Asthma in pakistan

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Asthma in pakistan

  1. 1. Asthma in Pakistan Nayyar R. Kazmi
  2. 2. <ul><li>It’s a chronic inflammatory condition of the airways, characterized by inflammation in the small airways, narrowing of airways and excessive mucus production resulting in difficulty in breathing, cough and wheeze. </li></ul><ul><li>Presents with a wide spectrum of signs and symptoms. </li></ul>
  3. 3. Burden of Disease <ul><li>More common in the developed countries </li></ul><ul><li>Also increasing in the developing countries </li></ul><ul><li>Pakistan </li></ul><ul><ul><li>Adults prevalence 5-10% </li></ul></ul><ul><ul><li>Children 19% (ISAG Study) </li></ul></ul>
  4. 5. World map of the prevalence of clinical asthma (Global Burden of Asthma, 2004).
  5. 6. <ul><li>Responsible for 70% of pediatric hospital admissions in winter and spring season. </li></ul><ul><li>Responsible for approximately 40% of emergency adult admissions in spring season. </li></ul>
  6. 7. Etiology <ul><li>Allergic disorder </li></ul><ul><li>Either caused by Atopy or bronchial hyperresponsiveness in susceptible individuals. </li></ul>
  7. 8. <ul><li>Allergic Factors </li></ul><ul><ul><li>Airborne Pollens </li></ul></ul><ul><ul><li>Environmental Toxicants </li></ul></ul><ul><ul><li>Molds </li></ul></ul><ul><ul><li>House dust </li></ul></ul><ul><ul><li>Animal dander </li></ul></ul><ul><ul><li>Feather pillows </li></ul></ul><ul><ul><li>Smoke </li></ul></ul>
  8. 9. <ul><li>Other Factors </li></ul><ul><ul><li>Smoke and other pollutants </li></ul></ul><ul><ul><li>Infections (viral) </li></ul></ul><ul><ul><li>Aspirin </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><li>GERD </li></ul></ul><ul><ul><li>Sleep (PEFR lowest at 4.00 am) </li></ul></ul>
  9. 11. Risk Factors <ul><li>Positive Family History </li></ul><ul><li>Viral Lower respiratory Infections during infancy </li></ul><ul><li>Lack of Breast Feeding </li></ul><ul><li>Pets in the home </li></ul><ul><li>Dusty Atmosphere </li></ul>
  10. 12. Why the Asthma Prevalence in increasing <ul><li>Increased in utero exposure to antigenic challenge </li></ul><ul><li>Increased incidence of childhood and infancy viral respiratory infections </li></ul><ul><li>Increased environmental pollution </li></ul>
  11. 13. Screening criteria <ul><li>All cases of chronic cough with/without wheeze </li></ul><ul><li>Cases of seasonal exacerbations of respiratory infections </li></ul><ul><li>Cases of cough not responding to conventional therapies. </li></ul>
  12. 14. FLCF Criteria <ul><li>PEFR is a simple cost effective tool for assessing Asthma in FLCF’s. </li></ul><ul><li>Spirometry facilities at DHQ level </li></ul><ul><ul><li>FEV1/ FVC less than 80%. </li></ul></ul>
  13. 15. Mainstay of Treatment <ul><li>Steroids </li></ul><ul><li>Bronchodilators </li></ul><ul><li>Prevention </li></ul>
  14. 18. Public Health Measures <ul><li>A good reporting system on Asthma (incorporation into the national HMIS) </li></ul><ul><li>Asthma treatment centres at local FLCF’s (Drugs, Equipment, training) </li></ul><ul><li>Asthma health education ( incorporation into School health system) </li></ul>
  15. 19. Public Health Measures (Contd) <ul><li>Environmental sanitation </li></ul><ul><li>Regulations on smoke and Tobacco control. </li></ul><ul><li>Promotion of use of nasal air filters </li></ul><ul><li>Ban on growing of known severe polligenic wild mulberry trees </li></ul>

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