Asthma - take a deep breath

Asthma is on the increase all over the world – and in Australia the prevalence is high by international standards. With two million sufferers (or approximately 10 percent of the population), asthma is Australia’s most widespread chronic health problem affecting 1 in 6 children, 1 in 7 adolescents and 1 in 10 adults*.

Asthma is a chronic inflammatory disorder of the airways causing wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning.

During an asthma episode or ‘attack’, the airways narrow, the inside lining of the airway becomes red and swollen (inflammation), extra mucus may be produced and the muscles around the airway tighten (bronchoconstriction).

The causes of asthma are not really understood, but there is often a family history of asthma, eczema or hay fever. Asthma can begin at any age and change over time. Unborn babies whose mothers smoke during pregnancy, and children exposed to smoke in early childhood have a higher risk of developing childhood asthma.

People with asthma can be affected by different ‘triggers’, the most common being:

• Colds and flu
• Exercise (‘exercise induced’ asthma)
• Inhaled allergens (eg pollens, moulds, animal hair and dust mites)
• Cigarette smoke
• Changes in temperature and weather
• Certain drugs (eg aspirin and some blood pressure medications)
• Chemicals and strong smells
• Some foods and food preservatives, flavourings and colourings
• Some occupations (eg baker, pest controller)

Asthma can’t be cured, but it can be controlled. As a chronic condition requiring long term attention, asthma should be proactively and consistently managed.

1. Taking asthma medications as directed

There are three main types of medications:

Preventers make the airways less sensitive, reduce the redness and swelling inside the airways and dry up mucus. The medication containers are normally autumn-coloured (brown, orange or yellow) and should be taken every day, even when feeling well. Eg Becloforte, Becotide, Flixotide, Intal, Intal Forte, Pulmicort, Respocort and Tilade; and tablets including Accolate and Singulair.

Relievers provide relief from asthma symptoms (coughing, wheezing, and shortness of breath) within minutes. Relievers relax the muscle around the airways, making the airways wider and breathing easier. The medication containers are normally blue. If a reliever needs to be used more than 3-4 times a week to ease asthma symptoms (other than before exercise), it may be a sign that the asthma is not well controlled. Eg Airomir, Asmol, Bricanyl, Respolin and Ventolin

Symptom Controllers (also called long-acting relievers) help to relax the muscles around the airways for up to 12 hours. The medication containers are normally green. Symptom controllers should not be used in an asthma attack and should only be used by people taking regular inhaled preventers. Eg Foradile, Oxis and Serevent

A plastic device, known as a spacer, can be attached to an asthma inhaler to maximise the intake of medication. This is especially useful in medicating younger children.

Source: Asthma medications and delivery devices, Asthma Foundations Australia. 

2. Monitoring asthma

Blowing into a peak flow meter, a device used to measure lung capacity, is a good way to check on asthma as it will indicate whether the airways are wide open or narrow. Each person should know their:

• best peak flow level
• level at which medication should be increased
• level at which urgent medical attention is required

Children under the age of seven years may find blowing into a peak flow meter difficult as an effective reading is dependent on a strong fast blow. Parents of young children and other people without a peak flow meter can monitor asthma by keeping a diary of asthma symptoms.

3. Exercising or being active

Regular exercise helps better control asthma. People with exercise-induced asthma should always use their medication before starting.

4. Avoiding triggers whenever possible

Try to avoid or minimise triggers. Allergens such as dust mites, animal hair and moulds can be controlled somewhat by the following:

• Buy a new baby a new mattress (old mattresses and pillows can have thousands of mites living in them). Only buy bedding you can wash regularly and wash all blankets, under-blankets, pillows and valances at least every two months.
• Avoid sheepskins and soft toys in the cot, pram and car capsule - soft, furry materials can hide thousands of mites. Wash soft toys in the washing machine on a gentle cycle, or wash by hand at least every one to two months.
• Keep the house dry and well aired - use extractor fans in the kitchen, bathroom and laundry where possible. Leave windows open while vacuuming, and for 20 minutes after, to flush out invisible dust created by vacuuming.
• Don’t get a pet (particularly a cat or dog) if someone in the family has asthma or, if you already have pet, keep animals outside where possible.
• Do not smoke near children or in houses where children live. Asthma can be more of a problem for children exposed to cigarette smoke.
• Breastfeeding babies for longer than six months reduces the risk of lung infections and can delay the development of allergies and asthma.

