Apakah itu asma?

Asma merupakan penyakit paru-paru kronik yang membengkak dan menyempitkan saluran pernafasan. Semasa serangan asma, simptom-simptom yang mungkin akan pesakit mengalami adalah seperti ‘wheezing’ (bunyi bersiul apabila sedang bernafas), kesesakan dada, sesak nafas dan batuk.

Serangan yang ringan hanya akan berlangsung selama beberapa minit dan dapat diselesaikan sama ada secara spontan ataupun dengan ubat sedutan pelega. Serangan yang teruk akan berterusan walaupun dengan penggunaan ubat sedutan, dan akan memerlukan pemeriksaan segera oleh doctor.

Apakah Penyebab Asma?

Faktor-faktor ini berbeza untuk setiap individu:

1. Jangkitan sistem pernafasan seperti selesema, sinusitis dan bronkitis
2. Pencemaran udara ataupun pendedahan kepada asap rokok
3. Bahan penyebab alahan seperti debu, bulu haiwan, makanan, dan lipas
4. Pendedahan kepada cuaca sejuk dan kering atau perubahan suhu secara tiba-tiba
5. Perubahan emosi atau tekanan
6. Senaman fizikal
7. Ubat-ubatan (aspirin, asid mefenamic, ibuprofen)

Apakah Gejala Asma?

Serangan asma mungkin berlaku secara tiba-tiba atau secara progresif selama beberapa hari atau jam. Simptom yang menandakan serangan asma adalah seperti berikut:

1. Bunyi berdeham atau “wheezing” semasa bernafas
2. Sesak nafas
3. Ketat dada
4. Batuk
5. Kesukaran bercakap
6. Keletihan
7. Jantung berdebar-debar
8. Penggunaan otot aksesori untuk bernafas
9. Kadar pernafasan berkurang

Apakah Rawatan Asma?

Ubat-Ubatan

1. Ubat Penyelamat (reliever)

Ubat penyelamat diambil apabila tanda-tanda serangan asma bermula. Contoh: Salbutamol.

2. Ubat Pengawal (controller)

Ubat pengawal diambil setiap hari untuk kawalan asma yang berterusan. Ia membantu mengurangkan keradangan ketika serangan asma.
Contoh: Budesonide, Fluticasone.

Supplemen

1. Vitamin D

Vitamin D dianggap memberi kesan kepada tahap sel imun tertentu dan mengurangkan tindak balas keradangan yang disebabkan oleh jangkitan pernafasan virus. Banyak kajian telah menunjukkan hubungan antara vitamin D dan asma. Tahap vitamin D yang tinggi telah dijumpai untuk melindungi daripada perkembangan asma dan wheeze yang berulang pada zaman kanak-kanak. 

2. Vitamin C

Vitamin C mempunyai ciri-ciri anti-radang dan antioksidan yang menjadikan ia potensi minat dalam asma.

Antioksidan biasanya menghalang kesan merosakkan tekanan oksidatif dan spesies oksigen reaktif yang dihasilkan oleh sel-sel radang di dalam paru-paru. Idea ini ialah pengambilan antioksida yang rendah seperti vitamin C menyebabkan ketidakseimbangan yang menyokong keradangan kronik dan kerosakan pada paru-paru.

3. Cendawan susu harimau (Tigermilk Mushroom)

Cendawan susu harimau merupakan salah satu alternative yang boleh menguatkan system pernafasan. Cendawan susu harimau boleh melegakan simptom pernafasan contohnya batuk kronik dan berulang, asma dan resdung dengan berkesan sebab ia merupakan agen anti radang yang semula jadi.

4. Cordyceps Sinesis

Cordyceps mengandungi nutrient seperti adenosine, cordycepin, asid cordycepic, polisakarida, asid amino dan vitamin. Menurut klinikal studi, Cordyceps dapat meredakan masalah pernafasan seperti asma atau batuk dan menguatkan fungsi paru-paru.

5. Bawang Putih

Bawang putih mengandungi bahan pencegah radang (anti-inflammatory) dan juga allicin iaitu sejenis agen antioksida yang dapat mengurangkan serangan asma.

