Thursday 21 September 2017

15 Ways to control asthma

With almost half-a-million sufferers in Ireland, our reporter asks the experts for some simple steps that can dramatically improve the quality of life for those dealing with asthma

There are simple steps you can take to take control of your asthma
There are simple steps you can take to take control of your asthma

Niamh Cahill

The cold and flu season is well and truly under way and for some asthma sufferers, symptoms are worse during winter. This is a worry for many considering over 470,000 Irish people suffer from asthma.

One in every five children and one in 10 adults have asthma. The condition is the most common chronic childhood disease in Ireland.

Around 60pc of sufferers have uncontrolled asthma and one individual dies every week despite the fact 90pc of asthma deaths are preventable.

However, there are simple steps you can take to gain control of your asthma that can have a dramatic impact on quality of life.

1 Watch the seasons

Professor Richard Costello, chair of the Asthma Society of Ireland Medical Advisory Committee and consultant chest physician at Beaumont Hospital, explains that asthma patients need to pay close attention to seasonal changes and pollution levels.

"Asthma attacks are common when there are high levels of pollution and high levels of viral infections in the community, so during the spring and the autumn, and also in times of high levels of pollution."

It is usually recommended that sufferers get the flu vaccine. If you have poorly controlled asthma and you contract a viral infection, you're more likely to end up with a chest infection and on oral steroids.

2 Understand the condition

Asthma is common in Ireland. But how many of us fully understand it? You are more likely to get it if you have a family history of asthma, eczema and allergies.

Professor Pat Manning, consultant respiratory physician and Health Service Executive (HSE) lead for the National Asthma Programme, says the majority of people with asthma will develop it by the age of six, but some people who develop asthma in childhood and grow out of it in their teens may see their asthma return during their 30s or 40s, particularly if they smoke.

Every individual patient is different, he explains, with some patients suffering intermittent asthma while others have it regularly.

A diagnosis of asthma is not usually made until the age of six, but children as young as two years old have been diagnosed with the condition.

3 Don't be afraid

There is no cure but thanks to novel treatments, a diagnosis of asthma is nothing to be afraid of. According to Waterford GP Dr Dermot Nolan, who has a special interest in asthma, a diagnosis can trigger fear among parents and patients.

"There is probably still a much unfounded fear of a diagnosis of asthma," he says. "Years ago if you said 'asthma', some parents would start crying for the kids and think it's a horrible diagnosis. But nowadays, with modern treatments and with people engaging with health professionals, it should be fully controllable."

4 Prevention is key

Some sufferers make the common mistake of stopping their preventive treatments when they are feeling well, but according to Costello, it is extremely important to continue to take preventive therapies.

"Remember, if you haven't been taking your preventive therapy when you've been well, it's never too late to start again, particularly if there's an infection in the home or if your symptoms are coming back. It's very common that people feel well, stop their treatment and then get sick again."

The protective effect of preventer medicine builds gradually and to work correctly needs to be taken daily.

5 Improve your inhaler technique

Improving your inhaler technique can make a huge difference to your quality of life, according to Dr Nolan.

"We try to have patients on the same inhaler device as different inhalers require different techniques. Most of them, called metered dose inhalers - the standard inhalers - people are often breathing too fast through them. It's a very slow breath… that's one of the commonest mistakes on the average metered dose inhalers. Some of the other inhalers do require a fast breath but for the vast majority of patients with standard metered dose inhalers that's a slow breath."

The Asthma Society of Ireland website, asthma.ie, has videos on technique and how to use each device correctly.

6 Don't smoke

It sounds obvious, but many people with asthma continue to smoke despite the significant impact it has on their condition. Around 29pc of the Irish population smoke. Exposure to second-hand smoke is also harmful, particularly for children, Dr Nolan explains.

"Young children and infants seem to be extremely prone to second-hand smoke as one of the major factors on poor asthma control."

A study published last year found that children with asthma and second-hand smoke exposure are nearly twice as likely to be admitted to hospital with asthma exacerbation.

