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Understanding asthma

Martin Bell  
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Do you or does someone you love suffer from asthma? Can stress or even a fit of laughter send you desperately hunting for your inhaler? Do you have to stop your child from even entering a house where there is a dog or a cat because just breathing in the animal hairs can trigger an attack? You are not alone. Nearly a quarter of children and a significant 6% of adults are affected by asthma.

Victims’ conditions can vary from being very severe to fairly mild. Asthma can range from being life threatening or limiting a sufferer’s ability to lead a normal life to just being a nuisance. Some victims cannot go outside if there is a high pollen count and others cannot do strenuous sports. But how do doctors diagnose asthma and what can sufferer do cut down its effect on their lives?

Treatment has improved dramatically in the last few years but the range of different medicines available can be bewildering. Each sufferer’s asthma is different and how can victims or the parents of children with asthma know which treatment is best for them or their little ones?

Dr Martin Bell will be clearing up the confusion surrounding this very common condition and giving advice on how sufferers can lead a completely normal life. He will be happy to answer any questions you might have about asthma and its treatment.

TRANSCRIPT:

LS: Lis Speight, host
MB: Dr. Martin Bell, guest doctor

LS: Hello and welcome to the Healthcare Show I'm Lis Speight. Now do you or your loved ones or friends suffer with asthma? Does stress or even an outburst of laughter send you hunting around desperately for your inhaler? Or maybe you have an asthmatic child and you’re worried about letting them visit friends or family who have cats or dogs for fear that the pet hairs could trigger an asthma attack? Well it might be comforting to know that you’re not alone, nearly a quarter of children and a significant 6% of adults are effected by asthma. Now thankfully treatments for this condition have improved dramatically over the last few years but there’s a real wider range of medicines available to treat it and it can be quite bewildering. Everyone's asthma is different so how do you know that the treatment you're getting is the best for you or the best for you child. Well I’m pleased to say that to help guide us through this confusion GP Dr Martin Bell has joined us in the studio. Welcome along Martin.

MB: Thank you.

LS: It's nice to see you again. Now we’re going to be discussing what causes asthma, how to treat it etcetera, etcetera, so if you have any questions at all for Martin then do get in touch. All you have to do is type your name and where you’re from in the box that's on your screen press submit and it’ll come thought to us in their studio and we’ll try to get through as many as we can. Now lets kick off the chat then Martin. Can you explain to us first of all what exactly is asthma?

MB: Yeah. I suppose the technical way if describing it is something called a reversible airways disease but without getting too technical essentially what that means is that a few things happen to your breathing tubes during asthma. One of them is that the tube becomes a little bit smaller because of muscle contraction in the muscle of the tubes, but probably more significantly than that you get inflammation and swelling of the lining of those tubes,

LS: Right.

MB: with lots of sort of mucus and all of that contributes to narrowing that little airway down the middle which we all rely on for the air to go in and out of our lungs. So quite a few things are going on there but probably the most significant is the inflammation of the airways.

LS: And what actually causes that?

MB: Well the honest answer to that is no-one really knows. It tends to vary from person to person so for instance you’ll get allergic asthmatics who will get asthma if that come into contact with cats, or dogs, or pollen.

LS: Mh-hm.

MB: Some people become asthmatic in certain weather conditions, others if they get a bit of a chest infection, or some people who have severe asthma will have that inflammation going on all the time for reasons that we don’t really know. There seems to be to a degree an inherited element.

LS: Oh right that's interesting.

MB: Yeah.

LS: So if your family has got it you’re likely to have it?

MB: That's exactly right. It’s not a 100% thing so if your parents have asthma it doesn’t mean that you will inevitably get asthma but it means that you’re probably more likely to.

LS: And why is that? Or is that too complicated. [laugh]

MB: It's a bit too complicated and really people don’t understand this. I mean I suppose you could say that so many things are genetically orientated.

LS: Yeah.

MB: So that there must be some sort of predisposition. Stick in another little trigger factor like an infection or an allergy or something like that and out comes this asthmatic problem.

LS: Yeah, and what are the actually symptoms of an asthma attack?

MB: Yeah, well most people think of the symptoms as those sort of classic very breathless, wheezy, gasping for breath thing which obviously is the case in quite severe cases, but probably GP would see asthma more often as a persistent cough in it's mildest form. A Mum or Dad will bring their child in and will say you know “My child has been coughing at night particularly.”

LS: Oh and that could be asthma,

MB: It can be asthma.

LS: but it wouldn’t necessarily link to the two.

MB: Absolutely right and often they’re quite surprised when the Doctor starts mentioning the word asthma you know. It isn’t always that but that can be one of the signs of a very mild type of asthma. Asthma is a bit peculiar in that it tends to get worse for some reason towards the end of the day or first thing in the morning.

LS: Oh right.

MB: So if ever you have somebody who’s getting breathless, or wheezy, or having a cough at that time of day most GP’s a little light will go on their head and they’ll be thinking &LSquo;I wonder if this is a bit of asthma?’

LS: Mmm, is that to do with lying down then at night or?

MB: No not really.

LS: No.

MB: It's thought that it may be due to believe it or not, leveLS of adrenaline.

LS: Oh.

MB: Which is this hormone that we all have and I suppose we tend to associate adrenaline with when we’re a bit anxious or nervous.

LS: So that's why stress could trigger a bout or an attack.

MB: Stress can sometimes trigger it that's exactly right. But equally apparently your adrenaline leveLS get a bit low towards the end of the day and for some strange reason that allows that asthma tendency to become more common at those times of the day. That’s the theory anyway. So we tend to sort of look for those patterns. Equally in it's more severe forms you know yes you do get that breathlessness, the gasping, you know the wheezing, and as you said in your introduction is such a variable thing.

LS: Yeah so actually putting your finger on that fact that you’ve got asthma can be quite difficult sometimes do you think?

MB: Can be sometimes, can be very obvious occasion you know Granny can spot it and say “Oh yeah you’ve definitely got asthma.”

LS: Yeah particularly if it's in the family I guess then you know.

MB: If it's in the family she's probably seen it before and you’re getting that classic wheezing and breathlessness and so on. But equally it can be sometimes a bit tricky and sometimes in the surgery we might think &LSquo;mmm. I wonder if this person’s got asthma?’ And may then have to so some further tests or even sometimes we would try out treatment for asthma to see if it would work.

LS: Right to sort of rule it out.

MB: Absolutely right you know so it's not always the easiest thing to diagnose.

LS: Mh-hm. Now is asthma actually increasing 'cos a lot of children these days seem to be getting it?

MB: Yeah no it's definitely on the increase.

LS: And why is that?

MB: I don’t think anyone really knows I mean most people at this point their thoughts turn towards pollution.

LS: Yeah well we’ve got a question in on that actually.

MB: Right.

LS: Funny you should mention that. Darryl MacDonald wants to know “With over 5 million asthma suffers in the UK” that's I lot I hope that figures correct, “could there be a link between the condition and air pollution? Has anyone ever investigated this?”

