Asthma deaths could be avoided – The importance of brown preventer inhalers

Preventer inhalers for the respiratory condition asthma usually comprise of a steroid drug and are used daily to prevent symptoms from developing by working to reduce inflammation in the airways. As the inflammation has subsided, there is less risk of the airways becoming narrow and causing symptoms like wheezing.

The brown preventer inhaler is usually taken twice a day. Your doctor may advise you to use the brown inhaler more often if you are experiencing a regular flare-up of symptoms. Medical Specialists™ Pharmacy have noticed a worrying trend of asthma patients very rarely or even not using their brown inhalers at all and over-using the blue reliever inhaler.

You should always remember it can take between 7 to 14 days for the brown preventer to build up its effect, or sometimes as long as six weeks, and will not give immediate relief of symptoms like the blue inhaler offers. Basically, the impact of the brown inhaler is built over time and will decrease the chance of an asthma occurring by slowly building resistance to triggers.

In fact, you may find your asthma is well controlled by regular use of the preventer and find you need to use your reliever inhaler less often, if at all.

This is particularly significant following a national review claiming that around two thirds of UK deaths from asthma in the UK — including nearly all cases where a child is involved – could have been averted if there was less complacency amongst doctors, carers and the patients themselves, with a quarter of sufferers receiving unsatisfactory care.

The report, led by the Royal College of Physicians, found a shocking number of needless deaths that experts described as “a tragic waste of life”.

Only Estonia and Spain has higher death rates than the UK in the Western world, and there are huge concerns about the increasing death toll. For instance, in 2012 there were 1,250 asthma related deaths – a 10% increase over the previous three years. The new review states 800 of those could have been prevented with better care.

The National Review of Asthma Deaths — the biggest single study looking into the circumstances involved with asthma deaths — examined 195 deaths within the UK. It was discovered that in about a quarter of the cases, care was not of a satisfactory standard and in 83% of cases, there was room for improvement.

Dr Mark Levy, a GP and one of the authors of the report, said ‘complacency’ was a fair word to describe the situation.

“We have known about the identifiable or preventable factors relating to asthma deaths since 1966,” he said. “The shocking and surprisingly sad thing about this report is that we still find preventable factors in over 70% of cases, some of which are pretty serious. For instance, 45% of those who died did not call or obtain help, which indicates that either these patients weren’t too worried about their asthma or they’d never been told how to recognise the danger signs.”

Those who died tended to over-use their blue reliever inhaler to subside the symptoms of an asthma attack as these inhalers help to open the airways for easier breathing. They do not treat the underlying problems however, and this is something many asthma patients do not realise.

“They don’t address the inflammation,” said Levy. “It’s like painting a rusty pipe.” Unsurprisingly, the study found an alarming under-use of the brown preventive inhalers.

The review has called for each hospital and GP practice around the UK to have a specified doctor in charge of asthma services and who should work at improving asthma care. In addition, patients need to be monitored more thoroughly according to the review, so that action is taken at the first instance if it is apparent that a patient’s asthma is no longer under control.

It is recommended that each asthma patient should keep a personal asthma action plan to help them realise when the condition begins to get worse and when to seek further help.

If you seek help from Medical Specialists™ for your asthma, you can be assured of an efficient and discrete service. We offer a wide range of both blue reliever inhalers, such as Ventolin Evohaler and brown preventer inhalers, such as Qvar Easi-Breathe.

Patient care is at the core of our aims and our GMC-registered doctors will carefully review your consultation to decide your suitability for that medication and then also assess the frequency of your orders with us thereafter. This is essential as if mentioned earlier, you are requiring too many relievers, it could be a sign of underlying problems with your asthma and we would recommend you see your own GP for further monitoring as you may need to undergo a lung function test. This is essential to determine if your asthma is getting worse or to check if your asthma is improving with treatment.

How losing weight helped one woman’s asthma symptoms

Sally, 45, a hairdresser from Aldington in Kent, was horrified when the nurse at her asthma clinic requested that she step onto the scales.

