Q&A about asthma with Dr Mike Thomas - ANSWERS BACK

[RachelMumsnet]

We are pleased to tell you that Dr. Mike Thomas, the Asthma UK Senior Research Fellow with the University of Aberdeen is returning to Mumsnet, to answer your questions about asthma. If you have a question for Dr Thomas, please post to this thread before midday on Friday 10th February and we'll be posting to his answers on Wednesday 22 February.

Asthma affects approximately 5.4 million people in the UK1. A recent survey in the UK shows that almost 50% do not have their asthma under control. Many people living with asthma are unaware of the Asthma Control Test (ACT), a simple 30-second test developed by leading asthma experts, which gives asthma patients a useful measure of their asthma control in an easy-to-understand score.

THIS ASTHMA Q&A HAS BEEN SPONSORED BY GLAXOSMITHKLINE

Mike, I'm really interested in the connection between a UK senior research fellow and GlaxoKlineSmith. Does this mean you only test their drugs? I know their is business is selling drugs however does it not become a vested interest for them to have you researching for them? Are you paid by them?

I'm a Buteyko convert myself by the way .

Hello
I'm in my 40s and have had - what I'd call mild asthma for 20 years. I use Becotide 100 once a day. I'm living in Asia just now and recently saw a specialist for a check up. I have no symptoms, am fit, exercise regularly etc.

The specialist carried out a spirometry test on me which shows moderate obstructive pattern and flow volume loop is indicative of airflow limitation at small airways level. It said I had a lung age of 73.

I have been shocked and quite gutted to have this on a report. The specialist didn't really explain much to me so I would be really grateful if you would tell me how serious this is and what it means for my future. I also have nasal polyps and suffer from Aspirin allergy. I never need to use Ventolin.

My mum has suggested my dh has asthma, he is 42 and as far as I am aware has never had any tests for it. He's not having asthma attacks as I think of them but does have breathlessness and a right chest as times as well as a cough type thing going on.

Is it worth him going to his GP?

Also I suffer from hayfever, I had one asthma type attack in childhood which was reacting to a situation, with this and the above should I be looking out for signs of asthma in my children? And what specially should I be looking out for? (guess that last question applies to adults too if different)

Thanks

I am a little bit greedy so I will ask two questions if I may. I have had suspected Asthma and have been on clenil modulite 100mg (2 puffs morning and evening) for probably 9 months. Before I moved house two months ago I had to use my ventolin inhaler at least two or three times a day. Things seem to have settled in my new house so I am thinking that either there was some environmental factors or that my treatment had settled. Anyway two weeks ago I saw the doctor here and she said that if I didn't use my blue inhaler everyday, I should reduce my dosage to one puff or less as I might not need it any more. I did that and every night for the past 10 days I have worken up with a tight chest and have had to use my blue inhaler. Does it mean I have to go back to two puffs twice a day and stay on that dose for the foreseeable future?

My second question is for DS2 18 months (DS1 has suspected asthma too and is on brown and blue inhaler). DS2 was prescrived a brown inhaler (clenile 50mg) last year. Despite this he gets a chest infection pretty much every months, followed by a course of antibiotics that never fully clears the chest infection follwed by strong doses of oral steroids. Last time we took him to the doctor, we mentioned this and wondered if perhaps is medication is not adequate but were met with a "18 months old get at least 6 infections and 6 courses of antibiotics a year". DS2 finished his antibiotics at the beginning of last week, the infection didn't seem to have completly cleared and he has flared up again yesterday with temperature and very bad dry cough. Are they right that this is normal or should be insist that his treatment be reviewed?

Sorry for the long posts and thank you!!!

Please may I ask what makes another illness so dangerous when the patient has asthma anyway? Is it the combination of drugs needed? My mom was an asthmatic and had an awful case of shingles which made her very poorly.

I always thought asthma was hereditary, is this correct?

I have two questions although they are sort of linked!

Firstly, does getting an illness such as bronchiolitis as a baby damage the lungs and hence help to cause asthma or would getting such an illness merely be an indication that a child is already on the path to getting asthma?

and

Secondly, I have heard of salt therapy (i.e. inhaling salt in a salt cave for example) having a healing effect on the lungs and treating conditions such as asthma. Do you think this works and if so, can the healing be permanent (e.g. if lungs were damaged) or is it a treatment that you need to keep up continuously and if so how often is it needed?

Thank you!

Can you prevent an attack?

I had asthma as a child, but went away. Gradually returned once I went to uni and I think all the GPs assumed I remembered or was told about asthma. I wasn't really and I felt silly for asking. I can recongise the symptoms of when I'm going to have an attack, sometimes several hours before but I was wondering if there is a way to tackle these signs and stop it in it's tracks.

