Prof Okonta: Asthma can be diagnosed by the presentation that the patient or the sufferer shows. One of such presentations could be, from the definition; difficulty in breathing, chest tightness, coughing, at times, through the night, whenever there is cold. But difficulty in breathing, particularly. So, when the presentations are like these, you say that the person is clinically presenting with asthma.
Interviewer: If someone complains of these, do you run a blood test or do you get to use any kind of machine to determine whether this is asthma and not common cold, sore throat or something else?
Prof Okonta: There is one spectacular presentation most times with asthma. Apart from difficulty in breathing, you discover that when you go close to the patient the breath shows the “whistling sound” such that when the patient breathes in a quiet manner, you would just be hearing the whistling sound. This is because the openings or what you call the trachea and the capillaries within the lungs are beginning to close up and narrow down because of the mucus secretion. So when the person breathes, it makes a wheezing sound and we now know that this is not ordinary cold. This is a problem that is like asthma.
Interviewer: Pharmacist Kosi Amorha, do you want to add something to that?
Pharm Kosi: Yes, in addition to what Prof Okonta did mention, sometimes, the symptoms of asthma appear to overlap with other disease states. Doctors can differentiate these. So, in such situations what is recommended is that referrals are made and doctors carryout the appropriate diagnoses. Most times, they use the equipment called the spirometer. The spirometer is used to check the lung function. Once a patient or sufferer presents with such symptoms, we would not conclude that the patient is asthmatic till the appropriate tests are carried out and it is usually with the spirometer.
Interviewer: Thank you Kosi. Prof Okonta just told us of some symptoms of asthma and I think we would like to have more just in case some individuals … (He paused). Is it possible some individuals might present with some of the symptoms and not present others? Are there symptoms that are peculiar to specific people or cases?
Prof Ukwe: Patients display varying symptoms. Some patients may have cough, some may have just chest tightness, some may not have even cough during the day but during the night the uneasiness wakes them up. With the definitive diagnosis by the doctor, asthma is diagnosed and differentiated from other airway disease states like what we call emphysema because this airway narrowing is reversible. Once it is diagnosed and the patient starts taking (she paused) the airway narrowing is reversed. That is why it is good to diagnose it early and properly.
Interviewer: We just lost an incoming call. Feel free to call us. The number is 08151860899. If you are just joining us here, today is world asthma day and we are marking it with this interview with Prof. (Mrs) Chinwe Ukwe, Prof. Mathew Okonta of the Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, and the initiator, Pharmacist Kosi Amorha of the same Department.
Before we go into the main reason why we are here I would like to find out more about … I have been hearing symptoms of chest being tight, chest tightness. Is it … or what does it mean? Is it like wearing a trouser that is very tight (laughed) or tying a belt across your chest? How do you know there is chest tightness? Especially for people who have not experienced it before.
Prof Ukwe: Sometimes, the patient may tell you that it feels as if someone or somebody is using pin to prick him in the chest and when he wants to breathe out it is difficult and when he wants to breathe in, it is difficult (this is what is called chest tightness). For some individuals, it may occur when the individual is in the environment of what we call triggers (what triggers the asthma) and the patient may start coughing or feel uneasiness. Symptoms vary with different patients because no two patients can present similarly.
Interviewer: Thank you very much Prof Ukwe.
Alright, you just heard Prof. (Mrs) Chinwe Ukwe on that chest tightness message. So, in case you start experiencing that you have a pain in your chest as if somebody is putting a pin through your chest, it is not from the village; it might not be a spiritual attack (all laughed). Just consult your doctor. Now, let us go over to why we are here. Today is the World Asthma Day. What is the World Asthma Day all about? Prof Okonta, can you give us an insight to what the World Asthma Day is?
Prof Okonta: The World Health Organization (WHO) has the world’s health interest at heart – and for so many diseases, both communicable and non-communicable diseases. The WHO has specific days when they tell the world about disease conditions; what to do in situations when such disease conditions occur. Asthma happens to be one of those non-communicable diseases that the WHO is interested in, like we have Malaria Day, Tuberculosis Day and so many days. These are just guided towards making the people of the world, the populace, know that these disease conditions can be managed and the ways to go about it. The World Asthma Day is as a result of the initiative by Global Initiative for Asthma. It came into perspective in 1998 and from that time, the marking of the World Asthma Day on the first Tuesday of May every year came into being just like we have the Malaria day. It is a day for awareness creation.
Interviewer: Thank you very much Prof Okonta. Pharm. Kosi, would you like to add something to that?
Pharm Kosi: Asthma cuts across borders and involves asthmatics, non-asthmatics, health professionals and non-health professionals. So the World Health Organisation advocates that all of us, in collaboration with the Global Initiative for Asthma (GINA), improve asthma awareness and care every first Tuesday in May. It is not like it cannot happen on any other day but on the specified day, it simultaneously occurs in different parts of the world.
Interviewer: For those just joining us, this is Lion FM. You can call us or send in your text message on 08151860899 … and we are dealing with asthma. A lot of people are wondering about asthma. What is it? How does it come about? How do you even get the asthma? Is it inherited? We would get to that. Is this a common medical condition? Because we are used to conditions like typhoid and the rest of them … or is it something that if we get to the hospital we can get consistent cases of asthma. Is it common in this part of the world?
