Dr. Gregory Efosa Erhabor is a Professor of Medicine and a consultant chest physician. He is also the founder and project director of Asthma and Chest Care Foundation (ACCF) and chairman of the Asthma National Guideline instituted by the Nigerian Thoracic Society (NTS). Erhabor, in this interview with The Guardian, said the Society has developed a blueprint on how to reduce the burden of asthma in Nigeria.
Why is Asthma under-diagnosed and under-treated in Nigeria?
The reason is the lack of understanding of the pathophysiology of the condition. The basic pathology in asthma is inflammation of the airways and the result is bronchial obstruction. Bronchial obstruction is the expression of the inflammation clinically. Most doctors concentrate on the expression of the disease rather than the actual cause. Moreover, there is lack of facilities in many hospitals for the diagnosis of asthma and the lack of specialized centers for the management of asthma coupled with inadequate training of health professionals.
What informed the development of the guideline of asthma management in Nigeria?
Asthma is a lung condition that can cause breathing difficulties. It occurs when the breathing tubes to the lungs become inflamed and narrow. Symptoms include wheezing, breathlessness, coughing and a tight feeling in the chest. It may be triggered by exercise, cold air or cigarette smoke. There is no cure. Inhalers relieve symptoms and reduce inflammation. It can result in severe asthma attacks, hospital visits and even deaths. The causes are not completely understood.
So the guidelines provide the minimum standard for the management of a disease condition. It showcases best practices in line with current scientific and therapeutic developments globally. However, for guidelines to be practicable it has to be situated in a way to suit the peculiarities of different nations. Hence, the idea of having a national guideline that is peculiar to Nigeria.
Do you have the facility and resources to support internationally endorsed standard of asthma care?
There have been a lot of improvements when it comes to the availability of facilities in the management of asthma in the country however; this falls below the minimum required internationally endorsed benchmark.
The increase in burden of asthma has been attributed to environmental factors such as urbanization, industrialization and adoption of western lifestyle. Please explain?
There has been a long held hypothesis known as the hygiene hypothesis which simply alludes that those exposed to viral and bacterial infections in the young, those who have more siblings and those who have worked in farming environments tend to be protected from asthma as oppose to children who have less exposure to these agents and use antibiotics and adopt a western lifestyle. In a sense, the former develop what is known as a Th-1 immune response in contrast to the latter who develop a Th-2 response, which favors asthma development. As beautiful as this hypothesis is, it does not explain the overall pathophysiology of the disease. The simplest way to understand asthma is to know that its development and expression is dependent on genetic and environmental factors. Genetic factors predispose the patient to develop asthma while the environment factors determine the expression of the disease. It is a combination of nature (genetic) and nurture (environment).
How can these be addressed?
- We have to identify the various types of asthma whether allergic or non-allergic in managing the condition.
- We must identify the trigger factors in individuals and strategize ways to avoid them.
- We have to institute and initiate an individualized self-management approach for each asthmatic.
- We have to focus more on therapies that address the underlying inflammatory condition in asthmatics.
As a rule, I have advised asthmatics to study their own asthma, know what triggers attacks and partner with their physicians towards managing them.
What is your advice to the government and individuals?
As I said above, the government should make management of asthma a priority, create specialized centers for the management of asthma, subsidize medications and support organizations that are at the frontline in tackling the disease. The government should come to the aid of Nigerian Thoracic Society (NTS) to ensure this guideline is improved upon and distributed nationwide.
Source: The Guardian Newspaper