Asthma is a condition where the airways narrow thus causing difficulty in getting air in and out of the lungs.
The airways narrow in three ways. Tightening or spasm of the outer walls of the airways, the inner lining becomes red and swollen, excessive mucus or phlegm blocks the airways.
This inflammatory process produces symptoms of: (a) Cough (b) Wheeze (c) Breathlessness (d) Chest tightness
Not all of these symptoms need to be present. In children the most common symptom is coughing, especially at night. It is important to remember that wheeze is not always present.
Asthma is an individual and variable condition; symptoms vary from time to time, and from person to person.
One in seven children and one in twenty adults have asthma. The commonest age of onset is in childhood with another peak in the thirties. Anyone can get asthma, and age does not give immunity.
Cause
The true cause of asthma is unknown. It tends to run in families who have a history of asthma, eczema or hayfever. Its a combination of genetic and environmental factors that lead to actual symptoms, so if you inherited the tendency to get asthma then something must convert that tendency into the actual condition. We call this something a ‘Trigger Factor’. Many are born with a tendency to develop asthma and may go through life without actually developing it.
Trigger Factors
- Infections—Viral infections i.e. colds, flu, chest infections etc.
- Allergies—House dust mite, pets, (cats, dogs, horses, guinea pigs ) rodents, cockroaches, pollen and moulds in damp houses.
- Smoking/passive smoking—Smoking is a very important asthma trigger, it also reduces the effect of preventative treatment. The best gift you could give your child is to have your home, a smoke free home.
- Irritants—Such as smoke, air pollution, car fumes. etc.
- Changes in the weather—Cold air, fog, warm summer weather which produces high pollen counts.
- Food additives—eg. E102 (tartarzine) a food colorant which may make asthma worse. Food allergy is relatively uncommon, but some asthmatics are allergic to milk, nuts, fish, wheat, eggs, sulphur dioxide in alcohol etc.
Additional Treatment
Long acting relievers i.e. Oxis, Serevent Foradil and Oxivent may be prescribed to produce sustained relaxation of the airway muscle. They can be used to control night-time or exercise induced symptoms. They should be used in conjunction with regular preventative treatment.
Seretide which is a combination of Serevent (long acting reliever) and Flixotide (preventer) may also be used.
Oral medications like theophyllines eg. Slophyllin, Uniphyllin, Zepholin, and Nuelin are sometimes used as second line treatment for asthma that is difficult to control. Your GP may prescribe additional treatment such as Accolate or Singular tablets if necessary.
Peak Flow Meters
Asthma can be effectively monitored with regular use of a Peak Flow Meter. The peak flow meter (P.F.M.) gives a reading, which tells how open your airways are. The more widely open the airways are, the higher the rate the air can be blown from the lungs and the higher the reading on the P.F.M. If your asthma is not well controlled the readings will begin to drop.
Peak Flow Meters are well worth buying and can be purchased at your local chemist for £10–15 approx.
Recognising Poor Control or an Impending Attack
- If you are Peak Flow Monitoring:
—Fall in Peak Flow of more than 20%
—Variation of AM / PM Peak Flow readings
—Peak Flow not returning to normal after taking reliever - Increased symptoms of cough or wheeze or chest tightness or breathlessness.
- Increased symptoms during exercise.
- Waking during night with symptoms.
- Increased need for Ventolin or Bricanyl.
- Ventolin / Bricanyl not being effective for up to four hours.
NB Children whose asthma is going out of control may appear, pale, quiet, under active and have poor appetite.
Delay in going to your GP with asthma symptoms is a very common problem. Early treatment will save a lot of unnecessary anxiety for everyone, and may save the sufferer from being admitted to hospital.
Do not try to do without medication at any time!
Reasons for Poor Control
Non compliance—Not taking preventer every day as prescribed. Preventer medication only works if it’s in the lungs, not at the back of the medicine cupboard!
Poor inhaler technique—Have your technique checked regularly by your GP or Asthma Nurse.