MB: Well yeah lots of people have investigated it actually but no one has proven that that's the case. In fact in North America they did a study on about a 1,000 children and measured the pollution leveLS in several cities and tried to monitor these children and see if their asthma got worse when the pollution leveLS were high. And their study basically showed that there probably was. But the word was probably and felt that more studies should be done. So I know we’re all very hot on pollution these days and there is that sort of feeling surely it must be something to do with pollution

LS: Yes it’s obvious, it must be that but it's not always that straightforward.

MB: It must be pollution yeah. It isn’t that simple and as I say it hasn’t been categorically proven that that's the case because I guess it different things for different people. And that's one of the tricky things about asthma is it is so variable one person to another. You know you can’t make a hard and fast rule about it.

LS: It's quite complicated for a GP then isn’t it?

MB: It can be yeah. It can be absolutely trying to spot it.

LS: Trying to sort it out, you earn you money we don’t mind that do we? [laugh]

MB: Absolutely, absolutely.

LS: Now Brian Clifton has sent in a question he asks why his asthma is worse in the countryside all year round than in central London. So maybe it's not pollution that’s affecting him then?

MB: Yeah. Yeah. Well I’m glad you asked that question 'cos his question highlights that you see because you know as we’ve said pollution isn’t always the problem and it can be other factors and probably for him it probably is a little bit of hay fever or some allergens some things that are speaking off his allergy in the countryside. So for him it's a bit of an individual thing you know and his question really does highlight that fact that it's multifactorial, different things for different people, it can be weather related, or it can be viral related so

LS: Oh right.

MB: you know it’s always so simple.

LS: So it's up to you to manage your asthma and to find out what's right for you. Which can be difficult I guess can’t it? Especially for children.

MB: Yes it can be, I mean sometimes it's sort of trial and error. You know you might find that every time you go and visit a particular Aunt who has horses it gets worse you know.

LS: Yes you’ve got to be a bit of a detective then really.

MB: Exactly sometimes you do have to be a bit of a detective and sometimes it can be very obvious but in other cases it's not so simple.

LS: Yes little dust mites and things like that I suppose.

MB: Yeah well dust mite is a very common problem because you know every household including Buckingham Palace has dust mites.

LS: Even the Queen has dust mites?

MB: Even the Queen has dust mites. Absolutely although I’m sure it's spotlessly clean in there. [laugh] But some people have an allergy to the droppings of the house dust mite and that is a very-very common allergen a very-very common reason for people to get their asthma if they are a bit prone to that sort of problem. And there are measures that those people can take to try and reduce that problem by hoovering their mattress regularly, turning it over regularly, I have even heard that a good way for getting rid of house dust mite is to put your blankets and your sheets in the freezer.

LS: Yeah, I've heard that 'cos it's quite good at killing them. You’d have to have a big freezer though to fit your duvet in though wouldn’t you?

MB: Absolutely, that’s right.

LS: I don’t think we’d fit it in our freezer not with all the rubbish I've got in there.

MB: Those massive great things. [laugh]

LS: But childhood asthma though can you actually grow out of that, I mean are you likely to have it as a child and then it just goes?

MB: Yes it's very common actually for children to grown out, it doesn’t always follow but a vast number of children who have it as a child as they get older the tendency gets less and less and less and certainly in the surgery we will find that we will be perhaps doing their annual check and then you’ll see these children less and less often and then you know they won’t be asking for their inhalers so often.

LS: Yeah.

MB: And gradually they disappear sort of off your radar screen and this is this child as he's going into sort of late childhood early teens, getting better you know.

LS: And is that because the airways are getting bigger?

MB: There must be something to do with that I think and aLSo there probably is an element of this inflammation, this tendency towards inflammation reducing, perhaps getting a bit less prone to the allergens a little bit less prone to things that stimulate the asthma as you get older you know perhaps as you get exposed to the world your body sort of get adapted to these things.

LS: Right. Yeah.

MB: And that's my own theory but it just does seem to follow that.

LS: Yeah. Okay. Now Mark Barton has written in and he says “My asthma always seems to worse in the summer. I have never suffered with hay fever so I was wondering if there is an explanation for this?”

MB: Yeah. Well that's good one because Mark again is saying that it isn’t necessarily pollution his is what would be called seasonal asthma. So there’s probably something in the air that is speaking him off. Now people often say that it isn’t hay fever and he might be right but remember there are different types of hay fever there are different things that people are prone to. So you know grass pollen will be a problem at a different time of year to lets say tree pollen. So probably for him there’s something in the air that is sparking his asthma off, probably is a sort of hay fever type problem even though to him it may not seem like it and he may not get the other sort hay fever symptoms, but you know he’s another person who’s sort of saying you know probably not pollution you know, probably seasonal rather than you know rather than any sort of pollutant activity going on.

LS: I don’t know whether you can answer this one at all. But Nicole has written in and she wants to know “Do dogs get asthma?” Do animaLS get it or do we know, would we know? [laugh]

MB: As far as I’m aware they don’t but not being a vet I couldn’t swear to that. [laugh] Probably I’m sure somebody will probably email us and say that their dog definitely has asthma.

LS: Maybe Nicole’s dog has been coughing a lot or something maybe take him to the vet I think that's what he might.

MB: Probably needs to go, I've never actually seen a dog have an inhaler but you know I’m quite happy to be taught this thing. You know [laugh].

LS: Now we were talking about dust mites a little bit earlier and modern houses a lot of modern houses have wooden floors don’t they and David has written in and he wants to know if it's better to have wooden floor in your house as opposed to carpets? Carpets are a little bit out of fashion at the moment aren’t they and a lot of people have got wooden floors.

MB: Yes, yes they have.

LS: Is it easier to keep them clean, keep the dust mites?

MB: Yes it is, and actually before the pollution theory came along one of the other theories that was around was this sort of central heating, closed atmosphere thing that you know people were thinking that you know because you’ve got this warm moist air in the house, we’ve all got double glazing, we’ve all got central heating, we’ve all got carpets, that somehow the air is perhaps less fresh, is a better environment for things to grow in, and there probably is something to that because you know that might explain why asthma is increasing so much. So yes is the answer you know having wooden floors definitely does help, along with having less of the sort of drapes all around the house you know those sorts of things.

LS: That can sort of harbour dust and nasty things lurking in there.

MB: Yeah the dust and the dust mite and that sort of thing yes, yeah.

LS: And do you think the British weather has any bearing on it because the sort of hotter counties, the drier climates,

MB: Yes. Yes.

LS: do you think hat that has an effect?

MB: I think that has a factor because certainly the UK and particularly Scotland have one of the worst leveLS of asthma, diagnosed asthma in Europe.

LS: The poor Scots they get lumbered with a lot of health problems don’t they?

MB: I know, they do yes, yeah. For once you know they really suffer with this one unfortunately and you can’t help linking the sort of weather that they have in Scotland and the weather that we have that sort of temperate you know damp climate you can’t help linking that a little bit with asthma, and any GP will tell you that sometimes you can actually predict when you’re gonna' see somebody with an asthma attack.

LS: Oh that's interesting.

MB: Because it will be sort of foggy, you know that sort of foggy weather.

