The Tribune, Chandigarh, India

Nine pearls for asthma care
Dr S. Lavasa

There is seasonal bronchial asthma which gets aggravated due to a change in aerobiology. The season for exacerbation is approaching fast (March-April). The treatment for these problems is best done in the pre-seasonal period. Therefore, patients should consult their doctors now for the prevention of acute attacks rather than suffer due to the seasonal allergy.

Primary care physicians are in the front line of asthma management. Although knowledge about diagnosis and treatment has improved, common misconceptions still exist. Some tips are given here to help primary care physicians to provide optional care for asthma patients.

1. Absence of wheezing does not rule out the diagnosis of asthma

Wheezing is a common feature of asthma exacerbation. In very severe exacerbations wheeze is inaudible and no breathing sounds can be heard. In less severe exacerbation there are only symptoms of chest tightness, cough, decreased exercise tolerance, etc. Asthma that produces cough without wheeze is known as cough-vacant asthma.

2. Respiratory symptoms that do not improve with properly administered bronchiodilator therapy and are probably not caused by asthma

Pneumonia, emplysema and congestive heart failure may produce symptoms that mimic asthma, but these are often not cured with bronchiodilator therapy.

3. Occupational factors should strongly be suspected in adult-onset asthma

In all cases of adult-onset asthma, the occupational history should be closely scrutinised. It is estimated that 5% to 20% of adult-onset asthma cases have triggers in work places. Occupational asthma is almost always preventable.

4. Sleep disturbance may be a sign of asthma

In asthma nocturnal exacerbations are common and difficult to manage. Treatment of nocturnal asthma will improve daytime cognitive performance.

5. Bronchiodilator therapy should not be used for at least six hours before lung function tests. Asthma medications are grouped into two categories:

(a) Quick relief medicines are for treating symptoms and exacerbations only.

(b) Agents for a long-term control of asthma are essential for proper treatment so that quick relief medicines are seldom required.

7. Allergy tests are useful to know the trigger factors so that the prevention of attacks and better control are possible particularly in occupational asthma, seasonal asthma, extrinsic asthma or any food allergy-related problem.

8. Arterial blood gas analysis has a very limited role in asthma management. Low-flow nasal cannula typically provides sufficient oxygen during an attack.

9. Patient education and giving a written plan to deal with an emergency before reaching the doctor is most important for asthma management. This equips the patient with scientific means to deal with his own problem, boosts his confidence, results in better doctor-patient relationship and overall better management of the disease process.

Let us attack asthma by all means.

The writer is an allergy specialist and can be contacted at 0172-562239, 892226, 782766.

Epilepsy: what everyone must know
Dr Gagandeep Singh

About one person in hundred has epilepsy. Epileptics and their families as well as people in many professions such as teachers, social workers, police personnel and legal experts who come in contact with those suffering from epilepsy need to know something of the many facets of this disease.

Epilepsy occurs when there are recurrent seizures due to abnormal activity in brain cells. Convulsions (being one of the common types of seizures) begin with a loud prolonged cry, stiffening of the whole or part of the body (particularly limbs), to and from movements and loss of consciousness. During this period, there is noisy breathing, frothing and bleeding from the mouth because of a tongue bite and sometimes incontinence of urine and stools. Not all seizures or fits are convulsive. Day-dreaming, unresponsiveness and confused or inappropriate behaviour may be signs of seizures.

Epilepsy and childhood

For most parents who witness seizures in their children, there is probably nothing more frightening. It is more often than not that parental concern regarding this dreadful happening leads to undesirable behavioral and psychological consequences. The important thing to realise is that although convulsions appear very frightening, they are not as dangerous as they appear. It is very rare for convulsions to last more than a minute or two and to cause adverse consequences like death and brain damage. Children with epilepsy are of mostly normal intelligence. They can go to school. However, it is important that the class teacher is informed about the necessary measures to be taken in the event of seizure.

Epilepsy and women

A major psychosocial issue is the stigmatisation produced by epilepsy in marital and family life. The fear that disclosure may adversely affect marital prospects of women with epilepsy of marriageable age is a very important concern among parents. Quite often this felt stigma leads the parents to establish a marital alliance without disclosing the fact that their daughter has epilepsy. Such marriages often take place and the wife continues to take anti-epileptic medications surreptitiously. Understandably, she misses the medications at some point of time and has a seizure. It is at this time that the husband and in-laws learn about her epilepsy and demand divorce or separation.

From the psychosocial point of view, it is rather acceptable for a marriage proposal to be rejected on grounds of epilepsy than to have a separation after marriage because of either epilepsy or the distrust created by its non-disclosure. From the legal point of view, the Hindu Marriage Act, 1955, and the Special Marriage Act, 1954, specifically stated that a marriage can be solemnised "if at the time of marriage, neither party suffers from recurrent attacks of insanity or epilepsy". Epilepsy was equated with insanity and could be considered as a ground for divorce.

