HOW TO CONTROL ASTHMA ?

It is easy to put the blame on the patient for non-compliance in the use of steroid inhalers. The causes for this lie both with the patient and those managing the disease — the physician, hospitals and the policy makers.

Patient's attitude

The first is the attitude of the patient. Many think that asthma is a serious one-time disease, which if treated well will not recur. This attitude is so deep-rooted that it will take time to change it. Most awareness campaigns on asthma are directed towards increasing compliance in using steroid inhalers rather than stressing that asthma is a problem whose management depends on long-term strategies rather than short-term gains. By short-term gains, I mean rapid cure for asthma, alternative therapies, complementary therapies and so on. Surprisingly some people are not aware that they have asthma and are not averse to taking regular treatment if advised. Many times asthma that was undiagnosed is picked up when the patient is admitted for some other problem or for surgery.

The idea of a long-term strategy for asthma control is to make the patient understand that asthma, like diabetes or hypertension, needs regular and long-term management. The symptom-free periods do not mean complete cure but only control of asthma, which needs to be maintained. The symptom-free periods are possibly the biggest disadvantage of asthma management. For example, when a patient is discharged after an asthma attack with discharge advice and a follow up, it is hardly followed because neither the patient nor the physician thinks about long-term management. Nor is there a discussion about the disease during discharge.

In this situation, a self-management plan is considered the best. The usual argument in our country about this strategy is that our country is poor, literacy rate is poor and comprehension capacity is poor. All this has been proved wrong by one study.

Study results

The Respiratory Research Foundation of India and Glaxo Smith Kline distributed a questionnaire called the Asthma Control Test to patients suffering from asthma. The study results came as a surprise, as many people were enthusiastic and clear about the disease and could understand the disease better and plan their treatment accordingly. The reassuring aspect was the interest shown by participants and also the regularity of use of steroid inhalers.

So it is clear that self-management strategies would work if the patient were given details about the disease. This should be done in the first sitting. The ACT forms can be translated into languages other than English and distributed to people who cannot follow English. Illustrations in the form can help people who are not educated understand the problem than didactic lectures.

The need of the hour is to educate the patient about asthma, the consequences of non-control and also help the patient create a self-management plan that teaches control without frequent visits to the physician's office.

SPORTS FOR HEALTH LIFE

SPORTS are a part of modern life and the zest for conquest makes a sportsperson prone to injuries. Prevention of injuries is crucial for a long injury-free career. A healthy diet, general body warm up and stretching are absolutely essential for every sportsperson.

While most people realise and understand the need for regular exercise, many are unaware of the importance of stretching or relaxation. Exercise, stretching and relaxation go together. Exercising without stretching can lead to pain and disability.

Why is flexibility important?

Flexibility is important for optimal athletic performance and for prevention of injury. Different sports have different flexibility requirements. Stretching is the best way to enhance flexibility.

What causes muscle cramp?

Muscle cramps are caused by the depletion of essential electrolytes in the body or due to improper coordination between opposing muscle groups. Tight clothing can also cause cramps due to decreased blood flow to active muscle tissue. In case of cramps, increase intake of water. Follow it up with an attempt to stretch the muscle involved. Then gently rub down and do mild exercises that require the use of that particular muscle.

What should be done immediately after sustaining an injury?

The best treatment is prevention. When any activity causes discomfort or chronic irritation, you need to treat the cause either by switching activities or by using better equipment. The standard method of treatment on the field is application of a cold compress if possible and elevation of the body part. This decreases blood flow to the injured part and minimises swelling. Do not hesitate to seek medical advice if you have any doubts regarding the nature or seriousness of the injury.

How can we tell if the injury is serious?

When there is obvious deformity as in fractures and dislocation, application of cold compress is the best provided there is no open wound. Never try to reset the fracture or dislocation by yourself as this may cause greater damage to the muscles, ligaments and nerves. Treatment of these injuries should always be left to specialised medical personnel. In other cases, seek medical advice if there is persistent pain, swelling or disability for more than 48 hours after the initial injury.

