Asthma is a major cause of frequent absenteeism in school, says Adeyeye

Dr. Olufunke Olayinka Adeyeye is a Professor of Medicine and Consultant Physician at the Lagos State University College of Medicine (LASUCOM)/Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos. She is also the Director, Achieving Control of Asthma in Children in Africa (ACACIA) Study, which is funded by the National Institute for Health Research (NIHR) UK, with the aim of improving the outcome of researches on asthma in children in Africa. Recently, she organised a sensitisation programme for health workers, teachers, guardians and parents on prevention, treatment of asthma and interventions in Lagos schools. She spoke with Paul Adunwoke

What is the ACACIA study about?
The study detected asthma symptoms amongst more than 10,000 students aged 12 to 14 in 40 secondary schools in Lagos, as part of an international study, which involved lung doctors in six African countries, including Nigeria, Ghana, Malawi, South Africa, Uganda and Zimbabwe. It also attempted to find out the reasons for poor control.

More than 10,000 young people aged 12 to 14 from about 40 secondary schools in public and private completed the ACACIA breathing survey to identify those with asthma symptoms. Those with symptoms were further assessed for asthma control, current treatment, knowledge of and attitudes to asthma, barriers to achieving good control and tests of their lung functions. Focus group discussions were conducted with parents, teachers, and students, both with asthma and without asthma.

So, what were your findings during the study?
It was observed that asthma is common among young people in secondary schools and that the symptoms are poorly controlled. The knowledge of asthma and the treatment is poor amongst the students, teachers and parents. And we believe that more information about asthma should be made readily available to everyone. A theatre intervention has been developed that is addressing some of the identified barriers to good symptoms control.

In Control, a drama presentation at the programme, illustrated clearly the difficulty people suffering from asthma often go through. The drama highlighted the struggles of Durojaye, a teenage girl, who is asthmatic and was the only child of her parent. She has passion for playing football, but her medical condition seems to be an impediment in the realisation of this dream. The situation starts making her feel disconnected from life’s reality. Things get worse, when her parents attempt to talk her into stopping sport. Durojaye’s struggles with the ailment gradually starts manifesting into a complex behavioural, which was leading into an aggressive disposition to everything and everyone, including her parents, teammates and classmates.

The drama, evocative and deeply emotional, teaches us that though, asthma is a lifelong condition, most people with the condition can and do go on to live very active and productive lives. The key is to properly monitor and manage the condition.

The ACACIA team in Nigeria is deeply appreciated for its support in employing the power and magic of theatre to intervene in every critical medical and social issue, such as the control and management of asthma in young people.

Also, the strategy of engaging in forum discussions after each performance has been a remarkable and effective feedback for the entire exercise.

I believe that the idea of seeking partnership for theatrical intervention in the execution of the ACACIA research has not only been productive, but also impactful and fulfilling. I feel confident, therefore, to recommend many more of this kind of interdisciplinary academic and research collaboration, particularly with the applied theatre strategy.

How would you define asthma?
Asthma is a chronic respiratory condition in which the airways are inflamed. The muscles of the airways contract and the linings of the airway are twitchy, swollen and the lumen becomes smaller with limitation to airflow.

Asthma affects approximately 10 to 13 per cent of people in the age 13 to 14 in Nigeria. It is the most common chronic respiratory disease in young people with increasing prevalence. It is a major cause of frequent absenteeism from schools in Nigeria, increased use of health case services and limitation of physical activities. Asthma symptoms may impact negatively on emotional and psychological well-being of suffers.

Symptoms may occur or get worse while in school, with teachers and peers as the only support for the individual.

What are the causes of asthma?
Asthma results from a complex interaction between genetics and environment. Some types of asthma are inherited, some run in families, where some members have what is called atopy. This includes itchy eyes, recurrent running nose and some skin disease. This is called atopic dermatitis. Interaction with the environment leads to the development of symptoms. Such environmental factors include air pollution, both indoor and outdoor, dust mite, cockroaches allergen. In the younger age, more males are affected compared to females. But after age 14, more females are affected. Obesity also increases the likelihood of developing asthma.

Exposure to certain triggers can lead to development of symptoms in those that are already predisposed.

What are the signs and symptoms of asthma?
Chronic cough, particularly at night, episodic breathlessness, chest tightness and wheezy sounds while breathing are common symptoms. These may be associated with specific triggers, such as exposure to dust and exercise, among others. Some patients may complain of cold that frequently become chesty.

How can asthma be prevented?
It has no cure, but there are steps one can take to reduce chances of developing symptoms. This include avoidance of triggers, not smoking, avoiding dirty rugs in home, regularly washing curtains and bedding, cleaning surface with damp cloths, sanitisers and avoiding dusty areas. It is also imperative to regularly change air filters of air conditioners and clean fans, among other measures.

What is the possible treatment?
Total control of asthma involves both patient and healthcare partnership. Treatment of an asthmatic is not done only with medication. There must also be good and continuous education about the disease, the long-term nature and the need for the sufferer to take charge. He or she needs to know about triggers, dust, cold, changes in weather, exercise and emotional issues, which can all increase the symptoms.

Patients should also avoid some drugs, for instance, non-steroidal anti-inflammatory drugs for pain relief and B blockers, among others.

Drug treatment includes reliever medications and preventer medications. The preventer medications are those that the patients must use every day, whether or not they have any symptoms, while the reliever medications are used only when they have symptoms to ameliorate them. Unfortunately in our environment, many asthma sufferers are undertreated and they suffer immense discomfort, hospitalisation, absenteeism from work and school, with even the risk of death from a severe attack, just because they are not taking preventer medications.

What is your advice?
Asthma is common. However, sufferers can have good quality life. They can be productive and be symptom-free. They need to partner their doctors to achieve total control. It is not a thing to be ashamed of. An asthmatic will need clean environment, understand his/her triggers and avoid them. He/she will need to have daily preventer medications and reliever medications to be used when necessary. Asthma need not limit anyone’s aspiration, with total control.
There is need for more awareness about asthma. Globally, it is estimated that 250,000 people die yearly from the disease, due to ignorance of the ailment.

Do many persons have access to asthma treatment?
Very few patients have access to asthma treatment. Drugs for managing asthma are very expensive in Nigeria. There is limited access to asthma medication for the majority of asthma patients that are poor.

What is the role of government in reducing asthma cases in Nigeria?
Government needs to help, so that cases can be diagnosed early and treatment commences. Government should partner pharmaceutical companies to provide low cost medicine for asthma sufferers.