was thought, say researchers. The study found young adults used 7 per cent more energy when they were forced to go 40 hours without sleep. In contrast, they used up less energy in the recovery period, which included 16 hours of wakefulness, followed by eight hours’ sleep. “The amount of energy storage needed to explain the obesity epidemic is 50 calories a day, so the finding is meaningful,” the Daily Express quoted Professor Kenneth Wright as saying. —
ANI
Kids of bipolar parents more susceptible to stress
Washington: If either your mom or dad is affected by bipolar disorder then it is advisable to keep stress in check, according to a Concordia University study. The study suggests that the stress hormone ‘cortisol’ is a key player in the mood disorder and children of bipolar parents may be overly sensitive to stress. “Previous research has shown that children of parents with bipolar disorder are four times as likely to develop mood disorders as those from parents without the condition,” says Mark Ellenbogen, senior author, Canada Research Chair in Developmental Psychopathology at Concordia University. —
ANI
New tool to assess asthma-related anxiety
Washington: It has been observed that when children or adolescents with asthma and their parents become overly anxious, it may weaken their ability to cope up with the disease effectively. Researchers at the New York University School of Medicine and LaSalle University have developed a tool to assess asthma-related anxiety among paediatric patients and their parents. Jean-Marie Bruzzese, Lynne Unikel, Patrick Shrout and Rachel Klein tested their Youth Asthma-related Anxiety Scale (YAAS) and Parent Asthma-related Anxiety Scale (PAAS) on a population of adolescents and their parents. —
ANI
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Asthma remains as enig-matic as ever. Derived from the Greek verb “aazein” (to pant), the term as a medical entity was first described in Corpus Hippocraticum by Hippocrates in the pre-Biblical era. Variously described thereafter in the Christian calendar, it was mostly the 17th century and later when the disease was better understood. In spite of the extensive knowledge which has got accumulated now, the disease continues to generate anxiety and panic.
Headache is one of those very common physical problems which most of us have experienced at one or another time in our lives. If we talk about migraine, it is a different type of headache which is periodic in nature, temporal or unilateral in origin and excruciating in intensity. Mostly accompanied by symptoms like nausea, vomiting and visual disturbances, migraine is found in over 10 per cent of people who suffer from frequent headaches. Studies reveal that women are three times more likely to have migraine than men.