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Asthma is the most common chronic disease affecting all age groups from young children to adults. Between 24,000 and 26,000 people attend A&E every year in Ireland due to an exacerbation of their condition, creating an additional burden on an expensive and already overstretched resource.

What is ASTHMA?

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs.

Asthma can occur at any age but is much more likely in childhood. However, it can be difficult to diagnose in children and this has lead to an increase in the diagnosis of milder asthma (and possibly over-treatment). Anyone can develop asthma, and it can affect several family members in one household. Conditions like hay-fever, eczema and hives, which are usually the result of allergies, may occur along with asthma.

Asthma symptoms may change over a period of years. Children who have asthma also tend to have asthma as adults, even though symptoms resolve during puberty in one-third to one-half of children. Asthma can improve, worsen or stay the same during pregnancy. Modern lifestyles such as changes in housing, diet and living in a more sterile environment are thought to have contributed to the increase in asthma over the years.

The actual cause of asthma is not known, however individuals with asthma may notice their condition deteriorates on exposure to certain trigger factors.

TRIGGER FACTORS

A trigger is anything that irritates the airways and causes the symptoms of asthma. Everyone’s asthma is different and you may have several triggers. An important aspect of controlling your asthma is avoiding your triggers.

It may be impossible to avoid all of your triggers but once you have identified them, there are things you can do to help you reduce unnecessary symptoms and better control your asthma. Sometimes it may be easy to identify what triggers your asthma, i.e., your symptoms may start within minutes of coming into contact with a cat or dog. However for others there can be a delayed reaction so it can be harder to figure out what the triggers are.

      ANIMALS    

Furry and feathery animals are a common trigger of asthma symptoms. The allergens (the substances that causes the allergic reaction) are found in their saliva, flakes of skin (pet dander), fur and urine.

If you have a pet at home and find that your symptoms are worse in their presence, you may need to find your pet a new home. Speak to your vet for further information.

     AIR POLLUTANTS    

The air we breathe contains lots of different particles that can trigger asthma symptoms. Air pollutants like cigarette smoke and car exhaust fumes release gases and particles into the atmosphere which can irritate your airways.

·         If you find pollution triggers your asthma, keep well informed about air quality.

·         Ozone can be a problem for some people. Levels are likely to be higher on hot, summer days. If you think this might be a trigger for you, avoid exercising outdoors, especially in the afternoon.

·         To  check air quality in your area visit: http://www.epa.ie/environment/air/

     COLDS AND VIRAL INFECTIONS    

Colds and viral infections are very common triggers of asthma. Unfortunately these can be difficult to avoid. At your asthma review you should talk to your doctor or asthma nurse about having the flu vaccination. This is normally available every autumn.

People who are regularly taking steroid tablets should also talk to their doctor about having the pneumococcal vaccination. Unlike the flu vaccination, which should be repeated every year, the pneumococcal vaccination is usually only given once.
Flu and pneumococcal injections are also recommended for everyone over the age of 65

     EXERCISE    

Some people with asthma find that exercise triggers their asthma symptoms. However, exercise is good for everyone, including people with asthma. If your asthma is well controlled, you should be able to join in, have fun and keep fit.

For more information see ‘Asthma and Exercise’.

     HOUSE DUST-MITES    

Many asthmatics are sensitive to the droppings of house-dust mites. These are tiny creatures that live in the dust that builds up around the house, in carpets, bedding, soft furnishings and soft toys.

If house-dust mites trigger your asthma, your symptoms could be reduced by following the recommendations below.

·       Use complete barrier covering systems on your mattress, duvet and pillow.

·       Remove all carpets and replace with hard flooring.

·       Vacuum all areas frequently. Use a vacuum cleaner that has good suction and a filtered exhaust that does not scatter dust.

·       Remove all soft toys from beds. Put them into a bag in the freezer for a minimum of six hours every one to two weeks to kill house-dust mites.

·       Hot wash (at 60 degrees C) sheets, duvet covers and pillowcases once a week. Although some people are allergic to feathers, there is no conclusive evidence to show that synthetic, 'hypo-allergenic' pillows are any better.

·       Clean your soft furnishings with anti-house-dust mite chemicals.

·       Use a dehumidifier to dry the air, as this makes it more difficult for the house-dust mites to survive.

     MEDICATION THAT CAN TRIGGER ASTHMA    

Some medicines that are used to treat a range of conditions can lead to asthma attacks in a small number of people.

These medicines include aspirin and non-steroidal anti-inflammatory tablets, such as; ibuprofen, diclofenac and naproxen (e.g. Nurofen®, Difene® and Naprosyn®). Other medicines that can sometimes lead to asthma attacks include beta-blockers, used to treat heart disease and glaucoma.