Prof Ukwe: Well, about 300 million people in the world have asthma and due to the climate change, we know that the incidence and prevalence of asthma has increased. In our environments, there is pollution; the lifestyle also contributes such as adopting the lifestyle of people living in the era of new technology. People living in rooms that have rugs increase the incidence and prevalence of asthma, even in children. So we find that in children, they can have the asthma mainly in males compared to the females before age ten (10). Many children who contract the asthma could be due to what we call allergies (triggers). For some, in adulthood, with proper treatments, it is cured and they don’t have it anymore. That is why the awareness is very important.
Pharm Kosi: Permit me to add some numbers. Between thirty to seventy percent (30 -70%) of children become symptom-free by adulthood.
Interviewer: Is that miraculous?
Pharm Kosi: Statistics.
Interviewer: It just goes on its own! Really?
Pharm Kosi: Yes. Asthma is a reversible obstructive airway disease. So it is reversible (comes, goes) either spontaneously or with therapy. In some cases, it persists but if the triggers are avoided – if the appropriate treatments are initiated – the patient would do very fine.
Interviewer: Thirty per cent you said?
All chorus: 30 – 70%.
Prof Okonta: Any age can suffer asthma but when it starts early in life, the tendency of resolution is there, so that it does not follow them – most of them – into old age. When it starts later in life, the tendency is that it can take the person to the grave but there are some people who have it running in their families. You see the first generation, somebody suffered asthma, parents, then the children, somebody suffers asthma then their children’s children, somebody will suffer asthma and the family tree just goes on like that. You know the Igbos ask questions about marriage.
All laugh – – –
For instance, whether they suffer from epilepsy but they rarely ask for asthma.
All laugh – – – when it becomes critical, they would start asking.
The issue is that at times, it can go through the family tree but that is not to say that totally, asthma is hereditary. At times, it can be as a result of the location where you live. If you are living in a highly polluted environment, the tendency is that the children or even the inhabitants of those locations, majority of them would begin to show symptoms of asthma.
Occupational hazards also contribute. For instance, somebody who was working in this campus, in a particular unit where they are exposed to chemicals recently died because of lung collapse. This could be as a result of the pollution they suffered at the site.
There are things that we call triggers. Triggers, just like the gun trigger, are anything that can elicit reaction. There are different kinds of triggers that can lead to asthma in a person that has the tendency of suffering asthma i.e. predisposing factors. An example is exercise. A person who has exercise-induced asthma may start wheezing after jogging when poorly controlled.
For those living in rugged houses, especially children, there might be dust mites in it. This is because the tendency is that the rug is not properly kept neat. There could be dust coming out of it and children, you know, are always very close to the earth. So, dust can be a predisposing factor.
People work in poultries and animal houses may be exposed to furs, danders and feathers of poultry birds. These things can elicit asthma. Some asthma patients may have perfumes or chemicals trigger an attack. There are perfumes that could be worn now such that when the person comes into the place, the person would feel uneasy.
Smoking of cigarette could be an asthma trigger. Passive smokers, at times, suffer as much as even active smokers. Children that are born to families where their parents, particularly where their fathers smoke within the house, may have a higher asthma predisposition. Then, there is also the issue of drugs. There are some drugs that are not favourable to people that are asthmatic or people that are predisposed to asthma and such drugs, if you take them, the tendency is that if you had asthma or you are having asthma, then the episode can start all over. These drugs can be prescribed. They can be what you buy over the counter (OTC). You know in Nigeria, we don’t have prescribed drugs anymore because you walk up to any drug shop and you order anything you want to order and so many people do not ask questions even when they are asthmatics. You just see them coming down with it because they went across and they bought aspirin or they bought ibuprofen or they bought any of these OTC drugs and even some antibiotics, so that it is always expedient that asthma sufferers should always seek advice. Advice from the doctor; advice from pharmacists; advice from nurses, especially nurses that have tendencies towards asthma management.
Pharm Kosi: In addition to that, I would advise that when asthmatic patients walk into a community pharmacy, for instance, they should always tell their pharmacists that they have asthma. You know many times, we believe that health professionals know it all but it is very far from the truth. We can’t actually see it on your foreheads. So, it is very important that you tell your pharmacists . . . every health professional, that you are asthmatic, if you are. It makes the appropriate medications to be recommended or dispensed. When we walk into a community pharmacy to purchase medicines, whether OTC medicines or to refill our prescription-only medicines, it is important that we are a little patient because sometimes a couple of us walk in and we are like: “Ah! Don’t worry. It is in the leaflet. I would read it.” Well, the information from the pharmacist could be a reminder or reinforcement. So, in as much as we can read – in as much as we are literate – it is also important that we learn more because no one knows it all. Always listen to your health professional.
Prof Ukwe: Talking more on the triggers. It is not always drugs, it can also be food. Yes, eggs. Some people, especially children that are allergic, when they take eggs (especially when it is fried) start having bumps. Why do these individuals have these bumps? It is because the airways, the trachea is hypersensitive. You can have two children in the house, one takes eggs and nothing happens while the second takes eggs, and it happens. Sometimes, it could be flour, it could be bread, it could be bread that has mould, and it could be flowers in the home or around the house. So, once these happens, it is important to identify these triggers and move away from it and document so that when the patient is taken to the doctor, he would say, I took this and I had this problem. It would help in the management.
