1. Asthma Information
70-75% of children have infrequent intermittent asthma, that is:
- they only have symptoms occasionally and for a short period of time
- episodes are usually mild and are commonly triggered by a cold or viral infection, or by exposure to an environmental allergen
- episodes vary in length from 1-2 days to 1-2 weeks
- there is more than 6-8 weeks between each episode
- no asthma symptoms experienced between episodes
For these children, treatment is only required during each episode and regular preventer therapy is generally not needed.
20% of children have frequent intermittent asthma and may benefit from regular preventer therapy; either a non-steroidal preventer or low dose inhaled corticosteroids, although this treatment is often only required during the winter months.
Frequent intermittent asthma is characterised by:
- episodes at intervals of less than 6-8 weeks
- minimal symptoms in between episodes eg. exercise induced wheeze.
With the onset of the cooler weather, now is a good time for your son to visit your GP for an asthma review and to update his written asthma action plan. Do also talk to your doctor about any concerns you may have about his treatment.
A friend says I should give my little boy 2 puffs of blue reliever before his Flixotide preventer and that way it will work better. Is this true?
You should always use asthma puffers as your doctor has ordered, and follow your written asthma action plan.
Relievers and preventers work differently. A reliever relieves the tightening of the muscle in the airway wall and should be taken when symptoms of asthma occur.
A preventer reduces the sensitivity of the airways (by reducing inflammation) and prevents symptoms of asthma. Preventers should be taken every day.
Preventers (such as Flixotide) will not work any better if you use a reliever first, and relievers should only be used when you have symptoms, ie. not regularly.
If there is a need to use a reliever for symptoms more than a few times per week, you should see your doctor to review your medication levels.
It’s very possible you may have recently seen someone smoking inside only to realise on closer inspection that it’s not a real cigarette that’s causing the smoke. It’s most likely that what you’ve witnessed is someone using an e-cigarette. So what are e-cigarettes and are they a better option to tobacco cigarettes and to help people to quit smoking?
Electronic cigarettes, also known as e-cigarettes deliver nicotine (although some are nicotine free) through a battery powered system. They are often made to resemble the look of cigarettes or cigars and produce a mist for inhalation to simulate the act of cigarette smoking.
They are being marketed as cheap and healthier alternatives to cigarettes as well as an option for smokers when smoking is not permitted since they do not produce tobacco smoke. However there is a lot of debate regarding their safety.
Where did they come from?
E-cigarettes initially emerged in China in 2003 and have since become widely available globally; particularly over the internet. Most e-cigarettes that are available in Australia are still being manufactured in China.
How do they work?
A typical e-cigarette consists of three components: a battery, an atomiser and a cartridge containing nicotine. Most replacement cartridges contain nicotine suspended in propylene glycol or glycerine and water. The level of nicotine in the cartridges may vary and some also contain flavourings.
Supporters of e-cigarettes claim that they are a useful tool to help people to quit smoking (although the Therapeutic Goods Administration has not approved their use as smoking cessation agents). E-cigarettes are also seen by some people as a safer alternative to burnt tobacco as they are free of the tar and ingredients of traditional cigarettes. It is also claimed that e-cigarettes do not provide second hand smoke and can assist smokers to cope with their addiction in situations where they are required to be smoke-free such as on airplanes.
The Health Concerns
There are numerous health concerns regarding e-cigarettes, below outlines some of the main issues that have been raised:
- They haven’t been thoroughly tested – There are concerns regarding the unknown long term safety of e-cigarettes. The World Health Organisation has advised against them, saying their potential health risk ‘remains undetermined’. Due to these concerns e-cigarettes have not been approved by the Australian Therapeutic Goods Administration for use as aids in withdrawal from smoking (however, they are still available for purchase without this approval).
- Poor regulation – Most e-cigarettes that are available in Australia are manufactured in China where their manufacture is not regulated and few manufacturers disclose the ingredients of their products. This means that e-cigarettes may deliver unreliable amounts of nicotine, or contain toxic chemicals, pesticides or carcinogens.