Langkah-langkah untuk mencegah serangan asma

1. Hindari daripada allergen
Allergen seperti bulu binatang, debu, serbuk dari bunga harus dielakkan.

2. Hindari daripada asap rokok
Asap rokok dapat mengiritasi saluran penafasan dan seterusnya mengalami serangan asma. Oleh itu pesakit asma digalakkan berhenti rokok suaya melindungi paru-paru sendiri.

3. Rajin olahraga
Berolahraga dapat membantu melatih stamina otot pernafasan dan memperkuat daya tahan tubuh penderita asma. Berenang agak digalakkan oleh doctor untuk penderita asma. Elakkan berolahraga ketika cuaca dingin ataupun cuaca jerebu.

4. Laraskan diet
Gastritis atau GERD merupakan salah satu factor risiko asma. Oleh itu, laraskan diet agar acid perut tidak naik dan mencetuskan asma. Elakkan kopi, the, makanan pedas dan masam.

5. Vaksinasi Flu
Influenza akan menyebabkan masalah paru-paru yang sedia ada menjadi lebih teruk. Pesakit asma digalakkan mengambil vaksin supaya mendapat perlindungan yang lebih baik terhadap pesakit asma.

Cara penggunaan inhaler (MDI) yang betul

1. Duduk atau berdiri tegak
2. Keluarkan penutup dari corong
3. Letakkan alat sedut dengan jari telunjuk di bahagian atas tabung dan ibu jari di bahagian bawah
4. Goncang alat sedut
5. Tarik nafas sepenuhnya melalui mulut dan hembus nafas perlahan-lahan
6. Letakkan pelekap mulut alat sedut di dalam mulut. Tutup bibir di sekitar corong dengan rapat. Dongakkan kepala sedikit ke belakang
7. Mula untuk menarik nafas perlahan-lahan dan mendalam melalui corong dan pada masa yang sama tekan ke bawah pada tabung alat sedut dengan jari telunjuk
8. Terus tarik nafas dalam dan dengan perlahan-lahan tahan nafas selama 5 hingga 10 saat (mengikut kemampuan)
9. Keluarkan alat sedut dari mulut dan hembus nafas perlahan-lahan melalui hidung tanpa membuka mulut
10. Tunggu 1 minit sebelum mengulangi dos kedua
11. Gantikan penutup selepas digunakan
12. Bilas mulut selepas menggunakan steroid yang telah disedut

Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs. The air sacs may be filled with fluid or pus (purulent material) which causes cough with phlegm or pus, fever, chills, and difficulty in breathing. There are a variety of organisms that can cause pneumonia which includes bacteria, viruses and fungi.

Pneumonia can be mild or even life-threatening. It can cause most serious damage to infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Symptoms

The signs and symptoms of pneumonia may vary for different individuals. It depends on factors such as the type of bacteria causing the infection, the patient’s overall health. Besides, the signs and symptoms can range from mild to severe. Mild signs and symptoms usually are almost identical to those of a common cold or flu; however, they will last longer.

Most of the pneumonia patients will experience chest pain when breathing or coughing, having confusion, productive cough (with phlegm), fatigue, fever, sweating, chills, nausea, vomiting, diarrhea and shortness of breath. For patients age 65 and above, they also experience signs and symptoms such as changes in mental awareness and lower body temperature. There may be no signs or symptoms at all in newborns and infants. However, some newborns and infants may vomit, fever, cough, lethargy and have difficulty in breathing and eating if they are infected.

Causes

The common causes of pneumonia include viruses, bacteria and fungi. For example, the common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). On the other hand, the common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus). However, it is hard for the physicians to detect which bacteria causes the pneumonia in patients.

We also say it is community-acquired pneumonia when someone got the pneumonia in the community (not in a hospital). While if someone develops pneumonia in a healthcare setting (hospital, long-term care facilities, dialysis centre), that would be considered as healthcare-associated pneumonia. Ventilator-associated pneumonia is when someone develop pneumonia after using ventilator (a machine that supports breathing).

Risk Factors

Pneumonia can affect anyone regardless of the age; however, children under 2 years old and adult above 65 years old are at the highest risk to get pneumonia. Even the signs and symptoms are more severe in this age group.

There are few risk factors that may contribute to developing of pneumonia, such as being in hospital as the patient’s immune system is already weakened especially if the patient is using a ventilator, the risk is even greater. Having a chronic disease such as COPD, asthma, heart disease, diabetes will pose a greater risk to the patient. People with suppressed immune system either due to disease or taking immunosuppressants will also have a greater risk of contracting pneumonia. 