Pharm Kosi: Another common asthma trigger could be emotions. Yes, emotions. Sometimes, even laughter could trigger an asthma attack. Laughter! Strong emotion!
Interviewer: So like Madrid is playing a game tonight and they score them like two…
Pharm Kosi: Oh! Yes
Prof Okonta: Someone who is asthmatic should not be so excited. Sorry to say that. If you are so excited, watch yourself. Otherwise, before you go back to watch your blue and red, what do you call it?
Interviewer: Manchester are the reds
Prof Okonta: Alright, your Man U, make sure you are with your inhaler or you have taken some of your medications, at least to stabilize you. Even in bereavement. Those people who are asthmatic suffer worse asthmatic attacks when they are bereaved – when they are very excited or when they are depressed. Any of these emotional shifts can always lead them to having asthmatic attacks.
Interviewer: So, you sport lovers, you have heard that Prof Okonta says that if you are going to watch the Chelsea match especially if Diego Costa is playing, please go ahead and carry your inhaler, in case something happens on the pitch.
All chuckle …
Pharm Kosi: But if a patient is well controlled, it is important we add that, the patient could still exercise and not have an asthma attack. The patient could be very happy or sad and not have an asthma attack. A well-controlled asthma patient could still enjoy his Chelsea, Arsenal or Man U match or actively participate in sports.
Interviewer: We have a question from Tochukwu (texting from Aku Road) asking whether a couple can pass asthma unto their child.
Musical break with asthma jingles.
Pharm Kosi: Thank you very much Tochukwu from Aku road. That’s a very good question. I would like us to know that asthma is not a communicable disease. Asthma is not an illness you can transmit to someone else like tuberculosis. However, you are more likely to develop asthma if you have a family history but it is not a 100% assurance. It is not a certainty that once you have parents, maybe one or both, having asthma, then all the children would be asthmatic. Be that as it may, if you have a family history of seasonal allergies, eczema or other allergies, you are more likely to have asthma but it still does not mean that you are definitely going to have asthma. For instance, if you have a mother who smokes the child may be born with asthma because smoking during pregnancy increases the chances that a child who is born would develop asthma but it doesn’t mean that every mother who smokes would give birth to an asthmatic baby. Do you get the point right? It just tells us to do the right things at all times.
Interviewer: Thank you very much.
Prof Okonta: Even a father who smokes within the confines of the house could make the children to be passive smokers and that predisposes most of them to having asthma.
Interviewer: We have a text message. Lucy is asking: “Please, can you highlight more ways of contracting asthma?” Lucy you did not tell us where you are texting from. I think we mentioned asthma is non-communicable.
All: Yes, it is non-communicable.
Interviewer continues: Mummy said something about lifestyle which might make children get asthma. Is there any other thing, probably for adults that should be avoided?
Prof Ukwe: For adults, irritants. Some adults during childhood may not have asthma. So, the asthma that develops in adulthood is extrinsic. It could be due to environmental causes; what we call risk factors. Somebody who works in the aluminium factory, somebody who works with chemicals and some irritants may be at risk. This is because the trachea, the airway is hypersensitive. For that hypersensitive person, the irritants may… (paused), it could be powders, could be perfumes because for some people when you spray perfume, you that sprayed the perfume may not have it but somebody close to you will not be comfortable and start coughing or sneezing. So, these are some of the ways by which somebody can contract asthma. It is not communicable but environmental factors can increase the risk of developing asthma.
Interviewer: Okay. Thank you very much. I must say, there was an associate of mine in a place I worked before who was posted to a particular unit. Nobody knew if he had a medical condition but the particular unit he was working in always had to be within a certain temperature (very cold) because of the equipment there. At a point in time, he had to be rushed to the hospital but he didn’t still say what his medical condition was … and to cut the story, he actually died and doctors had to say, “We think he was asthmatic” because all the signs were there but he did not indicate it in his employee’s form. He didn’t tell anyone and even when he was posted to the unit which was usually very cold, he still did not object … He worked there for about 8 hours a day. Now, looking at this, how can we get people to get tuned to their condition if they were asthmatic? What can they do if they like to live a normal life? Maybe they like sports and they have to go jogging, play football etc or they have to work in an industry with fresh paints or chemicals and other things. What precautions can they take?
Pharm Kosi: Okay. Still on the instance you gave us, I think I would want us to dwell a bit on that. It is important we note that cold or chest infection can cause late onset asthma in adults. So, it is very possible that the associate of yours may have not had a family history of asthma. He might not have covered up or lied about his health state. In some cases, it comes up in adult hood. You could have someone who was never asthmatic as a child and then, the person develops asthma at age forty. It does occur. So, it is very important that we do not take chest infections or even cold for granted. We should not expose our bodies to cold and should cover up properly when we should. Just do the right things at all times.
Interviewer: Okay. Prof Ukwe?
