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Every fall, theres an uptick in

childrens asthma flare-ups. The increase is so predictable it starts about three weeks after the start of school that theres a name for it: the September spike. Fall can be the worst time of year for kids with asthma, says Bev Kulbaba, a Certified Asthma Educator with The Childrens Asthma Education Centre in Winnipeg. Once back in school, they swap viruses, leading to colds that can exacerbate asthma. Ragweed allergies also cause respiratory problems, and students can be exposed to potential triggers in their own classrooms. The fact that some kids dont use their preventive controller inhalers

September can be the toughest month for pupils with asthma.

while on vacation leaves them vulnerable. In the summer, people may not feel like they need their asthma medication and they stop taking it, says Cinde Little, a Certified Respiratory Educator with the Alberta Health Service.

So what can you do? The beginning of the school year is a good time to review your childs Asthma Action Plan, says Lesley Stewart, also a Certified Asthma Educator at the Winnipeg centre. Refill prescriptions, and if kids havent seen their doctor in a while, this is a good time for a checkup. Some doctors will recommend starting or increasing a preventive medication just before the September spike. If this time of year has previously been a problem, remind your childs physician. Parents should alert school staff to a childs asthma triggers, so the school can take preventive measures. Frequent handwashing with soap, disinfecting shared items and keeping sick kids at home help combat the spread of germs. Reducing exposure to outdoor mould and ragweed (for example, by staying indoors when pollen counts are high) and taking antihistamines can reduce a childs symptoms. See Classroom Triggers on page 28

To Swim or Not To Swim?


When venturing to the pool, chlorine, a

common irritant, is not the only concern for swimmers with asthma. Saunas and damp change rooms are ideal breeding grounds for triggers such as moulds. Combined with the airway tightening that often occurs with exercise, swimming appears to be an asthma attack waiting to happen. But does swimming in a pool worsen

asthma? The evidence in this area is inconclusive. First, it is not the chlorine directly that is the culprit, but rather the reactive elements such as trihalomethanes that form in the presence of organic matter such as dead skin cells and (yes) urine. If the pool is cleaned frequently and well-ventilated, or better yet, outdoors, chlorine is less likely to cause issues. As well, asthma triggers are highly individual, so not everyone will experience asthma worsening due to pool water, just as not everyone will get See Asthma at the Pool on page 28





Classroom Triggers
Continued from page 27 Carpets contain dust mites and mould. Make your childs school aware that its best for health to get rid of carpet. If thats not possible, vacuuming should be daily. Minimize indoor mould with cleaning, building maintenance and low humidity (under 50 percent). Teachers can also remove plants, fish tanks and old books. Chemicals or items with strong odours (cleaning products, bleach, glue, paint or scented markers) can be triggers. Ask about switching to cleansers made of mild soap and water. Chalk dust is another irritant. Teachers should use no-dust chalk. Animals can cause allergic reactions. Any animal with fur or hair or even feathers, says Kulbaba. Teachers should avoid class pets or animal show-and-tells.

With Dr. Harold Kim, Allergist

agweed is the major outdoor allergen of late summer and fall in eastern Canada, and the one most often identified with the term hay fever. The timing of the ragweed pollen season is uncanny in its predictability: it always starts by mid-August and is over with first frost. Most who are diagnosed allergic to ragweed are positive on allergy tests to other common allergens such as trees, grass, dust mites and cats. Often they do not feel any significant symptoms with these other allergens, but they have very bothersome nasal and eye problems as soon as ragweed season hits. Allergists have long believed that these other allergens cause some allergic inflammation, but its mild enough that patients do not feel the symptoms. We feel that this inflammation may prime those with allergies for ragweed. A recent Canadian study proved that patients who have allergies to allergens such as dust mite, dog or grass had a faster and stronger allergic response after exposure to ragweed pollen. This study strongly supports the priming effect. With most patients having multiple allergies and with some allergens possibly priming for others, allergists must consider avoidance and treating all allergens that are confirmed by allergy testing. Perhaps to properly treat someone with allergy symptoms only during ragweed season, we should confirm other allergies so we can prevent the priming effect. As well, perhaps in patients with multiple allergens, we are doing the right thing by using all of the allergens in allergy shots. This is an intriguing idea in treatment, but still conceptual until we have more study findings.

