Episode Transcript
Speaker 1 00:00:03 Hello and welcome to the WBA podcast. My name is Sheena Mitchell. I'm a pharmacist in mom of three. I combine healthcare and practical advice to help you on your parenting journey. If you enjoy listening to a WBA podcast, I'd be really grateful if you could follow or subscribe and leave a review. It really helps to support the show. Thank you. I am delighted to partner with one of my all time favorite products, Sale Plus. This is the world's first 100% natural dry salt therapy device. It's clinically proven to relieve a wide variety of allergens and respiratory conditions. This salt therapy method has been trusted for generations and has become hugely popular worldwide. As more and more people recognize the superb results achieved from a natural and noninvasive method, this device will help you breathe easier and sleep better.
Speaker 1 00:00:57 In this week's episode, I'm joined by the Asthma Society of Ireland for a really in depth conversation about all things asthma. This is a must listen if you have a child or any family member who suffers from asthma. In this episode, we chat all about why Ireland has the fourth highest rate of asthma, and we talk about the fact that Dublin has the worst air pollution in Europe. It's amazing. I did not know that. We talk about if this such a thing as having to clean a house, I think you'll all be relieved by the answer. We also chat all about the symptoms and diagnosis of asthma and about triggers and the effect of hormones on asthma. Men really do have an easy gig. We discuss the typical September spike that happens in September, October, and we chat about all of the treatments of asthma and some alternative remedies which can compliment your medical treatment.
Speaker 1 00:01:53 We discuss the asthma safe school program and the difficulties for asthmatic children in school today. We also talk about how expensive it is to have asthma or any chronic medical condition and how that's so, so challenging for many families in Ireland right now. I really hope you learn lots of information on how better to control your or your child's asthma. With one in 10 people in Ireland now having asthma and with one in five kids experiencing at some time in their childhood, this is something that affects a huge part of our society. So I hope whatever you're doing while you're listening, that you're able to benefit from all the information that we discuss in this week's episode. Before I introduce my guests, I'm gonna kick things off by giving you a definition of asthma. Asthma is a condition that affects the airways, which are the small tubes that carry air in and out of the lungs.
Speaker 1 00:02:50 In asthma, the airways become oversensitive, meaning that they react to things that wouldn't usually cause a problem such as cold air or dust. When the airways react to a substance, the muscles of the tube walls tighten up, making them narrow and leaving little room for air to flow in and out the lining of the airways. Then get swollen just like your nose during a cold and sticky mucus is produced, which clogs up the breathing passageways. With so little space in the airways, if he becomes difficult for air to move in and out of the chest and it has to work much harder to breathe, tightening of the muscles around the airways can happen quickly. This is the most common cause of mild asthma symptoms. I am delighted to be joined today by the authors of that definition of asthma. I'm joined by Sarah O'Connor, who's the CEO of the Asthma Society of Ireland, and Ruth Morrow, nurse educator and asthma and C O P D nurse specialist. I hope you're both keeping well today. Feeling good. I'm really, really delighted to have you here because over the years spent a lot of time, I suppose, referring people to your website cuz it's such an amazing resource for people who are going through diagnosis of asthma. So can you tell me a little bit about the Asthma Society and its roles?
Speaker 2 00:04:05 Sure, Sheena. So I'm, I'm Sarah O'Connor and I'm the CEO of the Asthma Society in what we will fictionally call my spare time around being the ceo. I am also an asthma patient since I was 80 years old and I am mom to a small little boy who certainly experiences asthma symptoms and um, may be on the road to an asthma diagnosis as he grows up a little bit. And I'm more than happy to tell you a little bit about the Asthma Society of Ireland. So the organization was founded 49 years ago and um, we exist and our mission is to stop asthma death in Ireland. And where a lot of the work lies is to help and support people who have been diagnosed with asthma or their carers and to help 'em to transform their quality of life. Asthma, you know, is a, an illness that exists on a spectrum.
Speaker 2 00:04:50 People can experience mild to moderate to severe asthma. Um, but regardless of where they sit on that spectrum, we want to make sure that their symptoms become controlled and that they can live a full life symptom free. So we have a number of one to one services, um, one of which Ruth who's joining us today, uh, works on. Um, so there's service that Ruth works on is called our beating breathlessness Nurse WhatsApp service. It's available Monday to Friday and it's where any patients or carers can message back and forth with Ruth and with her colleagues Sam, who are both respiratory nurse specialists and who work on that service. They give advice and guidance, they provide videos, links, materials that people can save down into their phone and they really have to boost people's asthma self management on a day to day basis. We also have our asthma advice line where people phone in and they, uh, make a booking with us and they get a nurse appointment.
Speaker 2 00:05:35 380,000 people have asthma in Ireland right now. So that's one in 10 kids and one in 10 adults have it right now. And the figures show us that one in five kids will have it at some point in their childhood. So it is a really big healthcare challenge. There are 2.4 million GP visits a year in Ireland associated with asthma. Unfortunately most of those are associated with uncontrolled asthma and what that means is one person materializes at their hospital or at the a and e, um, with uncontrolled asthma every four minutes in Ireland. And the bigger picture piece, again, the bit that keeps Ruth and I awake at night is that one person dies every five days as a result of their asthma. 90% of those deaths, according to all of the international results are preventable. And so everything that we do is about self-empowerment, self-management, education support and all of that bolstered by medical evidence.
Speaker 1 00:06:25 It's quite frightening to listen to those statistics when you think that it's just everywhere in our community. And I think sometimes people can have quite a relaxed attitude towards asthma because they, they just maybe don't understand the importance of getting it, you know, really under control. And obviously we'll talk more about medications later, but just at this point it's so important for people to know that they shouldn't be reliant on their blue reliever inhaler it, you know, it really is just there for occasional use. But look, we'll get into that later. I saw on your website that Ireland has the fourth highest level of asthma in the world. Why is that?
Speaker 2 00:07:04 So, you know, the clinicians would say that part of it is genetics and I think people would understand that your listeners would understand that if they have, if if they themselves have asthma very often they may have a child with asthma. It does tend to run in families. So genetics is one bit, environment is another bit in Ireland, you know, we have a lot of rain, a lot of damp and we can have, you know, colder winters, I mean not cold like some countries have but that can be a factor. We're still learning so much about asthma and about respiratory health and, and even the medications have come along so much. Uh, in course of the last 20, 30, 40 years, the treatments have developed so much. Traditionally people think about asthma as being a childhood illness and you can tell from the stats I mentioned earlier that of course children do experience it then, but people can develop it later in life and you can have late adult onset and that can be actually particularly tricky for people to, to understand or to accept that diagnosis because they do think of it as being a, a childhood illness now.