Prof Ukwe: Still on “covering up”. If you move from here to Jos, for instance (Jos is very cold), the person that is prone to having this problem should cover himself. If the person already is diagnosed with asthma, he should cover himself and make sure that he moves away from the triggers. If you must be in the cold, you cover yourself with apparels that will prevent you from having the cold because the cold weather can increase the propensity of having asthma and manifesting the symptoms. Somebody had asthma and said that someone told him that using inhaler would quicken his death … It is a lie and should be dispelled. You talked about someone who goes for jogging. Yes. Asthmatic patients are athletes. I have a relation who is asthmatic and runs one hundred metres, four hundred metres but this asthmatic always has the relievers. His relievers which we call “short acting relievers” are always with him. When it comes, the symptoms are fast, you take it. So, it makes you better than killing you. People should be aware that if you take the inhaler, it is even safer than the drugs that you take because it acts straight in the lungs and relieves you of the symptoms. Asthmatics should not take these symptoms as a disability.
Prof Okonta: I would want to also say that the problem we have in this country is that almost every ailment is stigmatized. Somebody knows that he or she is asthmatic and you are going to work in a place that is endemically cold (if I may put it that way). The issue is, why not make the management know, “Please I am allergic to cold”. If they have to put off the AC for you or change your own spot temperature, follow it. Otherwise, if you must bear the risk you must clothe yourself properly to prevent such a situation. Also, take your medications properly if you are on medications. Asthma is not contagious. It is not communicable. Asthma ought not be stigmatized and you need to let people know “this is my problem” if you are prone to it. Especially to people you work with, your family members, your friends … because they are the ones that will help you in critical moments. When you come down with asthmatic attacks, they are the ones that would manage you. So, let them know what you are suffering and then be able to tell them … there is what we call diaries. Show them the diary and show them how to manage you in critical moments.
Interviewer: Thank you very much Prof Okonta. We have a call. “Hello!” I think we lost that, but let’s read a text, before we can go on. Remember, if you are just tuning in, this is Lion FM and we are discussing issues bordering on asthma. Today is the World Asthma Day. I have here with me; Prof (Mrs) Chinwe Ukwe and Prof Mathew Okonta of the Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka and the initiator: Pharmacist Kosi Amorha, also a lecturer of the Department of Clinical Pharmacy and Pharmacy Management. They are all from the Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka. You can reach us by calling or sending a text message on 08151860899. We just missed a call. You can try to call us again. The number is still 08151860899. We have a text from Christiana, asking: “Please, is there any other alternative to inhaler? I always forget mine. Christiana is texting from Odim gate. So, she is asking if there is actually something else she can use. Just in case she forgets her inhaler.
Pharm Kosi: That is actually a very good question, I must add that it is important we note that inhalers are the most common and effective way to take asthma medications because it goes straight to the lungs. If at all, we would say there is any best way to manage asthma, it is with the use of inhaler devices. What I would basically suggest is that we focus more on adhering to our therapy and there are very many ways by which we can improve adherence. There are very many ways and even health professionals are helpful. There are very many ways your pharmacists can be of help to you, to improve your adherence to your therapy in whatever disease state, not only asthma. Inhalers are the best way to administer medicines in asthma. If you have acute asthma attack and you really need a drug to give you that rapid relief, you would need to use your inhalers. You would need to use your rescue inhaler because it is fast-acting.
Interviewer: Sorry! We have a call. Hello!
Caller: Good evening.
Interviewer: Good evening. Your name is?
Caller: Nchedo
Interviewer: Nchedo, what is your question?
Nchedo: I would really want to know the list of drugs that are contraindicated in asthma.
Interviewer: Okay. Hold on. We would attend to that.
Prof Ukwe: There are no drugs that can cause asthma because when you say drugs that can cause asthma, it means that the aetiology of that asthma are those drugs. But we know that there are drugs that can precipitate the attack. “Precipitating” means the risk factors. If somebody has hypersensitive bronchi and takes aspirin, it will worsen it. It doesn’t mean that aspirin causes asthma. It is important to note that aspirin does not cause asthma. In any case, the Department of Clinical Pharmacy and Pharmacy Management here, is always available to give counselling, proper drug information to the public and to this community and its environs at any time.
Interviewer: Thank you very much Ma. Let us go over to the treatment of asthma. If there is a treatment for asthma, what are the treatments for asthma? Prof Okonta can you highlight that for us?
Prof Okonta: Asthma treatment can be done by non-pharmacological methods depending on the severity and then, you can also use drugs – which are pharmacological method. The ones that have been found to be very effective and useful are the ones that come in the form of inhalers. There are ones that are presented in form of injectables. You know the inconveniences of injections. Then there are ones presented for oral medication that can be in tablet forms or capsules or syrups but the inhalers have been found to be very useful. Why? Because they go directly into the lungs and because they go directly into the lungs.
Interviewer: Sorry, let’s take this call. Hello! Good evening. What’s your name and where are you calling from?
Caller: My name is Bisola and I am calling from UNN.
Interviewer: Bisola do you have a question or a comment?
Bisola: It’s something that has been asked before. I mean drugs that are contraindicated in asthma?
Interviewer: Do you mean the drugs that you cannot use if you are taking asthma treatment?