Asthma at the Pool

Continued from page 27 symptoms to pollen. Lastly, data from studies examining elite swimmers show that although pool water does irritate airways, swimmers breathing is no different than non-swimmers. A British study that examined new-onset asthma did not find an association between childrens visits to pools and increased asthma risk. In fact, swimming appeared linked to fewer respiratory symptoms. Bottom Line: Exercise is important when you have asthma, and swimming is a great way to get it. Choose pools that are clean, ventilated, and swim outdoors when possible, using your bronchodilator prior to exercise if advised by your doctor. If the pool environment is a known trigger, however, select another sport. Jolanta Piszczek is a pharmacist and CRE who lives in Victoria, B.C.


The Canadian Network for Respiratory Care is a non-profit organization and registered charity that works to improve the lives of Canadians living with respiratory disease. We certify healthcare professionals as Certified Asthma and Respiratory Educators (CAEs and CREs). Our CAEs and CREs work to help patients with their asthma, COPD, allergies and smoking cessation efforts. For more information or to find a CAE or CRE near you, please see or phone: 905-880-1092.


Jaimie Peters

Maria Muirhead

Paula Smith

Certified Educators take your asthma and allergy questions.
Send questions to:
Q. As a kid in Ottawa, I had asthma. The symptoms all but disappeared while living on Vancouver Island. Ive just moved back to Ottawa and the asthmas back too! Why is this? Maria Muirhead: Asthma is an unusal medical condition since

airways to become inflamed and the muscles around the airways to become twitchy and tighten. You must learn what triggers your asthma and, working with your Certified Asthma Educator, come up with strategies to avoid triggers. It is important to learn about the disease to be able to recognize the signs of an asthma flare-up. You have to stay on top of asthma: take the medications you have been prescribed daily and contact your physician if you are still having symptoms or if your medicine is not halting symptoms. While you have asthma, it should be noted that breathing difficulties due to COPD (chronic pulmonary obstructive disorder) also need to be considered in older patients.
Q. Is it OK for a 10-year-old with asthma to take cough medicine? Maria Muirhead: I wouldnt recommend this. The standard

treatment for asthma involves controller and reliever medications. Coughing indicates that asthma control may not be optimal. Ask your doctor for an Asthma Action Plan so that you can adjust your childs prescription medication as needed to improve asthma control and reduce the cough. A Certified Respiratory Educator can work with you to understand the relationship between peak flow readings and asthma control and how this information can be used to avoid flare-ups.
Q. Last fall, my 13-year-old struggled with his ragweed allergy, which led to asthma symptoms. Wed like to prevent a repeat: any advice? Jaime Peters: Although pollen is hard to avoid, there are

it requires people to worry about their environment. For instance, Vancouver Island and Ottawa are very different in terms of weather and pollen patterns. Ask your doctor for a referral for allergy tests; Southern Ontario is known for triggers such as ragweed and tree pollen, while pollution and cold air may also cause asthma to flare. A Certified Respiratory Educator can help you explore your asthma triggers. An Asthma Action Plan will help you manage any new asthma flare-ups.
Q. My 8-month-old recently had bronchiolitis, and Ive been told this means she might have asthma. What is the relationship? Jaime Peters: There are a few viruses that can cause bronchi-

actions you can take. First, check online for the pollen counts in your area. If the counts are high, try to limit outdoor activities (especially in the morning), and keep windows closed and use air conditioning at home, school and in the car. If your son has been prescribed medications for his allergy, be sure to continue them until the season ends.
Q. My mother says that acupuncture could help my asthma. Is this true? Paula Smith: Although there are anecdotal reports that

olitis, the two most common are Respiratory Syncytial Virus (RSV) and rhinovirus. Exposure to these viruses has shown to increase the risk for asthma, but researchers arent exactly sure why. While some studies see a relationship between the onset of asthma and previous bronchiolitis, other factors may be implicated, such as a family history of asthma or allergies or exposure to cigarette smoke. The severity of the infection may also contribute to the development of asthma.
Q. At the age of 65, I was just diagnosed with asthma. Im shocked to have developed this so late in life. What do I need to know? Paula Smith: Asthma can develop later on in life, and this is