- Inconsistent nicotine dose – Some overseas studies suggest that e-cigarettes containing nicotine may be dangerous as they can deliver unreliable doses of nicotine (above or below the stated quantity), or be leaking nicotine. Leaked nicotine is a poisoning hazard for the user as well as others around them, particularly children, as dangerous and lethal doses of nicotine can be absorbed through the skin.
- Local legislation – The Queensland state government has included e-Cigarettes use within the same legislation that govern the use of normal cigarettes.
- International bans – Late in 2013 news broke that Spain was planning to ban e-cigarettes from public places like hospitals and schools because of their possible health risks. Around the same time New York City also voted to extend its strict smoking ban to e-cigarettes, barring them from bars, restaurants, parks, beaches and other public places.
The potential impact on the community
The Therapeutic Goods Administration site states the following:
“The Australian Government is concerned about the use of electronic cigarettes in Australia. The impact of wide scale use of these devices on tobacco use is not known, and the outcome in the community could be harmful.”
Concerns have been expressed about the impact that e-cigarettes may have on the wider community, including:
• Some flavours may appeal to children.
• They may become a gateway to smoking or to nicotine addiction to new smokers, particularly among children and young people.
• They may undermine the comprehensive indoor smoking restrictions and smoke-free air policies.
• They may delay a smoker’s decision to quit.
Other concerns relate to the involvement of tobacco companies in the e-cigarette market and there is growing concern that “Big Tobacco” will have a renewed presence in a declining marketplace.
Are e-cigarettes better for your asthma than normal cigarettes?
As e-cigarettes are relatively new to the market, we don’t yet have enough evidence to know if they are a safer alternative that tobacco cigarettes. As a way of quitting smoking, there are certainly some benefits, but nicotine replacement therapy with the supervision of a medical professional is a more effective and proven option.
The Asthma Foundation notes that any inhaled substance may provoke asthma, either making controlled asthma persistent or making persistent asthma life threatening and strongly recommends against the use of any product which involves inhalants.
Are there other alternatives?
For some smokers wishing to quit (especially heavy smokers), Nicotine Replacement Therapy (NRT) can be a good option to consider in a quit smoking plan. Unlike e-cigarettes NRT products, have been rigorously assessed for efficacy and safety and approved by the Therapeutic Goods Administration for use as aids in withdrawal from smoking. If you plan on using a NRT it worth a trip to your GP first as you may be eligible for discounts on these products.
If you would like more information about different NRT products available in Australia visit the ‘I Can Quit’ website.
Getting help to quit smoking?
Quitting smoking is difficult, and most people make several attempts before they quit for good. It is usually easier with the right support and information, which can be available from your doctor, pharmacist, or QUIT on 131 848, or quitnow.gov.au.
Should I have the flu shot? I had the flu shot last year. Do I really need to have it again?
Yes, this is one shot that you do need to have each year. A new vaccine is developed each year to give you the best possible protection during the upcoming flu season.
What is the flu?
Influenza is caused by one particular virus, whereas most of what we call the “flu” is not caused by the influenza virus but rather by viruses that infect the respiratory tract (the nose, throat, and lungs) and are typically spread from person to person through the air or on hard surfaces when an infected person coughs or sneezes.
How does the influenza virus relate to asthma?
The influenza virus accounts for only a small percentage of asthma exacerbations, while the common cold virus contributes around 80% of reported exacerbations.
However, people with asthma who contract influenza are at higher risk than the general population of developing complications such as pneumonia, bronchitis, and ear infections, of time lost from work and school, of being hospitalised (especially among children younger than two, and the elderly), and of dying (especially among the elderly).
How can I avoid influenza?
The single best way to avoid influenza is to get vaccinated each year. While it does not give you 100 percent protection, it can greatly improve your chances of not catching influenza and in the event of you becoming unwell, will reduce the effects of influenza infection.
Please note it does not protect you from getting colds from other viruses.
Who should be vaccinated?
– have severe persistent asthma
– require frequent hospitalisation
– are over 65 years of age, or
– are over 50 years of age and of Aboriginal or Torres Strait Islander descent.
The National Health and Medical Research Council recommends vaccination if you have any chronic health condition, if you are a healthcare provider or if you would like to reduce the risk of becoming unwell with the flu.