If you have any concerns over your medication and asthma, speak to your pharmacist who will be happy to discuss these issues further.

     SMOKING    

Smoking is dangerous for everyone, but particularly for people with asthma. It can irritate the lungs and bring on asthma symptoms.

·       If you smoke (or breathe in other people's smoke) you increase the risk of an asthma attack and may permanently damage your airways

·       You are increasing the risk of your asthma persisting if you smoke as a teenager

·       You are putting children at risk of asthma if you smoke around them or during pregnancy

·       Many public places are now smoke-free areas but do not be afraid to ask other people to stop smoking around you

Smoking Quitline

ASTHMA & HAYFEVER
 

Every year thousands of people in Ireland experience the discomfort of hay fever.

Some people only have symptoms during the summer. Others have hay fever-like symptoms all year round called 'perennial allergic rhinitis'.

Hay fever is a seasonal condition. It is sometimes called 'seasonal allergic rhinitis'. People with hay fever are allergic to pollen and spores. Pollen is the tiny, dust-like particles given off by certain types of trees, grasses, weeds and flowers. Spores are given off by fungi and moulds.

In some people, hay fever-like symptoms occur all year round. This condition is called 'perennial allergic rhinitis' (or perennial rhinitis). This is usually caused by an allergy to allergens present in everyday life, such as house-dust mites, furry or feathery animals, certain chemicals or some foods.

If you have an allergy, your body reacts when you come into contact with certain allergens. As soon as you inhale them, or if they get into your eyes, they irritate the sensitive linings of your nose, throat and eyes. This causes the symptoms of hay fever or perennial rhinitis to appear.

WHAT ARE THE SYMPTOMS?

Typical symptoms of hay fever and perennial rhinitis are:

·       sneezing

·       itchy, blocked or runny nose

·       red, itchy or watery eyes

·       itchy throat, inner ear or mouth

·       headaches

·       a loss of concentration and generally feeling unwell

Different people will experience different symptoms. Some people might experience all the symptoms. Others might experience only a couple.

The common cold can often be confused with hay fever and perennial rhinitis because they all cause similar symptoms. However, a cold normally lasts for around a week. Sneezing, a streaming nose and itchy eyes which persist for a few weeks may well be due to either hay fever or perennial rhinitis.

Allergens can also trigger asthma symptoms: tight chest, shortness of breath, coughing and wheezing. If this happens to you, speak to your doctor or pharmacist as soon as possible. They will give you medicines to help you control these symptoms.

Helpful Hints - Asthma Society of Ireland

HOW TO CONTROL HAYFEVER AND RHINITIS

You can try to avoid those allergens that affect you, or you can take effective medication (as allergens are impossible to avoid completely).

A combination of the two is often the most successful method of controlling symptoms.

AVOIDING POLLEN & SPORES

Pollen and spores are a problem in towns and cities as well as in the countryside. This is because they are small and light enough to be carried in the air over great distances during the course of the day.

Most pollen is released in the morning and rises skywards with the heat of the day. It then gets whisked overland by winds and breezes. The pollen then sinks back to earth late afternoon/early evening as the temperature starts to drop.

Although it's difficult to avoid pollens and spores completely, there are several sensible and worthwhile precautions you can take.

Indoors

·       Keep doors and windows closed, especially mid-morning and late afternoon/early evening. These are the times when the pollen count is usually at its highest

·       Vacuum regularly and dust with a damp cloth

·       Avoid drying your clothes outside. But if you do, give them a good shake before bringing them back into the house. That way you'll get rid of any pollen and spores that might have blown onto them

·       If you've been out walking or gardening, shower, wash your hair and change your clothes when you get back in. That way you won't be carrying spores and pollen around the house

·       Splash your eyes with cold water regularly. This will help flush out any pollen. It will also soothe and cool your eyes

·       Keep furry pets out of the house during the hay fever season. If your pet does come indoors, wash or bathe them regularly to remove any lingering pollen from their fur

·       Keep fresh flowers out of the house

Outdoors

·       Check the pollen forecast on the television or in the newspaper before venturing outside. This will give you the chance to stay indoors if there's a high pollen count

·       Check today’s pollen count: http://www.met.ie/forecasts/pollen.asp (Please note this is only available from June to August)

·       Wear wraparound sunglasses. These will help stop pollen blowing into your eyes

·       Smear Vaseline inside your nose. It might sound horrible, but it can help to stop pollen and spores from settling on the lining of your nose

·       Keep your car windows closed. Some cars can be fitted with pollen filters. Ask at your local garage for further details

·       Try to stay out of places with lots of grass, like parks or fields

·       Try to avoid mowing the lawn or weeding. These activities can create clouds of pollen and spores

·       If you enjoy gardening, consider creating a hay fever-friendly environment for yourself.    

