Asthma

Over 470,000 Irish people suffer from asthma
and 90,000 do not have their symptoms controlled. Asthma prevalence is very high in Ireland - we are number four in the world asthma league after Australia, New Zealand and the United Kingdom. Estimates vary, but as many as 470,000 individuals in Ireland have the condition. There has been a considerable increase in asthma prevalence in developed countries over the last two decades. While asthma tends to run in families, the reason for the increase is not genetic. It is more likely environmental - either due to a great change in the external environment over this period (allergic substances, pollution, smoking) or a change in our bodies' response to the external environment.

470,000 people in Ireland have asthma the fourth highest prevalence worldwide
90,000 people do not have their symptoms controlled
Irish adults with asthma lose on average 12 days from work per annum
Irish children with asthma lose on average 10 days from school per annum
There are between 6,000 and 7,000 asth-ma related hospital admissions per year Annual A&E visits are four times this figure
About 55% of these admissions and visits are by children under 14 years of age Between 80 and 100 people die in Ireland each year from asthma - 30% of these are under 40 years of age

What is asthma?
Asthma is a chronic lung condition that causes your airways to narrow in response to various triggers like allergies, exercise, or even cold air, making it difficult for you to breathe.

What are the symptoms?
Having asthma is like running around for five minutes, then trying to breathe through one of those tiny coffee-stirrer straws, according to asthma sufferers. Typical symptoms include difficulty breathing and shortness of breath, wheezing (a rasping or whistling sound when you breathe), coughing or spitting up mucus, tightness in your chest, and restless sleep or insomnia.
For some people, these symptoms are mild, infrequent, and last only a few minutes. For others, attacks happen more often, are severe, and go on for hours or even days. In rare cases, asthma attacks can be deadly.

Signs of a life-threatening attack include the following symptoms:
Feeling as though you're suffocating
Being so breathless that you can't speak
Coughing and wheezing
Chest tightening
Shortness of breath
Lack of stamina during exercise
Laboured breathing with use of the neck muscles, and indrawing of the breastbone and gaps between the ribs
In severe attacks, a blue discolouration of the lips and tongue
If you (or someone you know) ever experience any of these symptoms, don't wait around - between 80 and 100 people die from asthma every year in Ireland
Take your asthma medication immediately and call 999 for emergency help

What causes attacks? No one knows exactly what causes asthma, but we do know that it can run in families along with other so-called allergic conditions such as hayfever, itchy eyes and eczema. Asthma attacks are also usually set off by a trigger, though sometimes they can strike unexpectedly.

Here are some common culprits:
Anything you may be allergic to, such as dust mites, pollen, mould etc.
Tobacco smoke
Strong odours or fumes, such as from perfume, paint, hair spray, pesticides, or household cleaners
Smoke from a wood-burning fire
Cold air
Colds, flu, respiratory infections
Exercise
Strong emotions (such as getting upset or angry)

When should I see a doctor?
Asthma can be very serious, so it's important to see your doctor if you have symptoms. Keep in mind, though, that a single episode of wheezing does not necessarily mean you have asthma.
If you've already been diagnosed, be sure to tell your doctor if you have breathing problems at night that prevent you from getting a good night's sleep, or symptoms that are making it difficult for you to do things during the day. See your doctor also if you find you need to take more medicine than your prescription allows, or your medicine stops working as well as it previously did.

How do you treat asthma?
There are two types of groups of medication Preventers and Relievers. The Preventers must be taken regularly, because their aim is to prevent wheezing or breathlessness. They are not meant to give rapid relief of wheeze. Often a combination of Preventers and Relievers are recommended. Preventers must be taken all the time, even if the person is not wheezy or in distress.
What form of medication do I take?
Medication comes in a variety of forms -Aerosol Inhalers, Dry Powder Inhalers, Tablets, Syrup, Nebuliser Liquid and Injections. Inhalers are preferred over tablets or syrup because they deliver the medicine directly to the air passage where it is needed. Also a much smaller dose is required than if it was taken in tablet form and Reliever inhalers work much faster than tablets do.
Peak Flow Meter
Patients can measure their own lung function at home using a simple device called a peak flow meter. When asthma control is good the PFM reading is high and during or approaching an attack it is low. Patients can use the PFM as an early warning system so that when readings fall they can increase their treatment in order to prevent an attack or render it less severe. The PFM helps put the asthma sufferer in control. Some patients who are suspected asthma sufferers may have normal lung function and it may be necessary to perform a 'bronchial challenge', where a narrowing of the bronchial tubes is provoked by performing an exercise test or inhaling a drug called metacholine.
How can I prevent attacks?
Identify and avoid triggers. Keeping a diary of the things you've done, the places you've been, and what you've eaten can help you figure out what causes your attacks. Once you know, steer clear of them.
Find a medication program that works for you
Monitor your lung capacity with a peak-flow meter. This simple, hand-held device tells you how constricted your air passages are. That can help you and your doctor decide which medications you need and how often you should take them. It can also alert you if your asthma is getting worse before you start feeling symptoms. Finally, it can help you identify triggers by showing you how your airways are doing at any given time. If your asthma is severe, your doctor may advise you to check your air flow several times a day; if it's mild, you may only need to use the meter when you feel your symptoms getting worse.
Stay healthy. Eat a healthly diet, get enough rest, and exercise regularly. However, since exercise triggers attacks in some people, it's important to talk to your doctor before embarking on a workout program. Some physicians recommend swimming, since the moist air around a pool can soothe lung tissue (but be sure you're not allergic to chlorine). Taking your medicine as instructed can also ensure a problem-free workout.
Do not smoke, and be sure to avoid places where there is a lot of secondhand smoke. Cigarette smoke is especially irritating to children who have asthma, so ask family members and friends to smoke outdoors.
Try cutting out milk products. While no formal studies have been done, many doctors report that cutting milk out of your diet can significantly reduce asthma symptoms. (But be patient: It takes a month to three months to see results.) Foods containing sulfites (beer, wine, wine vinegar, instant tea, grape juice, lemon juice, grapes, fresh shrimp, pizza dough, dried fruits, canned vegetables, corn syrup) have also been linked to allergic asthma attacks.

