Asthma & allergies: proper treatment can help lead normal life
Dr S. Lavasa

Asthma prevalence is increasing the world over. The mortality rate has declined to some extent, though morbidity has not, in spite of wonderful scientific advances. It is possible to prevent mortality and keep the disease under control by making lifestyle comfortable provided people follow the treatment advice and avoid myths. There is nothing asthmatics can miss out, provided they keep their disease under control by scientific practices. Several children keep suffering mainly due to the myths prevalent even among doctor parents.

Many doctor couples bring their little ones to me who are on several antibiotics, cough syrups and antihistamines. Off and on they take steroids for chronic cough. Children, however, need inhalers to manage their asthma, and not antibiotics, etc.

In spite of being doctors, it is difficult to convince them. They are not ready to accept the label ASTHMA “just for chronic cough”. They are not ready to accept the everyday use of inhalers. They are not willing to accept that cough syrups are not needed, and even unnecessary vitamins, etc, are a burden on the system.

It is not surprising that after the cough disappears the parents are each day worried about stopping the inhalers. It is feared that the child will become addicted to inhalers and these are steroids. I pull out scientific literature to show to the parents that inhalers, though they were steroids, are safe even in long-term use. They would not retard growth. In fact, the disease-free state would result in better growth and development, and also proper puberty.

Parents are not ready to give their child cold water, curd, banana, rice, oranges, lime and chocolates freely. One has to again convince the parents that there is no doubt that FOOD ALLERGY can be the culprit but there is no general rule to avoid any food for all asthmatics. If at all there is doubt, tests are possible.

It is again difficult to convince them that allergy tests need not be a battery of standard tests for everyone. Which test to apply and what to test would depend upon the detailed history of the patient by a qualified doctor.

Some children are forced into advanced breathing exercises in the name of yoga, which results in exercise-induced asthma attacks. Yoga is undoubtedly beneficial for healthy people and useful for asthmatics as an adjunct to pharmacotherapy and should be done under medical supervision.

Asthma can manifest in many ways, and even chronic cough can be due to asthma. At the same time, all that wheezes may not be asthma. Therefore, expert advice is needed.

Detailed history and clinical examination by an expert clinches the diagnosis and not the blood sent to some lab for allergy tests. Once diagnosed, treatment is simple and aims at making the patient independent and have good quality of life. Inhalers are the cornerstone of asthma management. They are needed as long-term management.

The rescue inhalers are for emergencies only. Preventive inhalers are needed even when you feel you are alright. Inhalers are the state-of-the-art research molecules which do not retard growth even on long-term use. Stopping the inhaler at your own will can be harmful.

Pushing oneself into an emergency and using nebulisers again and again is really harmful. The inhaler is the surest and safest device for drug delivery into the airway, but the salts needed are different for different purposes.

The steroids in inhalers are the state-of-the-art molecules of research which give benefits without side-effects. Leukotrein inhibitors, antihistamines and mast cell stabilizers are needed only for specific situations. Every medicine is not needed by every patient.

Allergy tests are needed only for difficult asthmatics, occupational asthmatics, seasonal asthmatics where immunotherapy is planned, and also for patients in whom food allergy is suspected.

Tests are never useful if done just by sending a blood sample to a particular lab. This causes more confusion and has to be discouraged.

The obsession of avoiding dust and white food articles, etc, result in personality disorders in children besides leading to nutrition deprivation. Frequent monitoring is needed.

Parents must not be anxious to stop the inhalers their children are using. They also must not focus on stopping food based on myths for growing children. If at all food has to be avoided it must only be done after allergy to food is proved by double-blind placebo-controlled food challenge rather than just by a blood test.

It’s heartening to see children achieve full growth, puberty, excellence in academics, music and sports if they take scientific treatment for asthma. And keep away from myths.

The writer is a Chandigarh-based allergy specialist.

The importance of local anaesthesia
Dr S.M. Bose

Surgery has become a common procedure for handling medical problems. Gone are the days when operation was a dreaded procedure with a high mortality (death) and complication rates. I tell my apprehensive patients that there are more accidents and resultant deaths on the roads of Chandigarh than in all the operation theatres of the tricity and this comparison seems to give a lot of confidence and solace to patients and their worried relations.

Surgical procedures have not only become safer but are also relatively pain-free, particularly if one compares them with the past experience. The credit for this not only goes to better surgical techniques but also to safe anaesthesia and quick recovery from its after-effects.

The type of anaesthesia a patient receives depends on the procedure being performed, the physical and emotional status of the patient and also on the preference by the surgeon.

Anaesthesia can be administered mainly by three techniques: (A) General or total anaesthesia in which the patient as a whole is put to sleep.