Like many other women, Sally had decided to avoid all scales out of fear, but stepping onto them gave her a startling shock – she could be officially classed as ‘obese’ weighing 11st at only 5 ft 2in tall.

“They saw on my notes that I suffered from asthma, but this was the first time anyone in the medical profession had weighed me”, she says.

“The problem was that I didn’t feel fat because the weight had crept on so gradually during and after my pregnancies. Then when the children left things on their plates, I’d pick at the leftovers.”

As her weight increased, Sally was finding it more difficult to control her asthma symptoms, meaning even doing basic things such as walking  up the stairs and looking after  her children, Maizie, now 12, and Merrin, nine, left her breathless.

What Sally didn’t realise is that weight loss is the key for an overall improvement in health for those overweight or obese, but especially so for asthmatics. Studies have shown that people with asthma who are also overweight or obese could see an improvement in their symptoms if they lose weight and this should be included in any asthma management program.

The asthma clinic nurse that Sally spoke to then recommended she should lose weight and would no doubt see an improvement to her asthma symptoms.

Sally says: “It was a real wake-up call. I knew that I had to do something about it or my asthma would just get worse because I would become more immobile and reluctant to exercise.”

Deborah Waddell, clinical lead nurse at the charity Asthma UK, explains: “Obese people find their asthma much harder to control.”

Asthma began for Sally following a severe episode of flu at the age of 19 – Upper respiratory infections are typically caused by cold and flu viruses and are a one of a number of triggers for asthma.

Her asthma gradually got worse. “Getting up the stairs was very scary because the wheezing was so loud.  And it stayed at the same level in my 30s and into my 40s. I couldn’t run after the children at the park.”

Sally now uses a brown preventer inhaler every morning for protection and a quick-acting blue reliever Ventolin inhaler when symptoms start to arise. Sally’s symptoms worsen during the winter, when feeling stressed, or when coming into contact with pet hair.

Despite the fact many people with asthma tend to avoid all exercise on fear of it triggering an attack, Sally began an exercise regime, which has actually been a huge benefit as asthma can boost the lung capacity in asthmatics.

She now goes running three times a week for four miles, attends a weekly spinning class and cycles for journeys where the car is not a necessity.

“I lost a stone-and-a-half in eight months and it made a huge difference,” says Sally. “It really brought the asthma under control and made the attacks less frequent and less severe – I have just one a month instead of three a week. When I was 11st, my body was struggling to  cope with the weight, especially climbing stairs, but the fitter you are, the stronger your  lungs become.”

Scientists discover gene that could lead to targeted asthma treatment

Young children with asthma may benefit from targeted treatment in the near future after US scientists discovered a ‘rogue’ gene – CDHR3 – which could be the cause of severe asthma in youngsters.

CDHR3 has been found to be particularly active within epithelial cells that line the inner surfaces of the airways. A faulty version of the gene can result in environmental triggers inducing allergic responses, the scientists found. CDHR3 is one of four genes that has been linked to the development of asthma; but the other three were already known as being associated with asthma.

The new study, published in the journal Nature Genetics involved a thorough comparison of the genetic codes, or genomes, of 3,695 Danish children and adults who have asthma. This comprised of a number of children younger than the age of six.

Data extracted children of both European and non-European ancestry was then used to replicate the findings, which are consistent with previous research suggesting other genes associated with the onset of childhood asthma are responsible for over-sensitive immune reactions.

Lead researcher Dr Hakon Hakonarson, from the Children’s Hospital of Philadelphia (Chop) in the US, said: “Because asthma is a complex disease, with multiple interacting causes, we concentrated on a specific phenotype – severe, recurrent asthma occurring between ages two and six. Identifying a risk-susceptibility gene linked to this phenotype may lead to more effective, targeted treatments for this type of childhood asthma.”

