A smoggy Saturday of October – my toddler gasping for breath amidst intermittent anguished cries of pain and bouts of coughing, lay listlessly in my arms, as I desperately tried to locate a doctor in the city I was visiting during the Diwali break. I was losing frantic minutes as each doctor I tried to locate was out of station – till at last I found one who said that my little one was in such distress that he needs immediate hospitalisation. As I was unwillingly ushered out of the emergency room, my heart heavy and tears misting my vision with the feeble calls of my son reaching my ears, the nurses pricked his tiny hands to run the intravenous. My baby’s face contorted with pain – and I could just watch helplessly beyond the glass barrier as his tiny frame shuddered with breathlessness. It was then that Rahul was detected with childhood asthma.
Avoiding the triggers is what Dr. Kanwar advices, pointing towards mosquito repellants as a common household irritant that escapes notice most of the times. “I am not saying that mosquito coils and vaporizers should be banned – it does not affect everybody, but at least a warning on the products should be inserted for the benefit of asthmatic children”, he declares.
Dr Anil Kanwar, MD, Pediatrics, Geetanjali Hospital, New Delhi
Asthma is the leading serious chronic illness of children all over the world and a prime cause of hospitalisation among children under the age of 15. In Delhi itself doctors have seen several fold rise in children with asthmatic afflictions, with monthly cases per doctor ranging from 400 to 1200 during change of season, as opposed to perhaps 30 odd cases per month, twenty years ago. In other cities too incidence of childhood asthma has shown a manifold leap. A well established pediatrician, Dr A Kundu, Salt lake, Kolkata, has about 200 youngsters reporting the illness every month. But, compared to Bangalore, the asthma capital of India, this is three hundred short, claims Dr Kundu. Organising frequent workshops with the assistance of drug manufacturers such as Cipla, Dr Kundu feels that parental education is vital in combatting the malaise.
Even though asthma supposedly cannot be cured, doctors prescribe control mechanisms that work through developing an understanding of how asthma happens. Asthma is an inflammatory condition of the bronchial airways. This inflammation, produced by allergy, viral respiratory infections and airborne irritants among others, causes the normal function of the airways to become over reactive, thus producing increased mucus, mucosal swelling and muscle contraction. These changes produce airway obstruction, chest tightness, coughing and wheezing. Common symptoms include coughing (constant or intermittent), wheezing or whistling sounds audible when a child exhales, and shortness of breath or rapid breathing and any child who has frequent coughing or respiratory infections (pneumonia or bronchitis) should be evaluated for asthma. Recurrent night cough is common, as asthma is often worse at night. Infants who have trouble feeding or who grunt during suckling may have asthma.
“It is advisable to enhance the immunity of the child by avoiding indiscriminate use of allopathic medicines even in the mildest of cases. In fact alternative therapies boost the immune system of the child, assisting the youngster in fighting a lifelong dependency on inhalers. Also, outdoor play and home cooked natural food reduces the allergic disposition of most asthmatic children” asserts Dr K Banerjee
Dr Kalyan Banerjee, MD, Chittaranjan Park, New Delhi
What then has led to this unprecedented rise in asthmatic afflictions? Doctors claim that not only rising pollution in cities but unhealthy diet, lack of exercise, consumption of aerated beverages, use of cosmetic agents, additives in food and weather anomalies, result of the so called climate change has added to the problem of childhood asthma. Every child with a smallest predisposition to allergy develops asthma in such conditions.
