3 December 2012

Kenya: Asthma More Complex Than Formula One Race

The formula one racing season ended last week. There was considerable excitement in the last race because there were two drivers in contention for the championship.

In the end the favourite won, though not before some drama involving a crash, a push to catch up with the race leaders - with some controversy about overtaking, all very exciting stuff even for the non-fan.

In case you do not follow the sport, formula one racing is a very expensive sport where teams have to build their own cars according to lay down specifications.

The car is a single seat open cockpit, which sits very low on the ground and has substantial front and rear wings. The engine is right behind the driver.

All the cars must have the same engine size. In terms of performance the cars reach speeds of over 300 km/h and have massive breaking and acceleration power to enable them to reach such speeds over very short distance.

From a physics perspective ,the formula one car is designed like an upside down aeroplane, able to move at high speed - the difference being it needs to stick to the ground rather than take off in the air.

For motor heads, the fun is in the car and the strategy of the driver, who overtook whom - usually just in the first corner of the race, or during a pit stop.

Interestingly the strategy that teams employ has some useful medical applications. Because the cars are almost identical, the margin for winning is in the tiniest bit of innovation that a team has, which can change from race to race.

The minimum weight for a formula one car including the driver is 640kg, the weight of three Kenyans after a good wedding luncheon. So the drivers have to be relatively short, lean and fit.

Few are six feet tall. Many are around 5 feet 7 or 8 inches tall. So to try and gain advantage to win, race teams constantly monitor and review each race performance.

If you watch a race, there are times when the cameras cut away to the team mechanics and they spend their time in front of a bank of computer screens, each monitoring some specific aspect of the car's performance.

The car has a sophisticated on-board computer that provides information such as the speed, brake position, tyre pressure and temperature, airflow over and around the car and so on.

Virtually everything that can be monitored is measured, often in real time so that the crew and the driver can make adjustments, sometimes during the race.

If you were to walk into a modern intensive care unit, the scene is the same as that of the formula one racing crew pit. Patients who are very sick need constant monitoring.

This is done by sticking tethered tubes and probes into the patient and connecting these to the various monitors. The patient has to be in the facility and not moving for most of the monitors to work.

Telemetry, technology that allows data measurement at a distance, is difficult in medicine mainly because unlike the car where mechanics can stick cameras and sensors everywhere, in humans there are challenges. Take for example, asthma, a condition that if not properly managed can land a patient in ICU.

The common sign is difficulty in breathing out air. The key issue that needs addressing is what triggers an asthmatic attack. Once the patient knows this then they can avoid the trigger or at least pre-medicate to reduce the effect of the attack.

Asthma like any other chronic disease depends more on the patient self-managing her condition than the doctor treating after the fact. So the patient has to keep a record of what diet (which foods); exercise; stress and anxiety; play in inducing an attack.

In addition, the attack itself when the patient cannot breathe properly is a cause of anxiety and stress. Not very different from the formula one driver driving at 300 km/h and trying to stay focused on everything that needs doing. Except that she usually does not have all the money or the cockpit crew available to monitor and change things in the same way.

So next season watch the formula one racing, not the cars, but the crew in the background. Then think about the statement "non-communicable diseases are on the increase in Kenya".

It is very tough being a patient with a chronic condition. People get used to you and stop appreciating the difficulty you have. A patient with a well managed condition has to have a level of education about the disease above that of a formula one driver and their car.

They have to be able to monitor their condition and self-manage most of it, without the help of sophisticated hospitals or doctors. And even after they see off an attack, there is no podium and celebratory champagne.

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