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by James Thomas, Saturday, July 8, 2017 | Categories: Asthma

If you’ve spent any time at all scrolling through the Daily Mail website, you’ll “know” that just about everything gives you cancer – whether it’s processed meat, chips, the contraceptive pill, or even having children. We live, in other words, in an age of shocking headlines, where our newspapers push scare tactics and a "can’t win" mentality that says – no matter what we do – we will find ourselves doomed to ill-health and unhappiness.

It’s with some scepticism, then, that you might find yourself approaching the asthma study carried out by the University of Liège back in March. Using mice, researchers examined how exposure to microbes could affect lung health. The findings indicated that the presence of bacterial DNA actively modified the immune environment of the lungs, which in turn helped to prevent the development of asthma. In simple terms: exposure to dirt was shown to be beneficial – and living in an environment that was too clean was shown to predispose you to asthma.

Time to Rethink Guidelines?

The reason this study is particularly frustrating is that all current guidance on asthma management stresses the importance of cleanliness. Just last year, we reported on new research that showed how "indoor pollution" – in other words dust, dirt, irritants and smoke within the home – play a worrying role in the severity of children’s asthma symptoms.

How, then, may we reconcile that knowledge with this new study? Well, the first thing to note is that this study has only been carried out on mice – although human studies have been planned. Secondly, it’s not clear from this research what constitutes "good" versus "bad" microbes. Lastly, the study seems to suggest that these findings are best applied in a preventative, as opposed to curative, manner. In other words – though this will require further consideration when more studies have been carried out – some exposure to microbes may be beneficial before, but not after, a person has developed asthma.

Going forward, asthma sufferers should not make changes to their asthma management – and parents wary of their children developing asthma shouldn’t stop vacuuming or washing their hands! For more guidance on good asthma management, read on.

Keeping Your Asthma Under Control

Many people with asthma do not consider it a serious or life-threatening condition, but that is largely because they are able to manage it well. Four simple rules for successfully managing asthma are:

  • Using your inhalers and medications correctly
  • Avoiding your triggers
  • Having a written Asthma Action Plan
  • Regular asthma reviews with your asthma doctor or nurse

Inhaler Use

If you only use a reliever inhaler, you should not be using it to treat asthma symptoms more than three times a week. Using it this frequently indicates that your asthma is not well-managed and that you probably require a preventer inhaler as well.

If you use a preventer inhaler you need to make sure you take it as directed – usually this means taking it twice a day. If you don’t use your preventer in this manner, you will not benefit from its protective effects. It’s also important to make sure you are using your inhalers correctly. You can do this by getting guidance from your doctor or nurse at your next asthma review.

To learn more about asthma medications, consult this guide from Asthma UK.

Asthma Triggers

Asthma symptoms are "set off" by certain triggers. These triggers vary from person to person; however, common ones include:

  • Allergens such as dust mites, pollen, and animal dander
  • Food allergies
  • Airborne irritants such as cigarette smoke and pollution
  • Infections of the upper airways such as the common cold
  • Food additives such as sulphites
  • Strong emotions such as stress or laughter
  • Weather conditions such as thunderstorms
  • Indoor conditions such as mould and damp
  • Exercise

One of the best things you can do for your asthma is to take note of your personal triggers in your Asthma Action Plan and try to avoid them as best you can. Because it’s not always easy to avoid these triggers, it’s even more important to make sure you are taking the correct medications and using your inhalers properly.

To find out more about asthma, and the medications available to treat it, visit our Asthma page.

by James Thomas, Saturday, March 11, 2017 | Categories: Asthma

Around the world, concern is growing over the quality of the air that people – particularly big city dwellers – are forced to breathe. In London during January, air quality was so bad that legally mandated pollution limits for the whole of 2017 were passed in the first week of the year. The city's mayor, Sadiq Khan, spoke of what he called a "public health emergency", as toxic air hung over the central boroughs, a problem exacerbated by unusually calm weather patterns.

Everyone is at risk when conditions like these persist, but the potential health risks are even worse for anyone with respiratory or heart issues, with asthmatics often experiencing serious problems. Evidence is also mounting that cases of chronic bronchitis increase with worsening air quality. The figures for air pollution-related deaths in London alone are astonishing; every year, almost 9500 people in the city die early because of pollution-linked conditions, according to research conducted in 2015 by scientists from King's College.

Measures such as banning certain kinds of traffic in parts of a city, or restricting people from using private vehicles, can have a beneficial effect locally. But changing weather patterns or unusual conditions can result in pollution from other areas – even other countries – having a dramatic impact in distant cities. The ability of people and governments to work across borders to combat problems like this becomes immediately apparent under such conditions.

