An Interview with Dr. Anjan Bhattacharya, Consultant Developmental Paediatrician, (MBBS(Cal); DCH (Lond); MRCP (Lond); FRCPCH, UK)
1- Why are the younger kids getting a lot of non-stop cough, wheezing these days?
India is taking a leap socioeconomically, with the consequence of moving away from the traditional ways of livelihood. Mostly, this is a good thing. Unfortunately, industrialisation brings its undesirable effects too, one of which is explosion of pollution.
Since responsible industrial practices and green technology remains beyond the reach of a country like ours due to its cost and responsible human behaviour; we remain helpless in curbing its menace. Our kids in turn, are left to suffer.
One of their organs that face the brunt is their respiratory tract.
It is compounded by a relatively unhealthy lifestyle that follows such industrialisation, namely, lack of facilities to play, unhealthy eating practices, sedentary habits like television watching, video gaming etc. We find ourselves unprepared for the parenting skills necessary to switch from a joint family structure to nuclear family mode. Nuclear family with healthy parenting practices are however, statistically much healthier for the kids than the joint family structure. But countries like India have hardly invested in parenting skill development, leaving it to Mother Nature, which unfortunately are not always the best options!
The compounding effects attack the children and their respiratory tract as their first victims!
2- Does it have any relation to Asthma?
Yes. What is a bit of cough and wheezing today can easily be asthma tomorrow. The inflammatory reactions to pollution and germ, witnessed at the respiratory tract level, meted out repetitively (a concept called the “Allergenic March”), leads to chronicity. A chronic inflammatory condition of respiratory tract is what Asthma is.
3- Can allergy and pollution be the cause of this problem?
Most certainly! In the first answer, rise in pollution has been named as one of the chief causes while the compounding factors can easily be blamed for the rise in allergenicity in our children.
4- What is this condition named?
There is a scientific concept that it is “one airway, one disease”. I find it attractive. It explains all these phenomena, which is a repetition of the experience of the western world when they were industrialising. Therefore, we need to look at it as “what’s in a name”? Basically, pollutants and allergens are producing unhealthy inflammation of the airways, which when leads to chronicity, is being labelled as “Asthma”! The scientific world is still grappling to give names to these pre-asthma states. Let’s not waste our sweat over this until they do so. Instead, let us concentrate, how we can curb these menace!
5- What are the symptoms?
The usual symptoms include coughing, sneezing, runny noses and these are largely from the overt effects of the irritations that the respiratory tract linings produce by being exposed to the allergens and pollutants. They also include itchy or red eyes or noses.
Covert features of these include itchy or painful ears, headaches (sinus) or sore throats. Some of these features can present as unrelated symptoms like vomiting, skin dryness, itching or eruptions (dermatitis), repeated hacking noises etc.
Classic symptoms include coughing during night (nocturnal cough) or early morning, dry cough; coughing after play (exercise induced cough), coughing before or after a meal etc.
Good quality data are emerging of the secondary morbidities, like sleep disturbances or poor/deteriorating scholastic performances, drop in ability to concentrate, coordinate movements or handwriting, and maintain executive functioning and behaviour, sustaining memory functions or day time somnolence.
Children with special needs like neuro-disabilities (cerebral palsy or CP, spinal muscular atrophies, myopathies, muscular dystrophies, spina bifida etc.) or with known depressed immune functions (Downs Syndrome, Autism, Psychogenic Depression, Immunodeficiency states etc.) are also coming to the limelight for being a victim of this respiratory attack more than their normal counterparts; some of the very recent publications in reputable scientific journals like Archives of Diseases in Paediatrics & Childhood, BMJ Publications, have recently highlighted.
6- What are the treatment options?
The good news is that these are still 100% controllable conditions, with good treatments.
In my anecdotal series, I am yet to meet a child whose ‘difficult to control’ asthma or respiratory tract symptoms are not amenable to judicious management. Moreover, the babies who are born under our unit, do not seem to go ahead and suffer from these respiratory troubles.
The secret to this seems to be a simple parent training programme teaching parents basic health education for their kids. When it is accessed (health access) before weaning, which is usually available to the children born under my care (almost all of whom are exclusively breastfed from my personal commitment to this cause, avoiding any fanaticism), it works as a Preventative Tool.