From the practical point of view, it was held that if the disclosure of the condition was not made before marriage, a divorce depended on the discretion of the judge. Fortunately, in 1999, the Rajya Sabha and the Lok Sabha passed a Bill delinking epilepsy from insanity as well as marriage and divorce. Epilepsy is no longer a ground for divorce.

The important issue for the public to realise is that women with epilepsy can marry, have normal sexual functions, bear children and go through the normal reproductive cycle as any other woman.

Epilepsy and driving

The Indian Motor Vehicle Act is rather vague about epilepsy. Section 186 of the Motor Vehicle Act, 1988, specifically states: "Whoever drives a motor vehicle in any public place, when he is to his knowledge suffering from any disease or disability calculated to cause his driving of vehicle to be a source of danger to the public, shall be punishable for the first offence with fine which may extend up to two hundred rupees and for a second offence with fine which may extend up to five hundred rupees". It is up to the medical practitioner to certify whether an epileptic is medically fit to drive.

In general, restrictions on driving have been placed upon people with epilepsy because of a fear that seizure while driving will result in an accident. Studies in the USA have shown that accident rates of drivers with epilepsy are about twice as that of unaffected persons. Most countries have definite regulations that relate to epilepsy and driving. For instance, countries like Australia, Germany and the UK allow driving after a two-year seizure free period. It is also mandatory in many countries for the doctor who treats individuals with epilepsy to inform the licensing authority about the individual’s disorder along with recommendations of withdrawal of the driving licence. There are no such well-defined rules in our country, but it is time that the concerned experts got down to the job of developing firm guidelines.

Treatment

Newer treatments are now available for epilepsy. Surgery is now being performed at several centres in India. The ketogenic diet, a dietary schedule that comprises of low intake of carbohydrates (such as chapatti, rice and potato) offers hope for some patients with epilepsy. Finally, a device that resembles a cardiac pacemaker known as the "vogus nerve stimulator" has been approved in the USA for use in epilepsy. It may be emphasised that these novel measures are applicable to only those patients whose seizures are not controlled by usual anti-epileptic medications.

The writer is Reader in Neurology, Dayanand Medical College & Hospital, Ludhiana.

HOMOEOPATHY & YOU
Do’s, don’ts & the truth
Dr Vikas Sharma

I have been a regular onion-eater. Hardly a day passes when I don’t take raw sliced onions as part of my meals. Still homoeopathy works on me, and the same is true of my patients who are fond of onions).

We all have heard that onion, mint and coffee are the "super antidotes" to homoeopathy and their complete abstinence is a must while using homoeopathic medicines. But it has always been very difficult for me to comprehend this; how is it so that these three substances, which are so dissimilar in chemical composition, can work against all the known 2000 homoeopathic drugs?

In this pursuit and without any bias I searched nearly all the known literature in the homoeopathic software and my library, which includes invaluable contributions by Hahnemann (founder of homoeopathy). To tell you the truth, I found no conclusive evidence that supported the antidotal effect of these three substances. Instead, I found a book in the local British Council Library quoting a recent research according to which mint has no antidotal effect on homoeopathic medicinal value.

It surely is one’s prerogative to interpret anything as one wishes, but all that Hahnemann has said is that one should avoid substances of medicinal value while on homoeopathic treatment. There is no mention of coffee or onion as an antidote by Hahnemann himself, although he advises against the use of coffee as a stimulant.

Hahnemann’s literature has been misinterpreted over the ages. On the contrary, what Hahnemann had actually said is often what is not practised. According to him, patients’ food cravings (strong desires) should be satisfied as they represent the voice of nature.

Hahnemann had warned of overindulgence to a stage where they would act as stimulants. This is very easily understood by the fact that every homoeopath would warn of indulgence in alcohol as a stimulant during treatment even though every homoeopathic medicine is dispensed in alcohol.

It is quite possible that the consumption of certain foods can trigger an allergic response and would aggravate the disease condition, but this does not imply the "antidoting" of homoeopathic drugs. Also certain food substances that are not permitted during disease conditions (e.g. coffee and tea in acidity) should not be misunderstood as antidotes to homoeopathic medicine.

It is often advised not to chew medicated homoeopathic globules and that they should be sucked or left to dissolve in the mouth. This has a great deal of truth in it and is supported by a biological fact that there is a rich supply of blood vessels in the mouth and thus absorption is much faster. That touching by hand can change the medicinal value and should be avoided is also true.

One should keep in mind that homoeopathic medicines are in highly diluted form and prepared with great sensitivity. So any contamination even with the minutest amount of another chemical can alter its constitution. Obviously, hygiene adds another factor. One should avoid touching the medicated globules.

Scientific knowledge is an ever evolving process and its evolution is based on inferences drawn from the process of exactitude. Thus, assumptions, beliefs and suppositions have no place in its advancement and should be dispensed with as soon as possible.

The writer, a Chandigarh-based homoeopath, can be contacted at phone numbers 0172-721501, 870739.