Bisola: Yes.
Interviewer: Okay. Thank you very much Bisola. She is asking of the drugs that you should avoid if you are on the medications for treatment of asthma. I don’t know if listing the drugs would break the code of ethics.
Prof Ukwe: If you are asthmatic and you are on medication and have any problems, you seek for counselling from your doctor and especially from the clinical pharmacist who should tell you the drugs because we cannot list the drugs here. The drugs depend on if you have any other disease state (what we call co-morbidity). So, if you have any other disease state, the pharmacist should be able to know and then counsel you properly on those drugs. Not just drugs but also lifestyle modification, the food that you may avoid so that you can help yourself. So, it is not just drugs because when you list drugs, the tendency is for people to abuse these drugs. That is why we are not here to list the drugs.
Interviewer: Okay. ND from greenhouse is asking … paused (by Prof Okonta)
Prof Okonta: Please, can we tell the last caller that was asking that question if she wants one-on-one touch she can come to the Clinical Pharmacy Department and we would talk with her. It is not good to air our prescriptions on air because most times people would abuse it. Also, we need to know if she has co-morbidity.
Interviewer: Okay. So, we have learnt all what asthma is about. The triggers, we have heard about a lot of triggers, diverse triggers, even the unusual ones. Sorry, Prof Okonta we had to cut short. We were talking about treatments, injectables, tablets but you said the inhaler is the most recommended?
Prof Okonta: Because they work directly. They go directly into the lungs.
Interviewer: Is it not possible to have a treatment where you don’t have to always look for your inhaler? In case of people like the last caller that says she always forgets hers. Something you can just take and you don’t have to look for your inhaler for about a month, two months or something?
Prof Ukwe: The inhalers are of two types. We have the relievers. We have the one that control (which prevents you from having these symptoms). So, whether you have the symptoms or not, you take the controller inhalers every day. You use the relievers (the one that is quick action) when you have an attack. Then when you the patient has an asthma attack and is hospitalised, he/she may be given injectables or drugs through other routes. So, it depends on the severity. If you have symptoms once a month, you just need the controller so that you would not have those symptoms. So, even when you are symptom-free, you are still taking it. If you know about the inhaler and you take it, you may not have the symptom for one year, provided you are on your inhaler. Inhaler is preferable to the drugs that you take because it has less side effects.
Interviewer: Okay. Kosi …
Pharm Kosi: Now that we have already differentiated the inhalers as being either reliever or controller, what it summarily means is that if you are on your controller, then you have to use it every day even when you feel well. The controller inhaler would help reduce the swelling and inflammation of the airways. So, if a patient is almost always using his or her rescue inhalers then it means the patient is not well controlled.
Interviewer: Okay. Tony Isiwu is texting from Ovoko and he is asking, “Can asthma be controlled through traditional means or food (this is not too clear), or vegetables. Please reply.
Prof Ukwe: Well, that’s a good question. When you eat vegetables, less of fried foods, you can control asthma. People that have asthma are more allergic to fried foods and something that is dry. So, when that is prevented, you prevent the symptoms. It could be the triggers. Triggers can be food like we stated before just like it can be the irritants in the air. Some other person who does not have asthma may not even realise that the irritant is there. So, eat vegetables and well balanced meals. Living well means eating right.
Prof Okonta: Another thing again is, we have to be careful the nuts we eat because most of these nuts could be carrying aflatoxins which are dangerous and can cause liver problems. So when eating your groundnuts, please ensure you pick the groundnut very well. Open them and pick them so that you do not get aflatoxins. It is dangerous to the system and in general. It is not only to the lungs, even the liver. So washing your vegetables properly can also save you from other health hazards. When I was an undergraduate, most times I used to follow the back of Franco and go to Ziks’ Flats. That was in the 90s. And there was a day I bumped to the realities of how they irrigate the vegetable … Behind Franco. It was from the sewage! I said God I would not eat anything again in Franco.
All laugh!!! And it’s so fresh. I said I would not eat because these canteen owners may not wash this thing properly. Heavy metals have been found to be resident in faecal materials. So, these things could even lead to poisoning of the system including the tracheobronchial tree i.e. the respiratory part. So, we should be very careful to take care of whatever goes into our system. You are in the best position to watch yourself to know that this particular vegetable, my body has accepted it or my body did not accept it. I would not tell you “Oh I don’t eat water melon or eat this one or eat that one” but when you eat it, how do you feel? Are you comfortable with it? That is the essence of diaries. Record the things that your body do not tolerate. I always tell people any time I have an opportunity to talk about health that the doctors are not magicians. It is just unfortunate that in Nigeria, most doctors would not allow the patients to contribute to what they are doing. They are not magicians. They do not know all things, especially about you. They don’t know the drug that would be dangerous to your body. Whatever you have taken before and is not good in your body, record it and tell your doctor on visitation so that he would avoid it while making his prescriptions and diagnosis.
