CANADIAN NETWORK FOR RESPIRATORY CARE SPECIAL …cnrchome.net/assets/currents-sum2011.pdf · steroidal anti-inflammatory drugs (NSAIDs) can make your asthma worse. Up to 29 percent

You’re struggling for breath. It’shard to speak. You’re pale and sweat-ing. All this, and your blue rescueinhaler isn’t helping. You’re experi-encing an asthma attack. You can avoid this frightening sit-

uation by acting on the No. 1warning sign that you’re heading intoan attack and the red zone of yourasthma action plan. “The precursor to an attack is a

How to Stop An Asthma AttackBY KIM SHIFFMAN

CANADIAN NETWORK FOR RESPIRATORY CARE SPECIAL SUPPLEMENT • SUMMER 2011

Exercising Control continued on page 35

With the warmer weather finally here,Canadians are outside and active.They’re cycling, jogging, playing socceror softball. But for up to 80 percent ofpeople with asthma, physical exertion isa key trigger for breathing symptoms.Yet exercise-induced asthma does nothave to limit summertime activities. What exactly causes exercise-induced

asthma? When your body needs moreoxygen, the air you breathe in doesn’tget sufficiently warmed and humidifiedby the nose and upper breathing pas-sages – even on hot, humid days. Thenot-quite-warm-enough air reachesyour lungs and can cause a reflex spasmin your breathing passages. The symp-toms – shortness of breath, wheezing,coughing – most commonly occurwithin five to 10 minutes of the start ofexercise. (They can also occur immedi-ately, and in other cases not for a halfhour or more.)Compounding the problem, a change

in environment can exacerbate exercise-induced asthma. Exposure to allergenic,airborne pollens in summer, for exam-ple, can contribute to a flare-up, just asthe cold, dry air of a hockey rink willbother a person’s airways once winterreturns. As far as exertion goes, “all therules of asthma apply,” says JolantaPiszczek, a pharmacist and CertifiedRespiratory Educator in Toronto. “If

BY JACLYN LAW

ALLERGIC LIVING | SUMMER 2011 33

If your asthma isunder control, youshould be able toundertake justabout any activity.

See Warning Signs on page 35

you’re inhaling a large volume of air atgreater speed, you’re exposed to theallergen that much more.”These factors may sound discourag-

ing, but with good asthma control, youshould be able to undertake just aboutany activity. “Those with asthma shouldbe encouraged to get daily exercise,” says

PlayingHard WithAsthma

Jan Regier, a nurse and Certified AsthmaEducator in Calgary. And exercise keepsthe lungs in shape, too.If your asthma is under excellent

control, you should not experiencesymptoms after exercising. If you do, useyour a rescue inhaler 15 minutes before

flare-up, and that’s when you have totake steps,” says Pat Steele, aCertified Respiratory Educator andnurse technologist at the CapeBreton Chest Clinic in Nova Scotia.The symptoms of a flare-up put

you into the “yellow zone” of yourasthma action plan. Here, there’s stilltime to head off an attack, says AnnBartlett, a CRE and respiratory nurseclinician at the Firestone Institute forRespiratory Health in Hamilton.

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Q&ACertified Educators take yourasthma and allergy questions.Send questions to: [email protected]

Kathleen Frame

34 ALLERGIC LIVING | SUMMER 2011

SUPPLEMENT

Q. I’ll be visiting relatives for a week later this summer andthey have a cat. I’m allergic to cats and they trigger myasthma. How should I best manage this?

Douglas Stewart: To reduce the sniffles and sneezes, take anon-sedating antihistamine, beginning a day before your visitand continuing through it. For your asthma, review with yourdoctor whether your preventive therapy needs to be adjusted.For example, you might take a higher dose of your preventiveinhaler or temporarily use a combination preventive inhaler. Ofcourse, bring your rescue inhaler with you and use it when nec-essary, without exceeding the dose suggested by your physician. Finally, make sure your written action plan is available to

allow for early self-treatment in case your asthma flares despitethese precautions.

Q. Recently after I took an Aspirin, my asthma seemed toflare up. Does that seem possible?

Shawna McGhan: Yes, it is possible that Aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) can make yourasthma worse. Up to 29 percent of adults with asthma will havebad – possibly life-threatening – reactions to NSAIDs. Aspirin-induced asthma was thought to be less common in children, butrecent studies show that up to 14 percent will react.As a general rule, people with asthma may want to avoid

Aspirin and other NSAIDs drugs such as ibuprofen, naproxenand diclofenac. Speak to your doctor about using alternativepain reliever medications, such as acetaminophen.

