Wendy Turner: Most of us know the discomfort and panic that can occur when we are short of breath. Well, asthma is an extreme form of this, particularly distressing for babies and the young children. Dr. Su Laurent is here. Now as you know she is our Medical Advisor and a Consultant Paediatrician at Barnet & Chase Farm Hospitals, welcome Su.
Su Laurent: Hi Wendy.
Wendy Turner: Right. What exactly is asthma?
Su Laurent: Well, asthma is -- this correct medical definition of asthma is reversible airways narrowing, which means that for a variety of reasons, the main airway supplying the lung becomes narrow and then these airways can be made it to widen up again using specific treatment or naturally by themselves in the course of time.
Wendy Turner: Is asthma something that you can be born with? As a baby, you sort of be born with asthma or just something have to trigger it?
Su Laurent: That’s a very good question. Usually, if you look at your family tree, you will find that there were lots of other asthma or hay fever or exma sufferers in the family. And therefore you are born with a genetic tendency to having asthma. It doesn’t necessarily mean you’re going to get asthma however. And we never diagnose asthma in a baby at birth. This diagnosis, we tend to make when they are quite a bit old, when they are about 18 months. The reason that you should delay a diagnosis is because many, many babies will become wheezy and have a lot of coughing in the first year of their life. And as they get older to about 18 months or so this tendency to wheeze with cold often disappears but as those babies and young children who get left with that tendency that we diagnose of having asthma.
Wendy Turner: So as a parent, how would you know that your baby is having an asthma attack?
Su Laurent: Well, the social symptoms as a child or a baby might have are severe cough, everytime they get the cold and a wheeze. And by wheeze, it’s that noise that a baby makes when they breath out. So in other words, there sometimes babies make noises when they breath in and sometimes they make noise when they breath out like that. It’s the noise breathing out specifically. And on top of that, it’s the difficulty of breathing that’s specific to asthma. So you will see a child coughing, making a wheezy noise and actually working quite hard at breathing. And looking at their ribs, you’ll see that the skin between ribs become sucked in and sometimes if you look at their neck, you’ll see that the skin just above the neck becomes soften as well. And the nose might even flaw a little bit. All these are signs that there is narrowing of the main airways.
Wendy Turner: And presumably as a parent to get in if that happens straight to the doctor or hospital?
Su Laurent: Well, certainly. It depends on how distressed the child is but if this happens, it’s certainly worth going into seeing your GP. Many children on what we call happy wheezes and babies particularly so they just wheeze a way that they carry on feeding, they are a lot pink and nice and happy and they cough a bit, and there is nothing specific you need to do those for children other than just getting them checked out by your GP. But there are some children who clearly become distressed when they have asthma and the short of breath and those children do need urgent medical attention and some advice about management.
Wendy Turner: How life threatening is asthma generally?
Su Laurent: That’s a very good question as well. And asthma as a whole is a potentially life threatening illness. In other words, every year, there are few children and adults who will die from asthma. However asthma is extremely common and the vast majority of people, it is not life threatening in. So that’s most important message really for parents, that the most children with asthma, this is not going to be life threatening and it’s very manageable but they do need to see medical attention.
Wendy Turner: Can you actually grow out of the condition?
Su Laurent: Are the question -- are always paying off.
Wendy Turner: With host.
Su Laurent: With host, exactly. And the answer is many children have asthma who then seem not to have asthma when they are teenagers or adults. So it seems to be common over the younger children, as you get older it’s less and less common. But you don’t grow out of that genetic tendency. So in other words, you may have it for a while when you were a young child, and then you may seem to have no symptoms as a teenager or an adult and you’re decorating your flat or you’re doing a lot of cleaning or you’re exposed to something that triggers you, and suddenly you might have an asthma attack again.
Wendy Turner: My husband suffers with asthma and it’s always cans, reaction to cans that brings the asthma on. Does he always have to have something to trigger it?
Su Laurent: Well, that’s interesting because a lot of people will meet to try and find a course for that child’s asthma, they want to find out something that they can remove or treat for the asthma. In adults, quite often you might find a provoking course such as a cat or a horse. But in short, it’s very unusual and in fact usually in adults, the test is not very helpful. The commonest reason in children is caused, it’s viral upper respiratory tract infections. Most parents will say the child gets a cold, then they start to wheeze. There are some other specific courses however and about 85% of children with asthma are allergic to house dust mite. And, of course, it’ll be very difficult with a house dust mite but you can use measures to try and reduce the amount of that is around. And lots of parents or children who have quite bad asthma will remove all their carpets and have wooden floors.