This thread seems to highlight how many people aren't involved in discussion about their asthma with health care professionals and what it all really means. Like it's so common we should all know about it.

My son now aged 4.5 was in hospital, on a nebulizer and steroids every time he got a cold from aged 8 months until almost two, for two or three days at a time (though never in intensive care.) We used salbutomol inhalers and he spent his 3rd winter on nightly 100 mg doses of beclomatazone (brown inhalter). That seemed to work but I was anxious about long term affects on someone so small. . . He came off the beclometazone for two yrs without major crises (we still used the salbutomol when he had colds) but is now back on, a low, (50mg) nightly dose, after the 1st course of predisonol for a while a few weeks ago. . . I accept this is the best solution at present (to avoid emergency treatment) but worry about the long-term effects of regular steroid use. . . will it affect his growth/eventual height/size, even slightly? (Is this actually known with any certainty?)
When I asked the GP she said, well, asthma attacks also have negative effects on growth, so of course I shut up. But the question remains. Is chronic asthma period associated with, er, being undersized, relatively speaking? (Are all asthmatics short!?) Have no other personal experience to draw on.
I also wonder if I could have avoided my son's last crisis by giving him the flu jab last autumn. It was offered us but I turned it down, given that we'd survived the last winter without anything (except salbutomol.)
Do you recommend flu jabs for (mild) asthmatics, even under 5's?

Same issue as hulahoop - is it possible to overmedicate? Have a close relative who is understandably very cautious with her 5 year old, who was in and out of paediatric intensive care with breathing problems in first years, so now every cough is a cause of anxiety, and they use a lot of medicine. Is there ever a danger in giving too many steroids, ventolin, montelukat etc? Can is suppress growth, or is there any risk of reducing the drugs efficacy?

(I'm asthmatic too, so know it has to be managed, also realise it's far more serious in children, so just want to support her in the best way possible).

Ds has been diagnosed with asthma along side his reflux problems. He does have a frequent cough but can asthma be diagnosed with checking peak flow first?
He is on blue inhaler " when needed"
Thanks

Ds has been diagnosed with asthma along side his reflux problems. He does have a frequent cough but can asthma be diagnosed with checking peak flow first?
He is on blue inhaler " when needed"
Thanks

Ps
Ds was 13 months when he was diagnosed with asthma and 2 months old when he was diagnosed with gastric reflux.

Hi,

how is asthma diagnosed in toddlers, what signs should I be looking at, and what questions should I be asking?

DS is 2.6, after a few minutes of running around or when he's overexcited he begins coughing until he calms down again/rests. He doesn't wheeze, just the cough. He doesn't really cough at night (that I've noticed) but when he gets a cold or any other bug it goes straight to a cough which seems to linger on for ages. He did have bronchiolitis as a baby, he was around 8-9 months if I remember correctly.

My GP keeps trying to push salbutamol inhalers at me but there haven't been any tests done and I don't want to give DS medication that he doesn't need.

DH, dd (11) and I are all asthmatic in a mild way - all on Clenil Modulite 100 every day and Ventolin as needed. We are aiming / hoping to go to Ladakh on a child-friendly trip with plenty of time for acclimatising in the summer - should we be ok at altitude? Everything I've read is encouraging so far but I'd hate to get there and find we've got that wrong!

Hi
My dd is 2 years old and has constantly suffered with a runny nose since she was tiny, it is always the same all year round. She quite frequently has a cough and always snores at night (bless her!). She has also had a hearing test and is not responding to the quieter sounds.
I've spoken to the doctor regarding this several times and he would like to try a course of inhalers as he thinks she could be asthmatic?

My question is really - I always think of wheezing and struggling to breath as symptoms of asthma, my daughter has none of these, so is it possible to be asthmatic without these symptoms?

Also, are there any side effects or long term effects of using inhalers. I am reluctant to give her inhalers regularly if its unlikely to help with her runny nose etc

Thanks

Hello, lots of worried parents on this thread, and I'm one of them.
My son is 14 months and was first hospitalised for difficulty breathing (70 breaths per minute = hysterical mother banging on the doors of the A&E).

I cannot accurately describe how horrifying it is to see your child struggle to breathe. I know all the parents on this thread feel the same way. My question therefore is this: are there guidelines for how physicians should communicate and educate parents of young asthma sufferers to help them cope? We have found this varies greatly, and when my poor boy is ill, his suffering is made worse by us 2 worryworts hanging over him counting his breathing every half hour, chasing him around with the salbutamol, rubbing potions on his chest, syringing his nose, the works.

Who's job is it to keep us calm and informed?

AND - do you have any top tips for getting a 1 year old to sit quietly while you administer a puffer with a spacer. We find the "half-nelson" is the only way - I guess if he screams he is only going to suck down more of the medicine!!!