There are some lifestyles that will increase the risk of getting pneumonia. For example, smoking will compromise the immune system’s ability to defend itself. Drug or excessive alcohol use will also increase the risk of developing pneumonia as one may aspirate food, drink or vomit into the lungs. Being malnutrition also contributes to a higher risk of contracting pneumonia and a higher death risk.

Treatment

A mild pneumonia can be usually treated at home with rest and antibiotics (if the cause is bacteria). Drinking plenty of fluid is also necessary in recovery from pneumonia. Antibiotics should be taken as prescribed by doctors following the course even if the patient already feels better. This is because if stopped half way without finishing the antibiotic course, it will create an antibiotic resistant in the bacteria which help the bacteria to evolve and become stronger. There is a general guideline for the recovery of pneumonia.

• 1 week: high temperature should have reduced
• 4 weeks: chest pain and mucus production should have slowly decreased
• 6 weeks: cough and breathlessness should have substantially reduced
• 3 months: most symptoms should have reduced, just the patient may still feel fatigue
• 6 months: many people will feel back to normal

However, if there is no improvement after three days of starting antibiotics, the patient should go to doctor. This may due to the bacteria causing the infection is actually resistant to the antibiotic prescribed by the doctors or the pneumonia is not caused by bacteria rather it is caused by virus.

Painkillers such as paracetamol and ibuprofen usually will be given also to cope with the pain and fever. Cough medicine can also help to relive the cough and phlegm so that the patient can have a good rest.

There will usually be a follow up with doctor after 6 weeks of starting an antibiotics course. A chest X-Ray may be needed for patient whose symptoms have no improvement at all or the symptoms come back after they have gone away.

Hospitalization may be needed for patient who is older than 65 years old, having signs of confusion, declined kidney function, low blood pressure, rapid breathing, need breathing assistance, low body temperature or a rapid heart rate.

Prevention

Pneumonia can be prevented by getting vaccination. Taking a flu shot every year can help to prevent seasonal flu. It is important as flu is a common cause of pneumonia. Certain group of people should also take vaccination against pneumococcal pneumonia as it is a common form of bacterial pneumonia. This group of people includes children younger than 2, children aged 2 to 5 but with chronic disease, adults aged 19 to 64 with chronic disease such as asthma, COPD, diabetes and also includes all adults older than 65 years old.

Regularly hand washing especially after coughing or blowing your nose can also reduce the risk of getting pneumonia. Avoid smoking as tobacco damages the lungs’ ability to fight infection, which will expose the smoker to higher risk of getting pneumonia.

Good habits such as eating healthy diet, having sufficient rest and exercise regularly can keep one from illness. They also help to boost the recovery from respiratory illness such as cold and flu. Patient with existing respiratory health conditions such as asthma, COPD, diabetes and heart disease should also manage their condition well to lower the risk of getting pneumonia.

Reference

– Pneumonia. https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204#:~:text=Pneumonia%20is%20an%20infection%20that,and%20fungi%2C%20can%20cause%20pneumonia. Mayo Clinic. June 13, 2020.
– Causes of Pneumonia. https://www.cdc.gov/pneumonia/causes.html#:~:text=Common%20Causes%20of%20Pneumonia,is%20Streptococcus%20pneumoniae%20(pneumococcus). Centers for Disease Control and Prevention. October 22, 2020.
– Causes and Risk Factors of Pneumonia. https://www.verywellhealth.com/pneumonia-causes-risk-factors-770691. Verywell Health. Accessed April 8, 2022.
– The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis – World. https://reliefweb.int/report/world/impact-childhood-malnutrition-mortality-pneumonia-systematic-review-and-networkmeta#:~:text=We%20estimated%20a%20median%2018.3,dramatically%20increases%20with%20malnutrition%20severity. ReliefWeb. Accessed April 8, 2022.
-https://www.nhs.uk/conditions/pneumonia/treatment/#:~:text=Mild%20pneumonia%20can%20 usually%20be,cases%20may%20need%20hospital%20treatment. NHS Choices. Accessed April 8, 2022.
– Preventing Pneumonia. https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/preventing-pneumonia#:~:text=Get%20a%20flu%20shot%20every,Children%20younger%20than%202. American Lung Association. Accessed April 9, 2022.