Wendy Turner: Floor bed.
Su Laurent: They’ll have sort of high pillows so that you can wash and therefore get rid of house dust mite; they will mattress covers to prevent the house dust mite from coming up and in the night and causing allergy.
Wendy Turner: Does that really help?
Su Laurent: It does. It certainly seems to helping some children. But I think before we just move on from the trigger factors, one of the most important trigger factor is cigarette smoke.
Wendy Turner: Really?
Su Laurent: And I can’t stress this enough. In a child who has asthma, particularly the under 5s, the most important provoking factor is cigarette smoke and that’s even in parent who smoke outside the house only, it’s important just to really make every effort to stop smoking completely.
Wendy Turner: So even for instance, if he was on a parents’ clothing.
Su Laurent: Yes. They can still inhale it from parents’ clothing and that’s so important. And removing smoking atmospheres, not taking children who are wheezes in to -- smoking, that sort of thing, it’s very, very important.
Wendy Turner: Absolutely excellent point.
Su Laurent: Now you’ve got an array of good issue brought into the show.
Wendy Turner: So you just take me through -- there is actually one I recognize and it’s the white turn --
Su Laurent: The while inhaler.
Wendy Turner: Yes.
Su Laurent: Well, many people will recognize this inhaler. This is what is commonly used to treat asthma. And what you do is you have a little puff like that and out it comes and it’s an aerosol. This is what’s commonly used in adults and requires an awful lot of coordination to use this. So in young children who are using inhaler like this into a space such as this, hold this, hold this.
Wendy Turner: So these three things are doing the same.
Su Laurent: There are a number of different things that you may be given by your doctor.
Wendy Turner: Right.
Su Laurent: This one actually is being faced out. But I will show you this one, this is been around for a very long time and it’s easy one to show you because it’s quite big and colorful. What you do is with a young baby, you’ll put this mask over the baby’s face, and then you’ll press the inhaler like that, it forms a mist in here and the baby breaths in and out. And what they breath in will help to relax their airways. It’s very effective and can be used at home, you can take this around. It’s not particularly handbag size.
Wendy Turner: No, it isn’t, not my bag anyway.
Su Laurent: We provide these two that become much more useful recently.
Wendy Turner: Yes.
Su Laurent: This is a much smaller one and this one is a nice little because you can fit it in, you inhale it, any old inhaler will go in there. You can either put a mask on the end here or again the lips around here and then hold the child.
Wendy Turner: Yes.
Su Laurent: Again, press here, the child breathes in and out through here. This requires no coordination. There are two different types of inhalers that we use in asthma. There is one that you use to treat the child immediately. So when they are wheezing, when they are coughing, when they are breathless, you use this inhaler, which is usually a blue inhaler.
Wendy Turner: That’s right.
Su Laurent: Remember that, yeah?
Wendy Turner: Yes, yes the blue one. I’ve also seen a brown one.
Su Laurent: Well the brown ones are the preventers and they are very important in children who are getting lots of asthma attacks. So some children just need blue ones, they have this regularly everytime they have a cold but they’ll go for weeks and weeks or months without using it. But there are some children who really get wheezy most days, when they run around and do exercise or they are just generally wheezy. And those children will need a preventer and that’s where the brown one comes in. the brown one is an inhale steroid, which just goes in tiny little dosages into the lungs, but not into the rest of the body. And it’s very, very successful at preventing asthma attacks or reducing the severity of the asthma attack.
Wendy Turner: Is there any danger with these kinds of things, you mentioned steroids?
Su Laurent: Well, that’s the question that parents will frequently ask me, is there a danger from giving inhale steroids? If you would give massive high doses for very long periods of time, a small amount can make harm absorbed into the blood stream. But these days, they are normally prescribed for the average child with asthma has no danger at all because we are talking about micro grams and micro grams are millions of a gram that you’re getting inhaled. Whereas when you get steroids by mouth, and sometimes we have to do in severe asthma attacks, we’re giving milligrams, which are thousands of a gram, so a thousands times more you’re giving by mouth.
Wendy Turner: But it’s really nothing to stop nothing to worry about?
Su Laurent: Nothing to worry about. And it’s far more dangerous to have a child with prolonged untreated asthma. Untreated asthma can lead you to long chronic illness in your later life whereas treated asthma will give you a child who goes to school everyday, reaches that full potential, there’s plenty of exercise and it’s a healthy child.
Wendy Turner: Okay. So -- now why is this worth being -- just because it’s --
Su Laurent: It’s fading it out, may be because people prefer slightly smaller devices. I am sure but they are providing these instead nowadays. And I think a lot of parents will like there because you can set them in your handbag and carry them around with you.
