3 DR. SRIKANTA J T DR. SRIKANTA J T
First published in India by HarperVantage 2024 An imprint of HarperCollins Publishers 4th Floor, Tower A, Building No. 10, DLF Cyber City, DLF Phase II, Gurugram, Haryana – 122002 www.harpercollins.co.in 2 4 6 8 10 9 7 5 3 1 Copyright © Himalaya Wellness Company 2024 Illustrations © Shutterstock 2024 P-ISBN: 978-93-5699-547-5 E-ISBN: 978-93-5699-548-2 This book and its content represent the author’s viewpoint backed by factual data as reported by the author. Dr. Srikanta J T asserts the moral right to be identified as the author of this work. This book only intends to provide educational and informational value and is not a substitute for professional medical advice. Readers should consult medical experts for the latest childcare information. The publisher is not liable for the opinions expressed in the book. All rights, including copyright, are reserved. Reproduction, storage, or transmission of any part of the book requires written consent from the publisher and Himalaya Wellness Company. Printed and bound at Thomson Press (India) Ltd.
5 It all began in 1930 in the forests surrounding Dehradun. Mr. M. Manal, the founder of Himalaya Wellness Company, curiously looked on as villagers fed the roots of a local herb to calm a herd of agitated elephants. This herb was Rauwolfia Serpentina, the inspiration that led to the creation of Serpina®, the world’s first natural antihypertensive drug which was launched in 1934. Mr. Manal embarked upon the journey of uncovering the mysteries of Nature at a time when herb-based healthcare was looked at with skepticism. Fuelled by his vision of bringing the best of nature’s solutions backed by scientific research to people suffering health concerns, he was determined to contemporize Ayurveda through modern technology. With a single hand-operated tableting machine bought after pawning his mother’s bangles, he strode ahead on the road less travelled and full of challenges. It took him four years of extensive research to formulate the first offering, Serpina®, which laid the foundation for Himalaya’s strong foothold in research. In 1955, came the historic breakthrough that established Himalaya as a symbol of trust in the Indian healthcare landscape. Liv.52, a formulation for liver health, became the best-selling flagship offering and a name synonymous with brand Himalaya. Ever since, as a head-to-heel problem-solving brand, Himalaya has introduced many other iconic products such as Septilin, Cystone, Bonnisan, and Rumalaya forte, which reinforced the trust of millions of customers, making Himalaya a household name. Broadening horizons, Himalaya diversified into Personal Care, BabyCare, Wellness, and Animal Health while consolidating all portfolios under one umbrella, “Himalaya Since 1930”. Today, Himalaya is a leading global health and personal care brand with close to 500 products sold in over 100 countries – touching millions of lives every day and realizing the promise of Happiness through Wellness in every home and heart. OUR STORY
7 F O R EWO R D Asthma is a serious health problem that affects all age groups across the globe. Children in many countries are being increasingly affected by the condition. Although, with advanced medical care, the rate of hospitalization and deaths have decreased, asthma does still disrupt families by posing a daily healthcare burden on them, resulting in reduced productivity for the child and the parents at school and the workplace, respectively. This book is designed to help parents and children understand more about childhood asthma – how it is diagnosed and treated, and how they can help their child stay well. This is the story of a child named Sameer, an asthmatic, and his parents. It outlines their journey of understanding his condition, accepting the health problem, starting appropriate treatment, and achieving his goal of becoming a successful badminton player in the under-12 category at the district level. Dr. Srikanta JT MBBS, DCH, DNB; Fellowship in Pediatric Pulmonology & Sleep Medicine (Singapore); Fellowship in Intervention Pulmonology
8 Our Purpose Babies have always been a top priority at Himalaya BabyCare, and we are committed to bringing wellness and happiness to babies via head-to-heel baby care solutions based on science. We are devoted to offering continued support to moms and parents across the initial critical years of parenthood through education and awareness on baby care, facilities, and amenities to ensure convenient on-the-go care for babies, delivering a hassle-free experience for parents. Childhood asthma, a chronic respiratory condition, has the potential to significantly disrupt a child’s daily life if not managed effectively. Childhood Asthma: Overcoming the Challenges! is a comprehensive and accessible guide designed for parents seeking a deeper insight into asthma in young children. Through the interactions between a healthcare professional, a concerned mother, and her eight-yearold son, Himalaya BabyCare intends to provide guidance on the intricate aspects of childhood asthma, including its symptoms, triggers, and diagnosis in a simplified and interesting way. This book is crafted to equip readers with the knowledge and practical tools required to effectively manage asthma in children. Sameer’s story, at just eight years old, serves as a powerful example for parents. It illuminates the path to helping their children lead fulfilling lives, even in the face of asthma. By highlighting the significance of proper precautions and medication, Sameer’s narrative offers hope and dispels misconceptions surrounding asthma and its treatment. Ultimately, it aims to enhance the overall well-being and quality of life for children dealing with this condition. We hope that with the knowledge and advice shared in this easy-to-understand book, parents will be able to make the right choices and provide appropriate care and support to their children, helping them lead active and fulfilling lives.