LS: But why does that have an effect then, you’d think would sort of damp it all down and it would?

MB: Well as you’re gathering now there’re are lots and lots of theories surrounding asthma

LS: Different triggers yeah.

MB: which means that we don’t really know, but one of the theories is that when you have, 'cos asthma is often worse after a rainstorm strangely.

LS: You see that would seem the wrong way round to me that’s really funny isn’t it?

MB: Absolutely the wrong way round, you know you think the rain would sort of cleanse the air, less pollution that sort of thing but actually the theory is that in amongst the rain you get lots of droplets coming up from the ground carrying these things that spark people off. Next minute every GP surgery in the land has got somebody on of those nebulisers you know tryna’ make them better you know, so that sort foggy or recent rain is the sort of thing that tends to spark people off.

LS: Yeah, now talking about the weather actually we’ve had a question from Joan in Bristol and she wants to know, oh she says “Hi there.”

MB: Hi.

LS: “My daughter suffers really badly from asthma in the winter but it dies down in the warmer months is there a reason for this?” So it's similar to what we were saying really.

MB: Yeah. Well again this just highlights how different things effect different people when they’re asthmatic and certainly there are people who will be altered by the weather some people will be effected by that sort of muggy weather that we talked about, but definitely other people will be effected by colder weather, and she will not be alone in as much as there are lots and lots of people who on those very cold winter days they will go out of the front door and within minutes they will have to use their reliever or puffer you know to make them better. So that's another very good question that sort highlights how there is no one thing you can say right this is asthma, this is what sparks it off, this is what treats. It's a sort of multifactorial thing and that's why it can be quite challenging you know when you come to treat somebody because you need to look at all those different factors that.

LS: Look at their lifestyle and where they go and.

MB: Yeah and what sparks that particular person off you know that will be fairly classic question that a GP would ask of somebody about their asthma is when do you notice it most you know, what do you find sparks it off? Because that might provide a bit of a clue as to what that person can do themselves to reduce the amount of asthma they get.

LS: And what are generally the triggers we’ve talked about this a little bit but explain what are the main ones you think.

MB: Yes well the main ones, exercise is a very common one, so you’ll often get people who have exercise induced asthma, seasonal asthma like the person who sent in the question about the winter months, you know that's a very common so a particular season will spark somebody off. Sometimes pollution or you know when somebody’s in that sort of environment that has to one, and some smokers will find that when they smoke it get worse.

LS: Mmm. You can’t imagine smoking when you’ve got asthma?

MB: You can’t imagine it but people do.

LS: You must wring your hands mustn’t you? When they come through your door.

MB: [laugh] I’m afraid people do unfortunately and it's only when it gets really bad that you sort of convince them that that is not the thing to do. And I guess things like stress you know is another factor that sometimes people when they get very stressed they get an asthma attack you sometimes see these people in a meeting or something and they have to sort of sneak off and have a couple of puffs of their reliever inhaler. So those are the sort of main things.

LS: And what about allergens as well.

MB: Yeah definitely absolutely allergens which will be different for different people. You know pollen for some people, dogs or cats, for other people sometimes those can actually be the easiest people to treat because obviously if it’s very specific to cats, I mean for instance I’m quite allergic to cats and when I visit somebody I don’t even have to I know that they have a cat but within a few minutes I will be you know wheezing slightly.

LS: Yeah and is that definitely and asthma 'cos that happens to my husband as well actually he's very allergic to cats he aLSo gets hay fever and he thinks it's sort of his hay fever but that's actually asthma is it?

MB: Yeah it is it's allergy asthma it's allergic asthma basically. So he is right and you know it's on that huge spectrum of asthma from you know only bothers you very occasional and in certain situations to those unfortunate people who have it sort of all the time every single day and they have to manage it every single day like a very much a chronic condition. There's this huge spectrum of severity so your husband like myself will be on that sort of mild end and he will hopefully know you know what to avoid if he possibly can.

LS: Yeah now Annette has written in and she wants to know “Can asthma, panic or crisis attacks be triggered physiologically?” I think they’re all different aren’t they?

MB: To a certain degree Annette yes. I mean certainly I think psychology plays a big part in so many different things and I’m sure that is true of asthma. But if you are a bit stressed or panicky or anxious you probably are right that your’s will be made worse in those situations, hard to explain why that happens but very definitely that does happen, we know of those people where you know stress or anxiety will make it worse and very hard for people like Annette really because it's all very well to say you know well try and avoid stress, but you know stress is part of every life isn’t it, everyday life.

LS: Even just running for a bus or something like that, well not running 'cos that exercise but you know just being late or something you can’t avoid it these days can you?

MB: Yes that's exactly right so of her it will be more about you know what I can do perhaps with my medication to prevent that or to be one step ahead of it. But actually quite good that she seems to have been able to identify those situations where she knows that it's gonna' get worse because often that will allow her to take certain measures. I mean some people for instance get to in the habit of using their inhaler before a situation where they know they’re gonna' get it.

LS: Right. Preventative.

MB: Yes a preventative type of measure which is really useful 'cos then they don’t even have to be rushing out to use their inhaler they can use it what's called prophylactic you know before they have the problem they use it so.

LS: Yeah. Okay. I hope that's helpful Annette. Thomas from Suffolk has aLSo sent in a question and he wants to know “What are the symptoms of an attack and what I would do if I saw a friend suffering from an attack?”

MB: Yes.

LS: It's quite frightening actually isn’t if you don’t really know?

MB: Yes, yes I mean what a good question that is because it's such a common problem. Asthma UK tell us actually that half a million people suffer from some sort of asthma attack every day which is quite an amazing statistic really isn’t it? Having said that it's probably worth just saying what an attack is because.

LS: Yeah how serious that is I suppose the range is huge.

MB: It's huge and I actually try and avoid using even in my medical notes using the word asthma attack 'cos that makes it sound like you know being set upon or something and you’re about to collapse. But probably what they mean by attack or what he means by and attack is that he’s having to consciously having to do something about it that day. And I suppose and asthma attack can be anything from noticing that you’re having to use your reliever inhaler more often and that perhaps your exercise it a bit limited that would be a relatively mild asthma attack, but a severe asthma attack would be one where really you’re having to concentrate all the time on breathing that your really can’t do anything other than sit in a chair. You know a severe asthmatic can’t get to the end of a sentence for instance.

LS: Mmm and how does that feel? Does your chest tight? I mean have you ever had and attack like that?

MB: I haven’t luckily but I imagine that it must be a very-very worrying thing.

LS: Really terrified.

MB: Because you’re absolutely right it's, you know patients describe it a very sort of restricting tightness across their chest here sort of feeling, which is restricting their breathing and actually when you are examining or if you think about their breathing what they will be finding is actually trouble breathing out strangely which makes it different from other conditions like croup where the problem is with breathing in.

LS: Mmm.

MB: But without getting too technical this person who’s having quite a severe attack won’t be able to get to the end of a sentence without having to take another breathe, their whole body will be concentrating on breathing and they might be using other muscles to help breathe. So you may have see people so are literally sitting like that breathing like this and what they’re doing is using what they call the accessory muscles of breathing in that they’re actually using their pectoral muscles and their arms muscles to help them breathe.