Wendy Turner: Yes, it’s lot more user friendly.
Su Laurent: And of course, some children, when they reach – when they are slightly older, and when they are four or five, they sometimes not really want to use these big devices, which I would always recommend the big devices but there are other things, you know, all devices like this, which you can take again in the bag and breath in through here, like that, and also very successful. And there’s something like this, the other one that you breath in and out and you just breath in this way. So there were lots of different ways of treating asthma. We’re usually try and match the device to the child bearing in mind that, if you’re very breathless, it’s much better to use spacer device that it is to use to one of these devices, it’s much easier to use spacer.
Wendy Turner: I see, yeah. And what’s this one for here?
Su Laurent: You might like to try this one. This is a way of -- in a child who is sort of four or five older. We can assess how much puff they’ve got and it’s quite difficult way of finding out if they really have got or not because we know how hard you should be able to puff according to your height.
Wendy Turner: Okay.
Su Laurent: And therefore, if you can’t puff quite as hard or if we find, we sent the child away with one of these and if we find that the amounts of puff they’ve got is actually reduced from time to time, it’s always that, yes that awful cough you have is actually because of asthma and then we know how to treat it.
Wendy Turner: So what is that going?
Su Laurent: Well, this is yes, they goes on. First that we have to take a very deep breath in and then you have to build a blow very hard, and if you’ve got narrowed airways, you can’t get the air out quite so much, quite so quickly. So what – this is an adult one because I brought this along for you to try.
Wendy Turner: Thank you.
Su Laurent: And what I am going to ask you to do is take a big breath in and then blow as hard as you can, not as long but as hard as you can and we’ll see how much puff you’ve got, how much you push this thing over here, okay. And first of all, don’t put your finger over the little finger.
Wendy Turner: It’s full swing?
Su Laurent: Exactly. Now, that’s fantastic, very good. And you have got a 450 litres per minutes, which for your height is very good.
Wendy Turner: Oh really?
Su Laurent: And I think you are probably not a smoker in that case.
Wendy Turner: No, you are right.
Su Laurent: Now many smokers, even if they don’t have any symptoms will actually have a lot less puff in that.
Wendy Turner: Really?
Su Laurent: Which is another sign that they are damaging to their lungs.
Wendy Turner: Yeah, that was interesting.
Su Laurent: So, well done.
Wendy Turner: Yes. Do some people get around to the tip?
Su Laurent: Some people are -- don’t worry about that. I repeat it’s all related to height. So if certainly some very tall man might get up to 700 or 600.
Wendy Turner: Oh, I see, yeah.
Su Laurent: But if I was to worry about you having asthma, then I’ll send you away with one of these, so you keep a dairy of this and we’ll see if your values go down. And if they do go down, then you take your inhaler and we’ll see if your value goes up again and that’s how we would organize asthma.
Wendy Turner: Okay. There’s no cure is to as such, it’s just a manageable?
Su Laurent: That yes. Another very good question. There’ s no cure for asthma, it’s something that you may find as you get older, you grow out of. But using the preventers, and there are a number of preventers, not just inhale preventers but also little tablets which work to prevent this. Using those, we can often eliminate all or most of the symptoms so that you can manage day-to-day life with absolutely no symptoms. And there are a quite a number of sportsmen out there who have got asthma but they doesn’t inhibit them in anyway from doing exercises.
Wendy Turner: So if a parent is concerned, obviously see their GPs?
Su Laurent: See their GP. I think most GPs are extremely good at managing asthma, it’s a very, very common problem. Many GP practices have an asthma nurse. And that asthma nurse is probably the best person to go to on a regular basis to check out how the inhalers are going, how well the child is doing, whether they are sleepy all through the night or coughing all through the night. And I certainly recommend going to see your GP for advice.
Wendy Turner: And of course it’s one of those things that you don’t want to take over your child’s life.
Su Laurent: Exactly, which is why it’s important to seek advice and not worry about using inhaler. I think this is the important thing, the inhalers are there for a very good reason. There is a national company called the – which is here, the National Asthma Campaign, and they produced lots of very good leaflets and we’ll have that details on our website.
Wendy Turner: On the Baby Channel website?
Su Laurent: On the Baby Channel website. So I also find that parents find reading that sort of information, one which had a little conversation very helpful and also looking out this website and calling and getting more help. It’s a very, very common problem, there’s lots of help out there.
Wendy Turner: Right, I am sure you put lot of minds at rest giving excellent advice. Thank you very much.
Su Laurent: That’s right. Thank you.
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