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Women and Asthma
Written by Shobha Shukla, Citizen News Service - CNS
Thursday, 07 March 2013
Unsafe air in the home is responsible for poor women's plight
Breath is life, and yet the importance of lung health is
under-recognized, especially in women. No wonder then that lung diseases
account for more than 16 percent of deaths among women worldwide.
Exposure to tobacco smoke and indoor air pollution, from using solid
fuels for cooking and heating, are the two leading risk factors that have an
impact on women's lung health much more than that of men, especially in
low/middle income countries. Each of these pollutants kills more than 1.5
million women worldwide every year.
Although asthma affects 235 million people and is responsible for just
0.5 percent of all deaths among women worldwide, it is a highly debilitating
disease, making the simple act of breathing a real challenge at times.
"Asthma is under-diagnosed and poorly managed in resource limited
settings," said Dr Chen-Yuan Chiang, Director, Department of Lung Health and
NCDs, International Union Against Tuberculosis and Lung Disease.
"Unfortunately, in developing countries many women (and also men) living with
asthma have limited or no access to affordable inhaled corticosteroids, which
are essential in asthma control."
Asthma is a non-communicable, chronic respiratory disease of the
bronchial tubes that is characterized by recurrent attacks of breathlessness
and wheezing. During an asthma attack, the lining of the bronchial tubes
swells, narrowing the airways and reducing the flow of air into and out of the
lungs.
The risk factors for developing asthma could be genetic predisposition,
lowered immunity levels, cold air, physical exercise and exposure to tobacco
smoke, pet fur, mould spores, dust mites, pollen, some medications and chemical
irritants that may trigger allergic reactions or irritate the airways. The
trigger stimulates Immunoglobulin E antibodies to produce histamine and other
chemical mediators which swell the lung's lining and tighten the muscles of the
airways.
"Over the past 20 years the burden of asthma has been steadily
increasing, affecting around 10 percent of the general population (but more
women than men) in our setting," said Amita Pandey, Associate Professor of
Obstetrics and Gynecology, King George's Medical University. "Women are more
likely to show acute exacerbations of the disease. Pregnant women need to take
some special precautions to keep their asthma under control—keep house humidity
low, avoid outdoor activity between 5am and 10am when pollen and pollutant
effect is maximum, take inhalation therapy and avoid allergic foods like
peanuts and eggs."
Biomass and solid fuels are a major source of indoor air pollution, but
their health effects are poorly understood in developing countries. A study
published in November 2012 examined the effect of cooking smoke produced by
biomass and solid fuel combustion on the reported prevalence of asthma among
56,742 adult men and 99,574 adult women in India.
The results showed that adult women living in households using biomass
and solid fuels have a significantly higher risk of asthma than those living in
households using cleaner fuels.
Interestingly, this effect was not found among men. However, tobacco
smoking was associated with higher asthma prevalence among both women and men.
Combined effects of biomass and solid fuel use and tobacco smoke on the risk of
asthma were greater and more significant in women than they were in men.
A guide book on
lung-health-consequences-of-exposure-to-smoke-from-domestic-use-of-solid-fuels-
refers to another study from India which showed an increase of 22 to 30 percent
in symptoms of asthma in non-smoking women living with asthma and exposed to
biomass or liquefied fuel smoke.
"Passive exposure to tobacco smoke and indoor air pollution due to
domestic use of solid fuel for cooking and heating are the two main factors
that contribute to asthma in women," Dr Chang said.
It would be worthwhile to mention here a study published in 2012 in the
American Journal of Respiratory and Critical Care Medicine which found that
women's asthma symptoms became more severe when they were menstruating. The
lead author of the study, Ferenc Macsali of Norway's Haukeland University
Hospital,said that, "In a cohort of nearly 4,000 women, we found large and
consistent changes in respiratory symptoms according to menstrual cycle phase,
and these patterns also varied according to body mass index, asthma, and
smoking status. Our results point to the potential for individualizing therapy
for respiratory diseases according to individual symptom patterns. Adjusting
asthma medication, for example, according to a woman's menstrual cycle might
improve its efficacy and help reduce disability and the costs of care."
According to Professor Dr Surya Kant, Head of the Pulmonary Medicine
Department, King George's Medical University, "If one of the parents has asthma
then there is a 25 percent chance of the child having it too. If both parents
are asthmatic then this increases to 50 percent. If the mother is asthmatic
then she should become more cautious about her asthma and more regular with the
inhaler during pregnancy. Her environment should be clean and not harbor dust
mites hidden in carpets, soft toys and cobwebs. The house in which she is
living should not be painted/ white washed during the period of pregnancy; else
an asthma attack is sure to follow. Smoking by or before a pregnant lady is a
crime."
Says Professor Innes Asher, Chair of the Global Asthma Network: "Millions
of women in the world struggle to breathe because of asthma, and this affects
their ability to look after their families and to stay in paid work. The
environment within the home may be a contributing factor - especially tobacco
smoke, but also other pollutants like open fire cooking may be a factor.
Policies need to support women having clean air to breathe in all situations.
We know that asthma can be treated by effective medicines, but many women miss
out because these medicines are not available or too expensive."
So on International Women's Day on 8th March 2013, let us all resolve to
do our little bit in making the air we breathe safer by saying no to smoking;
making non-polluting cooking fuels available in all homes; and practicing
simple hygiene methods (no spitting or coughing in the open, washing hands, no
littering). Shared air has to be safe air, because unless we breathe well, we
cannot live well.
(Shobha Shukla is the Managing Editor of Citizen News Service Email:
[email protected], website: http://www.citizen-news.org)
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