Interviewer: Okay. If you are just joining us, this is Lion FM. Today is the World Asthma Day and we have Professors: Chinwe Ukwe and Mathew Okonta and Pharmacist Kosi Amorha (the initiator) from the Department of Clinical Pharmacy in the Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka. Remember to call us on 08151860899 if you have a question, a comment, an observation or you just want to contribute to this show. You can also send us a test if you do not have enough airtime. Let us go into the use of inhalers since it is most recommended. How do we use inhalers? I know they are L- shaped, kind of. So, what is the proper way to use an inhaler in order to get the best out of it? Kosi, you are taking that.
Pharm Kosi: Okay! It is very important that we know how to use our inhalers when we are asthmatic because research actually shows that most of the drug therapy problems that occur in asthmatic patients stem from poor inhaler techniques and poor inhaler techniques may mean that we are getting enough of the medicines into our lungs. If we don’t use them right, it amounts to wastages and also means that the drug would not work the way we expect them to. This could also contribute to more expenses in the long run because the patient ends up being hospitalised if he gets worse than he actually is. So, it is very important that if you are not sure about your inhaler technique, you should ask your pharmacist. Every time you purchase your medicines, every time you walk into a community pharmacy, just see your pharmacist as your friend. Anytime you see your doctor or pharmacist in the hospital, if you are asthmatic you should always ask, “Is my inhaler technique appropriate?” It is very important that we know how to use our inhalers and we re-demonstrate the use every time we see our health professionals. So, any time you go for a refill, you want to buy more medicines, nothing stops you from asking your pharmacist, “Please, can you demonstrate to me how to use this inhaler?” Even if you think you already know about it, nothing stops you from confirming. Peradventure you are in the university environment and you want to know more about how to use your inhalers, feel free to walk into the Department of Clinical Pharmacy and Pharmacy Management as we have many capable hands. We have many clinical pharmacists who would be more than ready to show you how to properly use your inhalers.
Interviewer: Alright. We have this text here with no name attached to it and it goes this way: “How good are aerosol compressors during an attack?” That is a high tech question.
Pharm Kosi: Rescue or reliever inhalers usually come as aerosol inhalers, commonly called pressurized metered dose inhalers. That’s a very good question but remember that when a patient is having an attack, the patient may lack some co-ordination. That’s exactly why in some cases, we have some aerosol inhalers attached to spacer devices. A spacer device is just like a plastic or metal container that has a hole at one end where the patient can put his or her mouth and has the inhaler attached at the other end. Aerosol inhalers are pressurized and after shaking and actuation, the drug is released in the form of vapour. With spacer devices, the drug is released into a chamber, so very little is lost. During a severe asthma attack, the patient may need help. Some spacer devices also have nose masks at the point where the patient should put his/her mouth. Also, in some instances, the patient may need to be nebulized with the aid of a nebulizer. Nebulizers also come with nose masks. The use of pressurized metered dose inhalers only, pressurized metered dose inhalers attached to a spacer device or the use of nebulizers would depend on availability at the point of asthma attack, and severity.
Interviewer: Are all attacks that severe? A patient gets to lose co-ordination and recognition of what is happening around him or her?
Pharm Kosi: All attacks should be treated as severe as they are signs of poorly controlled asthma. However, the severity of asthma attacks vary. If I must add, in some cases the patient could just sense that the symptoms appear to be worsening.
Okay? So, what should be done in such a case when the attack it is due to a trigger, a known trigger? For instance, if a patient whose asthma is triggered by smoke is exposed to such, there could be an asthma attack. If such a patient can avoid it, he/she should walk away from the causative agent and if it can’t be avoided, the rescue inhaler should be used.
Interviewer: Thank you very much Pharm Kosi. Well that’s a …. We have heard one or two things about asthma review in our long discussion but I think we would want to know categorically what asthma review is all about. When should an asthma patient have a review? Prof Ukwe, would you like to say something on that?
Prof Ukwe: Asthma review is having an appointment with your doctor. Wherein if you have your appointment, the doctor tells you about your disease and because you have a diary, because you are the sufferer, you tell your doctor what your symptoms are, what you envisage and what you experience. Then your doctor would be in a position to tell you what to do and what not to do, so that your asthma may be managed well and you feel better. I have always said that it is a nuisance and not a disability. It doesn’t make you move from your work, you still have to do your work
What is the essence of a review? It has to be done. If you are somebody that has fewer symptoms, the review should be at least once a year but if you are somebody who has symptoms that are frequent, you need constant review with your doctor and after you have seen your doctor, you refill your prescription, you see the pharmacist who counsels about your drugs and any drug therapy problem(s) you have, the clinical pharmacist is ready to resolve. That is the importance of asthma review.
Interviewer: Okay. I think we are gradually coming to an end. Today marks the World Asthma Day. We have had a wonderful time with Prof. Mrs Chinwe Ukwe and Prof. Mathew Okonta of the Department of Clinical Pharmacy and the Initiator – Pharmacist Kosi Amorha, a Lecturer in the Department of Clinical pharmacy and Pharmacy Management, University of Nigeria, Nsukka. I am John Ogbonna and I have been having a swell time. I told you we would have a cool time this evening celebrating the World’s asthma day.
I heard with shock that asthma at some point can just disappear. So I would like to ask the question again, when and how can a person outgrow asthma? Is it possible and how is it possible? Because I am sure a lot of people who have asthma would wish they can just outgrow it.
