KOCHI:Asthma is a common long-term inflammatory disease affecting the airways of the lungs. It is characterised by reversible airflow obstruction and bronchospasm. Symptoms include wheezing, coughing, chest tightness and shortness of breath. Episodes may occur a few times a week or a few times a day depending on the severity. In 2015, 358 million people in the world suffered from asthma.
Since the construction of the Kochi Metro, a large number of people have developed cough-variant asthma, which is often mistaken by general practitioners as an infective cough. The patient takes multiple courses of antibiotics in a span of three months with no relief from a cough. Finally, after coming to a tertiary hospital, they are diagnosed with the above condition, are given inhalers and within a few days, the cough subsides.
So, how is cough-variant asthma diagnosed? Clinician has to take a careful history. Is the cough accompanied by sputum production or is it a dry irritating cough? Is the cough accompanied by breathing difficulty or symptoms of nasal congestion or sneezing? More importantly, what triggers the cough? Is it cold, dust, food stuff or any antibiotics or medications? Does the patient have wheezing (noisy breathing) at night? If the answer to the above questions is yes, then the patient is likely an Atopic (allergy prone) individual who has developed cough-variant asthma, which is a type of moderate persistent asthma.
Spirometry is the gold standard for the diagnosis of asthma. If the forced expiratory volume in the first second (FEV1) increases by more than 12 per cent and increases by more than 200 millilitres following the administration of a bronchodilator such as salbutamol, this is supportive of the diagnosis.
Asthma is classified as intermittent, mild persistent, moderate persistent or severe persistent depending on the symptom frequency, night time symptoms, FEV1 variability, and short acting beta agonist use.
According to the latest GINA guidelines 2018, Step 1 and 2 entails low dose inhaled corticosteroids (budesonide) along with short-acting beta agonists (Salbutamol) as reliever medication and leukotrine receptor antagonists like montelukast. Step 3 entails LABA (Long-acting beta-adrenoceptor agonist like salmetrol or formetrol) along with inhaled steroids. Step 4 is medium or high dose ICS plus LABA along with controller medications such as anticholinergic drug like ipratropium bromide.
Step 5 entails the addition of oral steroids also. Other latest medications include sublingual immunotherapy and monoclonal antibody like omalizumab.Apart from above measure, lifestyle modification is important for Kochiites to prevent exacerbations. First and foremost is cigarette smoking, both active and passive. It must be banned in public places including clubs. Another major villain is diesel cars, buses and autos. These vehicles must be phased out in the next five years to either CNG or electric vehicles.
The industries functioning at Irumpanam and Kalamassery must be closely watched by the Pollution Control Board. Houses must be kept clean and bed linen and curtains must be washed regularly. Two-wheeler users must use a face mask while riding the vehicle. Yoga is beneficial in asthma patient as well as regular exercise. Let us strive to reduce air pollution in Kochi. It is always the right time to address airways disease. World Asthma Day is on May 1.The views expressed by the author are his own.
Dr Joseph K Joseph, MD (Med), CCCA (Asthma Certification by PHFI), Consultant Internal Medicine, VPS Lakeshore Hospital, Kochi.