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C A N A D I A N N E T W O R K F O R R E S P I R AT O RY C A R E S P E C I A L S U P P L E M E N T S P R I N G 2 0 1 2

Pollen allergies can lead to sleep loss, inability to concentrate and mood swings.

These useful strategies can reduce your reaction to springtime allergens.
1. If you were able to reduce asthma
medication in the winter, make sure youre back to taking enough in the spring if you have allergic rhinitis, says Kulbabas colleague, Lesley Stewart, a CAE. Its important for people with a pollen allergy to start inhaled corticosteroids, nasal sprays or antihistamines around the spring melt to establish good asthma control.

2. Avoid early-morning activities, when

pollen counts are higher.

3. Close windows at home and when



youre in the car.

4. Stay inside on dry, windy days; the

morning hours tend to be the worst.

5. If you air-dry your laundry, do it indoors

so clothes dont become full of pollen.

6. Do regular follow-ups with your allergist

concentration at work or school and mood swings, says Bev Kulbaba, a Certified Asthma Educator (CAE) at the Childrens Asthma Education Centre in Winnipeg. Theres a loss of productivity and feeling of dragging through the day. Rhinitis allergens can also be big asthma triggers, so those with asthma need to be prepared to avoid asthma flare-ups. The vast majority of people with asthma have an allergy of some sort, Kulbaba notes. Allergies that cause symptoms in the upper airway can worsen asthma. The key to staying well is to have your asthma under control, to follow an asthma action plan and to tackle seasonal allergic rhinitis symptoms before they exacerbate your airways.
or family doctor, recommends Kulbaba. Have an asthma action plan that gives guidance on how to treat asthma and make changes to your medication.

Spring is literally in the air. Tree and grass pollen and even mould are causing sneezing, runny noses, congestion, watery eyes and worse. Many Canadians enjoyed a pleasantly mild winter, but this means the symptoms of seasonal allergic rhinitis better known as hay fever have been plaguing them for months. In the prairies, where snow doesnt usually melt until April, those with allergies have been suffering since January. But whether your allergies are just ramping up or you didnt catch a reprieve this winter, its important to appreciate: spring allergies are much more than a case of the sniffles. Allergic rhinitis can have a major impact since symptoms disrupt sleep, leading to daytime fatigue, poor


with Jolanta Piszczek

True or False: The rst symptom of asthma seen in infants is usually cough. True or False: Patients allergic to ragweed are more prone to reacting to melons and bananas.
Quiz answers, page 35

Photo: Michael Keller / corbis

1 2 3

True or False: Asthma has no effect on life expectancy.

that is resistant to treatment, ask your doctor for a referral to a respirologist or allergist and speak to that specialist about Xolair.
Q. I consider my asthma under control but when I visit my in-laws farm, I get symptoms and need my reliever. What could be triggering my asthma, and how can I deal with this? Lindsay Douglas: Many things can trigger your asthma when visiting a farm. Some barns have high temperatures, humidity and poor ventilation, which can promote mould growth and is an ideal setting for dust mites. Other triggers include grain, grain dust and mould found in fields. Many farm animals are also triggers, including horses, cattle, sheep, pigs, goats, chickens, geese and ducks. You may need to adjust your controller medication when visiting the farm to reduce the need of your reliever. Trigger avoidance is also important; make sure to keep windows closed when indoors and shower after spending time outdoors to rinse away allergens. Q. How can I prepare my 7-year-old for spirometry testing? Shona Elder: Kids are often concerned when you tell them they

Shona Elder

Olsen Jarvis

Lindsay Douglas

Certified Educators take your asthma and allergy questions.
Send questions to:
Q. Recently our 5-year-old was diagnosed with asthma and we are working to understand the disease and gain control. Hell be playing soccer outdoors this spring; the rst time hes taken part in an organized sport. How can we make sure his asthma doesnt are up on the eld? Shona Elder: Spring allergies, such as tree pollen and grass, can