9 We understand that your precious little one's delicate skin needs special care. Keeping this in mind and your baby's safety at the forefront, we have thoughtfully crafted a range of baby care products based on the Ayurvedic discipline of Kaumarabhritya. Our products are gentle, research-based, and free from harsh chemicals, formulated to help nourish and protect your baby's skin. Himalaya BabyCare Gentle • Safe • Researched
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11 Table of Contents The Story of Sameer ���������������������������������������������������������������������� 12 Sameer Has Asthma ������������������������������������������������������������������������ 15 What Can Sameer Be Allergic to? ����������������������������������������������� 20 Alleviating Fears About Sameer’s Medication ��������������������������� 23 Inhalers to Make Sameer Better! ������������������������������������������������� 27 Time for Sameer’s Review! ����������������������������������������������������������� 29 Sameer’s Moment of Triumph ������������������������������������������������������ 35
12 Sameer, a cheerful eight-year-old boy, was brought to my clinic by his mother Priya. He came with a complaint of cough that had persisted for the past six months. He was quite eager to tell me that his mother never allows him to play with his friends due to his cough. Priya explained his condition, “He has intermittent (occurring at regular intervals) coughs that occur mostly at night, sometimes even during the day, ones that often induce vomiting.” I could gauge Priya had gone through a lot in the past six months. She had witnessed Sameer making unusual sounds during his sleep due to breathing difficulties. She knew something was not right as her husband also suffered from wheezing. The Story of Sameer Uncontrolled asthma can certainly be responsible for poor growth in children. – DR. MARK LEVY general practitioner with expertise in asthma
13 Priya exclaimed, “I have visited many pediatricians, and most have prescribed either tablets or syrups while others advised regular nebulization. But I said no, as I have heard they are addictive. Is it true doctor?” After listening to Priya, I started asking more questions about Sameer’s personal, family, and environmental history. To diagnose an ailment, the attending doctor must examine the patient thoroughly and carefully note down every little detail possible. Priya opened up, “As a kid, Sameer had eczema or skin allergy until the age of two years. Though he is much better now, but once in a while he does get skin rashes.” My husband’s family has a significant history of allergies. My husband experiences both wheezing and sneezing and uses an inhaler regardless of me telling him that it is not good for his health. My parents did not have any history of such ailments.” » To diagnose an ailment, the attending doctor must examine the patient thoroughly, and carefully note down every little detail possible.
14 “We have a very clean house; our maid vacuums it twice daily. You see, we have a carpeted house. We only use blankets made of pashmina wool. Recently, we also got a Persian cat. I am positive these aren’t the causes of Sameer’s condition.” After listening to Priya, I carefully examined Sameer and used the stethoscope to listen to his chest, and voila! Wheezing. The symptoms, family history, and physical examination were all pointing to a classic case of asthma. Priya was shocked after the initial detection of the condition. “How can it be? He’s so young. Are there any further tests we can do?” muttered Priya.
15 Sameer Has Asthma I waited patiently until Priya regained her composure; I took a model of the lower airways in my hand and started explaining to her all about asthma. » Asthma is a condition that affects the lower part of the airways – the small tubes that carry air in and out of lungs. SHORTNESS OF BREATH CHEST PAIN COUGHING ATTACKS WHEEZING SOUND WHILE EXHALING Don’t let mental blocks control you. Set yourself free. Confront your fear and turn the mental blocks into building blocks. – DR. ROOPLEEN surgeon, writer and personal development coach
16 Asthma is a condition that affects the lower part of the airways – the small tubes that carry air in and out of lungs. A child with asthma has “hyper-responsive” airways. This means that these airways become swollen and readily react to things that can cause irritation. The irritants may include but are not limited to pets, pollen, cold weather, and mold. When the airways react to these irritants, they become narrower and even more irritated, eventually leading to asthma and making it difficult for your child to breathe. Sameer experiences a night-time cough, daytime cough, cough while playing, or inability to play due to cough, but gets better with medication, all indications suggestive of asthma. Though he may not have cough for a couple of weeks, asthma does not go away completely. It is a long-term condition that can be managed based on the symptoms, but there is no potential cure for it to date. However, if not treated properly, it can be life-threatening. “But why did Sameer get asthma?” asked Priya. I explained, “Mrs. Priya, it’s hard to say for sure, but we do know why Sameer was more likely to develop it.”