Speaker 2 00:07:56 But Ruth May have something to add in terms of why in Ireland that's the factor. We
Speaker 3 00:08:00 Don't know why it is because the UK is ahead of us and Australian New Zealand are one and two. So it's just, it's so interesting because like we have very different climates in Australian compared to Ireland as well as climate obviously has an impacted in a Sarah said there about the dampen the cold. We are better probably at diagnosing asthma than we were a number of years ago. So we are probably picking up more Now there is evidence to say that sometimes there's a bit of overdiagnosed but there is underdiagnosis too cause the right people aren't actually getting diagnosed. So that's kind of a work that's going on all the time even in the uk that's something that come up recently about the underdiagnosis. But yes, our trigger factors, um, as we've probably be talking about later on as well, like the environmental ones, the air pollution is the big one. We do know that Dublin actually has the worst air pollution in Europe coming into kind of this time of year. And you have small guy and you have cars built up cause we're back up now pre pandemic levels of cars on the roads and that, so that's not helping either. It
Speaker 1 00:08:51 All
Speaker 2 00:08:51 Adds up. There's an argument that the cleaner we get and the better we get with the sterilization and the constant cleaning of the floors mean that actually children as they grow up their immune system may not be as good at encountering the kind of natural viruses or bacteria that you might expect to encounter in the world. And so they may have an exaggerated response to that from an immune system point of view. And that may be a factor I suppose in that we, we do all try and have a clean kitchen floor in Ireland or we try our best but most days of the week, some days of the week maybe.
Speaker 1 00:09:20 I know <laugh> and I always laugh, I actually saw a really funny meme online and you know, it was of someone kind of sterilizing their kitchen basically saying a parent trying to protect their child and then a picture of the child, like a little baby on the beach just eating sand. And I was like, that's it. Like
Speaker 2 00:09:35 Yeah we had that experience in my house because my partner was, there was some bit of cleanliness that he got really, really into after we had our little toddler and I eventually had to share regimen and say, just look at what's going on over there. And he was eating the mud off the wheel of the buggy and I was like, I I think you need to just break away from this behavior because it's really pointless.
Speaker 1 00:09:52 My seven year old a year or two ago thought that if the dog licked him, he licked the dog. I was like good lord, stop. Yeah look, I think we can all do our bit to um leave more dirt line around. That's what you're saying to me. Yeah, <laugh>, yeah
Speaker 2 00:10:05 That's my excuse and I'm sticking to it. It's for the immunity. That's
Speaker 1 00:10:08 The only reason I feel productive already. Okay. Yeah,
Speaker 3 00:10:11 Yeah.
Speaker 1 00:10:13 Okay. So can you explain for people a little bit about the symptoms of asthma? Obviously we had the definition there at the start, but the early onset symptoms and the journey to getting a diagnosis we'll focus on identifying asthma and children first of all, I know you've mentioned obviously there can be late onset asthma and adults, but for the purposes of today, really just to explain how it typically presents.
Speaker 3 00:10:39 Okay, so there are four symptoms of asthma as you've mentioned in the introduction of the wheezing, the shortness of breath, the cough, the chest tightness. And to have a diagnosis of asthma you need to have at least two of those four symptoms. So having one of those symptoms, it more than likely is not asthma. You know, most children will actually have cough for some actually younger children will complain of tummy pains and that's their chest tightness but that's how it can present with them. So another one to watch out for the journey to getting a diagnosis for a lot of children can be quite challenging because again, in the under fives in particular and say alluded to earlier about the under twos, the under two, we don't diagnose asthma in children number two because there's too many other things going on. So it's very difficult.
Speaker 3 00:11:19 So even though your doctor might treat your child as if they have asthma and put them on the the medication, alright, but that doesn't mean that they're actually making a diagnosis at that particular time. So, and even up until the age of six it is very difficult to diagnose it because we can't actually do lung function testing or get them to blow into a peak flow meter. They need to be at least five to do that. We always kind of follow the history and again going right back to the birth history if the child was born prematurely or if it a low birth rate, that would be a risk factor as well. And again, listening to the parents in terms of what that child's journey the first couple of years would like was like in terms of getting chest infections and if they needed, if they needed oral steroids maybe and loads of antibiotics then all that history is really important.
Speaker 3 00:12:01 If there's actually a family history of asthma or if there's a family history of atop, which we call eczema and hay fever or allergic Citis because allergic neuritis hay fever or hey fever and eczema and asthma are all linked, they're all, I always call them sisters because they're so closely linked because it's just like what's going on? Whatever your skin is like with eczema, that's exactly what's going on in your air airway. That redness, that irritation and it's that irritation that actually causes all the symptoms, the coughing and the wheezing. Getting the diagnosis is very difficult and that's, it's really just watching what's happening and how things unfold for your child over those first five, six years of life. If you have a family history of asthma or atop any of the allergic illness or the eczema, the chances of you actually having asthma is a lot higher.
Speaker 3 00:12:46 So that diagnosis might get made that bit quicker. But if there is no family history, particularly if fire infections are the big trigger, that's question about whether that is going to develop into asthma or not. So that's why even though they put the child on the correct treatment as in the brown inhaler and the blue inhaler and you carry on with that and you treat it and very often a lot of children might be on that over the winter months and then come off it over some months and and you kind of watch that over a period of time as children get older. That is the interesting one. Asthma is more prevalent in boys up until the age of 11 and this is when hormones start to kick in and start causing all sorts of havoc and then it tends to lessen in boys as they get older from 1112 onwards and then it increases in girls in that age group again cause their hormones are kicking in also.
Speaker 3 00:13:30 So testosterone actually is a positive effect on, on boys in that it is an anti-inflammatory. So it has been shown actually to decrease in boys at that stage and then as girls develop their hormones and the period start and all that, that can be a problem time for girls as well right up through their teenage years as well. So it's another one to watch out for and one that's not readily thought of has been a big trigger but it can be quite problematic the symptom wise you need to watch out nighttime is the big warning sign and not just waking up and coughing during the night or wheezing during the night, but even early morning a lot of young children will actually wake up at five, six o'clock in the morning. That's normal for them. That's their normal day and maybe even four o'clock in the morning but that's when they will actually have symptoms at that time in the morning.