Insufficient dose of preventer—Asthma may have worsened. Dose may need to be increased. Go to GP for advice.
Increase in trigger factors—Smoky environment, flu etc.
Impact of Poor Management / Poor Control
- Frequent visits to GP or hospital
- Emergency call outs, regular nebulisation, and regular courses of oral steroids
- Time off work / school
- Inability to partake in sporting and leisure activities
- Sleepless nights
- Undiagnosed and untreated asthma can lead to lung deformities and poor growth in children.
Get wise, take control! Don’t let your asthma control you! Do not settle for a lesser quality of life!
- Avoid known trigger factors when possible.
- Ensure correct inhaler technique.
- Take medication as prescribed—two minutes spent each morning and evening can save a lot of unnecessary suffering. Parents should take full responsibility to see that this small chore is carried out.
- Regular Peak Flow monitoring and charting is invaluable. It gives you a clear picture of how well controlled your asthma is.
- Never ignore asthma symptoms. Remember wheeze is not always present. Cough alone is a true symptom.
Fight those Dust Mites now!
Approximately 80% of children with asthma are allergic to the house dust mite. They are about 0.25mm in size, which is not visible to the naked eye. They live in bedding, carpets, soft furnishing and cuddly toys, in even the cleanest of houses, and a single bed mattress may contain one million mites!
They survive and thrive by eating our shed skin. They thrive best in a bed used by someone with eczema who sheds skin profusely and who may sweat, scratch and bleed. The major allergenic part of the mite is the excreta (dung) which form into tiny pellets about the size of pollen grains. When the dust mite is released into the atmosphere and enters the respiratory tract there are immediate and delayed responses. In the nose and sinus these cause irritation producing swelling of the mucosa, mucus secretion and blockage. In the chest they cause asthma.
Signs of dust allergy are sneezing, blocked or runny nose, wheezing or coughing during vacuum cleaning or going into a dusty environment.
The house dust mite is extremely difficult to eradicate completely but if certain guidelines are followed the numbers can be reduced greatly, especially in the bedroom.
Guidelines
- Use polished / painted floorboards, cork tiles or linoleum in preference to carpet. Do not use any rugs.
- Use vacuum cleaner with special dust filtration. Vacuum mattress and room regularly.
- Remove fabric covered headboards.
- Mattresses and pillows should be fully enclosed in recommended covers, eg. Anti-dust mite covers. Some stores stock anti-dust mite covers. They cover the top of the mattress only. They are not expensive. It may be worth while buying two to seal the mattress completely. Chemists will order special anti-dust mite mattress, duvet, and pillow covers. They have zips and seal bedding completely. They are expensive eg. £50 for a single mattress cover but they have the advantage of comfort and are noise free. Plastic covers may also be used but they tend to be sweaty and noisy.
- Remove feather pillows, and use polyester pillows and cover.
- Use synthetic or cotton bed linen and wash weekly at 55°C or higher.
- Wash quilt or eiderdown every 2–3 weeks, if not specially covered.
- Use light, washable curtain material or blinds.
- Dust room with damp cloth. Do not dry dust.
- Place cuddly toys in freezer every week for six hours.
- The dust mite increases in numbers, especially when the heat is turned on during the autumn / winter months. Keep Rooms at an even temperature.
- Rooms should be as clutter free as possible.
- Open windows and keep rooms well ventilated.
- Mite spray or anti-dust mite spray, may be used on the mattress, divan or other soft furnishing. It is a non-toxic spray, which is effective for up to three months (Be careful, you may stain soft furnishing). Ask your chemist for more information.
- Avoid drying clothes on radiators.
- Do not keep furry animals or birds in the home.
NB Remember to keep all your Doctor, Chemist and Hospital receipts for tax relief purposes.
Hoping this information is useful to you all!
Catherine Kirrane SRN. SCM.
Asthma Nurse Specialist in Cregboy
