In the UK 1.1 million children have asthma. On the 6th May 2014 the National Review on Asthma Deaths was published. It showed that the UK has one of the worst survival rates from asthma in Europe. We all commonly hear about asthma and may well have members within our own family, or indeed ourselves, who are diagnosed with it. In general we see asthma as a very common, mild condition – which it is it in many cases.
The report shows that us as medical professionals are often failing to manage asthma and initiate specialist referrals appropriately- even mild asthmatics can have serious and life threatening asthma attacks.
What is asthma?
Asthma is a condition in which the airways go into spasm, this narrows the airways and leads to difficulty breathing. The lining of the airways become inflamed and start to swell, the cells of the airway start producing sticky mucus or phlegm which block up the narrowed airways and can make breathing even more difficult.
What causes asthma
There is no single one cause of asthma. Asthma is often triggered when someone is exposed to something that irritates their airways.
Triggers that can cause asthma;
- Tobacco smoke – children whose parents smoke are more likely to develop asthma
- Allergens – pollen, house dust mite, animal fur, feathers
- Respiratory infections – coughs and colds
- Temperature changes – especially cold air
- Stress and emotions
- Foods and drinks that are high in sulphites – concentrated fruit juice, jams, prawns, pre-cooked meals
- Irritants – chemical, pollution
- Some medications – ibuprofen, aspirin
If you or your partner/husband have a history of asthma, eczema or allergies, such as hayfever, then there is a higher incidence that one of your children could develop asthma.
Symptoms of asthma
- Shortness of breath and in extreme cases may not be able to complete a sentence
- Tightness in the chest- like a band tightening around it
Not everyone will get all of these symptoms. Some people experience them from time to time; a few people may experience these symptoms all the time.
There is no cure for asthma, however there are very effective treatments. They are broadly divided into 2 categories;
- Relievers – these relieve the symptoms at the time of wheeze. This is usually a blue inhaler, salbutamol.
- Preventers – these help to prevent future wheezing events. These can be tablets or inhalers.
Your GP should be able to assess the treatment that is required from the history that you give them – how often the wheezy episodes occur and when.
The National Review on Asthma Deaths showed that we tend to rely on the blue puffer (reliever) far too much. Blue inhalers should only be needed as a maximum 2 or 3 times a week and if required more frequently you should go back to your doctor for a review medication.
As a child, and even as an adult, taking an inhaler can be tricky. There are different styles of inhalers for older children, but for younger children using a spacer device has been shown to deliver the medication much more effectively and increases the amount of the medication reaching the airways rather than hitting the back of the throat. This helps to achieve much great control of the asthma.
Spacers for smaller children are usually fitted with a face mask and for older children have a mouth piece. You use the spacer device by attaching the inhaler (which needs to have been shaken first to mix the medication inside) and squirting in one puff from the inhaler, then take 10 deep breaths through the spacer. A second puff can then be given and 10 deep breaths through the spacer are required, and so on.
There are other things that can be done to help prevent asthma from being triggered;
- In some cases having the flu vaccination can help by reducing the amount of respiratory infections and hence asthma attacks.
- Stopping smoking is a very important way to help anyone who has asthma. Anyone within the household who smokes is bringing small smoke particles into and around the home. These can be enough to trigger a wheezing episode and this can lead to an asthma attack. www.nhs.uk/smokefree is a great website if you are considering giving up smoking.
- If house dust mite is the trigger then you can get duvets and pillows that are resistant to the mite. Also, removing carpets from the bedroom can help.
How to help in an asthma attack
Be calm and reassuring- reducing the stress and keeping the situation calm really helps. Panic and fear can increase the severity of an attack.
Children often have a variety of different asthma inhalers and medication to control their asthma – if they are having an asthma attack it is the reliever inhaler that they need – this is usually the pale blue one.
- Encourage them to sit upright or stand up as this helps to open up the airways
- Loosen any tight clothes around their neck and chest
- Get them to take two puffs of their blue inhaler (see above for practically how this should be done- one at a time)
- If they do not start to feel better and their breathing does not ease with another 2 puffs of their inhaler then call 999 and ask for an ambulance, tell them that the child is having an asthma attack so they can bring specific items with them to help
- They should keep taking the reliever inhaler one puff at a time until their breathing is easier or until the paramedics arrive
For more information about asthma visit http://www.asthma.org.uk/
DR ANASTASIA ALCOCK
MRCPCH MBBS BSc(Hons) DTM&H DPID DRCOG