Speaker 3 00:14:10 So if, if the child is big enough to do a peak flow, it's actually very interesting to watch to see that the peak flow actually would be quite low in the morning time and then as the day goes on it, it comes up to normal levels. But that's the big warning sign and the big red flag we always watch out for is the nighttime symptoms. Again, wheezing can be very variable, it can come on at any time. And that's the problem a lot of people would ask asthma struggle with is the fact that can be very well for days and even weeks, months on end and have no symptoms and then all of a sudden I can just hit them and they're not prepared for it. We don't like to use the term mild asthma because really I feel myself that there is no such thing as mild asthma. You actually have it or you don't have it and you need to take it very seriously. But that's the problem with so-called mild asthma in that patients do actually end up getting acute asthma attacks outta the blue and they're not prepared for them or not ready to deal with them. And it's that whole variability with that kind that people do struggle with.
Speaker 2 00:15:00 Yeah and I, I think she likes as a parent to a a child kind of going through some of the processes that uh, Ruth is talking about there, one of the things that I'd experienced myself and that we would hear most commonly from parents is that their child has been very unwell during the night they phoned, they tried to get a GP appoint maybe today, maybe tomorrow by the time they get the appointment when the GP is listening to the child's chest, it may have improved a little bit, they may be a little bit better. And because what you're trying to look at really is patterns and trends in the child's. That's really what the diagnostic yes process that Ruth is talking about there. You're trying as a parent to equip the the GP to know the trends and the processes but they're only seeing the child in a snapshot moment in time.
Speaker 2 00:15:40 And so for us that's one of the hardest things for adult patients or for parents, you know, looking after children is to try and convey the trend. So one of the things that we've done that we think is quite useful is we've created a symptom tracker. It's a sick quick symptom tracker on one a four page. But it basically says what medications has the child of the adult taken, how were they feeling? Were they awake with their um, asthma at any given time and it just tracks the symptoms and allows you to come back for example, to the next GP appointment to say actually it wasn't great and it wasn't great in between me seeing you and here's the scale of the change. And really what that does is it empowers the patient to have the right conversation and also it means that G the GP is saying oh thank God I'm actually seeing the trend as opposed to just right now. So it's something we definitely recommend that people come back to us and look for whether it's through uh, Ruth on our beating breathlessness WhatsApp service or through the advice sign or the website.
Speaker 3 00:16:29 And like I Sarah said very often like, and I don't seen this myself and I was working in clinical practice like very often you would listen to chest and they are perfectly normal. You will hear nothing, you will hear no wheezing and that doesn't mean you don't have asthma, you know, but you're not seeing that child or that adult at that moment in time when they did experience the wheezing. You know, it, it is very challenging and difficult in older children then we can get them to peak flow diaries as well and we can do spry testing and that as well on them. So that does make the diagnosis that little bit easier to make and we can give them some salbutamol or the blue inhaler and see how they respond to it and if they have a really good response to it then we know what is asthma that's, that is the goal standard test, that's where we want to go with it. But as I say in the child under five, that's not possible. So it's very much down to monitoring and systems and just kind of as Sarah says, keeping an eye on the trends and what's happening with them.
Speaker 1 00:17:17 It reminds me very much of when I'm advising people who are trying to identify a food allergy or intolerance, just you know, by having I suppose a diary or record of behavior over a number of weeks and of symptoms, it means not only are you providing the doctor with the essential information they need to make clinical decisions, we are also potentially enabling yourself to look back and say, God did you know we were actually in okay my mother will kill me now, but my mom's house. Those two weekends we were in a different environment that, you know, had had different, I suppose airborne irrit could be a different type of pollen, it could be anything. And by kind of documenting and looking back over a couple of months at a time you might just find a trend which highlights a trigger. And actually that's something I wanted to ask you about today is the most common triggers and how to kind of identify them. Obviously keeping a diary or a record and what you said there, the A four sheet sounds ideal, but is there any other ways of identifying triggers or what are the common triggers for an flare up?
Speaker 3 00:18:25 The most common triggers for asthma, the length of your arm, there's lots of triggers out there. You know, you have the ones that you hail obviously, so things like dust pollen, that sort of thing. Strong smells are from sprays, from flowers for example. They can be a big trigger, you know, strong smells in a small enclosed area. This pearl ventilated is a massive trigger for some people, you know, like for example, even with teenagers that might spray deodorant and they do spray deodorant and they, you know, and it comes out in bucket loads and you know, you know yourself, you open the bathroom door and you can see the deodorant coming out the bathroom after them. You know, that actually can be a big trigger for some people. So even some perfumes can actually irritate some people. Cleaning agents can irritate some people. So even if you're a mom that's doing the, you'd just be very vigilant on what you're actually using to clean and avoid using things like bleaches and strong smelling cleaning agents maybe use things like bread, soda and vinegar and salt going back to the old reliables from donkeys years ago.
Speaker 3 00:19:20 But they're much safer and more, more environmentally friendly anyway to use them to clean. So, um, we all probably should be using them
Speaker 1 00:19:26 And more cost effective
Speaker 3 00:19:28 <laugh>. Exactly, exactly. Again, smells kind of maybe in the kitchen when you're cooking, not having your, maybe your windows open, your ventilation on you're doing the cooking. That actually can be a big trigger for some people. Then you have the cats and the dogs and the horses and all that, the animals, the dander and again, you know like probably not, not a good idea really to have your dog in the bed with you at night. Look it, I could given you that myself, but the cat and the horse riding is a big trigger for a lot of people as well. Not just children but adults as well. But again, it's the dust and the dans on the, the animals is the problem. But however with do and cats, it's actually the triggers actually in the saliva. Yeah, and like you said with your son actually, you know, the licking of the, the dust, the dog licking and that sort of thing, you know, they're always
Speaker 1 00:20:08 So much wrong with that. I actually did an episode recently on animal on Dustin animal allergies, which might be interesting for people to listen back to because in that I just goes exactly what you're saying there, Ruth, about how, you know, it's the dander but also say with cats because they lick themselves to clean themselves, then you're touching the cat, the cats just lick themselves and the allergen is in the saliva. So there's a lot of information on I suppose how to allergy proof your house in that episode and how to reduce, obviously you're not gonna ever eliminate allergens, but how to reduce them effectively. Yeah, so I'll, I
Speaker 2 00:20:44 Can listen to that one myself. So
Speaker 1 00:20:45 <laugh>, yeah, I'll pop a link in the show notes for this episode. Cause I think there's a lot of people who suffer with asthma, you know, obviously it's so closely related to allergies.