17 “Sameer has a history of eczema during infancy, and there is a strong family history of asthma and related allergies. Apart from these, there are other factors that could definitely increase the probability in him. Many triggers could cause the asthmatic conditions in a person, and isn’t it true that Sameer has more than one?” “It is believed that our lifestyle choices, including our living conditions, unhealthy diet, and unhygienic environment may have added to the increasing number of people with asthma over the past few decades. Moreover, smoking during pregnancy or exposing a child to cigarette smoke early in life increases their risk of asthma.” “Isn’t there a test that can definitively tell if my child has asthma?” asked Priya. “Mrs. Priya, asthma, in the majority of cases, is diagnosed based on the symptoms which may include frequent coughing during day or night or while playing. However, we do have an objective way of prognosis, called a lung or pulmonary function test, which helps in diagnosis. This test evaluates the severity of asthma and its response to medications.” » It is believed that our lifestyle choices including our living conditions, unhealthy diet, and unhygienic environment may have added to the increasing number of people with asthma over the past few decades.
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20 Mrs. Priya took Sameer for the lung function test and visited the clinic with his reports. I went through the report thoroughly and asked Sameer how the test was. Sometimes, the observer (the mother in this case) and the patient (Sameer here) may feel differently about the test and its outcome. It is a good practice to make the patient feel included in the process and connect with them especially when the patient is a child. Sameer had my full attention now as he started explaining how it all went. “You know, doctor uncle, I was able to blow up all the three balloons after the medications which I couldn’t before. I felt really good after the medicine! I continued where Sameer left, “Yes! That’s precisely What Can Sameer Be Allergic to? The toy that I hold to fall asleep can be the reason for my difficulty in breathing! – DR. SRIKANTA J T practicing consultant, author
21 what the test does. Before the medications, your lung function fell into moderate severity. This gets better and almost reaches normal after medication, which is why you were able to blow up all three balloons.” Mrs. Priya asked, “Doc, are we late in bringing him? Is there anything in the house that is triggering his asthma?” I consoled Priya saying that it is better late than never and started explaining about possible triggers at Priya’s house. “Mrs. Priya, the obvious triggers are the floor carpets, the pashmina blankets, and maybe the Persian cat. Of course, other triggers may also cause inflammation of airways.” The other triggers may include: 1.Cold and flu: Common cold and seasonal flu can cause inflammation of the airways and increase the risk of exacerbating asthma. 2. House dust mites: Small, invisible creatures live in the dust in carpets, bedding, and cushions. The droppings of these mites contain chemicals that can irritate your airways and aggravate asthma symptoms.
22 3. Pets: Especially in Sameer’s case, his pet could be an asthma trigger. Dander from pets or other animals can trigger asthma. 4. Mold: Mold or fungus on the wall or inside the wardrobes can increase the severity of symptoms. 5. Cold air: If children breathe in cold air while playing, most often through their mouth (negating the advantage of the air that gets warmed up when passing through the nose), it may lead to an increased narrowing in the already sensitive airways. 6.Smoking and vaping: Smoking and vaping around the child can increase inflammation of the airways due to toxic chemicals. 7. Pollens: Small particles produced by grass, plants, and weeds can also induce airway inflammation and aggravate symptoms. “There are multiple allergens or triggers, and in Sameer’s case, there are a few. This can be ascertained with allergy testing.” “Oh gosh,” Mrs. Priya exclaimed. “I did not know that these things could probably be the reasons for my child’s asthma! Doc, what can we do now? I do not want my child to take inhalers like my husband.”