are having testing done at their doctors appointment. I would explain to him that this is a very simple test that does not hurt at all. He will have to blow into a machine that measures how much air he can blow out of his lungs, and how fast. Be sure to find out ahead of time which inhalers he needs to stop before the test and for how long. Its also a good idea not to have a large meal or do any vigorous activity prior to spirometry testing.
Q. Im allergic to birch and maple tree pollen. Would getting allergy shots for those help my asthma control or am I likely to still need to increase my controller meds in spring? Lindsay Douglas: Things you are allergic to can cause inflammation in your lungs. Allergy shots can be an effective way to decrease allergy symptoms, thereby helping control your asthma. They begin to take effect over a period of six to 12 months. You will then continue to get shots for three to five years. If effective, allergy shots can be a good way to help control your asthma and can lead to a decrease in the amount of controller medication needed. Q. Im a graduate of hairdressing school and got a great job four months ago. But sometimes in the salon, I have breathing difculty. Could this be a form of asthma? I certainly dont want to give up on my career! Olsen Jarvis: Shortness of breath does not necessarily mean

be a trigger for some asthmatics. Combine this with exercise and some people can run into trouble. The key is to achieve asthma control before he begins to play soccer, which means using his prescribed medications appropriately. Asthmatics should not feel limited by exercise or activity if their asthma is controlled. Having his rescue inhaler available at the field is a requirement. He could also take a non-sedating antihistamine before playing, if he is bothered by allergic symptoms.
Q. Im in my fties, and have struggled with severe asthma all my life. Ive been hearing about the drug Xolair lately. Whats your opinion of it for someone like me? Olsen Jarvis: Xolair is a drug for asthma that requires an injec-

tion once or twice a month. Asthma experts are seeing encouraging results with it, and you could ask your specialist about the drug. However, it is not covered by many insurance companies and is very expensive. To qualify for coverage in most provinces you will also need a specialist to support that your asthma is severe. Before pursuing Xolair as a treatment option, make sure the asthma basics have been covered. Have you had allergy testing and done your best to avoid or eliminate allergens that trigger your asthma? Have you addressed all causes of rhinitis and post nasal drip? Do you have gastric esophageal reflux disease, characterized by regular heartburn and nighttime awakenings with coughing, wheezing, sore throat and shortness of breath? If these issues have been addressed and you have allergic asthma

you have asthma. If you are only experiencing your symptoms at work this could indicate a reaction to one of many chemicals in the salon. My suggestion is to note the time and the tasks being performed when the symptoms occur. Make an appointment with your doctor who can determine if you need allergy tests or a breathing test or both. As well, if you figure out that a particular chemical or work procedure sets off your breathing, try to arranging with your workplace to avoid that task or chemical. Shona Elder is a pharmacist and CRE in Regina; Olsen Jarvis is a respiratory therapist and CRE in Winnipeg; Lindsay Douglas is a registered nurse and CAE in Windsor, Ont.





With Dr. Harold Kim, Allergist
here has been a clear increase in the number of people with allergies in the developed world. Whats baffling is why this is so. One of the widely believed theories is the hygiene hypothesis. It suggests that more of us have become allergic because we are too clean, have fewer infections and therefore do not have the proper immune responses to different proteins that become allergens. A major social trend in the developed countries has been a push from rural, farming lives to urban lives. The move away from farming has resulted in less time outdoors, less exposure to good bacterial particles, having smaller families and altered diets. Several scientific studies have shown that farming families are simply less prone to allergies. There is good Canadian data that farmers are about 60 percent less likely to develop asthma than urban dwellers. When one considers the numbers involved, living on farms could potentially prevent asthma in millions of Canadians. Getting back to the land may not sound like a potential treatment, but