Speaker 2 00:20:55 I find furniture polished quite problematic, but like cleaning the floor is fine. If I ever did it, it'd be fine. You know, that kind of way. Um, so, but we can do a lot to help people to figure that stuff out because it does put people in control really to know the triggers and then to be managing them. And you can imagine if you're talking about children and you're sending them into crash, you need to be able to say to them, look at a particular thing as a trigger. If you're sending them to somebody's house for a sleepover, you just want to be able to say, look, can we really be careful about the dog? The dog can't be in the room if they're doing the sleepover, the two kids or whatever, that kind of thing. Um, and really it's just about knowing those bits and pieces of the puzzle.
Speaker 2 00:21:26 Some of the stuff is quite simplified as well. She, I mean like none of us are washing our pillows or due days as much as we should be, you know? Yeah. Um, and even those kind of basic pieces go a long way. And similarly, for example, I find myself, I mean when I had a, a GP appointment where the GP recognized that my nose was a big part of the problem and this was in my early thirties, I'd say actually after really tough 18 months where I didn't realize how much the allergies were affecting me. I always slept on my bedroom window open in the summer I thought was fresh air and it was really good for me. And actually closing the window in the wind in the summertime is one of the biggest changes and the mo biggest impact has had on my respiratory health because it has made a huge difference to my experience of my asthma and my allergies as well. So sometimes some of those pieces are quite straightforward and like I said, the nurses can help people to do that bit of detective work that they need to do to figure those pieces out. You know,
Speaker 1 00:22:15 Back to basics kind of Yeah.
Speaker 2 00:22:17 Is a bit. Exactly.
Speaker 3 00:22:17 Yeah, there are a few other triggers I suppose maybe they aren't kind of dust related ones, but just things like exercise and you're laughing and crying and stress and anxiety, all those things. Well they all can be different triggers as well. Air pollution of course is the other one then and say particularly from this time of the year onwards, he just knows that. But even there during the summer, the air quality index is quite high when it was really, really hot, you know, that really kind of, and a lot of people with respiratory conditions and including asthma actually really struggled in that spell of weather that we had that it was up at 30 degrees. Um, so it, you know, it's, it's not just as I say, a winter condition or anything, so it's all year round you're gonna pick up the triggers.
Speaker 2 00:22:51 Yeah. And around now is a good time for us to be talking about this because we, you know, there's traditionally something called the September spike in asthma. So lots of parents will find that their child gets sick or ends up being sick enough that they have tot brought to the hospital. When we mention this to people, people kind of say, Oh yeah, I know that happens to me every year. And they think it's just them. They don't realize that this is actually a population health challenge. Um, and, and so like cold and flu viral season and when the temperature drops in September and obviously when the kids go back, so they're spreading those cold and flus among the rest, uh, their classmates. Those are big challenges for people with asthma. And I suppose we are a little bit more aware of the impact of the virus on respiratory health as a result of covid two and a half years ago. You know, because now people with, uh, respiratory think, well I need to make sure I don't get covid because it'll make my underlying condition worse. But obviously the impact of a virus or a cold has always been a factor and is always tricky for people to manage. You know, the more liquid the nose makes that gets down into the lungs, the, the bigger the impact, uh, that that has and, and certainly we see this in our house every time there's a runny nose it's like all jeepers, here we go. You know?
Speaker 1 00:23:55 Okay, so I might just take this opportunity to exercise my inner pharmacist and explain the medications. So bear with me for a few minutes. Many of you will have heard the term reliever inhaler and this is used to describe a Bronco dilator. These are drugs that widen the airways which allow easier breathing. They provide pretty immediate relief working within about five minutes and they can help prevent breathing difficulties during exercise or when you have a cough or congestion. These drugs are short acting, so they offer relief for about four to six hours. They're not a long term fix and they have no role in the management of asthma except provide relief of your symptoms when they worsen or for treating an asthma attack. If you do find that you need to use this inhaler regularly, for example, more than a couple of times a week, then you need to speak to your doctor to try and tailor your asthma action plan.
Speaker 1 00:24:49 Side effects wise, they're pretty well tolerated. Sometimes they can make you feel a little bit jittery afterwards by increasing your heart rate ever so slightly and by causing some slight muscle shakes. But this usually settles down within a few minutes of using your inhaler. Examples of reliever inhalers include inhalers which contain Salbutamol like Ventin or salol or another drug called tributing, which is ol. Another brand name that you might be familiar with is A or primal bronchodilators can be used in a normal aerosol inhaler device or they can be used through nebulization. Administering any type of inhaler to a baby or child can be challenging. But there are lots of different devices that can help to make it easier. These consist of a chamber that you can click the inhaler into and either a mask or mouthpiece depending on the age of your child. Many adults also find these kind of devices helpful because sometimes it can be tricky to coordinate the movement of pressing down on your aerosol device at the start of a long slow inhalation.
Speaker 1 00:25:55 The other type of inhaler that you might have heard of are preventer inhalers. So these are the backbone of asthma control for patients with chronic symptoms. Their role is to prevent symptoms so that you rarely need to use your reliever inhaler. This type of inhaler requires regular and consistent use as they work by reducing inflammation in the airways over time, not instantly. So one dose of this kind of inhaler isn't going to do you much good on its own. They need about two to eight weeks for your prescribed dose to be working effectively and sometimes your Dr. May need to review the dose if symptoms persist. In general, your maintenance dose will be the lowest dose that keeps your symptoms up. Bay corticosteroid inhalers can alter the natural flora in your mouth, which can lead to oral irritation or sore throat. So it's important to rinse your mouth after using these inhalers.