Dr Hakonarson added: “Asthma researchers have been increasingly interested in the role of the airway epithelium in the development of asthma. Abnormalities in the epithelial cells may increase a patient’s risk to environmental triggers by exaggerating immune responses and making the airway overreact. Because the CDHR3 gene is related to a family of proteins involved in cell adhesion and cell-to-cell interaction, it is plausible that variations in this gene may disrupt normal functioning in these airway cells, and make a child vulnerable to asthma.”

The researchers now hope their findings will lead to a more targeted treatment a condition which affects a staggering 5.4 million Britons; many of whom will probably be struggling in the coming months due to the fact that cold winter weather can exacerbate asthma symptoms.

Even a basic cold virus can trigger a serious asthma attack and worsen symptoms for around 90% of people with asthma and According to Asthma UK, three quarters of people with asthma blame cold for triggering their symptoms. Common symptoms are: coughing, wheezing, shortness of breath, tightness in your chest and difficulty speaking in full sentences.

Asthma UK have five important pieces of advice that are vital in controlling your asthma symptoms during the cold weather:

1. Keep taking your regular preventer medicines as prescribed by your doctor.

2. If you know that cold air triggers your asthma, take one or two puffs of your reliever inhaler before going outside.

3. Keep your blue reliever inhaler with you at all times.

4. Wrap up well and wear a scarf over your nose and mouth – this will help to warm up the air before you breathe it in.

5. Take extra care when exercising in cold weather. Warm up for 10–15 minutes and take one or two puffs of your reliever inhaler before you start.

Summer holidays cause ‘September spike’ in asthma hospital admissions

Parents are being warned about an increase in the number of children admitted to hospital after they go back to school in September.

The charity Asthma UK say the ‘September Spike’ happens each year in the first two to three weeks of the autumn term and is attributed to poor asthma care over the summer holidays, with a more relaxed approach to medicine use over this period.

They say that three children actually died from asthma attacks in early September of last year, and attacks are usually more prominent because of exposure to common triggers such as cold and flu viruses.

An estimated 1.1 million in the UK suffer from asthma; this equates to about two children in every classroom as having the lung condition. The charity say over 25,000 children required hospital treatment due to their asthma in 2011-12, with 18 children under the age of 14 dying from an asthma attack in 2011.

In addition, the Health and Social Care Information Centre have compiled information showing in 2011-12, 582 children in England required hospital treatment due to their asthma during the week beginning 19th September. This is in comparison to only 125 children for the week commencing 8th August.

However, with proper use of medicine and the correct care, a staggering 75% of hospital admissions could be avoided say the charity. Prevention, i.e. through the use of a preventer inhaler, is a major factor is managing the condition.

If children use their inhaler twice a day during the summer holidays, as they usually would before the break, they can severely reduce their chances of suffering an asthma attack and make sure they are in control of their symptoms.

The problems can begin during the school holidays when families go away to holiday destinations or leave children in the care of others who are either not aware of the child’s asthma or not fully clued up on how it is best treated/managed.

Delia Balan, Asthma UK’s senior nurse, says poor inhaler use is a problem that appears at around the same time each year: “Some children are out of their routine; they’re getting up later, going off on holidays, staying at their grandparents’ houses, and maybe some children are feeling better because it’s summer.”

Deputy chief executive Dr Samantha Walker added: “Normal routines can go out of the window during the summer break, which can effectively create a time-bomb for children with asthma. Those who forget to take their preventer inhalers over the summer will be less in control of their symptoms and therefore more vulnerable to asthma attacks come term time.”

The charity has now launched the ‘Teach Asthma a Lesson Next Term!’ campaign which is aimed at encouraging parents, healthcare professionals and schools to get a head start in combating the September asthma problem.

As part of the campaign, Asthma UK’s free, award winning My Asthma pack will be available to help parents create a fun routine with their child to manage their asthma and reduce the risk of attacks. The pack is aimed at children aged 6 to 12 and should be discussed with a doctor or nurse in order to fully reap the benefits of it.