AVOIDING OTHER ALLERGENS

Indoors

If you have perennial rhinitis and are allergic to the house-dust mite:

·       Use barrier covers for your bedding

·       Hot wash (at 60°C) all bedding at least once a week

·       Vacuum frequently using a high-efficiency vacuum cleaner

·       Dust regularly with a damp cloth

·       If you don't already own a pet, think carefully before getting one

·       If you already have a family pet, keep it out of lounge and bedroom areas and bathe it regularly

HAYFEVER AT EXAM TIME

If you're sitting an exam, it's important that you get your hay fever symptoms under control as early as possible. Once your hay fever is under control you'll find yourself sleeping better at night. This means you'll feel much fresher during the day, and will be able to concentrate much harder on your revision. Of course you will obviously feel a lot better in yourself if you're not sneezing or sniffing or rubbing your eyes all the time.

Before your exam

·       See your doctor or pharmacist well in advance of the hay fever season (and certainly no later than the Easter holidays) to make sure you've got the right treatment. You don’t want to be taking medication that may cause drowsiness!

·       Tell your teacher you have hay fever. Your teacher might want to write to the exam board on your behalf. The exam board might take your hay fever into account when your paper is marked - especially if your symptoms are really bad during the exam

On exam day

·       Take your regular medication

·       Tell the adjudicator if your hay fever is bothering you

·       Splash your eyes with cold water before going into the exam room

·       Try not to sit near an open window

·       Keep a supply of tissues and an effective, quick-acting hay fever treatment close at hand – just in case. (And good luck!)

HAYFEVER TREATMENTS

There is no cure for either hay fever or perennial rhinitis. However, in most cases symptoms can be controlled effectively.

Below are some of the most widely used treatments for hay fever and perennial rhinitis. For some you need a prescription from your doctor. Others can be bought over the counter without a prescription. Talk to your doctor, nurse or pharmacist about the most suitable treatment.

Antihistamines

Antihistamines provide quick relief for symptoms such as sneezing, runny nose, itchy, watery eyes and itchy throat. They work by stopping many of the effects of histamine – one of the chemicals the body releases during an allergic reaction.

They come in tablets, capsules or as liquids. Examples include Clarityn® (loratadine), Zirtek® (cetirizine) and Piriton® (chlorphenamine).

Side effects

Newer antihistamines cause little if any sleepiness, but older types such as Piriton® (chlorpheniramine) can make you drowsy. Don't take these older types if you are going to drive, operate machinery or sit an exam.

Decongestant sprays: Otrivine®, Sudafed®

Decongestant sprays may be used occasionally to relieve stuffy or blocked noses.

Although side effects are rare, they must only be used for 7 days at a time. If overused, they can lose their effect. This can lead to a need for bigger and bigger doses.

Preventer treatments

Preventer treatments are used to prevent nose and eye symptoms developing in the first place. They do this by reducing inflammation in the nose and eyes. They are very effective at controlling hay fever and perennial rhinitis symptoms if used regularly each day. If you have hay fever, you should start using them a couple of weeks before the hay fever season starts.

Nasal sprays and nose drops are available. Some contain a corticosteroid - for example, Flixonase® (fluticasone) and Beconase® (beclomethasone). Others contain sodium cromoglycate (for example, Haycrom® and Opticrom® Ask your doctor, nurse or pharmacist as there are many others available.

How to take nasal sprays and drops

If you use a nasal spray, bend your head forwards to look at your feet before spraying one or two sprays into each nostril and breathing in slowly. If you use nasal drops, you need to bend right over so that your head is upside down. If in doubt, read the patient information leaflet that comes with the medicine. Ask your doctor, nurse or pharmacist to check that you are taking your medicine correctly.

Side effects

Some preventer treatments contain a small amount of corticosteroid. They do not generally cause side effects. Some patients report irritation and occasionally nose bleeds.

If you need to take corticosteroids long-term, discuss this with your doctor, nurse or pharmacist. Remember – always read the label and do not exceed the stated dose.

Eye Drops

Drops such as Haycrom® and Opticrom® are very effective at alleviating watery, itchy eyes. Care should be taken for those who wear contact lenses. Ask your pharmacist which drops are suitable. Side- effects with eye drops are unusual, however some patients say they can sting a little on administration. 

WHICH TREATMENTS ARE THE BEST TO TAKE?

If you have hay fever, early preventative treatment is the most effective. Visit your doctor or pharmacist well before the hay fever season starts. If your symptoms are mild, you may only need to take an antihistamine tablet when you have symptoms. If this is not enough to control the problem, you may need to use a preventer treatment also. An example might be one of the steroid nasal sprays listed above.