(B) Regional anaesthesia in which the region to be operated upon is blocked to sensations.

(C) Local anaesthesia in which only the operation site is anaesthetised facilitating a pain-free surgical procedure.

We will discuss the local anaesthesia in detail. A number of techniques are available for giving local anaesthesia :

l By infiltration of a chemical agent in the concerned area, which produces loss of sensations and operation can be undertaken without causing discomfort to the patient. The commonest drug used is Lidocaine in injection form, can be diluted and used in the strength of 0.5 to 2.0 %; the effect lasts about 30 to 45 minutes.

l The addition of Adrenaline prolongs its effective time for 60 to 70 minutes; and the addition of Hyalurinase extends its area of effectiveness. Newer drugs like Etidocaine in the concentration of 8mg/Kg with Adrenaline can provide satisfactory local anaesthesia for 120 to 180 minutes.

l Ring block — A local anaesthetic agent is used in the form of a circumferential ring so that the sensations below the block are blunted. This form of anaesthesia is commonly used for fingers, although previously I have seen it being used for a limb also.

• Blockage of the nerve either for a surgical procedure or to relieve excruciating pain in an area where other methods have failed — common examples being the blockage of trigeminal ganglion in the face and coeliac axis blockage in the abdomen.
• Tumescent techniques — In this, a large amount of anaesthetic drug is used in diluted concentrations (0.05-0.1%) with Adrenaline (1:1,000,000). The anaesthetic concentration is extremely small, allowing large amounts of solution to be used without reaching toxic levels and, therefore, it is quite safe.

Childhood obesity can lay the foundation for ill health
Dr Meenal Kumar

Shikha, 4, has been a victim of persuasive and forcible feeding by her parents, who have a mindset of a myth, ‘Chubby face and abdominal tier’s are the signs of good health. Repeated intake of a parathas and pizzas followed by repeated visits to the toilet have become a full-time activity for this hapless little girl. Loss of essential micronutrients in perpetual diarrhoea has rendered her prone to loss of immunity and she often suffers from infections of various kinds. She also abhors physical activity, thus protecting her calories from burning.

This child needs urgent attention of her doctor, and her parents need counselling to change their mindset. A recent study by an NGO highlighting the excessive intake of unhealthy fats and salts by children was an eye-opener for many citizens.

Indian parents are rather obsessed with feeding their kids, whether or not the child is hungry. In fact, offering food is the only way of showing affection to young children; sweets, pizzas, eggs, nuts and so on. Fast food culture — synonymous with hamburgers, pizzas, French fries, hotdogs, rolls, etc — is pumping in high calories, fats, sugar and salt content. With the result, an epidemic of obesity is in the offing among pre-school and school-going children. Resultantly, children with lot many layers of fats have been considered as healthy and beautiful by parents but unhealthy by doctors.

By their misplaced affection, parents and relatives are pushing the vulnerable children to deadly diseases in future.

A fat child is not healthy

Fat children become anaemic as they do not get the required vitamins and iron supplements necessary for their growth. Children become lethargic and get tired easily. Green vegetables and fresh fruits become almost non-existent in their diet, causing a deficiency of macro and micro-nutrient supplements in their bodies. This decreases immunity and children become susceptible to various diseases and ailments. Deficiency in calcium makes their teeth, nails and bones brittle.

Some scientists observe that obesity may be caused by thyroid disorders. Also, obesity could contribute to thyroid problems, a vicious cycle, indeed. Obese children lead a sedentary lifestyle which causes mental stress and other emotional disturbances. Fat children feel hungry most of the time, which leads to overeating and an increase in weight.

The problems

The first problems to occur in obese children are usually emotional or psychological. Obese children often suffer from teasing by their peers. Some are harassed or discriminated against by their own family. Stereotypes abound and may lead to low self-esteem and depression. Some of the other disorders would include liver disease, early puberty or menarche, eating disorders such as anorexia and bulimia, skin infections, asthma and other respiratory problems.

The American Academy of Paediatrics in a report on lipid screening and cardiovascular health in obese children observed increased risks of diabetes mellitus, hypertension, cardiovascular disease, premature block of carotid arteries and several other health risks in later life.

What can you do?

• A health-giving, low-fat diet should be recommended to all children.
• Children at increased risk for cardiovascular problems should receive routine screening for serum lipid concentrations, viz. family history of high cholesterol, cardiovascular disease, hypertension, smokers or with diabetes mellitus.
• All children with abnormal lipid levels should receive education on diet and exercise.
• Bile acid-binding resins can reduce cholesterol levels by 10 per cent to 20 per cent, and these medications do not have systemic effects. Statins have been found to be effective in children and have also been demonstrated to reduce atherosclerosis.