LS: Too move their lungs, move their ribs, move their lungs.

MB: Now this, yeah, so this person is in trouble and to answer that very good question if you have somebody who is struggling like that to breath, not being able to get to the end of the sentence, and not being able to sort of run around really they’re concentrating all the time on breathing, the first thing to do is if they do have their inhaler, their reliever inhaler to give them tow or three puffs you will never do any harm by doing that.

LS: Right.

MB: So that's the first thing to do but I think the question was if they don’t have their reliever with them. Really the advice would be to try and keep them calm because as you can imagine somebody in that situation is panicking.

LS: Yeah and the more you panic I should imagine the worse it gets.

MB: The worse it gets, very hard not to panic isn’t it?

LS: Yeah.

MB: But just to keep them calm and really the next step would be to call an ambulance because that will be probably one of the most important calLS to the ambulance service that day. Don’t think that you’re wasting the ambulance people’s time you know.

LS: Right that's a good tip actually isn’t it?

MB: Yeah absolutely don’t this is an important call to make because what sometimes can happen with asthmatics is that for a while they can cope with this situation where they're you know gasping to breathe and then after a while very understandably they get tired and at that point things can go you know quite badly wrong.

LS: Quite downhill quite rapidly. So will it pass though that asthma attack without medication?

MB: In that sort of situation the right answer to that question is no. Don’t assume that it's going to pass.

LS: Oh that's scary.

MB: This person who’s suffering a bad one definitely needs help you know they definitely need to be have medical attention quickly either an urgent, a very urgent appointment with their Doctor within you know half and hour or so, or they need to be in Casualty basically. A milder attack like we were talking about before where it's a bit inconvenient, the person is having to use their inhaler a bit more often that possible will pass, you know if the person just takes it a bit easy uses their reliever a bit more often, doesn’t exercise probably it would eventually pass. But this person needs to keep a very careful eye on how often they are using their inhaler because if they’re having to use it frequently during that day there should be ringing a little alarm bell in their head something is not right.

LS: Right.

MB: Possibly I need to be thinking of ringing Doctor, ringing NHS Direct somebody like that. So the answer to that question depends a little bit on how bad this attack is

LS: Right. Yeah.

MB: But to be taking

LS: If in doubt ring 999.

MB: Yeah to be taken you know to be taken fairly seriously if that's happening.

LS: And if you’re out and about I don’t know if you’re in the countryside or somewhere you’ve not got your inhaler with you and you’re nowhere near a Doctor what would you do? It's quite scary isn’t it?

MB: Yes, I think probably the answer to that is again to try and keep calm. Try and sort of walk slowly somewhere you know the last thing we want is you running and making it worse or trying to run and making it worse. And really try and go to the nearest person, go to the nearest house, go to the nearest person.

LS: Right.

MB: Say look I’m an asthmatic I’m suffering a little bit and really summon help.

LS: Yeah.

MB: 'Cos in that situation there isn’t really anything that you personally can do to make this asthma attack pass. The best thing you can do is keep calm and then summon help in the best way that you can. You know this is not likely to pass on it own in other words.

LS: Now I’ve read, or heard about if you have panic attack and you’re having problems breathing that you can breathe in and out of a paper bag

MB: Yes.

LS: Would that work with an asthmatic?

MB: Yes well I’m glad you’ve asked that question because for panic attacks where somebody’s hyperventilating, where they’re sort of breathing in and out you know all anxious and so on, this person with the hyperventilation actually has got nothing wrong with their lungs

LS: Right.

MB: and breathing in and out of a paper bag for this person probably would be quite helpful. For an asthmatic this is not the right thing to do.

LS: Right.

MB: Okay because what you’re basically doing is you’re re-breathing your already used air and for an asthmatic they need all the oxygen they can get and re-breathed air will have some oxygen removed from the previous breath.

LS: Right.

MB: So I guess the answer to that is if you are in doubt as to whether somebody is hyperventilating or having an asthma attack the safe option is to assume that they’ve got an asthma attack and summon help. If you absolutely know that this person is not asthmatic and is suffering from a panic attack fine get out the paper bag get them to breath you know keep them calm etcetera.

LS: But you don’t want to make an already bad situation worse do you?

MB: Absolutely right if in doubt not the paper bag, if you think it might be asthma not the paper bag basically.

LS: Right. Okay. Right. Well Charlie from London has written in and he wants to know if it's okay to get drunk if you have asthma?”

MB: [laugh] Right.

LS: I suppose it’s back to being that it out of control isn’t it? And not managing your asthma like you might be able to.

MB: Yes absolutely. Well Charlie there’s not absolute reason why you can’t get drunk if you’re suffering from asthma but sort of common sense would prevail really wouldn’t it that if you are suffering badly with your asthma at the time or if you think you’re suffering any sort of a asthma attack for having to use your reliever a lot, then probably the best answer is don’t only because if you asthma gets worse you may not be in a situation to do the sensible thing. But in terms of your normal life you know I’m an asthmatic, being an asthmatic does not mean that you can’t ever get drunk but it's just common sense prevaiLS if your asthma is causing you a particular problem at that time you know probably best not to go out and get hopelessly drunk because things could then get out of control.

LS: Yes.

MB: So it's more like a common sense thing really.

LS: Yeah but you could if you managed it properly live a normal life.

MB: Absolutely right and most GPs will aim for their asthmatics to live a normal life that will be your main goal when you see a newly diagnosed asthmatic is as far as humanly possible I want this person to live a normal life, travel the world, bungee jump if they want to, you know all those sort of things. That is what you’re aiming for obviously not always possible if this person has you know very severe asthma but this is your chief aim as GP is that you know is that the asthma should be like a side issue, that this person should know who to manage and often we will give them like management plan you know, if you asthma does this - this is what you do, if your peak flow when you blow into one of these peak flow meters drops below a certain amount - this is what you do and it's all about you know managing your asthma so you can lead a normal life really.

LS: So you’re constantly monitoring your asthma patients they come in and out for appointments on a regular basis do they?

MB: Yeah it depends again on how bad it is. I mean what we would do is averagely see one a patient once a year for a review or actually our Asthma Nurse would probably do that 'cos they’re often incredible well qualified often better then GP’s actually to sort of monitor this persons, asthma and you know check that they’re all the right thing and make sure that we can’t improve on their treatment. But obviously if an asthmatic is having problems controlling their asthma we would see them more often and discuss you know what is it they can do to get their asthma back under control because there's a whole load of different things, there’re a whole load of different steps that we actually call them that they can take according to how bad their asthma is to get it back under control and lead a normal life as you say.

LS: Well moving onto talking about treatments actually before we move on and talk about drugs and inhalers etcetera, etcetera Gita from East London wants to know “I was once told that inhaling oxygen can help alleviate the symptoms, is there any truth in this as I know there’s an oxygen bar in London?” Fashionable are these oxygen bars aren’t they’re supposed to make you look younger and make you feel fabulous.

MB: Is that right?