Will it affect my asthma?
If you have asthma, the risk of it getting worse immediately following vaccination is very low. Whilst it is recommended, the vaccination itself has not been shown to protect you against worsening asthma.
When is the best time to be vaccinated?
The best time to be vaccinated is before May, but the most common time for flu outbreaks is in July and August, so it’s not too late to protect yourself this year. Make an appointment with your GP today if you fall into one of the above categories, to discuss whether you would benefit from being vaccinated.
Should you be more concerned about swine flu if you have asthma?
Whilst H1N1 09, or swine flu as it has become known, has to date produced mild symptoms in the majority of people, it is now recognized that there is an increased risk of complications in those with underlying respiratory conditions, including asthma. So if you do have asthma and develop influenza type symptoms this winter it is very important to talk to your doctor.
Remember, you can take some simple measures to reduce your risk of contracting this flu and any other viral illnesses this winter
- Cover your mouth and nose when you cough to prevent the virus being transmitted through the air
- Wash your hands regularly, especially after coughing, sneezing or blowing your nose, and before preparing food
- Don’t share personal items if someone in your household has flu-like symptoms
- Clean surfaces regularly, especially if someone has a viral illness
- Avoid close contact with others if you are unwell with flu.
Don’t forget to keep your asthma action plan up to date too, to help you recognise and treat any worsening asthma symptoms.
And finally, if you are planning to travel, visit the Department of Foreign Affairs and Trade’s travel bulletin at www.smartraveller.gov.au for updated travel advice or call 1300 555 135.
Fore more information about flu, go to our asthma and flu page.
It sounds like you are overdue a visit to your doctor for an asthma review.
Using reliever medication more than 3 times each week (except before exercise) suggests that your asthma is not well controlled. Whilst your reliever will act quickly to relieve any symptoms you may have at the time, it does not treat the underlying inflammation in the airways that is a feature of asthma, leaving you more at risk of an asthma attack. Good asthma control is the result of regular preventer use, as prescribed by your doctor, even when you are well, rather than frequent reliever use.
When you see your doctor s/he will also be able to provide you with a written asthma action plan to help you manage your asthma at different times. It will help you to recognise worsening asthma symptoms, start treatment quickly and seek the right medical assistance.
Visit your doctor and control your asthma.
I had a cold about 6 weeks ago and have had a dry, irritating cough ever since. I don’t have asthma and my doctor says not to worry. Do you think it could be asthma?
Whilst cough is a symptom of asthma, everyone who coughs does not necessarily have asthma. Sometimes a cough will persist for several weeks following a viral infection and is more of a nuisance than an indication of being unwell. However, if you develop other symptoms, such as a fever or wheezing, or the cough changes, you should see your doctor again.
My elderly mother is having problems using her reliever puffer because she has arthritis in her hands. Any suggestions to help her would be much appreciated.
Your mother could try using a Haleraid. This is a plastic device that slips over the puffer and converts the push down action required to use the puffer into a lever. The device helps people who have difficulty pressing down their puffer as instead they can use a squeezing action to get their medication.
A Haleraid is an excellent option for your mother also because it’s compact and not much bigger than a puffer, so it still fits in a handbag. The haleraid device also still allows for normal use of a spacer, which helps the medication get into the lungs better.
My son’s asthma is well controlled and he rarely uses his blue reliever puffer. The script for his preventer has run out and since he has been so well I thought I would give him a break for a while and see what happens. I really don’t like him taking medication continually. Am I doing the right thing?
Your son’s asthma is well controlled because he is using a preventer. You should never stop prescription medication without first seeing your doctor.
Make sure you discuss any concerns you have about your son’s medication with your doctor, such as side effects or the length of time that the medication is required for.
If your doctor decides it is appropriate to reduce your son’s preventer dose or stop it completely, they will also give you a written asthma action plan to help you recognise and promptly treat any signs of worsening asthma and reduce the risk of your son experiencing an asthma attack.
You should also arrange regular medical reviews by your doctor, to ensure that your son stays well. Remember, it is especially important that your son always carries reliever medication with him.