acupuncture can help people with asthma to breathe better, medical studies show insufficient evidence to recommend acupuncture in the treatment of asthma. While there are relatively few side effects with acupuncture, this does not mean it is 100 percent safe. Its most important to speak with your doctor to get your asthma under control with medication that has been studied and proven to control symptoms. Acupuncture can be used in conjunction with a proper medication regimen, but should not be used as a replacement to medicines. Maria Muirhead is a pharmacist and CRE in Toronto, plus the author of My Asthma Book and Smoking = Problems (BIG Problems!); Jaime Peters is a nurse and CRE in Saskatoon and the Health Initiatives coordinator at the Lung Association of Saskatchewan; Paula Smith is a respiratory therapist and CAE in Orillia, Ont.

more common in women. It is a chronic disease that causes your



Teens Corner

Coach: Put Me In

All About The Asthma Spacer



Having asthma should not stop you from

participating in a sport and doing your part to support the team. But its important to get actively involved in discussing your asthma management. Be proactive: This starts with completing the health history on your registration form. Once you have let the coach know that you have asthma, make an appointment to talk about it privately. Remember, everyones asthma is different. Some coaches will surprise you with their knowledge; some may have completed an asthma-aware program. Bring your Asthma Action Plan when you meet the coach, and explain how it works. (If you dont have a plan, talk to your doctor and get one.) Tell the coach that as long as your asthma is under good control, you should be able to be a full participant for the team. Let the coach know what triggers your asthma. Coach isnt playing you: Talk to the coach. Ask for feedback about your abilities and your performance in practice. Does the coach have concerns about your asthma? If so, offer to bring a doctors note that confirms your ability to participate. If the coach still still isnt receptive, ask for a parents assistance. Taking medicine: This can be embarrassing for some teens in front of peers. Work with your doctor to identify times of day when controller medicine can be taken. Always carry your reliever inhaler. Exercise Triggers: If exercise causes symptoms, warm-up exercises and taking your reliever medicine 10-15 minutes prior to an activity often will help. Buddy System: Its important that you identify a teammate who is aware that you have asthma and knows the location of your reliever medicine. AnnMarie Woodrow is a CAE and allergy nurse at the IWK Health Centre in Halifax.
Photo: Courtesy

The pressurized metered dose inhaler

or MDI has revolutionized the delivery of respiratory medication. But the device only works if used properly: you inhale while pressing down on its canister. This can be a tricky manoeuvre, and much of the medicine can end up in the air instead of the lungs. Out of this difficulty, the holding chamber, or spacer, was born. A holding chamber is tube that fits on the end of an MDI and provides a reservoir of medication for the patient to inhale. Today, weve even advanced to the valved style of holding chamber to prevent medication leakage.

1. Breathe out first. 2. Inhale slowly if you hear a whistle, youre breathing in too fast. 3. Hold your breath up to 10 seconds. 4. Wait 15-20 seconds between doses while shaking the canister. 5. If not breath-holding, take four to six breaths (six is best). 6. Never put more than one puff into the chamber and clean it weekly.


Infants (0-12 months) A holding chamber with mask is used to ensure the MDI medication gets into the lungs. Hold the mask securely over the infants nose and mouth as 3-4 breaths are taken. Child (age 1-5 years) Children grow quickly and proper mask fit is important. With the mask in place, have the child take 4-6 breaths. Adult (ages 5 years & up) Guidelines suggest young patients transition from mask to mouthpiece once they can form a tight seal around the mouthpiece. (This is usually at about age 5.) Adults continue to use the holding chamber for better drug delivery. For an elderly person, the chamber with mask is likely the best choice.
Patricia Steele is a CRE and nurse/cardiopulmonary technologist in Sydney, N.S.

CNRC thanks GlaxoSmithKline for helping to make Currents possible through an educational grant.