Introduction

Influenza, also known as flu is classified into seasonal influenza, avian influenza and pandemic influenza. The influenza A outbreak in Malaysia is classified as seasonal influenza. Avian influenza occurs mainly in birds and poultry (chicken and ducks) and usually do not infect other species but if virus get mutated, there will be a possibility for human to get infected. Meanwhile, pandemic influenza occurs once every 10-50 years when an animal influenza virus (avian influenza) undergoes major genetic changes and develops into a new influenza virus that will be transmitted among human, leading to a pandemic.

Seasonal influenza that affects human can be divided into:

• Type A
• Type B

Influenza A viruses are caused by RNA viruses belonging to the Orthomyxoviridae family, which is categorized into subtypes based on the types of 2 proteins on the surface if the viral envelope:

• H= hemagglutinin is a protein that causes red blood cells to agglutinate.
• N= neuraminidase is an enzyme that cleaves the glycosidic bonds of the monosaccharide sialic acid.

Avian influenza is also known as the bird flu, caused by type A strain (H5N1) of the influenza viruses. Influenza A is a subtype of the type A influenza viruses. It can be found in many species, including humans, birds, horses, and pigs, due to the breadth of potential hosts and its ability to genetically change over a short period of times, influenza A viruses are every diverse. Normally, its capable of causing a pandemic.

Unlike influenza A viruses, type B influenza viruses are only found in human. Influenza B viruses are further classified into two lineages: B/Yamagata and B/Victoria and will not cause pandemics. Influenza B virus may cause lesser reaction than influenza A virus, but it is still extremely harmful.  

Transmission

Normally, airborne transmission occurs particularly in crowded enclosed spaces, from direct contact with droplets circulated by unprotected coughs and sneezes and contamination of the hands.

Risk group

• Pregnant women
• Children under 5 years old
• Elderly above 65 years old
• Patient with chronic disease (asthma, diabetic, heart and lung illness)
• Immunocompromised patient (HIV, cancer, chemotherapy patient or with steroid treatment)
• Obese

Incubation period:

The seasonal influenza that occurs yearly is type A and B with an incubation period of 1-4 days.

Sign & Symptoms:

Once the symptoms begin, one will experience high fever for 2-3 days. Influenza symptoms can range from mild to severe and they vary person to person:

• High fever
• Chest discomfort
• Cough
• Shortness of breath
• Sore throat
• Muscle pain
• Headache
• Sneezing
• Tiredness and fatigue
• Loss of consciousness
• Diarrhea and vomit

Complication:

High risk populations may develop complications:

• Pneumonia (lung infection)
• Encephalitis (brain infection)
• Heart diseases
• Rhabdomyolysis (Inflammation of muscle tissue)

Treatment:

Home remedies:

• Drink plenty of water
• Maintain a balanced diet
• Get enough of rest
• Avoid stress as it can weaken the body immune system
• Medications such as paracetamol or ibuprofen to treat fever or muscle pain
• Medications such as expectorants or mucolytics to treat cough and cold

Medication:

For Influenza A

• Antiviral medication is available by prescription only. It can shorten the duration of symptoms or prevent complications such as pneumonia. Antiviral medications such as Tamiflu (oseltamivir) or Relenza (zanamivir) can be started within 1-2 days of onset of influenza A symptoms and given around 3-5 days. Antibiotic are not effective against influenza virus at all.

Prevention:

Vaccine:

The World Health Organization (WHO) recognizes vaccination as one most effective way to prevent the influenza. Influenza vaccination provides protection for children and adults from different virus strains and help to reduce the disease transmission and complication. Vaccination takes 2 weeks to become fully effective for protection to develop after immunization and can last up to 1 year.

Precaution:

• Cover mouth and nose with tissue or handkerchief when sneezing or coughing
• Frequent hand wash with soap
• Wear a facemask while infect with influenza
• Avoid being in public places when having influenza

Reference:

1. https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
2. http://www.myhealth.gov.my/en/influenza-2/
3. https://www.healthline.com/health/cold-flu/influenza-a-vs-b
4. https://www.medicalnewstoday.com/articles/326672
5. https://www.homage.com.my/health/influenza/
6. https://specialty.mims.com/influenza/treatment?channel=respirology