Will taking anabolic steroids help enhance performance?

First of all use of drugs for performance enhancement is against the spirit of fair and ethical competition. Almost all steroids and performance enhancing drugs cause various health hazards. Agitation and irritability are the most common side effects. Problems of addiction, dependency and withdrawal can occur in long-term users. Other adverse effects include, hair loss, impotency, hypertension, stroke, insomnia (sleeplessness), tremors, seizures, increased heart rate or tachycardia, cardiac arrest and death.

The right diet for athletes

FOOD is the fuel that will power a sportsperson's performance. A well balanced diet is the key to good health and successful weight control. Food is made up of carbohydrates, proteins and fat.

An athlete's diet should be high in carbohydrates and moderate in protein and fat. Another key element is water. The five golden rules for healthy eating are:

# Eat fresh foods. Avoid processed or readymade meals.

# Eat plenty of fibre-rich food like fresh fruit, vegetables, cereals, pulses and grains.

# Cut down on fats, especially saturated fats.

# Decrease intake of sugar and salt.

# Vary your diet to maximise your vitamin, protein and carbohydrate intake.

# Drink three to four litres of water every day. Drink about 400-600 ml of water before starting the game/event.

# During a game, players should ideally drink about 150-200 ml of water mixed with salt and glucose every 10-15 minutes.

# Sports drinks help athletes who exercise at high intensity for more than 90 minutes. They provide energy in situations where glycogen stores are likely to be depleted. Though many sports drinks are available, it is advisable to drink one with fluid, electrolytes and six to eight per cent of carbohydrate content. This helps regulate temperature and fluid balance.

FOR CLEAN AND HEALTHY TEETH

HEALTHY teeth and gums are the result of several factors ranging from oral hygiene to eating habits and genetic influences. Special children tend to be more susceptible to dental diseases.

The reasons for this lie in the altered physiological conditions in special children like poor oral hygiene, swallowing defects, macroglossia, lack of lip seal and bad habits.

Brush the teeth

Special children tend to maintain poor oral hygiene. This is due to not brushing the teeth properly. Accumulation of plaque in the long run turns into calculus and results in poor oral hygiene, thereby leading to development of gum disease and dental caries.

Another problem is that poor neuromuscular coordination of the tongue and pharyngeal muscles leads to defects in the swallowing mechanism. Drooling and dribbling of saliva paves the way for drying up of saliva leading to bad breath and dental caries.

In some cases, the tongue is enlarged; a condition known as Macroglossia, which results in the problems like protrusion of teeth and increased inter-dental spaces; dripping of saliva leading to a dry mouth, rampant caries and bad breath and lack of lip seal.

Lack of lip seal can occur in three ways: First as incompetent lips seen in case of children with short lips. The second is potentially competent lips in which children have normal lips that fail to form a lip seal, due to proclination of upper incisors.

The last is Everted lips where the lip muscles are weak and do not form a lip seal.

Bad habits such as sucking thumbs or fingers and thrusting the tongue out have a deleterious effect on the teeth and their supporting structures.

Other problems

Then there are other normal dental problems. Rampant caries is a widespread, rapidly burrowing type of caries that appears suddenly and is uncontrolled. Special children sometimes crave for sweets to overcome emotional disturbances, continuous tension, anxiety and fear. Too much sugar in the diet causes rampant caries.

Retained deciduous teeth are milk teeth that fail to shed and block the normal eruption of permanent teeth below it.

As a result, the permanent teeth are deflected from the normal eruption pathway causing irregular arrangement of teeth. Malocclusion is irregular teeth alignment, which occurs due to the any of the above factors.

The management of all these problems includes diet, use of fluoride, frequent examinations and hygiene. The children should be encouraged to eat raw vegetables like carrots, tomatoes, cucumber, radish, onion and gooseberry and also fruits like apples, pears and other seasonal fruits.

Fluoride application helps in prevention of caries. Dental examination in children is usually started in 12 to 14 months of age. Frequent dental examination helps to prevent the onset of diseases.

Good oral hygiene is also crucial to keep the teeth and gums healthy.