Public action needed for asthma, tobacco awareness -- 'Take your breathing seriously'

BAVINA SOOKDEO

EARLIER this month, the world marked World Asthma Day (May 6), and with World No Tobacco Day approaching on May 31, pulmonologist Dr Shiva Jaggernauth is urging citizens to prioritise their lung health – by managing asthma more effectively and committing to quit tobacco.

“Take your breathing seriously. Whether you are managing asthma, considering quitting smoking, or advocating for cleaner air, your actions matter,” said Jaggernauth, a respiratory specialist practicing at Apley Medical Clinic, Pointe-a-Pierre Road and Southern Medical Clinic in San Fernando. “Let’s create a future where fewer children wheeze, fewer adults struggle to breathe, and more people enjoy the simple act of taking a deep, clear breath.”

A specialist in internal medicine and pulmonology, Jaggernauth’s interest in respiratory medicine developed early in his training when he saw the impact that breathing disorders – like asthma and chronic lung disease – have on people’s daily lives.

“I chose this speciality because it allows me to treat both common and life-threatening conditions while also focusing on prevention and public education.

“I’m particularly passionate about asthma, tobacco-related disease and improving access to care for patients with respiratory illnesses.” Having graduated from the University of the West Indies, Mt Hope campus in 1998, Jaggernauth attained membership from the Royal College of Physicians (London) in 2003 and respiratory specialist certification with the Royal College London in 2013. He is currently the vice president of the Thoracic Society of Trinidad and Tobago.

A rise in asthma – especially among children

Highlighting that asthma affects 262 million people worldwide and was responsible for more than 455,000 deaths in 2019, according to the World Health Organization, the doctor also noted a local uptick in cases, especially among children and adolescents.

He attributes this to environmental and lifestyle factors: “The rise can be linked to air pollution, climate shifts, increased Saharan dust and more indoor exposure to allergens.” He added that urbanisation and lifestyle changes have also introduced new triggers, including the use of tobacco products and vaping among young people.

Jaggernauth also pointed to a worrying trend: increased use of tobacco and vaping among young people. “Many young people falsely believe it’s harmless. However, recent studies show that vaping increases the risk of chronic bronchitis, asthma flare-ups, and even acute lung injury.”

He made reference to a 2022 JAMA Pediatrics study which found that vaping teens had double the rate of respiratory symptoms compared to non-users. JAMA Pediatrics is an international, monthly, peer-reviewed medical journal published by the American Medical Association, focusing on all aspects of paediatrics.

Common triggers and poor asthma control

In Trinidad and Tobago, some of the most common asthma triggers include Saharan dust (especially between June and October), tobacco smoke, air pollution from vehicles, industry and burning waste, mosquito coils, mould from damp indoor conditions, pet dander, pollen and house dust mites (especially in carpets, bedding and upholstery), and respiratory infections like the common cold and flu. “House dust mites and pollen are especially problematic for children and adults with allergic asthma, contributing to year-round symptoms.”

Despite free access to inhalers through the CDAP programme, Jaggernauth notes that many patients rely too heavily on reliever inhalers. “While awareness is improving, asthma control remains suboptimal for many patients. One issue is over-reliance on ‘blue’ reliever inhalers and underuse of preventive medications.” However, with inhalers available at public health centres and pharmacies, he encourages patients to access these services and use their controller inhalers daily as prescribed.

Tobacco use: Still a major threat

“Tobacco smoke contains more than 7,000 chemicals, many of which cause inflammation in the lungs and worsen asthma. Smokers are at greater risk of developing asthma and those with asthma will experience more severe attacks if exposed to smoke,” Jaggernauth explained. Even passive smoke is harmful – children exposed to second-hand smoke are 1.5 times more likely to develop asthma, according to WHO data. “Passive smoke is a major trigger for asthma in children” warned the doctor. “Their lungs are more vulnerable, and even short-term exposure can lead to wheezing, persistent cough, or emergency hospital visits.” According to World Health Organization data, about 40 per cent of children worldwide are exposed to second-hand smoke. “In TT, exposure often happens at home or in vehicles” he pointed out.

Jaggernauth doesn’t mince words when it comes to smoking: “Quit now – there is no safe level of tobacco use. Smoking damages the lungs, narrows the airways, and accelerates diseases like COPD (chronic obstructive pulmonary disease) and lung cancer. Vaping is not a safe alternative.”

He advises individuals to talk to their doctor about quit-smoking programmes, nicotine replacement and support services. “Quitting smoking can cut your risk of heart and lung disease in half within months,” he encouraged.

Climate and environmental concerns

Climate change and environmental degradation are exacerbating respiratory conditions. “Saharan dust contains PM2.5 particles that lodge deep in the lungs and cause inflammation. Heat waves increase ground-level ozone, a known asthma trigger,” he warned further pointing out that prolonged dry seasons can worsen air pollution and allergens.

“Climate change also extends pollen seasons, making allergic asthma more difficult to manage. These factors are increasingly linked to higher rates and severity of asthma attacks.”

So what can asthma patients do to protect themselves, especially in worsening environmental conditions? Jaggernauth encourages asthma patients to take practical steps such as:

Checking daily air quality via apps or weather reports

Staying indoors during dust or smoke advisories

Using HEPA filters or air-conditioned spaces with clean filters

Wearing masks during high-dust days if outdoors

Taking controller inhalers every day, even when well

Getting vaccinated against the flu and pneumonia – both available at public health centres

Having an asthma action plan and reviewing it with a healthcare provider

“Vaccination is especially important, as respiratory infections are common triggers for asthma attacks and hospitalisations” he noted.

Many people tend to overlook early warning signs of serious respiratory issues, Jaggernauth said. These symptoms include a chronic cough lasting more than three weeks, shortness of breath – especially during light activity – frequent chest tightness or wheezing, night-time symptoms or waking up short of breath, and persistent fatigue, which may stem from low oxygen levels. If these signs occur regularly, he stressed, it is crucial to seek medical attention promptly, as early intervention can prevent more serious complications.

National action needed

Looking ahead, Jaggernauth says several initiatives at the national level could improve respiratory health. He suggested the following:

Expansion of biologic treatments – for severe asthma in the public sector. These newer medications – like anti-IgE or IL-5 inhibitors – are not currently available for patients in public hospitals and can significantly reduce emergency visits and steroid use.

Stronger anti-smoking regulations and education on vaping risks

Air quality monitoring in schools and urban centres

Community-based asthma education to promote use of action plans and correct inhaler technique as well as spacer devices.

Better integration of environmental policies with public health planning

In his message for both awareness days, he offered a reminder that lung health is everyone’s responsibility.