Often the best way to control symptoms is to take a preventer nasal spray or drops together with an antihistamine tablet. Anti-allergy eye drops can be added and should be used regularly if you have symptoms affecting your eyes.

Talk to your doctor, nurse or pharmacist. They will be able to advise you on which treatments are the best for you.

ASTHMA IN CHILDREN 

Asthma is very difficult to diagnose in young children, as at least one in seven children will have ‘wheezing’ at some point during their first five years. Many of these children will not go on to have asthma in later childhood, so your doctor may not want to use the term asthma at this stage. The diagnosis will be based on a wide range of questions, including whether your child has wheezing, a dry cough, breathlessness or noisy breathing.

As a parent you will be asked about any family history of asthma or eczema, the pattern of your child's illness, its severity and incidence, as well as possible triggers - such as allergies, colds or exercise. Your child may be asked to take a skin prick test, blood test, a chest X-ray or simple lung function tests.

The following factors will help your doctor decide whether your child has asthma:

·         A family history, particularly in the mother, of asthma and/or rhinitis

·         Signs of allergies, e.g. to pollen, dust, animals or exercise

·         Gender - Before puberty boys are more at risk than girls. Boys are more likely to 'grow out' of it, while girls are more likely to have persistent asthma when growing from childhood to adulthood

·         Viruses - A virus causes many young children to wheeze, but this will not necessarily mean they have asthma. Children often find this viral wheeze gets less as they grow older.

·         If the child’s mother smokes. Maternal smoking leads to a higher likelihood of wheezing in their small and young children

·         If the baby was born prematurely

·         Wheezing is more common in young children born prematurely, although this link disappears when premature babies are in their teens. The earlier your child starts to wheeze the better the final outcome. Most under 2s who wheeze become free of symptoms by the age of 6. However, this is not likely to be true if the wheezing is due to an allergy

·         The frequency and severity of wheezing

Sometimes your child may be referred to a specialist. This happens when:

·         The diagnosis is unclear

·         The symptoms are present from birth

·         The child vomits or regurgitates a lot

·         There is a severe infection in the respiratory tract

·         The child has a persistent cough which produces phlegm

·         There is an unusual family medical history of chest disease

·         The child fails to thrive

·         There are some unusual symptoms, i.e. an abnormal cry or voice, or strange noises made when breathing

·         The child doesn't respond to normal treatment

Over time you will become more able to recognise when your child's symptoms are getting worse; below we list some signs that this might be happening.

Make sure you have a written personal asthma action plan for your child and that they have regular asthma reviews. These will help you to control your child's symptoms. Ask your pharmacist for an asthma diary. This will help you keep a record of when the symptoms are getting worse.

MY CHILD’S ASTHMA IS GETTING WORSE?

Link to Childrens 1 MINUTE Asthma Control test 

The following signs could mean that you child's asthma is getting worse:

• Wheezing and coughing first thing in the morning
• Increased wheezing and coughing after exercise, or doing less exercise
• Waking at night with a cough or wheeze
• If the reliever inhaler is not providing relief of symptoms for longer than 3-4 hours
• Needing more and more reliever medicine with less and less effect

YOUR CHILD’S ASTHMA REVIEW

Asthma is a long-term condition that needs to be treated on an individual basis. Just like visiting the dentist or the optician it is important for your child to have regular review appointments with their doctor or asthma nurse to monitor their asthma symptoms and the medicines they are taking.

When should my child have an asthma review:

• Most doctors suggest you and your child visit them or an asthma nurse for an asthma review every six to twelve months, or more regularly just after your child has been diagnosed
• A month or so after your child's asthma medicines are changed to new medicines or if their normal medicine has been increased or decreased
• Within 48 hours of a serious asthma attack to make sure your child's symptoms are better controlled. Your child will also need another review one to two weeks after a serious attack to make sure their symptoms are back under control
• If your child's personal asthma action plan is not helping them to get back in control of their symptoms

During your child's review you should expect to be asked the following three questions:

• Has your child had difficulty sleeping because of their asthma symptoms (including cough)?
• Has your child had their usual symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
• Has their asthma interfered with their usual activities?

ADULT ONSET ASTHMA 

Asthma is often thought to be a condition you get when you are a child and for many, asthma does start in childhood. However, some people are diagnosed with asthma for the first time later in life. This is known as 'adult onset asthma'.

In older people, the symptoms of asthma are less likely to be triggered by allergies such as house-dust mites, animals and pollen.

Symptoms are more likely to be triggered by:

·       Flu, colds or other viral infections

·       Exercise

·       Laughing or getting excited

·       Depression or anxiety

·       Some medicines

·       Irritants such as cigarette smoke, cold air, perfumes and chemical fumes

ASTHMA TREATMENTS 

Although there is no cure for asthma, there are some excellent medicines available to help you to control your asthma so that is does not interfere with your daily life.