Occupational asthma – I have suffered from hayfever since I was a child and usually manage it with antihistamines. However about nine months ago I started a job in the home insulation industry and in the last few months I have started to wheeze and cough when I’m on the job. I seem OK on my days off though. Is this related to my hayfever problem or could I now have asthma?
You may have developed what is called Occupational Asthma. This is specifically related to exposure to a substance at work to which you are sensitive and as a result develop wheezing, coughing, shortness of breath and tightness across the chest from repeated exposure.
Symptoms may vary during the working week and in the early stages these symptoms tend to improve when you are away from work. One of the common occupations at risk is the insulation business due to exposure to isocyanates (chemicals).
It is essential that you to go see your doctor who will ask you questions about your symptoms and workplace as well as carry out tests such a lung function tests to get an accurate diagnosis. They may also ask you to keep a diary of your symptoms to compare with your working hours. Once accurately diagnosed, there are a number of management options.
Over the last 9 months my asthma has been really bad. The problem started after a bad cold and my doctor changed me from Pulmicort 100mcg to 400mcg and added Oxis 12 mcg. When that didn’t help he started me on Symbicort 100/6mcg and now I am up to 400/12mcg 2 puffs three times/day. I am still coughing at night and really getting fed up with struggling to breathe. My doctor has given me 3 lots of oral prednisone over this time and that has worked for about a week whilst I’m taking it and then it’s bad again. What can I do?
The three medications you mention all come in a device called a turbuhaler which requires a very precise technique to make sure the medication is actually delivered to your airways. This device must be “loaded” (clicked as indicated) in an upright position otherwise there won’t be any medication to inhale.
Has your doctor, pharmacist or nurse provided instruction on how to use your turbuhaler? It would be very worthwhile to have your technique checked by an expert as it may be a simple matter of a small adjustment to your technique, to get the most effective medication delivery.
Most studies show that between 50 – 90% of people with asthma are not using their inhaler correctly so it’s important to not assume your technique is correct. Incorrect technique will mean that you need to take higher doses to get the desired benefit and this may be what is happening with you.
We have simple videos on our website and YouTube page showing the correct way to use your turbuhaler. These may be very useful for you to watch, and research shows that techniques should be checked at least every 3 months in order to maintain correct medication delivery. Do watch the video, but also get your technique checked as soon as possible by an expert.
Pregnancy and asthma – I have just discovered I’m pregnant. Should I stop taking my asthma medication?
While you are pregnant, it is very important to have good asthma control to ensure the best outcome for both yourself and your baby. If your asthma is well controlled, your baby will have a good oxygen supply and be able to grow properly. Stopping your medications can put your baby at risk. So to answer your question No, you should not stop taking your asthma medication.
Most asthma medications are safe to take during pregnancy. However, do talk to your doctor about any concerns you may have and discuss whether you are on the most appropriate medication regime now that you are pregnant. You should also have regular asthma reviews and a written asthma action plan – that way you will know how to recognise and treat worsening symptoms. And tell your doctor if your asthma symptoms change.
Many women will experience no change to their asthma whilst pregnant. For about one third, their asthma may be worse and for another third, it will improve. Asthma control can worsen at any time during a pregnancy but any problems will usually occur between 17 and 36 weeks.
The risk of a severe attack is greatest for women who stop regular preventer medications during pregnancy. Therefore, it is important that you continue your medications and monitor your asthma symptoms carefully and see your doctor if your symptoms get worse. But the good news is that if your asthma has worsened during pregnancy it usually settles back to normal within about three months after the baby is born.
The aim of good asthma control during pregnancy is to avoid a lack of oxygen to the baby, and thereby avoid low birth weight and premature delivery. All of these problems can have an effect not only on the health of your baby but also on the baby’s long-term health. The good news though is that if your asthma is well controlled your risk for these problems are no higher than for women without asthma.
The other good news is that asthma attacks are rare during labour and you can therefore plan for your preferred delivery. But do talk to your midwife and/or obstetrician about your asthma. They may need to talk to the doctor who is managing your asthma.
Breastfeeding does not appear to protect a baby from becoming allergic or getting asthma, but there are many other benefits from breast-feeding.