Medical books espouse that episodes of asthma are triggered by a stimulus such as respiratory infections, allergy to pollen, mould, particular food, animals, etc., irritants – cigarette smoke, exhaust fumes, strong odours, aerosol sprays, paint fumes etc., and cold or humid weather. But, most of such stimuli are ubiquitously present. Inhibiting a child’s growing interest cannot be conducive for his intellect, however vital it may be for his health. Dr Anil Kanwar, practising pediatrician at the Geetanjali Hospital, Delhi, says “It is important that the child engages in normal activities that his age demands. We recommend an inhaled treatment through bronchodilators and the new side effect free steroids that are efficient even in minute doses. The MDI inhalers before strenuous activity can prevent an attack.” Dr Kalyan Banerjee, a reputed homeopath of a charitable clinic at Chittaranjan Park, Delhi, however disagrees with the line of treatment. “I strongly feel that bronchodilators and steroids are extremely unsafe and its prolonged use can lead to a gamut of health problems. They suppress the body’s natural immune response and their continued usage definitely affects the overall growth process of the child. They should be used with caution only in the rarest and severest of emergencies.” Dr Banerjee also points towards “over medication – particularly cough syrups, inhalation of vaporising gels, use of anti allergics, over dosage of the polio vaccine in children with asthmatic conditions which are responsible for maintaining, aggravating or initiating asthmatic complaints, in many cases.”
What is most interesting though is the rural urban differential in the incidence of the affliction. A farmer’s child is less likely to turn asthmatic as compared to a white collared employee living in the city. And no – it is not related to urban pollution. As Dr Kanwar puts it “the cleaner the home environment, the more trouble we are getting into.”
Research over a ten year period suggests that the incidence of asthma in children are lower in rural counterparts due to the presence of certain organisms, bacteria and fungal spores that are present in the soil. These organisms seem to offer an immunity shield to the child by allowing the body’s immune system to identify harmless allergens so that it doesn’t rush into an allergic overdrive with every exposure. Although the linkages are yet to be conclusively proved, it is almost certain that rural children enjoy benefits that do not accrue to their city bred counterparts. Parents today have turned into hygiene freaks with every conceivable detergent, cleaning agent and antiseptics fighting for space in the family closet. The child, confined within the four walls of this sparkling home find it difficult to build up the immunity shield. Dr Banerjee and his team of assisting homeopaths, Dr P Datta and Dr (Mrs.) M Sethi, also believe that regular exposure to the natural environment and mud play helps in developing immunity against allergens. “The immune system learns to identify allergens on initial exposure and is only then conditioned to respond appropriately,” reiterates Dr Banerjee. Dr Kanwar however indicates that cases of dust mite and smoke induced asthma are fairly common in rural India, but in most cases they are precipitated among women largely confined to indoor activity.
Packaged and processed foods, rarely find shelf space in rural India. Doctors confirm that the presence of additives, preservatives and high sodium content in the food can adversely affect the child’s immune system. “Urban India’s fast track, increasingly westernised lifestyle, with both parents working, make it easier to pick out ready to eat solutions over the counter. Although time and cost effective, long term benefits accrued are fewer – with obesity being the other big problem” confirms Dr Kundu. Rural incidence of childhood asthma is perhaps lower than the urban precisely because its dependence on packaged food is minimal.
No doubts allergic reactions run through the family and an asthmatic child will continue to live with an allergic predisposition, but childhood asthma does not necessary develop into a full fledged asthma in adulthood. “A lot of children, about seventy to eighty percent, outgrow the symptoms as they mature and the body begins to produce steroid based hormones”, adds Dr Kanwar.
What then are guidelines for the parents of an asthmatic child? Dr Kundu advises parental awareness as the first step to cure and prevention of asthmatic episodes in a child. Preventive medication is still at an experimental stage asserts Dr Kanwar but new chemicals called Leukotrines have been identified in the body that have a role to play in allergies. Thus Leukotri inhibitors seem to be a fairly safe, effective and steroid sparing programme. Opposed to this approach, Dr Banerjee urges parents to refrain from the injudicious and indiscriminate use of allopathic medicines for asthmatic children. “This causes life long drug dependence, in even the mildest of cases. Homeopathy on the other hand provides a safe and effective treatment for the management and permanent cure of asthma, which no amount of allopathic medication can provide,” adds the doctor.