It is important that you take your asthma medicine properly and that your doctor, pharmacist or asthma nurse has explained how to use inhalers properly so that every dose you take gives you the most benefit. There are different types of inhaler devices, including, pressurised metered dose inhalers (Ventolin®), breath-actuated inhalers (Easi-Breath®) and dry powder inhalers (Turbohalers®).

See the section on inhaler technique for demonstration videos on the various inhalers.

RELIEVER INHALERS

Everyone with asthma should have a reliever inhaler. Reliever inhalers are usually blue. Brand names you may be familiar with are Ventolin® and Salamol®. They come in the three different delivery devices listed above.

Relievers are taken immediately to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways, allowing the airways to open wider, making it easier to breathe again.

Relievers are essential in treating asthma attacks. You should take a dose of reliever inhaler when you are having asthma symptoms. If you are using your reliever inhaler three or more times a week, your asthma may not be well controlled and you should go back to your doctor or asthma nurse and have your symptoms reviewed. 90,000 people in Ireland do not have their symptoms controlled. Follow the links below for inhaler technique advice.

Side effects of reliever medicines

Relievers are a safe and effective medicine and have very few side effects. You cannot overdose on reliever medicine. Some relievers can temporarily increase your heartbeat or give you mild muscle shakes. These effects are more common when taking high doses. However they generally wear off within a few minutes or a few hours at most.

PREVENTER INHALERS

Preventers control the swelling and inflammation in the airways, stopping them from being so sensitive to trigger factors and reducing the risk of severe attacks.  Not all asthmatics will be prescribed preventer medication.

The protective effect builds up over a period of time so they need to be taken every day (usually morning and evening) even when you are feeling well.

Preventers do not give immediate or quick relief when you are breathless but instead they reduce long-term inflammation. Preventer inhalers usually contain a low dose of steroid medicine.

There are several kinds of preventers, but they all work in the same way. You will be started on an appropriate level of treatment to get your symptoms under control; once this has been achieved the treatment will be reduced to the lowest possible dose.

Preventers are usually brown, red or orange inhalers. Brands include Becotide®, Flixotide® and Beclazone®.

DO I NEED A PREVENTER INHALER?

You should be prescribed a preventer if you:

·       Are breathless, cough or have a tight chest during everyday activities three or more times a week

·       Need to use your reliever inhaler three times a week or more

·       Have sleep disturbed by cough or chest tightness each week

·       Suffer from bad attacks of breathlessness when you have a chest infection or are in a smoky atmosphere.

HOW WILL MY PREVENTER HELP?

As the protective effect of the steroid builds up, you will be less likely to have asthma attacks. You will be less likely to be breathless during the day and night and you will not need to use your reliever inhaler as often. Over time, the steroid reduces airway inflammation, meaning that the airways are less sensitive to the trigger factors listed above.

It can take up to 14 days for full effect to be reached. It is important to not stop taking your preventer because you think it is not giving any relief. Gradually, chest tightness, night cough and wheeze should become less. You should notice that you need to use less reliever inhaler.

Your doctor or asthma nurse may want to see you again one month after you start a preventer. This is just to check that the inhaler and dose you are on is controlling your symptoms.

Take Control of your Asthma - Asthma Society of Ireland

Link: Take Control

Side effects of preventer medicines

The possibility of side effects from taking your inhaled preventer medicine is very low. Because the inhaled medicine goes straight down to the airways where it is needed, very little is absorbed into the rest of the body.

If you use preventer medicine there is a small risk of having a sore tongue, sore throat, hoarseness of the voice and a mouth infection called thrush. To help prevent these side effects, rinse your mouth out and brush your teeth after using your preventer inhaler. Using a spacer will also help reduce the possibility of thrush.

Long-acting reliever inhalers

As the name suggests, long-acting relievers work in a similar way to your usual reliever inhaler but the effects last for longer - around 12 hours instead of four. Long-acting relievers open up the airways by relaxing the muscles that surround the airways and are generally taken twice a day. This type of inhaler should only be used if you are also taking a steroid preventer inhaler. They are an add-on therapy and should not be used on their own to treat asthma (e.g. Serevent®).

Combination inhalers

Combination inhalers contain both a long-acting reliever and a steroid preventer. They should be taken regularly, every day as prescribed, even when you are feeling well.

One of the combination inhalers available can now be used both as a preventer and as your reliever. An example of this is Symbicort®. This is because the long acting reliever medicine in this particular combination inhaler has been shown to relieve asthma symptoms as quickly as short-acting relievers. If you have been prescribed a combination inhaler ask your pharmacist to explain how it works.