LS: Is gonna' help your asthma going to an oxygen bar?

MB: Well Gita the short answer is no. I am afraid, I’m sorry about that.

LS: It was worth a go wasn’t it?

MB: Oxygen is a wonderful thing. We all need it very regularly but in terms of persistent relief of your asthma problems the answer is no. The longer answer is that obviously if somebody is suffering from a severe asthma attack the answer is yes, you know very definitely if somebody is struggling with their breathing one of the chief things that we will think about is administering oxygen to that person. And the first thing you’ll find when you call an ambulance for somebody who is suffering an asthma attack is they will get the oxygen cylinder out and stick on this person and of course that will help them 'cos one of the problems, they’re having is getting oxygen into their blood stream. 'Cos at the end of the day the thing that we have sort of skirted around is the reason why asthma is such a big worry is at the end of the day you need oxygen in your blood stream to get to your celLS and without that essentially you die so.

LS: So if you have a really bad attack, if you passed out would you then start breathing properly or?

MB: No you wouldn’t with asthma.

LS: Oh dear.

MB: You know with some conditions you might do but with asthma you wouldn’t and one thing that certainly paramedics would routinely carry and a lot of us in surgeries have in our surgeries is something called a puLSe oxy-meter, the thing you see in Casualty on television which is plugged onto the end of you finger and actually does measure your level of oxygen.

LS: Right.

MB: And you’ll find with somebody that is suffering quite a bad asthma attack that oxygen level will dip and that's what it's all about is making sure this person oxygen level goes up. Now in normal air the oxygen level is about 20%. By administering oxygen in that situation you’ll boost that saturation, that oxygen saturation.

LS: Very quickly.

MB: Very quickly and in that situation yes, the answer to Gita’s question that situation is absolutely vital really, but in terms of treatment as a regular thing you know if you go to the oxygen bar once a week your asthma will get better I’m afraid not sorry.

LS: Oh well never mind Gita I should go anyway it makes you look younger that's what they say anyway. [laugh] Now we’re coming up to about halfway through the show now you’re watching the Healthcare Show and today we’re talking about asthma. Causes, triggers symptoms, and what we can do to help relieve it as well, and our guest today is Dr Martin Bell who’s a GP who sees a lot of asthma patients I’m sure during his time.

MB: Certainly do yes.

LS: Now Martin telLS us a little bit about the treatments for asthma then, what can we do to try and help patients lead a normal life?

MB: Yes yeah. Well I suppose as always we should start with lifestyle things and sorry if this sounds a bit familiar but the very first thing to do is not smoke.

LS: Yeah it would seem obvious but people I mean if you’re hooked you’re hooked aren’t you at the end of the day it's difficult.

MB: It would seem obvious. Yeah absolutely and sometimes it worth saying 'cos I have had patients who have said to me “You never told me to give up smoking.” Fairly obvious to most people but some, perhaps the message hasn’t got through to others, 'cos a) it's not good on a million different fronts, but certainly if you’re asthmatic that absolutely will not help. Taking regular exercise obviously helps, being.

LS: Does that not trigger, or can it not trigger?

MB: You’re absolutely right and those who have exercise induced asthma yes, but still taking exercise is good because it keeps you fit, makes your body function better, gets that oxygen pumping round your system, and we can cope with the exercised induced asthma, you know we can help this person with inhalers and so on to get on top of that problem and if in the meantime they’re making themselves healthier that will help, and at then of the day probably will mean that they have to have fewer inhalers.

LS: Right.

MB: So still it's the right thing to do. Maintaining a normal weight because obviously the less weight you’re carrying around the less oxygen you need etcetera etcetera.

LS: Yeah that's a good point.

MB: So all those lifestyle things are definitely worth mentioning. But fair to say you could be the fittest person in the world and still have asthma I mean probably a lot of people watching won’t remember Alan Pascoe but he was an Olympic

LS: I remember him yeah,

MB: hurdler who had asthma. And good for him he made a thing of it and he is absolutely living proof that can have asthma and be an Olympic champion hurdler.

LS: Yeah that’s amazing when you think about the lung capacity that they must need and.

MB: Yeah, but what he’s basically emphasising is, it's totally controllable you know for most people if they do the right thing.

LS: Right and how do you do that then how do you go about controlling it?

MB: Well a visit to the GP really or the Asthma Nurse would probably be the first step and what they would do is they would assess firstly is it asthma? You know just to check 'cos other things can make to breathless etcetera, secondly how bad is this asthma? And thirdly are there any sort of trigger factors that we can talk about?

LS: Right.

MB: And then according to the answers to those questions we then almost certainly would end up prescribing an inhaler or sometimes a couple of inhalers.

LS: Right and there are two different types of inhalers aren’t there?

MB: Well there are more than two

LS: Oh right

MB: and actually unfortunately although there are just a few drug groups in inhalers the number of different types of inhaler have absolutely mushroomed to the point where it confuses us quite often actually. But to keep it simple you could boil it down to the reliever, which most people would think of as a blue inhaler.

LS: Right.

MB: You know the most commonly use one is something called Salbutamol but there are others.

LS: And you use that when you’re having an attack.

MB: When you’re having an attack, or if you feel a bit wheezy, or if it's night time cough is a bit of problem, and you would use it and you would know if it was working because within minutes you feel better.

LS: Right.

MB: Problem with a reliever is it wears off, so nothing wrong with it and for somebody who just has mild asthma or like your husband who you know a particular situation will spark him off not problem, with taking a couple of puffs, fantastic relieves him immediately he can get on with life no problem.

LS: Yeah.

MB: But if you’re finding that you’re having to use the reliever more than you know two or three times a week.

LS: Right.

MB: Probably the GP or the Asthma Nurse might start talking about the other main group which are the preventers which people would think of as their brown puffer, they’re always brown but you know most people think of as their brown. Now this works in a different way where you would use it regularly, so morning and evening, almost whether you have symptoms or you don’t have symptoms you use this inhaler.

LS: It your insurance policy really.

MB: Yeah absolutely right this sort of puts the fire out it's the way that I sort of think of it.

LS: Right. Yeah and would you use that as well as a reliever?

MB: Yes you would. You would but you would normally find is if this person is quite compliant with their preventer they might well find that they then don’t have to use their reliever so often. Because remember what we said is that the main problem with asthma is this inflammation in your breathing tubes and although the reliever will work a little bit on the contraction of the tubes that we talked about it won’t do anything about the inflammation, and that's where the preventer comes in by reducing that inflammation in your tubes which has a much more fundamental effect on how bad your asthma is.

LS: Right.

MB: So probably the most common combination that we would see is somebody who uses their preventer twice a day, couple of puff twice a day and then their reliever as and when they need it, that would probably be the most common scenario.

LS: And do people who have asthma and have frequent attacks, does it scar the inside of their lungs? Does your asthma get worse as you get older?

MB: No it doesn’t actually there’s absolutely no evidence certainly that I know of that that happens, so you can carry on with this combination for as long as you like.

LS: So there’s no cure as such for asthma you just have to manage it as best you can?