Alleviating Fears About Sameer’s Medication Worrying about asthma medications is the number one reason for either not taking or taking them infrequently which makes the medicines ineffective. I asked Mrs. Priya, “Can you please let me know what are your concerns for medications and inhalers?” Mrs. Priya did have a lot of questions. I decided to work my way through explaining everything and clearing her doubts. “I wouldn’t like Sameer taking it everyday!” As I said previously, asthma is a chronic condition. Similar to the medicines for 23 » There are two types of inhalers – relievers and preventers. When used as prescribed, these two inhalers are extremely safe and effective. We don’t realize how valuable our breath is until we are struggling to breathe! – DR. SHRIKANT J T practicing consultant, author
24 chronic conditions such as hypertension or diabetes that need to be taken regularly to prevent long-term complications and control symptoms, medication for asthma needs to be taken for a long time to keep the symptoms in control. This will help Sameer prevent cough episodes and asthma attacks during the day or night that stop him from attending school, playing, or sleeping comfortably. “I am worried that using an inhaler can cause side effects.” There are two types of inhalers – relievers and preventers. When used as prescribed, these two inhalers are extremely safe and effective. They allow a very small amount of medicine to go directly into the airways, helping control the symptoms. “I am frightened by the thought of my child taking steroids.” Many parents worry about their children taking steroids. It is a very frequently asked question, so you’re not alone. Firstly, it’s important to remember that the steroids used to treat asthma are inhaled corticosteroids, which are a copy of the substances the body produces naturally. They are completely different from the anabolic steroids used to enhance performance by bodybuilders. Secondly, as inhaled corticosteroids ASTHMA
25 directly act on airways, there aren’t many side effects that may be a cause of concern with the long-term use of oral steroids and anabolic steroids. “I feel Sameer will get addicted to these medications.” Inhaled corticosteroids are like any other long-term medication used for conditions such as diabetes and hypertension. These are not recreational drugs. So the word addiction is a misnomer for these conventional therapies. “Should I continue to give him the medication even when he is feeling fine?” The medicine for Sameer is a low dose of inhaled steroids. This medication will help
26 control inflammation and swelling in Sameer’s airways, eventually reducing acute asthma attacks as well as the effect of triggers that cause them. The medicine works by creating a protective effect that when stopped, wears off, increasing the risk for acute asthma attacks. That’s why Sameer needs to use his preventer inhaler every day as prescribed. If he is feeling well, it means that his medicine is working. And if he stays well, then I may be able to reduce the dose of his preventer medicine over a period.
“So, doc, what do you suggest?” asked Mrs. Priya. “Mrs. Priya, treatment for Sameer will involve two inhalers – a reliever and a preventer.” “An inhaler is a device that contains medication for asthma. When actuated, the medicine is breathed into the lungs and goes directly to the airways.” “A reliever is a medication, usually a blue inhaler that will give on-the-spot relief to Sameer by relaxing his airways. It can be used to treat symptoms of both asthma and an asthma attack. So, I need Sameer to have this at home at all times.” “A preventer is a medication, that reduces swelling and inflammation in airways, prevents asthma attacks and permanent airway changes. This is the medicine Sameer will use, on a long-term basis. This medicine is available in different colors and for Sameer, it will be orange.” Inhalers to Make Sameer Better 27 » There are two types of inhalers – relievers and preventers. when used as prescribed, these two inhalers are extremely safe and effective. Asthma is treatable and can be controlled. – CATHY FREEMAN former australian sprinter and olympic gold medalist
28 “Apart from these, he will also be prescribed and taught how to take his medication (blue and orange inhaler) with a spacer. A spacer is a plastic container that will allow Sameer to take the medication with ease and no significant side effects. Encourage Sameer to take his medicines, by himself, with your support of course, as early as possible. Then, it will become part of his daily routine, which he can continue through his teenage years into adulthood.” “Thanks, doc, for all the information. I feel confident about taking care of Sameer now,” said Mrs. Priya. She was ready to go with the plan and asked, “So what do I do now?” After seeing the confidence in Mrs. Priya’s eyes, I handed an asthma treatment plan, advised her to read it, and asked her to take the medications from the pharmacy and come back to learn the technique from our medical support staff. I emphasized on both technique and compliance before the next visit. SPACER INHALER
29 Time for Sameer’s Review! Stay patient and trust your journey. – BRIAN FORD founder and host, self improvement daily podcast Mrs. Priya returned with Sameer after 15 days for his first review. Sameer and Priya entered my office. Sameer was at his vibrant best, and said, “Doctor Uncle! After a long time, I was able to play badminton without coughing and beat my opponent comfortably. I feel good now!” Priya looked untroubled and said, “Thanks, doc. I haven’t seen Sameer so comfortable for a while until now. He can sleep comfortably at night, and you know, he has not woken up even a single night! Ha-ha, I am getting a relaxed sleep after a long time. He also has no daytime cough, and you heard him – he is doing brilliantly in sports now. What else does a mother want?”