INHALER TECHNIQUE 

It is estimated that less than 50% of asthmatics use their inhalers properly. Click on the link to see video demonstrations from the Asthma Society of Ireland on how to use your inhaler correctly.

Using an inhaler is the most common way of taking asthma medicines. It is also a very effective way because inhaling the medicine takes it straight into your lungs.

It is important that you take the medicine properly. Your Pharmacist should explain how to use your inhaler so that every dose you take gives you the most benefit. It is very common to experience problems using inhalers.

Inhaler technique – Asthma Society of Ireland

Link: http://www.asthmasociety.ie/inhaler/index.html

Are you using your inhaler correctly?

Take a minute to do one of our inhaler technique assessments - Click on the assessment appropriate to your inhaler.

Or to get a more thorough assessment call into one of our pharmacies where the pharmacist can assess your technique for you free of charge. (Click on the  to download PDF Docs).

• Using a Metered Dose Inhaler e.g Ventolin evohaler
• Using an Easi-Breathe Inhaler e.g. Salamol Easibreathe
• Using a Turbohaler e.g. Symbicort Turbohaler
• Using a Discus Inhaler e.g. Seretide Diskus
• Using a Handihaler  e.g.  Spiriva Handihaler or a Breezhaler e.g. Onbrez Breezhaler
• Using a Respimat Inhaler e.g Spiriva Respimat
• Using a Novolizer Inhaler e.g. Novolizer Budesonide
• Using a Volumatic (Single breath technique)
• Using a Volumatic or Babyhaler (Multiple breath technique- preferable for children) 
• Using an Aerochamber (Single breath technique) 
• Using an Aerochamber (Multiple breath technique- Preferable for children)
• Using a peak flow meter

If you are still having difficulties using your inhaler, you may benefit from a ‘spacer device’. This device traps the medicine until you are ready to breathe it in, so you don’t have to worry about pressing the inhaler and breathing in at exactly the same time (see below).

SPACERS 

A spacer is a large plastic container, with a mouthpiece at one end and a hole for the aerosol inhaler at the other. Spacers only work with an aerosol inhaler.

WHY SPACERS ARE IMPORTANT

Spacers are important because they help to deliver asthma medicine to your lungs. They also make your inhaler easier to use and reduce the risk of side effects.

There are several different brands of spacer that fit different inhalers (including Volumatic® (pictured),  AeroChamber® and Babyhaler®)

Spacers are very important because:

·       They make aerosol inhalers easier to use and more effective

·       You get more medicine into your lungs than when just using the inhaler on its own

·       They are convenient and compact and work at least as well as nebulisers at treating most asthma attacks in children and adults

·       They help to reduce the possibility of side effects from the higher doses of preventer medicines by reducing the amount of medicine that is swallowed and absorbed into the body

 HINTS FOR USING A SPACER

·         Your doctor, asthma nurse or pharmacist should show you how to use your inhaler and spacer properly

·         Make sure that the spacer you have been given fits your inhaler

·         Put one puff of your inhaler into the spacer and breathe in deeply through the mouthpiece

·         Hold your breath for ten seconds (or for as long as is comfortable) then breathe out slowly

·         It is best to take at least two deeply held breaths for each puff of your inhaler

·         If you find it difficult to take deep breaths, breathing in and out of the mouthpiece several times is just as good

·         Repeat the step above for each dose/puff needed

·         Wash your spacer once a month – leave it to drip-dry (don’t rub dry) as this helps to prevent the medicines sticking to the sides

·         Spacers should be replaced at least every year, especially if you use them daily

USING A SPACER WITH BABIES & CHILDREN

If your child is under the age of three, or unable to use the mouthpiece, you will probably need to use a face mask as well.

When you first get the spacer, wash it in warm soapy water and leave to drip-dry.

1.     Fit the mask on to the spacer if necessary

2.     Shake the inhaler well

3.     Fit the inhaler into the opening at the end of the spacer

4.     Place the mask over your child's face so it seals around the nose and mouth

5.     Press the inhaler once and allow your child to take five slow breaths in and out of the spacer. This is called tidal breathing

6.     Remove the inhaler and shake again

Repeat steps two to six for each dose of medicine. Your doctor or asthma nurse will tell you how many puffs are needed. Always check with your pharmacist if you are unsure.