MB: That's exactly is management thing like so many things in medicine unfortunately it's a management thing. But most times we can manage it. So the common thing would be you know reliever, possibly a preventer, is that wasn’t working you then would get on to what are sometimes called long acting relievers which are usually most people would recognise that as their third inhaler, their third puffer.

LS: Oh right you’ve got to have a whole handbag full of stuff haven’t you.

MB: I know that right, and they all come in different colours so people will often talk about their blue inhaler, their brown inhaler, and their sort of orange or green inhaler, and that third one is usually a sort of long acting reliever which is sort of somewhere in the middle actually.

LS: Right. Yeah.

MB: And then just to sort of cover the whole gambit if I can, some people are actually on a tablet.

LS: I was gonna' ask that actually is there a pill as well that could do the same thing?

MB: Yeah. Yeah. There is a pill called Montelukast is the most common one or Singulair is what most people would recognise it as. Which is pill that's works for some people it seems to be particularly good for exercise induced asthma. It doesn’t work with everybody but obviously and it’s often used in addition to. You know you wouldn’t very often start somebody on the tablet they would usually be in addition to I somebody was.

LS: So you would sort of build up to that if you think out need it and would you take that everyday then?

MB: You would take that very day that's exactly right almost as another sort of preventer thing. And for those who get bad asthma attacks occasionally you know some people who are watching would recognise those sort of scenarios where their Doctor would give them a burst of steroids by mouth.

LS: Right.

MB: So the brown inhaler that we talked about 9 times out of 10 will be and inhaled steroid but sometimes if things get really bad and if somebody is struggling we will give a short burst of steroids by mouth which will calm that inflammation that we talked about

LS: Right but is it bad to have that a lot are there any side effects with the inhalers talking about steroids that always a bit of a nasty word isn’t it, steroids.

MB: Yeah. Yeah. Steroids yeah. I mean there are certain words that GP’s hate to mention 'cos they know they’re gonna' get this terrible reaction. Asthma strangely enough is one of them you know the minute you say to Mum “your child may have asthma”, oh my God you can see the panic across their face you immediately have to follow it by “it's very mild” usually. But yeah the steroid issue is an on going thing really. The answer to that is that in low doses so these preventer inhalers that have very low doses microgram doses, used in low dose there is no real evidence that they have any long term effect but in those quite severe asthmatics who have to use high doses yes some of it is gong to get into your blood stream and there is some evidence that it can effect your own production of certain hormones in you body.

LS: Oh right.

MB: Something called adrenal suppression but without being too technical your adrenal glands produce your own steroids and if you have too many steroids in inhaler form or in tablet form you own adrenaLS stop producing what you should produce.

LS: Oh dear so it all goes a little bit wrong.

MB: It goes a little bit wrong and the problem with that is in certain situations that can be a problem but I want to emphasise that that is only usually a problem for people on really quite high doses of inhaled steroid or for people that have to have very frequent bursts of you know steroid by mouth. But remember as always the Doctor is doing this for a reason. He doesn’t sort of wake up in the morning and think &LSquo;I know what gonna' do I’m gonna' provide’.

LS: What can I inflict on my patients?

MB: What can I poison them with today? This Doctor is trying to keep you well and in certain circumstance’s he’s trying to keep you alive.

LS: Yeah. If it saves you life then maybe you have to put up with the side effects. And are there ways of managing different drugs, trying out different drugs to try and find that one that if, you’re having really bad side effects maybe try a different brand.

MB: Yeah absolutely right, absolutely right. So our aim and the Asthma Nurses aim will be to control this persons asthma so he can have a normal life with a minimum medication to their life as simple as possible, so we are not gonna' leap in you know with high dose steroids just to make this person better, we are gonna' start with something low and we are gonna' gradually increase until we get to that recipe of inhalers that controLS this persons asthma, allows them to lead a normal life but with a minimum of fuss.

LS: Yes it's a bit of trial and error with every patient. Isn’t there?

MB: It really yeah. Against a background of having taken the history, you know examined them, and most often you know we will use this thing called a peak flow inhaler, a peak flow meter which most asthmatics will recognise that you sort of blow into and it will tell the Doctor how good your lung power is at the particular moment. It’s not an absolutely guarantee, it’s not a precise tool but it's part if a jigsaw puzzle of you know how bad is this asthmatic how often do they get it, and quite often we will give this person a peak flow meter to take home with them.

LS: Oh right to see how it works through the day.

MB: Yeah.

LS: And different activities they are doing through the day etcetera.

MB: Absolutely or remember we walked about this business where often asthma will get worse at the end of the day or in the morning.

LS: In the morning or at the end of the day yeah.

MB: Well one tool that we use is to give this person a peak flow meter get them to do a peak flow in the morning, get them to do a peak flow perhaps in the middle of the day, peak flow in the evening write it down and actually draw a graph, and what you’ll often is like a dip in this graph at night and first thing in the morning and that is you know if you look at this you think almost certainly these persons got asthma, you know.

LS: Right.

MB: It's part of that jigsaw puzzle of working out does this person have asthma? But if you see that pattern of peak flows dipping you know that's very-very useful guide as to this person’s got asthma and the peak flow meter can aLSo be a very-very useful tool for that asthmatic to monitor their own.

LS: See if their conditions getting worse or whatever, now as you get older does it get slightly worse or?

MB: Again not necessarily actually can strangely get better but if this person carries on smoking for instance it may gradually merge into another condition chronic bronchitis.

LS: Right.

MB: Or what's no called COPD. Chronic Obstructive Pulmonary Disease.

LS: Actually we have a questioning on that.

MB: Have we yeah.

LS: If I can find it somewhere yes. Phil Uckly has written and he says I've suffered with asthma since the age of 5 and he’s now 57, oh poor Phil that's along time isn't it, “I take Salmeterol, Fluticasone, and Triopropium regularly and Salbutamol when necessary, the condition seemed under control when a sudden worsening resulting in a further diagnosis of COPD which is sort of like Emphysema isn’t it? And am told that there is not further medication I can take to help this latest development but the current medication I am taking has very little effect at all.”

MB: Yes.

LS: “I have never smoked, I have visited a respiratory physiotherapist who has shown me some breathing exercises to help expectoration, is there anything else I can do? “ 'Cos he says “it's most debilitating.”

MB: Right. Yes, yeah. What a good question Phil because you’ve painted a picture that we very often see of people merging from asthma into this COPD thing which used to be called Emphysema or Chronic Bronchitis, the bit that you haven’t told us is that if you were ever a smoker 'cos that's pretty much the critical bit because what we find in smokers is.

LS: He says “I've never smoked”.

MB: He’s never smoked well it's very-very usual.

LS: Mmm. There you are you’re a medical miracle.

MB: And very unfortunately medical mystery yeah. I wonder if he was a passive smoker because COPD is very usual in never smokers or people who have not been exposed to smoking because it's essentially lung damage. Now remember right at the beginning I started a bit by slightly technical by saying that asthma was a reversible airways disease and what I meant by that Phil is that with asthma as you will remember when you used your reliever your symptoms got better almost miraculously that's the reversibility, what you’re now saying to us is that is not now happening, it's not reversible. That is the big difference between asthma which is reversible and COPD which is not reversible or hardly reversible.