5. Having a written asthma action plan

A written asthma action plan from a doctor should outline:

• How to recognise worsening asthma.
• What to do when this happens.
• How and when to get medical help quickly.
• The National Asthma Council Australia has Asthma plan templates available.

6. Controlling asthma – regular visits to the doctor

Dr Ron Tomlins, the Chairman of the National Asthma Council, advises that parents of asthmatic children should work with their doctor to better understand asthma and how to treat it. Have a written asthma action plan and see the doctor regularly for review. This leads to better asthma control and less restriction to an asthmatic’s life.

Recognising an asthma attack

An asthma attack can take anything from a few minutes to a few days to develop. During an attack coughing, wheezing or breathlessness can quickly worsen. Signs of a severe asthma attack include:

• Shortness of breath
• Rapid breathing
• Severe chest tightness
• Being unable to speak more than one or two words per breath
• Distress or feeling frightened
• Little or no improvement after using reliever medication (Airomir, Asmol, Bricanyl, Respolin or Ventolin)
• 'Sucking in' throat and ribs
• Blue colour around the lips

During an asthma attack, young children may appear restless, unable to settle and may have problems eating due to shortness of breath. They may also have severe coughing and vomiting.

If any of these signs are present call an ambulance (dial 000) straight away and follow the 4-Step Asthma Emergency Management Plan:

Step 1: Sit the person upright and give reassurance.

Step 2: Without delay give 4 separate puffs of a reliever (Airomir, Asmol, Bricanyl, Respolin or Ventolin). The medication is best given one puff at a time via a spacer device. Ask the person to take 4 breaths from the spacer after each puff of medication. Use the puffer on its own if a spacer is not available.

Step 3: Wait 4 minutes.

Step 4: If there is little or no improvement, repeat steps 2 and 3. If there is still little or no improvement, call an ambulance immediately (dial 000). Continuously repeat steps 2 and 3 whilst waiting for the ambulance.

Tips for Parents

1. Find a doctor with a special interest in asthma – check with friends, local health professionals such as pharmacists or community health centre staffs.
2. Ask the doctor for a home management plan, including medication needed to control the asthma, how to recognise signs of worsening asthma, and what to do in the event of an attack.
3. If your child has exercise induced asthma, ask for specific information on this.
4. Check that your school or child-care service:

• has staff that have been trained to manage an asthma attack.
• have a record of students with asthma, including details of medication needs.
• that there an asthma first aid kit available, with asthma medication in case of emergencies.

Further information 

• Contact your doctor
• Asthma Foundations Australia - Asthma Australia, an association of the Asthma Foundations throughout Australia, aims to eliminate asthma as a major cause of ill health and disruption within the community.
  Telephone 1800 645 130.
• National Asthma Council Australia - Continuing priorities for the National Asthma Council include education, identification of the latest asthma management practices and encouraging public discussion of asthma.
  Telephone 1800 032 495.
• NSW Health - provides public sector health services and funds a multicultural website that provides information in a range of community languages.
  Telephone 02 9816 0347.

Useful books

Fed Up with Asthma by Sue Dengate

Food intolerance expert Sue Dengate wonders if what we eat rather than what we breathe is the cause of the increasing number of asthma sufferers. In her latest book, Fed Up With Asthma, Sue examines scientific research that shows links between a whole range of synthetic and natural food chemicals and the rising number of children and adults diagnosed with asthma each year.

Source:
With thanks to National Asthma Council Australia, NSW Multicultural Health Communication Service and Asthma Australia for assistance with this article.

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.

This article was first published in Australian Family Magazine, July 2003. Updated July 2009.