Remember:

·       Only put one puff of medicine into the spacer at a time. If you put in more than one puff, the droplets of spray stick together and coat the sides of the spacer so your child actually gets less medicine

·       Wash your spacer once a month - leave it to drip-dry as this helps to prevent the medication sticking to the sides

·       Spacers should be replaced at least every year, especially if you use them daily

USING A SPACER & MASK WITH BABIES

If you are finding it difficult to use a spacer and mask when giving medicine to your baby, try the following:

·       Cuddle your baby on your knee or cradle the baby in your arms. Gently tuck your baby's arms out of the way with one hand if she/he tries to knock the mask away

·       Be positive and smile. Your baby will know if you are anxious

·       Gently stroke your baby's cheek with the mask so that she/he gets used to the feel of it

·       Use it when your baby is asleep

·       Wipe your baby's face after using a preventer

USING A SPACER & INHALER WITH CHILDREN OVER 2 YEARS

Sometime between the ages of two and three, your child will learn to use a spacer without a mask.

·       Show your child how to use their inhaler and spacer first without puffing medicine into it

·       Turn the spacer into a toy - decorate it with coloured stickers

·       Turn it into a counting game. Count aloud as your child takes a deep breaths

·       Have a routine - set a time of day to give preventer medicine. It is best to do this before brushing teeth

·       Praise your child when she/he uses their spacer correctly

Many parents find it difficult to use a spacer with very young children. Don't worry - you are not alone, but do keep trying. Getting a child to take inhaled medicine properly is the most important way to control their asthma

OTHER ASTHMA TREATMENTS 

LEUKOTRIENE receptor antagonists e.g. Singulair®

These are medicines that are sometimes referred to as ‘preventer tablets’, but unlike your preventer inhaler they do not contain steroid medicines. If your doctor or asthma nurse prescribes you preventer tablets, they should be taken in addition to your usual preventer inhaler.

Preventer tablets work by blocking one of the chemicals that is released when you come into contact with an asthma trigger. They may be particularly effective if your asthma is triggered by exercise or allergies. Preventer tablets are usually taken once or twice a day, even when you are feeling well. However, if you are prescribed preventer tablets, your doctor or asthma nurse should discuss with you how often you need to take them. If they have no effect after four to six weeks, then they are probably not the right medicine for you and you should discuss other treatment options with your doctor or asthma nurse.

THEOPHYLLINE

Theophylline (Uniphyllin®, Phyllocontin®) works by relaxing the muscles that surround the airways. It is usually prescribed as a tablet and is generally taken twice a day. It is important that your doctor gives you the dose of this medicine that is exactly right for you, so you should have regular blood tests to monitor the levels of theophylline in your blood. If your blood level of theophylline is too low the medicine won’t work, but if it is too high it can cause unpleasant side effects. If you are taking other medicines, these can affect how well theophylline works. Smoking can also stop theophylline from working the way it should.

Ensure you tell your doctor if you are taking prescribed, complementary or over the counter medicines or if you are exposed to cigarette smoke. Different brands of theophylline may provide different doses so it is important to check that your pharmacist gives you the exact brand that you have been prescribed. You should continue to take the same brand unless your doctor discusses a change with you.

STEROID TABLETS

If your asthma symptoms become severe, your doctor or asthma nurse may give you a short course (3-14 days) of steroid tablets. Steroid tablets work quickly and powerfully to help to calm your inflamed airways. Short courses of steroid tablets are also used to treat acute asthma attacks and are used for essential emergency treatment of asthma attacks.

If you finish a short course of steroids but are not back to normal, you should visit your doctor. You may need to continue the course for more days to get your asthma back under control.

Will the steroids I take for my asthma make me put on weight?

Steroid treatment is an essential part of asthma management. For most people, a regular dose of a steroid inhaler is all that is needed to keep their asthma under control. This contains a very low dose of steroid and it won't make you put on weight. Steroid tablets themselves won't make you put on weight. However, they can make you feel hungry and, of course, if you eat more than usual you'll start to put on the pounds. Stick to your usual eating habits, take regular exercise, and you should be fine.

NEBULIZERS 

A nebule is the small plastic container that is filled with liquid medication used in a nebuliser. A compressor is used to blow air through this solution to make a fine mist of medicine. This mist is then breathed into the lungs through a mouthpiece or mask.

Most people with asthma will find they do not have to use a nebuliser at home. However some people with severe asthma symptoms or other lung diseases may find that normal inhalers do not work for them. The nebuliser helps to open up airways faster, so that these patients can deal with an attack quicker.

It is important that you check with your pharmacist how to use the equipment properly. There are several different types of nebuliser on the market including portable devices that can plug into car cigarette lighters, as well as compact desktop models. All of these, as well as replacement parts can be ordered in your local Hickey’s pharmacy.

MONITORING YOUR ASTHMA 

Monitoring your asthma is extremely important so that you are aware your asthma is under control. There are several ways by which you can monitor your condition; the best way is to measure your peak flow and keep a record in your asthma diary.

WHAT TO DO IN AN ASTHMA ATTACK 

Sometimes, no matter how careful you are about taking your asthma medicines and avoiding your triggers, you may find that you have an asthma attack.