Prof Ukwe: I have a testimony. I have a grandchild who was asthmatic from about age five. We were always taking the child to the University of Nigeria Teaching Hospital (UNTH) and at some point we were counselled to remove all the rugs in the house and replace them with linoleum. Now she is about fifteen and no longer has asthma. So, it is no magic! It happens when it occurs early in life and with proper management. We removed the triggers (they also lived in a place that is very cold). They moved away from the environment. Now, the child is free.
Interviewer: Wow!
Prof Okonta: So, what she is saying in essence is that we have to as much as possible identify the triggers. In children, once the trigger is identified, there is a tendency that it could be reversed.
Interviewer: Okay. When Prof Ukwe was speaking, I was wishing I was her pastor because by now I would have taken the credit and perhaps, started a crusade on that.
All laugh
Prof Okonta: John, there is divine healing and there is also human-induced healing. Please don’t dispute that (laughing as he said this).
Interviewer: We have this text. “Please is one who is allergic to stuffy place or less ventilated place said to be asthmatic?” This is exactly the way the text is.
Prof Okonta: Everybody is allergic to a stuffy place. Everybody is allergic to a poorly ventilated space.
Prof Ukwe: … where there is low density of oxygen.
Prof Okonta: But the problem is this: Three of us can stay in a place that the person that sent that message is classifying as stuffy; not three of us would come out wheezing; not three of us would come out with tightness of chest and coughing. Okay? But to him, he has described it as stuffy. These are individual differences. But it is not advisable for patients that have such tendencies of being asthmatic, to stay in stuffy or poorly ventilated places.
Interviewer: Okay.
Prof Ukwe: I am allergic to a stuffy area. So, whenever I go to a place, I stay near the window so that I would have better ventilation. But I am not asthmatic. Remember we said that it is individuals who have this hypersensitive bronchial tree that have it. If we have persons who have these hypersensitive bronchi, then, staying in a stuffy place or low ventilated place would be an asthma trigger. But for somebody who does not have the propensity, no hypersensitive bronchi, you may just feel uncomfortable but you may not manifest the asthmatic symptoms.
Interviewer: Okay, because I dare say, when I was an undergraduate, we were a legion in our room (all laugh). We slept as if they were shipping us for slavery (All laughed again). The funny thing is we had this room mate who liked smoking and he was asthmatic. But because he wanted to show off that he could do it, every now and then he was rushed to the Medical Centre.
All laugh and talk (You see, asthmatics should not smoke).
Okay we are going to have our last text here before we wrap up because it is way past our bed time and remember 08151860899 is the number and we are going to be wrapping up very soon so if you don’t have it, you can now text in.
“Please what can we call episodes? Are they worse?” No name attached to this one. We have another text: “Can asthma cause eye problem because I have a friend that whenever she is about to have an asthmatic attack her eyes redden and produces some … (The text is not complete).
Okay, two questions: What are episodes? Are they worse? And then, can asthma cause eye problems because I have a friend that whenever she is about to have an asthmatic attack her eyes redden and produce some … (I want to believe maybe some liquid or something).
Prof Ukwe: Episodes are asthmatic attacks. We have said that some people may have episodes, “what they call episodes” i.e. the symptom worsens when the sufferer does not take his or her medications, as required. So with episodes, the symptoms would worsen and then for somebody who is allergic, who has allergic asthma (they are asthma that come from childhood, mostly allergic); some children have reddened eyes; some start sneezing. In fact some children have bumps on their body. So, in such cases, it is allergy because the allergens (allergens are what predisposes the symptoms) react with chemicals in the body, then the bronchioles start swelling and narrowing. When it swells, it narrows and when it narrows, you know you have inflammation and when the airways are narrow, the patient cannot breathe. So, it can start with reddening of the eyes when the person is where the trigger is, what we call allergens. So, it can cause reddening of the eyes. It can even cause runny nose. It causes dryness and sneezing. So, these are what start the asthma symptoms; cascade of reactions. We call them the allergens.
Prof Okonta: When we talked about the triggers we made mention of people staying in pollen areas, where you have pollens and dusts, mites and all these things. These are allergens that affect not only the trachea but also the nostrils, eyes and everything. So, the redness the person complained of may be due to an allergen. This may predispose the person to asthmatic attack at that point in time. So, when such a thing is happening, the advice is that he should step out of that vicinity. There are some people, it could be carbon from the car, fumes from the car; some people it could be perfume; it could just be flower; some it could even be grains, pollen grains from flowers that are around. So, it is advisable that such a person should step out from that area. I have heard stories of people who change their locality and the asthma is gone. Especially when they travel abroad, they just discover that, “Oh the asthma they were suffering in Nigeria, they don’t have it anymore”. Some, it is the asthma they were suffering abroad they don’t even have again, in Nigeria, just because of location.
Interviewer: Okay, because for a while, it sounded as if Nigeria, you know, the recession, everything, asthma, power out… like there a lot of things now being associated with the country but maybe… (Laughs)
Prof Okonta: The problem with Nigeria, why it seems everything is cascading on Nigeria is because of our spending from our pockets to buy drugs. If we make drugs free or if the National Health Insurance Scheme (NHIS) is powered to help the poor masses, the tendency is that everybody would like to go to the hospital to find out their health issues. But when you think of what you are going to spend from your pocket and you don’t have enough money for family budget, the next thing is, “I reserve this one, if it kills me, they would use and do burial.”