Speaker 1 00:26:47 And if you've used a mask on your child or yourself, then wipe around the mouth there yet too. Examples of these kind of inhalers include betide, beone, por, and flixotide. Some patients end up using a combined inhaler which combines a corticosteroid preventer and also a bronchodilator reliever. The reliever in these inhalers is a little bit longer acting. Examples of these are serotide and Simba Cort. There's another type of medication which is commonly prescribed and used for asthma. It's an add-on therapy. So you would use this in a scenario where a treatment with a corticosteroid isn't enough on its own or in the case of very young children, sometimes it's prescribed instead of a steroid up till about five years of age. But this is only possible if they have mild persistent asthma with no risk of an asthma attack. Lutrin receptor antagonist, the most common would be monu cast or singular.
Speaker 1 00:27:45 They work by blocking rines, which cause inflammation. Rines are part of your body's immune response similar to histamine, which is released as an immune response in allergy. So histamine causes runny nose itching and sneezing. Lerins can be responsible for chronic cough or sinus issue. So often the effects of lutrin buildup these drugs can be really useful to help people who have asthma symptoms and also suffer with seasonal allergic rhinitis and exercised induced asthma with lutrin receptor antagonist. So UL caster singular, they need to be taken on an empty stomach. So they're an oral medication for children who are six months to five years old. They come in gra form for older kids, they're in a chewable tablet and for people over 14 years of age, they come in a regular tablet. So the best time of day to take them in the evening. Just while I'm talking about medication, it's really important to highlight that in September October, every year the flu vaccine becomes available. The flu vaccine is free for children two to 18 years of age and is available in community pharmacies and GP surgeries. The flu vaccine is also free for any adult with moderate to D severe asthma for children. The flu vaccine is a very simple nasal spray, so it's non-invasive and they don't need to be afraid about going in to get an injection.
Speaker 2 00:29:10 One of the things Ruth and I have been talking about recently is we can sometimes lose track of our wellness and we can lose track of what our child's wellness looks like. So if they have a chronic illness and it's crept open them, we maybe kind of think that child isn't as active as another child and it actually may be that their asthma is stopping them being as active as another child. Or for example, we all kind of think, Oh but I, I always need my blue inhaler when I run to get the bus because that's just what happens. But we've done that thing, which in medical circles is called poor perceiving, where we have lost the really good perception of what feeling brilliant and good is. And instead we kind of accept something that's below par. And again, we, we do think that people had their attention drawn to that a bit more during covid. The more people know what feeling well feels like from an asthma point of view, the better they'll be able to recognize things are going downhill. I have my um, my asthma action plan. I know what to do, I know the steps to take and I know when to get help. And really that is just the puzzle. That is just the piece of the puzzle that people need.
Speaker 1 00:30:07 Yeah and yeah, it's exactly that. Don't let your standards drop because no one needs to be suffering with it because while we can't cure asthma we can certainly control it.
Speaker 2 00:30:17 Diagnosis and management is actually, it gives you a life back. Yeah. Um, as opposed to being bad news, you know, and that's possible for really so many of the 380,000 patients with asthma,
Speaker 1 00:30:27 I spoke there about using various devices to help administer medication to children. Common brands are aero chamber volumes, baby haer and these are all very straightforward to use but initially can look like something that came from outer space. So <laugh>, you know, I think it's really useful to have your videos to encourage, you know, parents to go and look at to see how to use these devices.
Speaker 3 00:30:52 Of course intimidating for a child produce this spacer thing and they have to use it, you know, when they've been told how to use it. Try and make the space as if you can a bit more child friendly. Now I know the arrow chambers come with the teddy bears on them, but some of the other spaces don't have anything on them. So maybe putting stickers over your child's favorite toy on them, it can be challenging for younger children, particularly that two year old or even the child younger than that even to get them to use the spacer. So really, um, not that easy to break the spacers. So I say you could leave it in the child's toy box or leave it that they can play with it. You're not just producing it twice a day, you know, for them to use it and it's all scary so leave it around, let them play with it and the next thing you'll see the child actually putting it up with their face and using it themselves.
Speaker 3 00:31:31 Just as I said, leave it lying around the place and let them get used to it and use the stickers at definitely. And then another tip on maybe the children's child's um, favorite TV program or whatever kind of videos or whatever they like to watch and uh, maybe give it during that stage as well. But really important actually that you make sure the child rinses their mouth out after using the steroid inhaler or the, you know, the preventer inhaler and watch their face as well. Whatever the face mask has been. The other device is then that for older children, once the child gets to the age of 6, 7, 8, a lot of them are actually well able to use a dry powder inhaler and something that's a bit more portable. So it makes it definitely more user friendly for them. But we do recommend at all times for the ordinary meter dose inhalers, the space is used regardless of what age the child is and even for adults as well because again, the deposition rate that the amount of drug that actually ends up in the lungs if you use an inhaler directly into your mouth is from little to nothing is actually is what it is.
Speaker 3 00:32:27 So it definitely does increase the, the deposition into the lungs by up to 50, 60%. So it's quite huge, you know, the difference a spacer can make. Yeah. And everybody should have a spacer anywhere with their blue inhaler for an
Speaker 2 00:32:39 Acute attack for. We're a bit obsessed Tina to be honest. Um, the other bit that we actually found quite helpful, and this might reflect just us being absolutely appalling parents in this house, we did bring it down to the crash for the crash to also give it to him because you know, the crash are often able to reinforce some norms that kids don't accept at home. So for example, our local crash would tell us that there's one kid who won't get their temperature taken at all at home, but they'll queue up to get their temperature taken in the crash. So we have found actually that the crash bed has been quite helpful for you know, creating it as just something normal in the day to take the inhaler. And we also have a chart out there, which I'm sure we ignore most of the time I'm maybe when he gets a little bit older in terms of what happens at different times of the day. So the more it's presented as normal in the same way that you're trying to get a child to get used to brushing their teeth and all of that stuff that they really would necessarily rather not do, but we have to do.
Speaker 1 00:33:25 And I know lots of parents find it really helpful to let the child role play with their teddy bears, you know, give, give them Exactly. Yeah. All that kind of keeping a positive I suppose. I like the idea. Yeah, you
Speaker 2 00:33:35 Probably do um, an email to Cocome and, and ask them to do a charge investment because they're great on the brush, brush brush your teeth at the moment. So if we could get them to, you know, face their space or space or we'd be doing great, it would, we've an animated video actually scripted by some kids. Um, all about um, air pollution. We have the symptom tractor sheet that I uh, I showed earlier that people can fill in or that they can even provide for the school to fill in if they need that. We have a lovely kids activity book, either a Christmas version or a normal version for kids to learn a little bit about asthma or within a family or in a classroom setting for other kids to know enough about it to support another child. We have a September back to school checklist, uh, for parents and FRA adults and we've that as graphics that we share in our social media as well as for people to download.