Douglas Stewart Shawna McGhan

Q. I’m 22 and have just been diagnosed with asthma. Will Ihave this for the rest of my life?

Kathleen Frame: Asthma is often part of one’s genetic make-up. But it is a disease that can be treated and well-controlled.Most days and nights, you should be symptom-free – but youmay have periods throughout your life when it worsens. The keyis to know your triggers, avoid them when possible, and quicklybring any flare-ups under control. Asthma will likely always be a part of you, but with a self-

management plan and education about the disease – often froman asthma or respiratory educator or health-care provider – youcan live almost as though you don’t have it at all.

Q. With controlled asthma, do I really need to worry aboutbeing outside on smoggy summer days?

Douglas Stewart: Airborne pollutants can worsen symptoms.If your asthma is worse on smoggy days, the simplest solution isavoidance. It’s wise to check the weather forecast and spend lesstime outside when the Air Quality Health Index is high. Stayinginside on those days, using air conditioning and even exercisingindoors instead of outdoors are all great ideas. Of course, if youmust be outside, be sure to carry your rescue inhaler.

Q. My 10-year-old complains that taking his corticosteroidinhaler “hurts his throat.” I wonder if he’s just trying to getout of using it. Any thoughts?

Shawna McGhan: A sore throat is a common side effect ofinhaled corticosteroids. To reduce or eliminate the discomfort,have your son gargle and rinse his mouth after using the inhaler.Next, confirm that he is using his inhaler properly; poor inhalertechnique can result in medicine particles getting stuck in hismouth. Finally, the addition of a spacer may reduce the amountof drug left in the throat. The spacer makes it easy to use theinhaler properly, avoids side effects in the mouth and maximizesthe amount of medicine going into the lungs. You may need to work with your doctor to address this sore

throat issue. But your son shouldn’t stop using the corticos-teroid; it’s essential for the treatment of his asthma.

Q. My son is 8 and always gets a cold that triggers hisasthma shortly after returning to school in the fall. Why?

Kathleen Frame: Every year in Canada, a phenomenon occurscalled the September Spike. In the weeks after school begins,many school-age children experience a severe asthma flare-up.Viral infections are the leading cause of the spike. Other factorsinclude decreased asthma control in the summer and seasonalmold spores. To stave off the September Spike, tell your son towash his hands frequently to avoid getting a cold, and make surehe takes his preventer inhaler as prescribed.

Douglas Stewart is a pharmacist and Certified RespiratoryEducator in Sudbury, Ontario. Shawna McGhan is a CRE and anurse at the Alberta Asthma Centre in Edmonton. Kathleen Frameis a registered respiratory therapist and CRE at the South RiverdaleCommunity Health Centre in Toronto.

ALLERGIC LIVING | SUMMER 2011 35

THE ASTHMA EXPERTWith Dr. Harold Kim

The Canadian Network for Respiratory Care is a non-profit organizationand registered charity that works to improve the lives of those living withrespiratory disease. We conduct exams and certify health-care professionalsas Certified Asthma and Respiratory Educators (CAEs and CREs). Our CAEs and CREs work to help patients with their asthma, COPD,

allergies and smoking cessation efforts. For more information about CNRC or to locate a CAE or CRE, please

see www.cnrchome.net or phone: 905-880-1092.

ABOUT US

W hen you think aboutsummer allergies, treesand weeds might spring

to mind. But don’t forget aboutgrass, a major cause of allergy. Itstarted in May, and will be polli-nating in June and July right acrossthe country. People with grass allergy typi-

cally experience allergic rhinitis,the most common symptom ofwhich is nasal congestion. It can bequite severe. Another symptom isallergic conjunctivitis, which strikes80 percent of grass allergic people,and is typically mild to moderate.Still, some people’s itchy, red andwatery eyes become so trouble-some that they require a referral toan ophthalmologist for potenttopical therapy and monitoring.Another potential complication

for those with grass allergy is food-triggered oral allergy syndrome (orOAS). This occurs because the pro-teins present in grass are structuredsimilarly to proteins in certain fruitsand vegetables, and that may triggera reaction. Tomatoes and kiwis, forexample, can cause oral symptomsin grass-allergic patients.To manage your allergy, avoid