RECOMMENDED STEPS

The following guidelines are suitable for both children and adults and are the recommended steps to follow in an asthma attack:

You are having an asthma attack if any of the following happen:

·         Your reliever does not help symptoms

·         Your symptoms are getting worse (cough, breathlessness, wheeze or tight chest)

·         You are too breathless to speak, eat or sleep

Do not be afraid of causing a fuss, even at night. If you are admitted to hospital or an accident and emergency department because of your asthma, take details of your medicines with you.

After an emergency asthma attack:

·         Make an appointment with your doctor or asthma nurse for an asthma review, within 48 hours of your attack

·         You will also need another review within one or two weeks after your asthma attack to make sure your symptoms are better controlled

Do not ignore worsening symptoms

Most people find that asthma attacks are the result of gradual worsening of symptoms over a few days.

If your asthma symptoms are getting worse do not ignore them! Follow your personal asthma action plan. If symptoms continue to get worse make an urgent appointment to see your doctor or asthma nurse. Quite often, using your reliever is all that is needed to relieve your asthma symptoms when you start to have an asthma attack. At other times, symptoms are more severe and more urgent action is needed.

ASTHMA & WOMEN 

As a woman your body will go through changes that can affect your asthma.

PUBERTY

Hormonal changes can affect asthma in adolescent girls. Some girls find their asthma is worse around the time their period starts for the first time. However, other factors such as the pressures of starting a new school and emotional stress need to be taken into account as well.

Their symptoms usually settle down once their menstrual cycle becomes established. However, some women continue to find that their asthma gets worse before their period.

MENSTRUAL CYCLE

If you have noticed that your asthma is harder to control at certain times of the month, you are not alone. Studies have shown that around one third of women think their symptoms are worse just before or during menstruation. This link seems to be stronger in women with severe asthma.
If you find that your asthma gets worse during your period, keep an asthma diary . If you notice that over a few months your asthma gets consistently worse at that time your doctor may advise you to use extra preventer medicine during the week before your period. Some women who experience very severe asthma attacks before their period may benefit from progesterone hormone therapy either given as a tablet or by injection. Your doctor will be able to advise if this is appropriate for you.

 

Aspirin and other non-steroidal anti-inflammatory tablets, e.g. ibuprofen (Nurofen®), and mefenamic acid (Ponstan®) used for period pain may induce an asthma attack in a small number of people. Paracetamol is usually safe.

 

THE CONTRACEPTIVE PILL & ASTHMA

 

Your asthma treatment is just as effective when you are taking the pill. As with all women taking the pill, it is best if you do not smoke and have your blood pressure checked regularly.

 

MENOPAUSE

 

Menopause is a natural process. It marks the point at which the balance of hormones in a woman's body changes. You may find that, as at other times of hormonal fluctuation, your asthma becomes troublesome. It is important to keep an eye on your asthma at such times and discuss any problems you have with your doctor or asthma nurse specialis.

 

PREGNANCY 

ASTHMA & EXERCISE 

TRAVELLING WITH ASTHMA 

Link: Holidays Factsheet

Having asthma should not restrict you from travelling and enjoying holidays.

If you make the right preparations you should be able to minimise any potential problems and have an enjoyable and safe trip.

The following information should help you prepare for and enjoy your holiday.

Planning for your holidays

Planning ahead is the key to enjoying your holiday and overcoming the problems of asthma.

Use this checklist to make sure you are prepared for a pleasant trip:

·          Draw up a written personal asthma action plan with your doctor or asthma nurse before your holiday

·          Make sure you take enough inhalers and tablets with you to last the holiday plus a few extra days

·          Take all your asthma medicines with you as hand luggage

·          Before you leave, find out how you can get medical help (local ambulance or doctor) at your holiday destination

·          Speak to your doctor, practice nurse or travel health clinic about vaccinations for travelling abroad at least two months before you travel

·          Take out travel insurance to cover the costs of unexpected treatments while you are away. Check to ensure that your policy will cover asthma.

·          If you are travelling in Europe, make sure you have a European Health Insurance Card (EHIC). This replaces the old E111 form which is no longer valid. The EHIC entitles you to reduced cost, sometimes free, medical treatment in most European countries. However you should still always take out private health insurance, as an EHIC will not necessarily cover all the costs or your treatment.

For more information visit:

Link: http://www.hse.ie/eng/services/Find_a_Service/entitlements/EHIC/

Click on the link to the right for further Information »

For more information contact your Hickey’s pharmacist, GP or visit some of the following websites:

Asthma Society Of Ireland : www.asthmasociety.ie
Asthma For Childrens:  www.airplay.ie
Asthma UK: www.asthma.org.uk