Speaker 2 00:34:16 We have a kids' corner with videos and we have videos like with children as the voice talking about their experience. We have a wonderful kid called Ingrid who is really into dancing in football and sport and it's all about her talking about her experience of getting asthma controlled. So we've done a lot to build up that repertoire to try and facilitate either mom and dad or a carer at home or a teacher having the right conversation about asthma so that it stops being a scary, intimidating thing and actually becomes something, you know, that kids feel like good bit more okay about.
Speaker 1 00:34:43 Yeah, and I think, you know, children from my experience are so good at just accepting each other as they are. You know, they, they don't over complicate things so, you know, if, if you say it as fact to a young child, they're able to digest that and process that and just accept things so much easier than maybe adults or even teenagers obviously are maybe trying to battle against having the condition and you know, that realization that no, you can't ignore it cuz that's not gonna help, it's gonna make it worse, but children are a bit more compliant. Like it's, it's my children who tell me every day to give them their like, I'm, you know, I'm managed by my children half the time, but, you know, um, it is great. You spoke there a little bit about the school environment. Is there any specific areas of difficulty in school life for children with asthma? Yeah,
Speaker 2 00:35:34 So we would routinely hear some points of stress or tension from teachers and from parents in terms of trying to manage, um, asthma in the school environment. I mean one aspect of that is that, you know, because there is that query around the diagnostic process and because people may not get, you know, a dead certain here's what your child has and it's absolutely established and we know it for sure depending on what age they are. Sometimes parents or curious may not tell a school that a child has asthma. They may be, they don't, maybe they don't want have create a false or they say, well it's not been definitely diagnosed. And that can be a challenge because then it means that the school aren't fully equipped with the information that they need to know that this child needs special help. And then there seem to be often a lot of different circumstances in terms of different schools and how they choose to engage with it.
Speaker 2 00:36:19 So for us, we have an asthma safe schools program that we've been running for the last two years. The program provides regular webinars for teachers one day a first aid training for teachers so that they can then register and have an emergency, uh, reliever inhaler in the school. And it provides digital and print packs to schools to manage asthma. So for example, we've got the five step rule poster that's kid friendly. We have the wall cards, we have the activity books, we have the lesson plans for, uh, for classes and those go out to schools. We have a tiny piece of funding from three areas of Ireland, uh, through the HSC lottery. And we'll be able to deliver that program in three different areas of Ireland, but not nationwide. But we spent quite a bit of time this year talking about the challenges of managing asthma school.
Speaker 2 00:36:58 We met with uh, Minister Jafa Madigan in late May to talk about that. And one of the other complicating factors is, you know, you need the teacher to know enough about asthma, which is what that whole Asthma Safe schools program is all about. The environment around Covid, you know, we need to learn about what that means and we need to figure out how to best manage that. Children with asthma sitting in a classroom that's cold where all the windows are open, where they're sitting in their coat and they're freezing, that's a really unhelpful environment for children with asthma, particularly cuz as Ruth mentioned, cold air may be a trigger that's problematic in lots of instances. We have children, uh, or their parents reporting back. The children have lived, missed a lot of extra school because every time they experience asthma symptoms, they have to stay at home until they can categorically prove that it's not covid.
Speaker 2 00:37:38 And that's quite problematic. And these were all things that we were raising with Minister JCI Madigan to talk about the pragmatism about how we work from Iranian. Because let's be honest, Covid isn't going anywhere. So we need to figure out how to do that in a pragmatic way. It's a very frightening experience to not be able to breathe. It's a, it's a very frightening experience. And when we did the survey earlier on this year, 20% of children said that they worried always or often about having an asthma attack in public. They worried always or often about not being able to breathe. And about 22% said that they worried always or often about getting their asthma flared up when they were in PE class or doing sports or activities in school. Now when you think about that level of anxiety, that means that of the kids who have asthma, which is a big chunk of the population, one in four, one in five of them are worried all the time.
Speaker 2 00:38:27 And so we have a big piece of work to do to reassure a child that it's okay to have asthma, that they don't need to feel embarrassed about it. There's no stigma that they can ask their teacher if they need help to recognize when they might need help and to know how to take their medication themselves or you know, with the support of the teacher or the sna. And that's, that's a lot to take on. That's a lot of healthcare education very early on. And I suppose we would often feel like a huge amount of effort has gone in in the last 10 or 20 years to obesity education, but maybe not the same amount of help and support to children with respiratory health challenges. And you know, following covid we want to really make sure that that's changed and that doesn't exist anymore. Teacher education and support is definitely key to that. One of the things we think is really important is that every classroom has a HEPA filter and the appropriate kind of he filter and that the teacher knows how to use it and that that is a useful part of the puzzle as opposed to the window being open all day long, being the only thing that's going to work for, for the classroom setting because that isn't sensible and it isn't as friendly.
Speaker 1 00:39:28 Okay. I think anyone who knows me knows how passionate I am about holistic care. So I am a pharmacist and clearly I strongly believe in the benefits of medicine when necessary, but sometimes there are things we can do in life to compliment our treatment and I think it would be remiss of me not to mention one of my favorite products, which is Salmon Plus. It's really important to say here to people that Salmon Plus is a dry salt therapy device and the way it works is that it filters out small particles from the room. So things like pollens, bores, that kind of stuff. So the air goes through a fan and then is pushed through a salt filter which releases micro crystalline salt particles into the air, which can then be inhaled. And because they're so small they reach the airways and can help theoretically to reduce inflammation and help draw out mucus, making it easier to become productive and you know, reduce the incidence of infection.