7 Asthma and obesity are linked

Around 61pc of Irish adults are overweight or obese, resulting in a number of health problems. But carrying excess weight can also have a negative impact on asthma control. Studies show that obesity can lead to higher rates of asthma. "Obesity is a big factor in poor asthma control," says Dr Nolan. "As your body mass index (BMI) goes up, asthma control tends to go down. That's another big factor increasingly seen in young children in Ireland."

8 Have a self-management plan

An Irish study has shown that only 6pc of asthma sufferers have a self-management plan. Yet putting patients in control of their condition is proven to have huge benefits.

"One of the best things you can do for asthma patients is put them in control of it and show them how to monitor their own asthma and what to do when their peak flow measurement drops," Dr Nolan says.

A peak flow metre is a device that measures lung function. When levels can drop action is required to prevent an exacerbation. "Sometimes that can be a good way of recognising that asthma has been out of control. They can up their preventer inhaler... It's one of the things that's been shown to make a big impact, not only on deaths but on hospital admissions and out-of-hours visits."

The Asthma Society of Ireland has guidance for professionals on how to implement self-management plans.

9 Use medication correctly

Few sufferers actually know how to use their medication correctly, Dr Nolan says.

A study recently showed that 70pc of asthma patients are using their blue inhaler every day. According to Dr Nolan, it should be used less than twice per week. He says a lot of sufferers are unaware of this simple fact.

"If you're using it more than that, your asthma is probably not controlled except if you're using it for exercise. To relieve symptoms ,using it more than twice per week means that something's not right."

10 Check for allergies

There is a strong link between allergies and asthma. Allergies to house dust mites, pets, pollen, chemicals in preservatives known as sulphites and medicines can cause asthma.

Specific triggers can increase the frequency of and cause asthma attacks. Knowing what triggers your asthma is an important part of prevention and control. According to Costello, the cause of your asthma may lie in your foods or medicines.

"Certain foods contain high levels of sulphites, which can make asthma worse in some people, or alternatively dairy can make some people's symptoms worse. The same with other food allergies."

11 Do you have rhinitis?

Rhinitis is an inflammation of the mucous membrane of the nose and can often occur in people with asthma.

Costello says that a person's asthma can actually be in their nose.

"Your asthma may be coming because your nose isn't controlled. This is often the case in people who have airborne allergies, that they don't look after their nose and that makes their asthma worse because their nose doesn't protect their chest," he explains.

It is advised that sufferers with concurrent rhinitis make sure their nasal symptoms are treated. If your nose is blocked and you have allergic rhinitis in your nose, this can be a big factor in poor asthma control.

12 Night waking means your asthma isn't under ­control

If you're waking a lot at night, you're not only exhausted but it's also a sign you're asthma is poorly controlled.

"They're waking up coughing and getting tired and feeling wrecked the next day. They're often unable to participate in sport or do their normal daily activities. They tend to be using their blue inhaler quite a bit," Dr Nolan advises.

Asthma causes 25,000 annual hospital visits and the risk of death increases as a patient's control gets worse. "Although deaths are a rarity still, a significant number of patients die every year and by poor control, the risk of death greatly increases," he adds.

13 Get regular asthma ­reviews

Asthma reviews are a significant part of asthma management and usually involve a discussion with your doctor.

The Asthma Society of Ireland recommends six-monthly reviews for patients whose asthma is under control.

Prof Manning says reviews are essential and include an assessment on control, triggers, smoking, medication and inhaler technique, among other factors. "Essentially you're looking at asthma control and specifically looking at how asthma is affecting the person," he says.

14 Your occupation may be a factor

Asthma causes inflammation of the airways that transport air in and out of the lungs.

Exposure to chemicals can trigger an asthma attack. "There are certain occupations that perhaps people with a tendency towards asthma could avoid," Prof Manning explains.

"Bakers, people exposed to dust and things like that, spray painters, forestry workers... There are certain amounts of people that can develop asthma in these types of occupations."

15 Education is vital

Arming yourself with as much information about your condition as possible is vital and there are a number of resources you can call upon for help. According to Costello, the Asthma Society of Ireland has great advice for patients and family members who are concerned.

He says asthma can be controlled with regular treatment and that new therapies for conditions that can't be treated with standard therapies are available.

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