LS: Right.

MB: And he’s putting is very eloquently that that's what’s happened to him so I just wonder Phil whether passive smoking or something occupational, something in your past has meant that you’ve gradually merged from asthma to COPD. Now I've go to give credit to your
Specialist or your GP that you have listed an excellent treatment regime which includes this repository physiotherapist who will help him with his breathing problems, he’s on a particularly good type of treatment called Triopropium which can be very-very good for COPD. The answer to your question is I’m really struggling to think of anything else you can do to improve your breathing. The breathing exercises I think will be critical because they will help those breathing muscles that are so important to him.

LS: So persevere with that and it might just give him another 10% or something.

MB: That would help remain as active as you can Phil, obviously avoid smoke wherever possible because smoking has been shown to one of the few things that can - or not smoking has been shown to be one of the few things that can make a difference to COPD and if things are getting worse there is some evidence to show that having oxygen therapy, going back to Gitas question.

LS: Oh right yes.

MB: Yeah, for COPD can also make a difference so that you could have a cylinder or an oxygen concentrator in your own home and if you had that for several hours a day that has been shown to at least significantly reduce the symptom that you might get Phil.

LS: Right so it sounds like he’s really going through it actually struggling with it.

MB: So that's it, that's quite a difficult one actually.

LS: Yeah, well I hope that's some help to you anyway Phil now on the subject of drugs again. Avtar and Sandy have both experienced improvements in their asthma conditions when taking antibiotics for other problems, why would that be?

MB: Yeah what and excellent question I've often wondered the answer to this one and I've got a feeling that in future we might find the answer to that because.

LS: That is true you’ve noticed that have you with other patients.

MB: Definitely notice it. If you talk to any GP they will say that when they put their asthmatics on antibiotics often strangely they will get better even if you doubt that they actually have a chest infection. You know sometimes you will sort of if you’ve got an asthmatic child and you’re not quite sure if they’ve got and infection or asthma you’ll sort of hedge your bets and treat the asthma and add in an antibiotic. Or when asthma, was not so well recognised perhaps GPs sometimes were in the habit of thinking it was a chest infection when in fact in hindsight we think probably it was more asthma, but strangely it seems to have an effect. That's not to say that antibiotics are a good treatment for asthma, they’re not.

LS: You can’t be on them forever at the end of the day.

MB: You can’t be on them forever there are obviously downsides to having repeated courses of antibiotics .There are problems associated with antibiotics like thrush and all those sort of things plus there’s that problem that we all know about bugs becoming resistant to antibiotics so that's not a good treatment, but strangely when we give antibiotics sometimes for other things you know somebody's asthma will get better. Don’t know why I got a feeling in the future that we might find the answer to that.

LS: Might find it and of course treatments are improving all the time there’s new drugs coming onto the market all the time

MB: Yeah. Yeah. Yeah.

LS: And eventually you might just be able to take a pill and that will be that.

MB: Yes hopefully. I mean there's lots of research being done onto asthma because it's such a common problem as you say 5 million people in the UK have it and unfortunately in certain cases can cause a certain number of deaths every year. So it's certainly a very important area.

LS: Yeah. Okay. Now keep your questions coming in we’re nearly at the end of the show actually but Annette has written in and she wants to know “I sometimes heard that atmosphere helped asthma like people holidaying in the mountains, is that due to the oxygen quality or something else?”

MB: Well Annette it won’t be the oxygen quality if you think about it because in the mountains actually the oxygen concentration goes down. But perhaps it's the pollution thing perhaps it something about your particular asthma that helps being the in mountain air, certainly I’m sure you’ll know that your Grandmother used to talk about people going off to Switzerland to have the mountain air for their TB or their asthma or whatever, and possible with some people it help 'cos with the fresh air you’re away from pollution, its a different atmosphere, but probably that would be a very individual thing because equally you’ll find that some people will go off to the mountain air and because it’s a bit colder remember that person who asked that question before, you know there are some.

LS: Yes yeah. Or there may be loads pollen there or something, might be loads of cows that you’re allergic to or anything.

MB: Yeah. That’s exactly right so for some people that could be a total disaster.

LS: Yeah.

MB: But for other people probably it does help them and we certainly have plenty of patients who will lets say go off to Spain, no probably at all with asthma come back to England terrible, you know

LS: As soon as they step off the plane it starts again it must be really infuriating actually.

MB: Yeah. Yeah. They usually want a prescription to go off to Spain.

LS: Leave your job go and retire in Spain that's my advice. [laugh] Now we’ve got plenty questions coming in actually so we’ll try and rattle through a few. Shelia wants to know talking about sort of leading a normal life really and getting on with things that everyone else would do “Is swimming good for people with asthma or does the chlorine make symptoms worse?”

MB: Right. Yeah, another good question. Basically swimming is a very good exercise 'cos it uses up your body muscles, it makes you stronger, keeps you fit, keeps your weight down, all those positive health benefits so the short answers yes. The only people where that would apply to is that very small group of people how are sensitive to the chlorine and it may spark off their asthma. Having said that like we said before if you know that this person is a bit sensitivity chlorine you can take certain steps, they want to go swimming you well them to use their reliever a couple of puffs before they go swimming, or you can perhaps increase their preventer you know to calm their asthma down. So remember we said our main aim is for you to lead a normal life as far as possible if you want to go swimming your GP or Asthma Nurse will you know bend over backwards to make sure that you can go swimming and will really cope with that problem, give you advice on what you can do with your inhalers so that you can go swimming and not have any problems. So my main message would be unless it’s an absolute disaster for you I would still go swimming.

LS: Yeah. Okay, now children particularly it must be difficult trying to managing their lifestyles 'cos they run around how do you get them to take their inhalers and how do you manage child’s asthma?

MB: Yeah, that is a difficult one, it can be difficult but if you think about it sometimes children actually almost give us the answer and the reason I say that is if their asthma is so bad it's limiting their activities they will actually want to use their inhaler 'cos they will link up you know between using your inhaler and being able to play football with your mates.

LS: Right.

MB: If you don’t use your inhaler you can’t. So strangely the worse their asthma is the more they will sort of make that connection. I’m not saying it using 'cos using an inhaler in children is almost a science of it own.

LS: You can get special devices can’t you to help them?

MB: You can, most parents of children echo has asthma will recognise the spacer. There are lots of them but they are usually a sort of plastic tube that goes between the child and the inhaler which makes absorption of that aerosol from the puffer easier to absorb and it means that you don’t have to coordinate the sort of puffing and the inhaling bit. Now some children understandably, some little children can be quite frightened but equally I have some patients, some little patients who will actually tell their parents when they need their inhaler you know.

LS: Right and how you can you be diagnosed with asthma?

MB: That's a difficult one because there are some Specialists who say in the really young with the 1 or 2 years that you actually can’t have asthma, okay having said that talk to any GP and they see plenty of wheezy children. So we now have another like list of diagnoses that we use to skirt round that issue and we call it sort of something else like Wheezy Bronchitis, or Viral Induce Wheeze, or something. So I’m not saying these Specialists are wrong but we can sometimes start inhalers on sort of 2 year olds, 3 year olds that sort of thing.