Speaker 1 00:40:28 I say all this underpinned with the advice that no one should try a complimentary medication without discussing at first with their gp. And it's never a replacement for your normal asthma treatment. It's really important if you're trying out something like cell plus that you continue taking your medication or giving your medication to your child as prescribed and then feed back the response your child is having to the gp. So you know, if you find that it is genuinely very helpful. I know I've experienced with a lot of parents who have, that's something that you can feed back to your GP and bring up on your action plan. Yeah,
Speaker 2 00:41:06 I suppose a lot of what what we discuss with patients is about self-management and so being aware of the bigger picture and like I said, that environment piece, having an influence on all of us is really important. And I think certainly we do get queries about lots of different kinds of comentary therapies, but soil therapy is definitely one of them that crops up quite often that Ruth deals with. So I don't know, Ruth, in terms of the advice that you give, do you want to, I think it's probably another a thousand miles maybe from what some of what Sheena has mentioned there. Yeah, no, I would agree with what she has
Speaker 3 00:41:32 Said and we do get a lot of queries about the salt therapy and you know, we don't really suppose know enough about it. Um, there is has been some studies out there that has shown benefits, other studies have shown that no, it's not beneficial and it can actually cause some people that ask them to worsen, you know, have the conversation with your GP or your consultant and see if it could possibly suit you. For some people it does work very well and for others it doesn't, but you're not going to know until you have that chat with your GP as to how you're possibly going to react to it and you just need to do it in a safe manner. And it, as she has said, it's just so important that any complemented therapy does not replace your ordinary therapy of control or treatment. That's the most important thing. And you know, it's not to replace it, it's to compliment it. Exactly.
Speaker 1 00:42:18 And like I know just over the last say five or six years how much positive feedback I've gotten, one thing I'd recommend is, first of all, if you know someone who has a salon plus, you know, you could maybe borrow it for a few nights, it is quite well tolerated in most patients. And because it can clean the air ultimately, you know, as you were saying there, Sarah, about the environment, that's a positive thing and the research needs to keep going on the benefits of, of the salt therapy then thereafter. But yeah, I suppose a holistic view and, and everything we can do in a positive way while remaining responsible and cognizant of the overall action plan, I think is really important. Yeah,
Speaker 2 00:43:01 Yeah, I mean I, I think the science is really beginning to catch up now. So, you know, we really weren't talking about air pollution in an informed way and in 10 years ago in the way that we are now. So for example, now we understand so much more about what air pollution does to respiratory health, uh, but also what it does to, you know, cardiovascular health, you know, it's impact for example, on, uh, potentially in the long term for people for dementia, it's impact on fertility. All of those things were totally unknown to us before. There's a big learning going on about the air around us, which right now is invisible. Like we can't see any pollution. So we're, we're trying to learn about that using, you know, improved monitoring and systematic, um, work like that. And then you can imagine alongside that then, um, you know, researchers are looking at different devices than what works and what doesn't.
Speaker 2 00:43:48 And then alongside that, of course, patients have different kinds of asthma, they have different triggers than it, um, it works differently in people's bodies. So there's a lot of variation there in the mix. We would certainly get people asking us about devices quite regularly and you know, at the moment it's very challenging for people to pay for medication, to pay for healthcare and to pay for devices. So we'd often suggest that, you know, under the supervision of your gp, that if you are looking at a device that you certainly borrow it for a little while because, you know, people may spend money on something and then it doesn't work for them and, and then they stop using it, but they still have the expenditure. So that's certainly something we bear in mind because we're just really aware of the challenges of, of managing a chronic condition.
Speaker 2 00:44:28 And sometimes it's not only one child in a house that has it. And so that can be a big pressure for people. And it's certainly something that came through really loud and clear in the survey that we ran earlier this year, that parents were finding the cost of managing asthma quite challenging. And I suppose that's why every single service that we offer is fully free, whether it's the nurse's advice line appointments, whether it's the beating breathless WhatsApp, whether it's our webinars, the website, the Asthma Safe Schools program, everything that we offer is fully free to give every parent, every child, every carer, every person in Ireland with asthma full access to the best supports they can possibly have. And one of those that we've touched on a few times, Sheena, but it's probably worth us digging into, is the asthma action plan. And I'll kick it over to you and Ruth to have that really clever informed healthcare professional conversation about it.
Speaker 2 00:45:13 But just to say like, people are often really surprised when we wax lyrical about the asthma action plan. And it's a really simple piece of kit. It is a piece of a four paper front and back that folds into the center. It's a traffic light system, but internationally, all of the research, including a really important report from the UK called the N RA report, which was the National Review of Asthma deaths report, which they undertook in 2014. And they looked at every person who died as a result of their asthma and they figured what went right and what went wrong in every single case. And then they built out the trends for them to be able to better understand what was causing people to die for their asthma or what was a really major preventative action. And consistently across the board, one of the major preventative actions was if somebody had a written up to date asthma action plan personalized for them, they were at significantly lower risk of having a life threatening asthma attack and dying. And so that's really why we're obsessed because as, as we mentioned earlier, our mission is to stop asthma deaths and asthma action plans are absolutely key.
Speaker 1 00:46:13 All pop link, the show notes because I printed one off here at home, you know, I'm looking at it now. It's fantastic because I think the whole thing with asthma or any other chronic condition is that it's like rolling hills. You're gonna have days that are great and then you're gonna have days where all of a sudden you're climbing a mountain and things just aren't looking as good as they should be. And I think with the asthma action plan, what that does really well is it defines what's a good day, what's a not great day, and what's an emergency day? So you've got your green, orange, and red zones. The green kind of just reminds you and just defines for you what good asthma control is. Just like having no symptoms, not having to use your reliever frequently. And the same then with the orange.
Speaker 1 00:47:00 It kind of describes that your asthma might be waking you at night or it might be triggered a little bit with exercise. Your peak flow isn't looking as good as it was. All of these kind of things. And it just defines them all quite nicely and tells you what you should be doing with your medication on a green day or an orange day. Obviously I'll talk about a red day in a minute, but it, it kind of just makes it really clear and improves. I think that complacency that kicks in where all of a sudden you're having orange days but you're ignoring them, it kind of, it puts it right in front of your face that you can actually analyze how your day is going and what you need to be doing and what action you should take and when you should contact the GP or seek an update to your action plan.
Speaker 1 00:47:45 A red day is a day you have an asthma attack. So you know it's very clear that that day is an emergency and that you're seeking immediate medical attention. But it also shows all the symptoms of an asthma attack, which is very useful for people. And writing down an action plan for a panicked moment is so important because when you're afraid and you're frightened and your anxiety anxiety's high, you're not rational. And sometimes you might just need to go, Okay, I think we're having my asthma attack here, what do I do? And you just need to be able to read and act quickly.