And remember, if you smoke, you should stop if you are planning a pregnancy, and avoid exposure to second hand tobacco smoke to reduce the risk of your baby having asthma, respiratory infections or Sudden Infant Death Syndrome (SIDS).
Reference: Asthma and healthy pregnancy 2006 Asthma Foundation NSW
Many asthma medication delivery devices have an indicator to tell you when it needs replacing. If the indicator on your turbuhaler does not turn red or the counter on any other device does not work, replace the device immediately and contact the manufacturer.
Always remember to check the expiry dates on your asthma devices.
Note: Make sure you don’t wrongly assume your device still has medication in it if you hear a rattling sound when you shake it. Even when a turbuhaler is empty, it will rattle when shaken because of the drying agent in the coloured base. An MDI can also rattle when empty from the propellant remaining in the device.
Symbicort turbuhaler has a dose counter, which counts down in 20s, to tell you how many doses you have left. Other turbuhalers (Pulmicort, Bricanyl) have a clear window. On all Turbuhalers, you have 20 doses remaining when the indicator turns red.
Asmol, or Ventolin MDIs contain 200 doses. Because your reliever puffer is only used when needed, it can sometimes be more challenging to keep track of how many doses remain in the canister. If your asthma is well controlled, you will use very little of this medication, but if you have been using it frequently consider when you first used it and whether it needs replacing.
Seretide metered dose inhalers (MDI) or “puffers” have a counter to tell you how many doses are remaining in the canister, whilst Flixotide MDIs do not. Flixotide MDIs contains 120 doses (NB If your Flixotide MDI was dispensed in hospital check whether it has 60 or 120 doses). Therefore, depending on how many puffs are taken each day in total, you are able to work out how many days the puffer will last. All Seretide and Flixotide accuhalers have dose counters and contain 60 doses.
Allergic rhinitis, where the lining of the nose, back of the throat and mouth become inflamed and swollen due to exposure to allergens such as house dust mites, pets, pollens and moulds and other irritants, is very common among people with asthma.
Hay fever (also known as seasonal allergic rhinitis) is the best known type of allergic rhinitis, with its associated itching, sneezing, runny nose or eyes and often blocked nose occurring during the pollen season.
However perennial allergic rhinitis, where nasal symptoms occur throughout the year, is often seen in patients with asthma.
There is now good evidence that in patients with asthma, the presence of allergic rhinitis can also exacerbate their asthma. The reason for this is not entirely clear but suggestions include that breathing through your mouth when your nose is blocked can further aggravate your asthma by bypassing the nose’s filtering and humidifying function or that there is a reflex effect of nasal inflammation which triggers lower airway narrowing.
It is therefore recommended that when both asthma and allergic rhinitis co-exist that both are treated, with a preventer puffer in the case of asthma, and anti histamines and/or preventer nasal spray (generally a nasal corticosteroid) in the case of allergic rhinitis.
Antileukotriene preventer medications (e.g. Singulair) have benefits for both asthma and allergic rhinitis so are sometimes used as a single therapy if these conditions co-exist. If your allergic rhinitis is making your asthma more difficult to control talk to your doctor about which medications are best for you.
Will asthma medication change my voice? I have been using a combination preventer inhaler for the past 3 months and my voice has changed. Do you think it is caused by the medication?
Combination preventer inhalers such as Seretide™ and Symbicort™ contain a symptom controller, and an inhaled corticosteroid, in one device. Although inhaled corticosteroids are the most effective treatment for asthma, some people experience voice changes, a sore mouth or throat, or oral thrush when taking them. These side-effects are more common at high doses, or with some types of inhalers.
Rinsing the mouth out afterwards can prevent oral thrush but it does not prevent voice problems. If you are using a puffer, you can reduce voice and mouth side-effects and improve the amount of medication which reaches your lungs by adding a spacer. Another alternative is a newer inhaled corticosteroid called ciclesonide (not yet available as a combination inhaler) which has much fewer voice effects than other inhaled corticosteroids.
If you have voice problems, you should see your doctor for advice about whether your medication dose can be reduced, or whether a different medication or inhaler would be suitable for you.