Dorcas Masika: I dream of breathing without an inhaler

In 2002 when Dorcas Masika was three months old, her mother noticed that she had difficulty breathing and was “wheezing”. 

Now 20 years old, Dorcas narrates that being the sixth born in her family, her mother was quite familiar with the symptoms. Her mother, father and elder siblings often experienced them.

“In the hospital, my mother narrated all the signs I was experiencing and after thorough checkups, I was diagnosed with asthma,” Dorcas narrates. “Since my parents and siblings all had the same condition, the doctor explained that it was hereditary.”

According to Dr Justus M Simba, Consultant Respiratory Pediatrician at Mama Lucy Kibaki Hospital, asthma is a chronic inflammatory airway condition that presents with symptoms and signs that vary over time and intensity, meaning that there is a long time swelling inside the breathing air pipes that worsens and recovers at time.

“It occurs when individuals with the ‘right’ genes interact with certain environmental factors. For example, those born in an environment with air pollution are at an increased risk, so you are more likely to find more individuals with asthma in the urban areas compared to the rural areas,” Dr Simba says.

No single cause

“In addition to that, other environmental factors that have been associated with asthma include certain viruses, mould, smoke, diet poor in antioxidants among others. Growing up in farm areas is thought to be largely protective, and in fact, there is a theory referred to as the hygiene hypothesis that basically prepositions those not allowed to interact with certain ‘dirt’ are more likely to end up with asthma. In short, asthma is not a condition with a single cause,” Dr Simba says.

Dr Simba explains why asthma runs in a family in reference to Dorcas’s case. “Certain genes make individuals more likely to have asthma. Families that have a history of eczema (atopic dermatitis), food allergy or allergic rhinitis are likely to carry these genes,” he says. 

“Individuals who develop asthma during childhood are more likely to be those who belong to this type of asthma that runs in families. It is important to note that not all asthma is allergic, thus you may not have had any family members with asthma and still end up with it,” Dr Simba says. 

According to the World Health Organization (WHO), symptoms of asthma can vary from person to person but according to Dr Simba, this respiratory disease is associated with four main symptoms that is wheezing, difficulty in breathing and chest pain/chest tightness.

“By far, the most common symptom is having a cough. Characteristically, this cough occurs at night, especially a cough that is likely to wake up a child after midnight,” Dr Simba says. 

According to WHO, asthma affects 235 million people globally. It often starts in childhood but can occur for the first time at any age.

In 2017, the global incidence of Asthma was estimated to be 43.7 million new cases per year and, in the same year, it caused 490,000 deaths caused by this respiratory disease.

“In Kenya, it’s estimated that about 7.5 per cent of the Kenyan population, or nearly 4 million people, have asthma. It has been observed to be more prevalent in urban as opposed to rural areas, however, it is currently unclear if this difference persists,” says Dr Joseph Aluoch, Consultant Pulmonologist at The Nairobi Hospital.

Severe asthma

Growing up, Dorcas says she learnt to manage the condition. Upon diagnosis, she was given an inhaler that would help her recover in case of an asthma attack. 

“I refer it as my artificial lungs to date” Dorcas says. “Asthma is a lifelong condition so I have learned to live with it. Like any child, I went to school still managing the condition but one day I got a severe asthma attack and I was hospitalised, that is when I found out that I had severe asthma,” Dorcas says.

“I was advised by the specialist who was on duty that day that I should continue using the prescribed drugs and the inhaler which I should carry in my pocket everywhere I went because there was no way to predict when I would have an asthma attack,” she says.

“It can be months before you get an attack and you almost forget that you have the disease but when it attacks you, it’s very destructive, you can even faint after developing difficulties in breathing,” Dorcas says.

She, however, says that just before an attack, she can tell that it is about to happen.

“I start feeling severe chest pain. My chest feels heavy to the point of developing difficulties in breathing. So at this time, I can take asthma drugs but because I might not have the drugs, I use my inhaler which I always carry in my pocket,” Dorcas explains.

Dorcas says that doctors always advise her to avoid asthma triggers like smoke, pollution, cold air, dust and strenuous exercise. 

“This is what I usually employ to date so that my lungs can be safe,” she says. “It can be quite limiting. I love playing basketball but you can imagine how the game is -- there is bound to be a lot of dust and all sorts of triggers. Sometimes I am forced to stop playing just because I don’t want to feel sick again,” Dorcas says.

“Personally, I’ve never faced stigma in connection to asthma but I have a lot of my friends who have the same condition and I can testify that indeed this disease is associated with stigma,” she says.

“Imagine a scenario where some of your friend’s whisper, “Ni yule huwa anaanguka anguka. Hata unaweza ambukizwa hiyo ugonjwa ukikaa naye!” This denies you the chance to make friends and what is next? Depression takes over,”  Dorcas says.

“It’s high time that people are taught about asthma. It is like any other condition that needs to be managed. Rather than stigmatise people living with it, society should understand that this is not a communicable disease,” she adds.

“But despite all sorts of these, I’m strong and I believe tomorrow will be absolutely better than today. There will be a time I’ll breathe fine,”  Dorcas says.

Minor nuisance

To all people with this disease, Dorcas says,” Identifying and avoiding your asthma triggers can help you keep your symptoms under control because when you have asthma you have it all the time but you will have asthma attacks only when something bothers your lungs, “.

“For some people, asthma is a minor nuisance but for others, it can be a very major problem that interferes with daily activities and may lead to a life-threatening asthma attack,” George Morata who once nursed his late mother observes.

According to Dr Aluoch, there is no cure for asthma known, however, it can be controlled. Preventive mechanisms include some we can control for example diet, and maintaining a non-dusty environment in our household and some we cannot control for example environment, genetics and air pollution. Vaccination against flu and pneumonia is advised as these worsen this respiratory condition.

“Patients should know more about the disease (knowledge is power); it’s important to know the triggers and the danger signs. They should use their medications as advised by the doctors and use the inhalers using the correct technique. Vaccination (flu and pneumonia) is important as a preventive measure -- these worsen asthma,” Dr Aluoch advises.

“Asthma is the most common chronic lung disease in the globe but in many countries, and more specifically Kenya, it remains under-diagnosed and under-treated. This absolutely results in poor quality of life and enormous social, family and economic costs. So let the government give attention to this disease so that we can reduce premature deaths because asthma kills, that’s a mature fact,” Dorcas says.

“People with asthma and their families need education to understand more about their asthma. This includes their treatment options, triggers to avoid and how to manage their symptoms at home. This call for government and concerned stakeholder’s advocacy,” she concludes.