Frequently asked questions about asthma
Do children outgrow asthma?
This is a difficult question to answer. Each child is different, and accurate predictions are not possible. Many children with asthma get better when they get older. Their asthma symptoms become less severe and may disappear. Children with mild asthma in their early years are more likely to improve.
However, the outlook is not as good for children with frequent, troublesome wheezing, particularly in those with severe eczema; up to 50% of such children continue to have asthma during their teens and adult life. Regardless of what the future may hold, children with asthma require the best possible care. Withholding treatment in the hope that your child will outgrow asthma is not realistic and can be dangerous.

Will I lead a normal life?
Adolescents with asthma should discuss career plans with their doctor. Very few types of work are unsuitable for people with asthma. Occupations involving extremes of weather or exposure to dust, fumes or animals should be avoided, if possible.

Are asthma medicines dangerous?
Asthma medicines are safe and well tolerated, when used in proper doses. If your child does develop any side effects with a particular medicine, let your doctor know so that the dose can be reduced, or another medicine tried. Overuse or abuse of asthma medicines, particularly the "reliever" medicines, can cause serious problems, and even death. Teenagers, in particular, may overuse their bronchodilator puffers, so you should keep track of how long a puffer lasts. Also if you find that your child regularly takes "reliever" medicines every day, his/her treatment programs should be reviewed with your doctor.

Can I take part in sports?
Absolutely, providing instructions about medicine are followed correctly. Many children with asthma develop wheezing and coughing with exercise, especially after sustained physical activity, such as jogging. These symptoms can be prevented by inhaling a reliever medication five minutes before exercise. "Warming up" before exercise also helps. In cold weather, your child should cover his/her nose and mouth with a scarf while exercising. Swimming has been found to be particularly good for children with asthma and tends not to cause symptoms. Scuba diving can cause problems for children with asthma and should be avoided.

Does asthma affect the lungs permanently?
Probably not. However, some studies have shown that some adults who have "outgrown" asthma, continue to have "twitchy" airways when given a challenge (stress) test. The implications of these studies are not clear at the present time.

Should I move to a different climate?
Asthma occurs in all countries in the world, and in all climates. Moving to another country or different climate, therefore, is not likely to benefit your child's asthma in the long run. The occasional child who is very allergic to dust mites may benefit from living in a dry climate.

Is it safe for me to travel?
Yes, provided your child's asthma is under good control at the time. You should take a supply of medicines with you, as well as the equipment required to deliver these medicines. You should also obtain a letter from your doctor, outlining the treatment your child needs. If you are going overseas, check that your nebulizer will work in the country you are visiting or if an adaptor is necessary. Remember to always carry your medication as hand luggage, just in case your suitcase gets lost!

What about hypnosis, acupuncture, ionizers, and herbal medicines?
Claims are made for these alternative treatments, but there is no evidence that they give any lasting benefit. If you do decide to try any of these treatments, make sure your child continues to receive orthodox medicines as well.

Do all people with asthma wheeze?
Although wheezing is extremely common in people with asthma, not all these people wheeze, and sometimes wheezing is so slight, it can only be heard with a stethoscope. With some sufferers, coughing is the only symptom present. Similarly, children with chronic coughs may have asthma, even though no wheezing is present. Diagnosis of such children with asthma can be made if their peak flow improves when given an inhaled bronchodilator.

Is asthma hereditary?
No, asthma itself is not hereditary, but there does seem to be a hereditary component to the tendency to develop asthma. If neither parent has asthma, the chances of each of their children having asthma are less than if one or both parents have asthma. Children don't inherit asthma itself, but the tendency to develop it. Whether or not an individual develops asthma is also now thought to be influenced by their exposure, particularly in childhood, to various other factors such as infections, irritants, allergens, or passive smoking if one or both parents are smokers.

Are some asthma drugs banned in athletic competitions?
The determination of whether a drug or substance is banned or allowed in athletic competitions is not based on whether it is medically necessary. Rather, such a determination is based on whether the substance in question can be performance-enhancing and offer an unfair competitive advantage. There are several organisations that make this decision and an athlete on an anti-asthma drug should check with his coaches, physician, and appropriate athletic authority. Different athletic organisations may differ on what is allowed or banned.

Why are so many asthma drugs taken via an inhaler?
Medications taken orally almost always have a much higher systemic concentration (concentration in your entire body) than inhaled medications, as they have to get to your lungs and windpipe (the area they need to treat) through the bloodstream. So if the side effects are due to systemic concentrations, then an inhaled drug is less likely to have these side-effects, or may have them less severely.
The idea behind an inhaler is that the full dose is delivered to the lungs, where it is immediately absorbed by the lung tissue, and starts to take effect locally. Excess drug may be absorbed by the bloodstream and delivered to the rest of your body, but this amount tends to be minimal. So your lungs receive an immediate, high concentration of the drug, and the rest of your body receives very little.

If you or anyone you know suffers from asthma and you wish to find out more, you can contact the Irish Asthma Society at:
Asthma Society of Ireland, 26 Mountjoy Square, Dublin 1

Tel: 01 -8788511 / Fax: 01 – 878812
Email: office@asthmasociety.ie
Their Helpline is 01 8788122
Asthma Nurse is available at 9.30am - 1.00pm, Monday, Wednesday and Thursday