EU takes action

Around six weeks after the January pollution spike in London, the EEB (European Environmental Bureau) announced that five EU countries were consistently breaching air pollution limits. The UK, Germany, France, Spain and Italy were, the EEB claimed, failing in their duty to protect people's health, and legal proceedings would follow. Furthermore, the EEB statement pointed out that this was not a new issue; the situation had been going on for years.

One particular pollutant, nitrogen dioxide, was singled out for its likely effect on young children with asthma, and its probable contribution to increased cases of bronchitis and other lung infections. It is the job of the European Commission to ensure that EU laws regarding air quality are upheld, and recent EU legislation includes new and more stringent emissions targets. The EEB's senior air pollution policy officer, Louise Duprez, said there was "no excuse" for not meeting the targets, and that children "deserved better" than to grow up inhaling toxic air.

Bronchitis: causes and treatment

Bronchitis is frequently mentioned as one of the effects of air pollution, though of course poor environmental air quality is not the only risk factor. Bronchitis, like pneumonia, is an infection of the airways and/or lungs, and can be a mild and relatively short-lived condition – acute bronchitis – experienced by people who have simply caught a cold. When the condition becomes a long-term, more serious health problem, it's known as chronic bronchitis.

The chances of developing bronchitis are increased by a number of factors, smoking being one of the most common. Chronic bronchitis can vary in intensity throughout the year, and environmental factors can have a causative effect, and can also make the condition worse. The main symptoms of both the acute and chronic varieties of the infection are a persistent cough with chest/lung discomfort or pain, and possible breathing problems. In emphysema sufferers, chronic bronchitis can lead to COPD, which can cause permanent lung damage in the long term.

There are a number of recommended ways to avoid contracting bronchitis, and stopping smoking is, unsurprisingly, at the top of the list. Not only does smoking cause lung damage, it lowers the body's resistance to infection. Staying within alcohol consumption guidelines – currently 14 units or fewer per week – and eating a healthy diet can help the immune system to fight infections.

It's important to be aware that bronchitis can be caused by both viruses and bacteria. Viral infections are not treatable with antibiotics. Mild cases of acute bronchitis may not require treatment, and in fact, using cough medicines is generally not recommended, as the body needs to expel phlegm by coughing. You should see a GP if your symptoms get worse or the condition doesn't clear up relatively quickly. In cases where antibiotics are appropriate, you may be able to order them from The Online Clinic – see the Free Online Assessment at the link.

by James Thomas, Sunday, November 27, 2016 | Categories: Asthma

According to Asthma UK, there are 5.4 million people living with asthma in the UK, 1.1 million of whom are children. That adds up to 1 in every 11 children, meaning that on average there are three with asthma in every classroom in the country.

At first glance, asthma might not seem like the worst health condition to live with, but the reality can be scary. For adults and children coping with severe asthma, living a normal life can be a daily struggle.

The good news is that asthma medications and the techniques for managing the condition effectively are constantly improving. Recent research from the American Academy of Pediatrics also looks set to make a significant contribution to the health of asthmatic children and adults.

According to the experts, the indoor environment of asthma sufferers’ homes plays a crucial role in respiratory health. In fact, controlling this environment could be as vital to asthma management as the use of medication. This discovery is particularly important for parents of asthmatic children, because air-borne pollutants can disrupt the development of young airways. Children are also more likely to be exposed to irritants and pollutants than adults because they spend more time on the floor.

Keeping your Home Safe

The new guidance recommends that parents with asthmatic children take the following precautions in their home:

  • Reduce your child’s exposure to cigarette smoke
  • Dust and clean regularly to avoid exposure to dust mites
  • Address any mould or damp issues
  • Address any issues with pests or vermin

Ultimately, the best thing you can do for your child is to keep your home very clean, dust-free and regularly vacuumed – particularly the rooms they spend the most time in.

Pets & Asthma

The report also discussed the role that family pets can play in children’s asthma. Animal dander is a common asthma trigger and it’s not always easy to control – even if you have a so-called "hypoallergenic" pet.

Giving up your dog or cat is not necessarily the only option if your child has asthma. This is because animal dander is only a problem if your child has an allergy to it – not all asthma sufferers are automatically allergic.

You’ll be able to tell if your child is allergic by monitoring their symptoms when they are around your pets. When the allergy is severe, a reaction will be instant, causing coughing, wheezing, shortness of breath and sometimes even a rash. When the allergy is only mild, a reaction may take a few days to develop.

For children with only a mild allergy, it may be possible to keep pets as long as they are not allowed into bedrooms or communal living areas. Keeping your pets well groomed and clean is also important, as is regularly cleaning and vacuuming.