grass pollen by keeping windowsclosed and using air conditioningon hot days. Of course, when you’re

exercise. If that is ineffective, there may beother factors, such as improper inhaler use.Speak to your certified educator or doctor toget a grip on control. Long-time runner Nancy Perron, 54, began

using inhalers about 15 years ago after consis-tently experiencing asthma symptoms whileexercising. She now takes fluticasone twicedaily for control and terbutaline before runs. Over the years, “I’ve learned to really listen

to my body,” says the Ottawa resident, who’straining for her fourth half-marathon. She getstraining plans online and from running clubs,and modifies them to her abilities. Whenbreathing becomes difficult, she walks; aftertraining, she allows adequate time for recovery. “It’s not [about] expecting to win the race,

but expecting to do the race. It’s adjusting yourmindset,” says Perron. “Focus on the positive,expect some bumps along the way, workthrough them and carry on.”P

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ExercisingControlContinued from page 33

1. Shortness of breath and coughing (especially at night).

2. Wheezing and/or chest tightness.

3. Needing your reliever inhaler more than usual.

4. Difficulty with routine activities – like running up the stairs.

5. Fatigue and irritability are otherpossible precursors.

Warning Signsto Watch ForContinued from page 33

outside, grass can be hard to escape.From your backyard lawn to thefield where your child plays soccer,it’s everywhere. That’s where med-ication comes in. A non-sedatingantihistamine works well for mildsymptoms, or speak to your doctorabout intranasal corticosteroidsprays, which are highly effectivefor nasal and eye symptoms. Anti-allergy eye drops can be used if eyesymptoms persist. Finally, allergen immunothera-

py, commonly known as allergyshots, is something to consider iftreatment isn’t working. If you suf-fer from grass allergy, ask yourdoctor about these options.

What sends someone into that yellowzone depends on personal triggers – any-thing from a cold to fragrances. “It’s whatI call your specific bell ringer,” saysBartlett. “It’s an individualized thing.”If you end up in your yellow zone,

there’s no need to panic. Just get out yourreliever and follow your action plan.

B eing an adolescent isn’t a pieceof cake in normal circum-stances. So what’s it like when

you add asthma to the mix? Currentsasked two teens from the Halifax areaabout the peer pressure years withasthma. The differences in theiranswers may surprise you.

Q. Who do you tell that you haveasthma?

Ashley, 17: “My close friends andthe girls on my sports teams knowabout my asthma. But other thanthat, not too many people knowabout it.”

Alexis, 12: “Most of the kids in mygrade know I have asthma. Storiesabout a girl not being able to breathespread like wildfire!”

Q. What do your friends thinkabout your asthma?

Ashley: “My friends know where Ikeep my inhaler. But other than that,they don’t say too much about it.

SUPPLEMENT

CNRC thanks GlaxoSmithKline forhelping to make Currents possiblethrough an educational grant.

Teens’ Corner

Some of them have asthma, too. I’m not different from anyone else,so it’s not a big deal.”

Alexis: “My friends think way toomuch about my asthma! Theyworry that if they make me laughtoo hard that I will end up at thehospital because of them. Knowingthat they care is nice – but it can get annoying.”

Q. Have you ever been teased orcalled names for having asthma?

Ashley: “I’ve never been called aname for having asthma, but if Iwas, it would make me upset. Backwhen I was younger, I thought hav-ing asthma was embarrassing – I didn’t think anyone else had it, and I thought I would get made funof. But as I got older, I realized thereare so many other people with it, so it’s no big deal.”

Alexis: “Thankfully, nobody haslabeled me as a ‘nerd’ or a ‘loser’ for

having asthma. But there’s the worrythat, if you have an attack and youtake out your puffer, that people will label you as ‘the druggie.’”

Q. Do you have any advice forother teens with asthma?

Ashley: “My advice for teens withasthma is to take yourmedications properly and don’tbe afraid to tell people you have it.”

Alexis: “Having asthma is stressfuland annoying. But my advice toother teens is don’t worry about kidscalling you names. They only do itbecause they don’t understandwhat’s going on. If you have anyproblems or concerns, just ask yourdoctor. And don’t be afraid to talkabout your asthma with yourfriends, especially if they want to understand more.”

Are you a teen with an asthma story?Write to Currents at [email protected]

36 ALLERGIC LIVING | SUMMER 2011

Teens open up about what it’s like togrow up with a respiratory illness.

Me, My Friendsand My Puffer

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