Sorry - I meant to say he was first hospitalised at 5 months old.

Hi there
Thank you for reading my question,
My ds is 5. He was full term normal delivery, no neonatal issues.(born in may)
He started having breathing difficulties at about 6 months - croup / bronchiolitis - he is managed by a resp consultant to whom we were referred at about the age of 2.
She suggested singulair - we held
Off but then tried it as he was having soapy infections and antibiotics.
So fast track to age 4 - at a visit consultant says on reviewing x rays there s persistent collapse / something on x ray RML.
Broncho scope and CT later identified airway narrowing - Ct was deemed as 'grossly normal' but I was told come back to us if he s still getting chest infections ....
I just don't know where to go from here
He still gets RTI every month or so (have tried pushing him to not go to docs or have antibiotics but that has ended in a and e dash with pneumonia s etc.
Dust damp cold and illness aggravate his breathing and exercise tolerance.
Do we push for further investigations, or different meds - he s on 2x becotide 1x ventolin (plus prn) and singulair daily- when we try reduce this night time cough returns and his symptoms (daytime cough and poor exercise tolerance - doesn't want to walk/ run etc) increases.
Is the RML collapse likely to resolve (didn't after steroid wash out ) spontaneously as he grows?

Is there a chance he could have to have part of lung remover in the future due to complications with this?
What do we do about repeated antibiotics? If he were on different medication for asthma would he possibly be less likely to pick up infections?
Appreciate any answers or pointers you can give us - or even advise on what we should ask or talk to our own consultant about.

my son is 4.5. He has had a terrible cough, generally but not always worse at night, since mid Nov. He has probably had 2 colds during this period which makes the cough significantly worse. He has been prescribed antibiotics, then a blue reliever inhaler and now he has been given a 6 week trial of a brown inhaler. On 30 dec we took him to A and E with severe breathlessness and gasping. They gave him steroid medication.

The GP said we might want to consider cutting dairy for 3 months if the preventer inhaler does not work.

Is this asthma? If the preventer inhaler does seem to work (she said it would take 6 weeks to notice improvement) what should we do next? Should we see a specialist or asthma nurse? Can we get a definitive diagnosis at this age?

To add to it, we are awaiting ENT appointment as he has large tonsils and adenoids and GP thinks possible sleep apnoea. Can this be related to asthma?

Thanks for any advice!

My son who is 6 has had one admission to hospital for steroids and ventolin and I am worried when he coughs on exertion. i do not want him to be labelled as asthmatic but obviously worry incase I am doing the wrong thing. He has masses of energy, coughs on exertion mainly in cold weather, occasionally wheezes at night when I give him his inhaler, sometimes it resolves the coughing and wheezing at night but sometimes it doesn't. Is it best to give him ventolin everytime or wait and see if it does not settle before giving it?
Thanks

Hi,

Just a note to say that I used to be really bad at home when there was a Bank Holiday due to house dust. Three days at home. BUT since fitting the loft with a Baxi Clean Air system my Asthma has been soooo much better. It cleans the air in each room upstairs regularly and used to be fitted in a lot of pubs to clean the smoking (not needed now). I don't know if the company is still going, but they really saved me as I love ornaments and I dust regularly but was always poorly over a long weekend if I didn't go out and get fresh air. Hope this helps a few people. The cost was around £1,500 for the five rooms.

Hi
I was diagnosed with asthma as an adult maybe 5 years ago. I take Clenil 200mg twice a day, and rarely need my reliever. But my peak flow is always very low, about 250, it rarely reaches 275. (I am 5 ft 4). Despite gym going and the occasional run, it never improves and I seem to get more out of breath than my less active friends when plodding uphill, upstairs etc. Can I stop it declining with age? (I am 50 now).

My 8yo has had cough variant asthma for 2 years . he used to sore chests when he had colds. His peak flow is generally always good. But seems to have persistant dry cough - just in the day time. I use a nasal saline wash to keep his nose clear and in the hope it keeps colds away. He's on clenil modulite/ventolin. I almost wonder if it is more of a habit as no combination of inhalers seem to work that well. Is this likely or not?

My DD is 2 years old. she is getting ear infections for every 2 weeks and she is on antibiotics. does ear infection cause to asthma any time in future. or there is no relation?

Thanks.

My daughter has had a cough since she was 2 weeks old. She is now 3. Up until November last year it was almost constant with varying degrees of severity. She does not wheeze, but does cough when she runs. The doctors sent us away every time saying is was a viral or post viral cough or even croup. After several visits to A & E when she could not stop coughing one doctor finally prescribed Montelukast. She has not coughed since! She also now has a preventer which I use every day. The doctors want now want to take out her tonsils and adenoids. They say that they don't think it is asthma, but I am not convinced. Is there a test she can take?