For the children, who accessed this programme because their respiratory symptoms are not improving, the biopsychosocial approach to disease causation and its management accordingly produces that near-perfect result, which is what Evidence Based Medicine claims to be possible, i.e. 100% (full) control.
7- Does nebulisation has any side-effects?
Practically no. There is nothing in this world, which can be totally side-effect free. But, if there is anything that is almost side-effect free, it is nebulisation and inhaled method of medication delivery. It is because, in nebulisation/inhalation-based techniques, the medicine quantity is 100th – 500th of what is needed orally; i.e. in this way, the medicaments are used in quantities lesser than even homeopathic medicines!
A properly qualified doctor is only prescribing a nebuliser or an inhaler, when the benefits outweigh the risks! It is indeed seen that, if a judiciously prescribed and monitored nebulised/inhaled medicine is not taken properly, the side-effect of the disease can harm the child a lot more. This comes head to head in the matter of growth of a child, where the disease is known to cause far more permanent growth deficit than the inadvertent use of nebulised/inhaled medicine may cause!
But the key to this is a successful Doctor-Patient Partnership (GINA guidelines). We achieve this at our Child Development Centre through the Parent Health Education Programme called Programme of Care (PoC). Once parents learn how to be responsible with their child’s prescribed nebulisation/inhalation wherever needed, our experience gives us ample hope for prescribing appropriate treatment through appropriate (biopsychosocial training) means.
8- How can we increase the immunity of such kids?
In overwhelmingly large proportion of children, this can be achieved by securing their childhood for them. It is only a vanishingly miniscule minority, where we encounter primary immune deficiency, where the treatment needs to be escalated. In the large majority of our patients, we achieve boosting effect of protective immunity through training modern parents how to secure the child’s childhood through simple means. This of course, needs to be twined with some rather simple treatment programme for a limited period of time, until the immune power supersedes the disease process’ damaging cascade. ‘Hygiene Hypothesis’ do show that there is link between this immunity and development of auto-immune allergenic diseases, including asthma. Therefore, let a child be a child seems to be an efficient disease preventive measure.
9- What should be the do’s and don’ts for these kids?
a. Exclusively breastfeed
b. Wean appropriately
c. Avoid baby foods
d. Stick to a knowledgeable child specialist, who does not prescribe antibiotics at the drop of the hat
e. Adore, nurture and spend small aliquots of quality time with the child
f. Let them play heartily, they will not catch cold easily!
g. Understand responsible patient/parent behaviour, get some quality training
h. Healthy eating
i. Cut down Screen Time
j. Healthy sleeping
k. Regular toilet training
l. Let the child learn from their mistakes
m. Avoid tobacco, especially tobacco smokes (quit smoking, no excuses)
n. Avoid obesity
o. Avoid offensive allergens
a. Cut corners in your parenting practices
b. Criticise, humiliate, punish or reprimand a child
c. Give bribes for compliance from the kid
d. Be permissive either; learn laying boundaries
e. Bug them for studies, as if that is the only way to success!
f. Take the fun out of learning
g. Put so much clothing that it becomes counterproductive (mostly seen)!
h. Stop ice-creams! Can you imagine a healthy childhood without ice-creams!!
i. Doctor shop
10- Anything else that you would like to include?
It is important for the parents to realise that:-
1. Medicine is not a cake walk; doctors know best (not the medicine shop boy)
2. Doctors have specialisations, not every doctor can know everything
3. We are talking about a 100% controllable condition here
4. It is achieved through effective Doctor-Patient (Parent) Partnership
5. The disease causation model is biopsychosocial
6. Hence the solution is biospychosocial, where solution is not forthcoming
7. You and your child should be able to lead a completely normal healthy life, if the condition is fully (100%) controlled
Dr. Anjan Bhattacharya,
MBBS(Cal); DCH (Lond); MRCP (Lond); FRCPCH, UK
CONSULTANT PAEDIATRICIAN (Developmental)
Child Development Centre
Apollo Gleneagles Hospital, Kolkata
For Appointments, call: (0)9830987419
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