On the Thursday night after the hi-jack bombings in the United States, I was pleasantly surprised to find a very large turnout of medical practitioners at GlaxoSmithKline's launch of a new product "Seretide Diskus" for the treatment of asthma, one of the respiratory diseases which is very prevalent in Trinidad & Tobago and the wider Caribbean. And although guest presenters, Dr Harold Nelson, Professor of Medicine at the University of Colorado and Dr Carlos Adrian Jimenez Gonzales, Professor of Internal Medicine and Pneumology at the Universidad Autonoma de San Luis Potose in Mexico, did not make it to Trinidad because of flight cancellations, the local doctors, Dr Michele Monteil, a Fellow of the Royal College of Pathologists, Dr Albert Persaud, consultant physician and respirologist, and GSK'S Training Manager, Dr Ashraf Hanna, carried on with the programme drawn up by Glaxo's Marketing Coordinator, Deanna Davis, which was followed by a sumptuous dinner.
Immunologist, Dr Michele Monteil, a senior lecturer in her field at the Eric Williams Faculty of Medical Sciences presented "Aspects: local and regional perspectives" in which she discussed her own research and those of other colleagues in the English speaking Caribbean, which revealed to an astounded audience that one patient had visited the hospital 240 times in one year for treatment of this disease which is caused by inflammation of the airways.
"In asthma, the airways which are tubes taking air in and out of the lungs, are narrowed by the inflammation there, this inflammation can be pretty persistent and continues to exist in most patients even when they do not have symptoms" explained the very petite doctor with whom I was lucky to get an interview in spite of her very busy schedule.
Dr Monteil, who has a keen interest in research, spoke of the increases in allergic problems which are the basic causes of asthma, worldwide over the last 20 to 30 years. "Even in the Caribbean, figures from Barbados show that between 1970 and 1996 the percentage of children with asthma rose from over 1% to 16%."
There are lots of theories as to why there has been such an increase in asthma worldwide. One theory suggests that children spend more time indoors, and many modern homes in urban areas may be carpeted which favours increased exposure to indoor allergens, such as, house dust mites; also the presence of increased pollution may facilitate the development of allergies in people with this inherited tendency.
Another theory, says Dr Monteil "is that children are immunised at an early age against a range of organisms which diverts the immune system from its main job which is to prevent infection, the immune system is looking for another job and so begins to react against non- infectious things in the environment. Allergy is this excessive reponsiveness to non-infectious things in the environment. And allergy in the airways, leads to diseases such as asthma and rhinitis (commonly referred to as sinus problems.)"
What happens is that the inflammation in the tubes causes the walls to swell and more mucuous is produced. Changes in the muscles surrounding the tubes also occur and so the space in the airway through which air passes in an out of the lungs is reduced, so that something like a walk around the savannah when more air needs to be taken in and out of the lung will cause shortness of breath because there isn't sufficient space for more air to come in and out.
Since the muscle around the airways are twitchy and more sensistive to the environment, the muscles will contract tightly following exposure to irritants, such as, smoke or strong scents and the patient feels tightness of the chest, which is one of the symptoms of an asthma attack. The production of more mucus very often brings another symptom - a non-productive cough. And finally when the space in the airways gets small enough the whistling sound it produces is called wheezing, yet another symptom.
Dr Monteil stresses, however, that there can be chest tightness, shortness of breath and a cough without wheezing, and the patient does have asthma.
There are bad times and better times with asthma, the doctor and patient have to find what triggers an attack or what is making it bad, could be exposure to dust, cat fur, or in small children a respiratory infection. Job related asthma has been found in some occupations, to name a few, in the paint manufacturing industry and quarrying. "And while we are on the subject" said Dr Monteil "it has been shown that the children of parents who smoke are more likely to have problems of the nose, ear, tonsils and chest."
The non-diagnosis of asthma presents another problem, but there can be various reasons for this, particularly in children coughing, especially at night, which may be the only symptom. Also patients learn to live with a degree of ill health and will not complain about some shortness of breath and chest tightness to their doctors, and just put it down to being unfit. The disease relapses and remits so it depends on what stage the patient goes to see the doctor, could be in a good phase and the doctor may doubt the diagnosis of asthma. If the doctor is suspicious enough, a trial of anti-asthma medicines may be given to see if the patient improves. While other tests which can be done are lung function tests and it is also possible to measure the the peak expiratory flow in the doctor's office which can assist in the diagnosis.
Chris's first attack never occurred until her mid-thirties. Diagnosis was difficult and the PEF test was used to confirm that she did have asthma. But she has noticed that her attacks are triggered by bronchitis: "After a case of the flu comes the bronchitis and it moves to asthma. I get the shortness of breath, cough, wheezing and extreme tiredness. To walk up a short flight of stairs becomes a problem. And you do feel very sick."
GlaxoSmithKline's new product "Seretide", is a new innovative treatment against asthma which combines Salmeterol, a powerful bronchodilator to relieve muscle tightening, and Fluticasone, a very effective anti-inflammatory steroid, both of which work very well together and give better effect than separate drugs independently. It is hoped that this 2-in-1 combination will also increase patient compliance as the patient now deals with an easy to carry, easy to handle compact-type medication which will work over an extended period during which patients suffer no symptoms resulting in a substantial improvement in their quality of life.