For children with a severe allergy, it’s worth getting a definitive allergy test before you consider giving up your pet. It may be that your child is allergic to something else in your home.

Other Management Techniques

Keeping your home clean and safe is very important when it comes to asthma management, but there are other important techniques to keep in mind.

The first is having a written asthma action plan. This is a document which details all the vital information related to your child’s condition. It will include a list of your child’s triggers, medications, and what to do in the event of an asthma attack. To establish a comprehensive asthma action plan for your child you will need to take some time monitoring their condition, and working out what their asthma triggers are.

It’s also crucial to make sure your child is using the correct asthma medication. If they are only using a blue reliever inhaler (usually Ventolin) but experiencing symptoms more than three times a week, then it is likely that will need a preventer inhaler.

However, frequent flare-ups of symptoms could also be a sign of an unidentified trigger in the home – whether it’s cigarette smoke, animal dander, dust mites, food additives or mould. In this situation, an allergy test is recommended.

You can read more about asthma and the various medications available to treat it at The Online Clinic. Click here to view our inhalers and learn more about asthma management.

by Marijana Domazet, Saturday, September 6, 2014 | Categories: Asthma

The relationship between vitamin D and asthma has been receiving increasing attention in the scientific community. In the past five years, studies have looked at how vitamin D (or lack thereof) affects the development of asthma, the persistence of asthma attacks and the treatment of asthmatic symptoms. Here we consider the most recent study that looked at the use of vitamin D in addition to standard treatments.

The study, which was published in Annals of Allergy, Asthma and Immunology, was a case control study. In total 130 participants of varying ages took part. The study included participants who were classified as having mild to moderate asthma. Whilst one of the groups only received the standard treatment that included an inhaler with dry powder, the other group received the standard treatment and additional doses of vitamin D. The participants in this group received an injection of 100,000 units, followed by instructions to take 50,000 units orally on a weekly basis. The researchers then measured the lung functioning of both groups at different time points throughout the life of the study. The main findings indicated that both groups were performing equally well after eight weeks. However, 20 weeks after the study started there were marked differences between the groups. On average, the participants who had been given vitamin D performed 20 percent better than they had at the start of the study. In contrast to that, participants who had been given the standard treatment performed seven percent better. Based on this, the researchers concluded that larger studies are needed to see whether vitamin D could be used as supplementary treatment in the management of asthma symptoms.

These findings are far from surprising as they are pointing in the same direction as previous research. There are a few points from the current study that are worth considering when interpreting the results or when attempting to replicate its findings. One of the flaws is the reliance on self-report of adherence to treatment. The researchers measured the adherence to the treatment via telephone interviews. However, assuming that the adherence (or lack thereof) is equally distributed between the groups, the findings would still hold. Another flaw is that participants were not tested for vitamin D deficiency prior to taking part in the study. Having said that, it is clear that that the researchers were keen to stress the importance of further research. It is also worth noting that this study is one of the few studies within this line of research that included adults.

It is easy to see the appeal of vitamin D as an additional treatment. It is non-invasive and easy to administer. At the same time it is worth mentioning that experts in this field have stressed that the research is still in its early stages and individuals should not start taking vitamin D as a treatment.

We will keep an eye on developments in this field.

Further information can be found here.

by Marijana Domazet, Wednesday, August 7, 2013 | Categories: Asthma

A key issue with most asthma inhalers is that a large part of the medication stays in a patient’s throat rather than reaching their lungs. However, this may be about to change as a team at Monash University has developed a new method of making ultra-fine particles, which would pass easier to the lungs.

The team, which is currently sponsored by the Australian Research Council, presented its findings in China last year and has attracted significant interest from the pharmaceutical industry. Initially the team had been researching dairy production, with the purpose of attempting to produce lactose crystals using nitrogen laced with ethanol vapour. This led to the development of tiny and uniform lactose particles. Having investigated this unexpected outcome, the researchers concluded that the alcohol absorbed into the initial droplets led to the development of the uniform lactose particles.

It is now hoped that the method described above could be harnessed to develop ultra-fine and uniform particles of the asthma medications so that they would be able to reach the lungs. As a result of this, it is hoped that it could increase the efficacy and accuracy of inhalers. Moreover, it means it would affect the manufacturing process and potentially make the production of inhalers more cost effective.

It is still too early to say whether this method is viable in the manufacturing process of asthma inhalers. However, if this were to produce the expected outcomes then we would be keen to see what clinical implications it would have in terms of prescribed dosages in the inhalers.

You can read more about this discovery at Fierce Drug Delivery.

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