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.

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.