LS: Really yeah. That’s quite frightening for parents though isn’t it you think ‘this is it they’ve got that forever now’ but as you said they may grow out of it.

MB: They may well grow out of it and if it's more this sort of Wheezy Bronchitis or Viral Induced Wheeze thing they may easy grow out of it or it may be quite a temporary thing or often just an intermittent thing. So they will have for like a week or two, you’ll tell the parent what to do, once their better stick the inhalers and everything in cupboard, they gather dust then you know they get a cold and it all comes back.

LS: Then that dust gives them the asthma.

MB: Big vicious circle [laugh].

LS: So can you manage your lifestyle I mean we’re talking about sort of leading a normal life by having inhalers but can you actually sort of manage your lifestyle so i.e. don’t have cats and dogs, don’t have curtains.

MB: Yes. Yes.

LS: I don’t know dairy, does dairy effect it that sort of thing?

MB: Yes. Yeah. Often asked about diary. There will be some people who are you know dairy allergic but for every one of these there are probably 1,000 people who think they are but really aren’t you know it's probably more something else. Yeah shoot the cat sometimes the advice, often not followed.

LS: He didn’t mean that, don’t shoot the cat, give it to a neighbour of something.

MB: Only joking, only joking but of you know that cats’ fur sparks you off then

LS: Try and avoid it.

MB: probably when the moggy finally departs don’t replace it. Because that is quite a difficult one, having said that you know people can actually get used to that allergen, strangely children you sometimes find will get used to their cat allergen and will gradually get better.

LS: Yes your body kind of works out how to deal with it

MB: Body seems to somehow yeah absolutely. So you know finding those sorts of things can be quite useful so that at least you know what's sparking it off you can adapt your lifestyle perhaps hoover up the fur a bit more often that you should do, keep that cat out of a particular room that sort of thing.

LS: I know some people have a real regime don’t they of getting rid of dust mites don’t they and mopping everything and it's a lot of work but if it helps the child I suppose it's worth it isn’t it?

MB: Yeah. Yeah. Absolutely.

LS: Okay we’ve got time for a few more questions David has written in from the West Country and he wants to know “Is there any evidence to suggest a link between asthma and throat cancer?”

MB: No is the answer part from can I say again the smoking really that would be a common link in as much as, as we’ve already said not that smoking really causes asthma although in some people it probably may be a big factor, but it's you know ridiculous to smoke and have asthma it just goes without saying, the link is that throat cancer is so closely linked with smoking to the point where it would be quite unusual for somebody to develop throat cancer having never smoked or having never had exposure to smoke as in being a passive smoker so that's the link. But I wouldn’t want him to think that if you have severe asthma that somehow you’re at a higher risk of getting throat cancer there is no know link between the two of them other than you know the smoking link really.

LS: Well thanks for that Martin. Now Sarah from London has written in and she wants to know “Is it true that they’re removing CFC’s from inhalers?” They’re the gases that deplete the ozone layer aren’t they?

MB: That's exactly right yeah.

LS: There’s something going on with that at the moment isn’t there.

MB: Yes Sarah you’re absolutely right and you’ll be please to know actually that that process has been going on for quite a few years and is now pretty complete so that when your GP prescribes your reliever or your preventer it is almost certainly gonna' be CFC free. Pretty much 1005 now so you can rest assured you know that that avenue of reducing CFCs in the atmosphere is pretty much sewn up. You’d be hard pushed now to find an inhaler that has CFCs in it. Also quite a lot of people will recognise that fact that their inhaler is something called a dry powder inhaler which doesn’t have any what is called propellant in it at all. The propellant is the thing that sort of squirts the aerosol out and a lot of people have a dry powder inhaler where they literally just suck the stuff in, so no propellant at all no CFC you know very-very straight forward. So yeah we have you know I say we, the medical profession the pharmaceutical companies have actually thought of that avenue of things and have pretty much covered it now.

LS: Okay well I hope that helps you out, your GP will be able to help you out with that if you ask him or her. Now time for just a few more questions. We’ve got in from Maymee Richards I hope I've pronounced that right she says “I've never had asthma attack but often have bouts of breathlessness, this can happen when I walk briskly along flat ground and it gets worse upon exertion walking up hills and worse still when playing sports e.g. tennis. I use a Beconase inhaler and nose drops daily and Salbutimol as necessary every twelveish minutes with tennis.”

MB: Yes. Did she say she’s not sure she’s asthmatic?

LS: Yes she says “I've never had an asthma attack but often have breathlessness”.

MB: Right. Right. Okay. Yeah.

LS: Is that a very mild asthma or?

MB: Yeah she's describing asthma pretty much I mean obviously I can’t say that 100% without examining you, you know doing the peak flow and all that sort of thing that we discussed but pretty much Naomi you are describing asthma. Probably the exertion induced asthma we talked about a couple of tips you may already do these but one would be to use your reliever even before you do exercise because that can actually prevent you from getting the wheeziness or the breathlessness in the first place, and it's tip that an awful lot of people who have exercise induced asthma do. The other is I’m slightly perturbed to hear that you’re using your reliever that often, not that that is dangerous 'cos I rather you were breathing than not breathing but a little red light should be going on in your head thinking I’m having to use this quite a lot, perhaps my asthma is not 100% in control as it should be. Probably worth a visit to the GP or the Asthma Nurse at the Practice who may introduce or increase your preventer inhaler what most people would recognise as their brown inhaler, because gain what we said was we want this person to lead a normal life and not be breathless or struggling to play tennis or struggling to do things, so you know if I had to say what Naomi’s problem is I suspect it’s exertion induced asthma which is not perhaps as controlled as she would like it or we would like it really.

LS: As it could be yeah. So pop along to your GP and get a MOT really.

MB: Yeah. Absolutely.

LS: Time I think for just a couple more questions Valerie wants to know “My grandson is 7 years of age and is it true that they can grow out of this condition?” She probably hoping it's true and we have talked about this a little bit haven’t we?

MB: Yes there’s a very high chance that they will grow out of it. An awful lot of children have asthma for some reason when they are younger and as they get older that tendency disappears although with some of them you may find that I may slightly reappear at a later date or in particular situation, a stressful situation, seasonal, exertional, you know that tendency will probably be lurking somewhere. but yeah to intends and purposes that has a very high chance of going unfortunately you can’t look at a child when they’re 7 and say “this child is going to grow out of their asthma”, it is one of those things that you just sort have to keep a bit of an eye on and hope that person will do but there is pretty high change that they will gradually grow out of their asthma.

LS: Okay. Valerie well fingers crossed and of not well we should be able to manage it hopefully. Well that's all we’ve got time for today on the Healthcare Show. Thanks very much to Dr Martin Bell for coming in and talking us through some of your asthma questions, and thanks to all of you as well who’ve written in and sent your question. In I hope we’ve been of some help. So that's it from us for today and we’ll see you next time. Bye-bye.

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