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32 A healthy child translates into a relaxed mother! After listening to both patiently, I asked, “Hope you are continuing his preventer?” Mrs. Priya said, “Yes, doc, we understand the importance of taking medication. I have seen him suffer. Now that I have a way to prevent it, would I jeopardize it? No way!” “So what about the triggers at home?” I asked Mrs. Priya. She gave a rundown of the changes she had made in her house. “Doc! We have uncarpeted our floor, removed the pashmina blanket, and are using only cotton ones as advised. Can you believe it? I have given my Persian cat for adoption!” After checking both technique and compliance with respect to Sameer’s treatment plan, which by the way was good, I asked Mrs. Priya, if she has any more questions before the next visit.
33 Mrs. Priya said, “Yes, doc, I do have a few, if you don’t mind.” “Is there anything else I need to do at home?” she asked. “Yes, definitely,” I said. “Talk to Sameer – even though he is young, please explain how his medication helps him stay well. It will help him understand why he needs to take it regularly and keep him motivated to do so. Please encourage Sameer to talk about his worries about both asthma and its medications.” “Set a routine – Help Sameer take his preventer inhaler at the same time, at the same place, every day. It will help him set a daily routine. He will not forget to take it. An easier way to do it is by clubbing it with the time he brushes his teeth.” “Apart from these, take care of triggers that we have discussed previously.”
34 “How about his school and badminton tournaments? He has his state-level competitions coming up,” asked Mrs. Priya. “There will be a class teacher in school and a coach in training. Talk to both of them about Sameer’s asthma treatment plan. Make sure both know how to suspect symptoms, if any, and use the reliever, the blue one, if required. Make sure you tell Sameer to approach either of them in case he has any symptoms. Please check for the provision of storage space either in the classroom or the principal’s office, accessible by the person responsible for his inhaler.” “With these measures in place and the asthma treatment plan, I think Sameer will not have any significant issues. But please remember, if he uses his preventer inhaler regularly in the prescribed dose, the right way, he might not require a reliever inhaler in the long run.” “Thanks, doc, this has been helpful! So, adios until we meet next time”, said Mrs. Priya, as she left the office with a smile on her face.
35 Sameer’s Moment of Triumph It was almost two-and-a-half months since I had seen Sameer, and today, it was his third consultation with me. Sameer walked into my office with a trophy and a box of donuts. I was happy to see both Priya and Sameer ecstatic. Sameer again in his eagerness said, “Doctor Uncle! Thanks to you I am the champion in the recently concluded district-level badminton tournament. Now, I will be competing at the state level soon. Thanks to you I can breathe comfortably now.” Those words of Sameer stayed with me! After going through the routine with Mrs. Priya about inhalers, triggers, technique, and compliance, I told her it was time for us to reduce the dose. “But doc,” Mrs. Priya asked, “He is doing so well, should we rock the boat now?” Your positive action combined with positive thinking results in success. – SHIV KHERA author, motivational speaker
36 I patiently explained, “Mrs. Priya, Sameer has been doing so good for the last 3 months. It is time we reduce his inhaler dose to the lowest possible. By doing this, we achieve two things. Firstly, we continue to give him the inhaler at the lowest possible dose to reduce even the slightest possible adverse effect, and secondly, the lowered dose should be enough to prevent inflammation and triggers causing asthma attacks. The medicine is still working in the background but at a lower dose.” “That sounds great, doc!” Mrs. Priya said and left after handing over the delicious donuts. As Sameer was the last patient for the day, I couldn’t stop thinking about the value of our breath and how we take it for granted. It is only when we are struggling to breathe do we realize how truly important it is.
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39 R E F E R E NC E S Custovic, A., de Moira, A.P., et al. (2023). Environmental influences on childhood asthma: Allergens. Pediatric Allergy and Immunology, 34(e13915). Bateman, E.D., Hurd, S.S., Barnes, P.J., et al. (2008). Global strategy for asthma management and prevention: GINA executive summary. European Respiratory Journal, 31, 143–178. Global Initiate for Asthma, https://ginasthma.org/
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