All laugh!!!
Prof Ukwe: It is also known that asthma is more in individuals who are poor. That is a very proper statistics. The poor people live in crowded areas. They cannot afford their medicines. They live in houses with cockroaches and not well-ventilated areas with generators that give out lots of fumes (I better pass my neighbours; face me I face you). So, poor people suffer more asthma.
Interviewer: Okay. Thank you very much. It’s been so wonderful to have all three of you here but before we leave, we would like to hear some words in conclusion. You know parting shots from each and every one of you. Let’s take ladies first. Let’s start with Prof. Mrs Chinwe Ukwe from Clinical pharmacy.
Prof Ukwe: Well, asthma is a condition and not a death sentence. It is a condition that makes a nuisance not a disability. If you have asthma, you take your medications; and make sure you visit and have asthma review; and meet your clinical pharmacists to advice you properly. With your proper medication taking, you may find that, before you know it, the asthma is gone. God heals and when you receive Jesus Christ and make him your personal Lord and Saviour, with your proper medication, asthma may be a thing of the past. God bless you.
Interviewer: Thank you Prof Ukwe. Prof Mathew Okonta?
Prof Okonta: Thank you very much. We have to first of all know that asthma is non-communicable. So somebody suffering from asthma, don’t hide yourself and begin to say you are stigmatized. If you have asthma, please take your medications as they are prescribed to you. Prescribe means from your doctor, or recommended from your pharmacist, not buying drugs because some family members suffered it and this is the drug they used. You don’t buy asthma drugs because it was advertised. You don’t buy asthma drugs because it was a gift from someone. When you are having symptoms of asthma, go to a professional for counselling and for diagnosis, particularly a medical doctor. Once you are properly diagnosed, take your medications and God would effect your healing.
Interviewer: Thank you very much Prof Okonta. Okay before the initiator (Pharmacist Kosi Amorha) would speak, we have a text message and it goes this way: “I want to appreciate my colleagues Pharmacist Kosi, Prof Ukwe and Prof Okonta on a successful program sensitizing all on asthma. It is very informative. From Dr. Ebere Ayogu. Okay, Pharmacist Kosi Amorha before we leave, one last parting shot.
Pharm Kosi: First of all, I would like to say thank you very much for having us.
Interviewer: Of course, it was a pleasure.
Pharm Kosi: If you are asthmatic, never be ashamed of your inhalers. Using your inhaler is similar to using any other drug, so never be ashamed of your inhalers. If you have to bring them out in public because you have some discomfort, please bring them out. The more we know about asthma; the more we know about inhalers; the less we stigmatize. So, it shouldn’t be a case of I am not asthmatic, I do not have a family history of asthma, so I shouldn’t know about asthma. Our knowledge of asthma could help us save lives, if the need arises. We do not need to stigmatize asthmatic patients when we see them using their inhalers as it means that they are doing the right thing to get better. I would add that if you are asthmatic, you can be well controlled. It is very possible to be asthmatic and not have any attack. Very very possible! If you are well controlled, you will know as you would have no day time symptoms; no night-time awakenings due to asthma symptoms; no frequent use of your rescue inhalers; little or no hospital visits on asthma (you would only go to the hospital because you just want to see your doctor to give a feedback, just for a review); you wouldn’t have emergency department visit (you wouldn’t be rushed to the hospital in an ambulance. I think that is the better way to put it); you would have normal lung function as measured with the spirometer or peak flow meter; you would have minimal or no adverse effects from your medications; there would be no worsening of asthma symptoms or exacerbations. Alright. In conclusion, if you are asthmatic, you should strive towards being well controlled. Thank you very much.
Interviewer: One more thing. Just in case people might want to learn more, where do they come to? Is there a number, an email address or a place they should visit to learn more about maybe triggers or asthma control?
Prof Ukwe: You can come to our Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka. You have our phone numbers. My phone number is 08037782447. You can call any time and/or I can refer you if you can’t come to the Department. You can call any of us. We would give you our numbers so you can call and our emails are available.
Prof Okonta: My number is 08064724856 and my email account is mathew.okonta@unn.edu.ng. Mathew is single t.
Pharm Kosi: For Pharmacist Kosi Amorha. My number is 08038539349 and my email address is kosisochi.amorha@unn.edu.ng. Thank you.
Interviewer: Thank you so much. For me, John Ogbonna, my number is 005782152232. That’s my account number! I would tell you the bank but just use John Ogbonna, in case you want to support the ministry, you know.
All laugh hard!!!
But if you want to find out more, please call their numbers. If you want to donate, call me.
All laugh again!!!
Just kidding, alright?
Here is Michael Jackson’s, “Heal the world”. That’s of course because we want the world to be healed; everyone to be healthy and to go about their activities as best as they can.
Remember to keep it logged on to 91.1 Lion FM and remember we did this all to remind you that today is actually the World Asthma Day. Have a wonderful night rest.