Asthma and Your Weight

Besides the damage that high-fat,
sugary foods do to your waistline, research is revealing that those who are overweight are more likely to suffer from asthma. Theres an increased prevalence of asthma in obese subjects, we dont know exactly why, says Dr. LouisPhilippe Boulet, a respirologist at the Quebec Heart and Lung Institute at Laval University in Quebec City. It seems that very often, asthma develops after people become obese, which suggests a causal relationship. Almost half of people with a BMI of 40 or higher have asthma, says Boulet. (BMI, or body mass index, is based on height and weight; 30 or higher is considered obese.) Its also harder to control asthma in people who are severely overweight. Sometimes the obese person does not respond as well to asthma medication. That might be due to resistance to the drugs or to the fact that obesity per se is causing symptoms in addition to asthma, says Dr. Boulet. Even a modest amount of weight loss (10 to 15 percent of body weight) can significantly improve asthma. Dr. Boulet recommends consulting a dietitian about eating habits, as well as increasing physical activity. He cautions that asthma and weight may not be the only culprits. People who are obese tend to have other health conditions, such as heart disease. These should be treated, because they can either generate symptoms by themselves or worsen asthma. Jaclyn Law

there are studies looking at whether its conceivable to treat the allergic response that occurs in patients with asthma or other allergies with nondisease-causing microbes (or parts of the microbes). If successful, this could lead to more definitive treatment for all of the allergic conditions. It is certainly very early to suggest that returning to a more agrarian lifestyle or exposing ourselves to different aspects of rural life would reverse the epidemic of allergy. But it is nice to dream .

Photo: ricK chard

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 health-care 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.


Your Navigator on Asthmas Road

Dust-reducing decoration need not be boring.

Kids Corner

Playing With Kids Spaces


s a parent of children with allergies, Ive wrestled with how to make their spaces fun while minimizing asthma and allergy triggers. After taking care of basics such as appropriate flooring and mattress covers, I looked for ideas to make their bedrooms and play areas meaningful to them as well as allergy-friendly. Heres what has worked well: Clear storage boxes. Readily available at hardware stores, these containers help to seal out dust mites. The clear factor is important because I want my children to be able to see whats in the container. The kids then personalize them, using stickers and water-based markers.

Homes for stuffed animals. Using a garbage container with a lid, I helped my children to create a magic castle for their stuffed animals. We decorated the bin so that it looked like a medieval castle with an unusual entrance the roof. Putting toys away in the magic castle then becomes a part of play time, not a chore. (Again, the toys were stored away and not scattered around the toy room collecting dust.) Fun colour schemes. Kids with dust allergies have to have clutter-free rooms, so I made a point of ensuring that the rooms didnt look sterile and boring. They chose the lowVOC paint colours for their bedrooms and toy room. And, they werent limited to just one colour for each room. Maria Muirhead is a CRE and author of My Asthma Book and Smoking = Problems (BIG Problems!).

ou have probably heard the term self-management, a concept that puts you in the drivers seat of your respiratory care. But, like any good pilot, you need an effective navigator to help guide you, and this is the role of the Certified Respiratory Educator or CRE. The CRE is a trained healthcare professional with a special interest in respiratory disease, who has sought out education and passed a rigorous examination to achieve the CRE or CAE (Certified Asthma Educator) credentials. Educators, who can be found in hospitals, health clinics and pharmacies, share a common goal of improving lives and helping you to navigate your journey in respiratory health. A navigator doesnt simply read maps. She is a source of information, constantly updating the pilot to allow for optimal decision-making. Similarly, the CRE equips you with the knowledge, resources and tools. This includes information on how to manage your illness, what your medications do and how to use them. But importantly, the CRE will also help you troubleshoot challenges. The navigator will assist you in identifying symptoms, determining the best course of action, ensuring that care is received, and will follow up afterward. The CRE helps you create an action plan to head off future problems, and also liaises with your healthcare team, ensuring they are informed of your self-management journey. Respiratory health can be a bumpy path, but an effective navigator makes the trip much smoother. To locate a CRE, visit or ask your care provider for a referral.

Heather Sharpe is a nurse, CRE and doctoral fellow in the CIHR Canadian Child Health Clinician Scientist Program.

QUIZ ANSWERS from page 32

1. True: Rare deaths do occur from asthma, however, in the absence of other chronic lung disease, asthma does not increase mortality. 2. False: Wheezing is the most common rst sign of asthma in newborns although, in many cases, wheezing is outgrown. 3. True: Certain fruit contains proteins called prolins that are similar in structure to ragweed proteins and can cause cross-reactions. Jolanta Piszczek is a pharmacist and CRE based in Victoria.

Photo: Per Magnus Persson / Johnr iMages / corbis

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