Speaker 2 00:48:17 And in order to be able to read and act quickly, you need to have preread. It isn't that it in that, obviously we have a section on our website in red at the very top, which is asthma tech. People can click there to find out what to do in the event of an emergency. Like just to read quickly. And obviously one of the most important pieces, you know, is to contact emergency services when you need that help and support. But actually having read it in advance and having it sit out in advance and clear in your head in advance, that's actually the clarity you need rather than trying to scramble through things, you know, in the moment. Certainly. Yeah,
Speaker 1 00:48:46 I'd be sticking it on the fridge. Yeah, <laugh> as well.
Speaker 2 00:48:48 Yeah, I don't give it to grant. And granted if the kids are popping over there that the crash have it, you know, it's that really straightforward piece of, everyone's very calm, everyone knows what to do, there's no surprises here. Yeah,
Speaker 3 00:48:59 Yeah, that's really important actually. The sharing of the plan and keeping it updated is really important as well. So if your treatment changes for whatever reason, even if it's decreased, if not, just when it's increased, it needs to be changed and updated, you know, regularly. So you know, when you're getting your asthma review, that's when your plan needs to be talked through with your gp. But you also can talk with through with our nurses on the advice letter with myself and the WhatsApp service as well. So it's, it's there and we can send them out to people through the WhatsApp service also. And of course a digital version is the way to go with it as well.
Speaker 1 00:49:30 You mentioned there, Sarah, about cost associated with managing asthma. And as a pharmacist, this is something that irritates us greatly. For me, it's very clear that asthma is a long term illness and in Ireland we have a scheme which covers the cost of medication for long term illnesses such as diabetes, Parkinson's, Lots of things are on it, but asthma is not on that list. And therefore, yes, it's covered by the drugs payment scheme, which has reduced over the years and is now sitting at 80 euro a month per family, but 80 year old month per family for a family that don't have 80 year old month to spend on medications. In addition to heat like food shelter, like it's terrible because it impacts someone's compliance. And by compliance I mean their ability to stick with their dosing schedule. So we've spoken all about how important it is to control asthma and you control asthma through use of steroid inhaler ultimately. And if you're missing doses, your asthma is not going to maintain in the green zone. Realistically, by making it a financial choice to be compliant, it is negatively affecting an individual's health. And in the bigger picture, the health of the nation, because poor control like this 20,000 people visiting hospital every year, the frightening fact that one person dies of asthma every week and 90% of those deaths are preventable. For me, it it makes no sense that it's not on the long term illness plan. I'm sure you also have very strong feelings about this.
Speaker 2 00:51:14 We have strong feelings. We, we have all of the strong feelings in the, in fact we have strong feelings to the point that they might trigger our asthma basically about this particular topic. Um, the Asthma Society was formed 49 years ago, so be 50 years old next year. And it was formed specifically with the aim of getting asthma included on the long program. And we are not failures as humans, Sheena, because we are really passionate about what we do. And we've worked really hard for the last four to nine years and very particularly for the last three, you know, during covid to help and support patients. So we're not failures, but we have failed in this. And it is very hard to understand from a health policy point of view and a health spending point of view. It doesn't make much sense. It is not proper joined up thinking.
Speaker 2 00:52:00 Now some things have improved in the realm, right? So the government have introduced a chronic disease management program for people who have medical cards and that has been expanded out to include people over the age of 18 in the course of the last 12 months. And that's really rolling out at GP practice level. So that's a positive, right? And that is for anyone who's the medical card, they can get access to diagnostics and then they can get access to regular review that Ruth is talking about the regular review that we are totally and utterly obsessed with. So that's a positive. These new chronic respiratory hopes that are, um, being set up in communities that is a positive. The cost of living is an anxiety experience as well as a real life health experience. So what we want to do is to always help and support patients to say our services are free, please come to us so we can help and guide you as best possible. But we do very regularly hear about people rationing going to the GP when they think their child or they themselves are very unwell rationing the actual medication that they give. So giving less of it less frequently skipping doses or not getting all of the items that they need. And really those things have very serious knock on impacts on, on children and anonymous,
Speaker 1 00:53:06 To be clear, this is not a problem or a fault of the asthmatics. This is a policy problem. No,
Speaker 2 00:53:13 The really disappointing thing here is that it's not that it's not justifiable, it's not that asthma isn't important. It's not that it isn't a very real healthcare challenge. The problem here is that too many people in Ireland have it. If you don't manage a big problem, it becomes bigger at at later sections.
Speaker 1 00:53:28 No, you're so absolutely right there Sarah, and I just really hope that you don't feel defeated and there's a lot of people behind you and as you said, so many people, it's really important to try and drive change. Thank you so much for joining me today, Ruth and Sarah, what are the numbers or websites and also the social media handles, where can people find you?
Speaker 2 00:53:55 So if people want to come to us for help and we would say please do. Like we are here to help every single patient with asthma in Ireland. People can come to us on our website, which is asthma. Do i e people will find a whole lot of the resources we talked about earlier on, on that website. Um, if people would like to make an appointment for the one to one half hour nurse appointment, um, if they phone into us on one eight hundred forty four, fifty four sixty four, our receptionist would book an appointment normally within about 24 hours with the nurse and you take it from there. Um, and then Ruth and Sam both work our beating breathlessness WhatsApp service that is actually for both patients with asthma and with C O P D, but obviously you don't have children with C O P D. So when we're talking to your audience today, it's much more relevant to the asthma audience.
Speaker 2 00:54:32 And if people send a message to um, oh 8 6 0 5 9 0 1 3, they just send a message on WhatsApp. They can kickstart that that works from Monday until Friday, nine until five. Neither of those services are emergency services. So if you are concerned about a person experiencing an escalation, their symptoms or an asthma attack, they need to pick up the phone and call nine, nine nine. That is really the root if you're having an emergency. But for the self management education, support, guidance or just a plain rant, that is absolutely what we are here for. And just again, just to reiterate, like all of our services, everything that we offer is all about the medical evidence, the guidance we give is accurate, correct. It's best practice. And we can help people along the road to the point where they get to asthma control. That anxiety just goes away because the day to day symptoms are not a factor. And your child as well, they feel good, they're safe, they're active.
Speaker 1 00:55:23 Very, very worthy job. Thank you so much for joining us today. Thank you. If you enjoy listening to a wonderbra podcast, I'd be really grateful if you could follow or subscribe and leave a review. It really helps to support the show. Thank you.
