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BREATHE EASY WHILE CAMPING
BY JACLYN LAW
Camping is a great way to connect with nature and enjoy Canada’s rugged beauty. But if you or your child has asthma, you may feel anxious about prolonged exposure to the great outdoors. You can manage asthma and spend quality time under the stars – but it takes careful planning. “Choosing where and when you go definitely needs to be pre-planned,” says Julie Gaalaas, a Certified Respiratory Educator (CRE) in Camrose, Alberta. Your asthma should be well controlled before your trip; if not, refer to your asthma action plan for directions on
Camping near a beach is one way to avoid pollen triggers.
increasing your controller medication. “While you’re camping, I recommend doing a symptom diary or monitoring peak flows so you know how you’re responding to your environment,” says Gaalaas. Seasonal allergies can worsen asthma, so camp when your allergens are typically lower: tree pollen is airborne in spring, grass is most active in early summer, and ragweed causes misery in late summer and early fall. Check the
pollen count and the weather forecast before you go. (Damp conditions mean less tree, plant and grass pollen, but possibly more mould.) When picking a destination, keep in mind that beaches have less tree pollen than forests, and a beach, concrete pad or trailer helps with grass avoidance. Sites with showers will enable you to rinse off pollen before bedtime. See Smart Camper’s Tips on page 38
Your Asthma in a Heat Wave
Heat waves are sticky and uncomfortable for everyone, but they can cause extra trouble for people with asthma. “Heat and humidity can play a role in your asthma control,” says Carolyn Savage, a Certified Respiratory Educator in Portland, Ontario. One reason is that hot, humid air often contains more outdoor air pollutants, which aggravate the airways and cause inflammation. This leads to asthma symptoms, explains Savage. Those prone to symptoms when exercising will want to be mindful during a hot spell, and perhaps turn to an indoor activity. Staying hydrated is especially important during a heat wave: when you don’t drink enough water, your whole body feels it. “The heart has to work harder to pump the oxygen and nutrients to the body. Breathing can become faster as a helper to the heart,” says Savage. To help control your asthma during the summer, avoid your triggers, use your inhalers as
you’ve been directed, and check the Air Quality Health Index (www.airhealth.ca) daily – a value of seven or above is high, but everyone responds differently, especially those with asthma. “Decrease outdoor activity, keep your reliever puffer handy, and follow your asthma action plan,” says Savage. “These actions will help keep your breathing in good control during the heat of the summer.” –Jaclyn Law
ALLERGIC LIVING | SUMMER 2012
THE ASTHMA EXPERT
With Dr. Harold Kim, Allergist
SMART CAMPER’S TIPS
• A couple of weeks before your trip, clean and air out your tent (remove mould with a non-toxic mould removal product or mild bleach solution). Wash sleeping bags, sheets and blankets. • Do activities in the afternoon, when there’s less pollen, and keep your tent zipped so allergens don’t get in. On high-pollen days, consider visiting a nearby town. • Campfire smoke can irritate airways: pitch your tent upwind and don’t sit close to the fire. • Consider taking an antihistamine daily one week prior to and throughout the camping trip to help prevent allergic reactions. • Camp where you’ll have a cellphone signal. Know where the closest medical facility and pharmacy are, and have a list of your medications on hand. • Wear medical ID and carry your inhalers at all times, and your epinephrine auto-injector if one is prescribed (pack two injectors if emergency help is over 20 minutes away). • If your asthma worsens, refer to your asthma action plan for instructions. And if camping proves too challenging, don’t be a martyr – have a backup plan, such as decamping to a motel. Tips provided by: Certified Respiratory Educators Julie Gaalaas and Kristine Petrasko.
hen it comes to allergies, often a newborn will start out with allergic eczema. Then a food allergy will occur. Then the child may develop asthma with allergic rhinitis. One of the great hopes is to have a treatment that may prevent this “allergic march”. For patients with allergic rhinitis, allergists will advise trigger avoidance, followed by therapies such as antihistamines and nasal steroid sprays. We may then turn to immunotherapy – allergy shots – to desensitize to the allergen. An important discussion has emerged as to whether childhood immunotherapy could halt the progression to asthma. A few studies are, in fact, showing this outcome. The European PAT study is the most important in considering the longterm effects of immunotherapy. Children in the study received either allergy shots to birch and/or grass allergens or standard medical treatment for three years. The researchers then followed up seven years later. In the group that didn’t receive immunotherapy, 45 percent of children developed asthma. In the group that had allergy shots, only 25 percent developed asthma. The children who got injections also had fewer nasal and eye symptoms. The significant difference in asthma emergence suggests we
could have a dramatic public health impact by simply using this readily available treatment. As we say in medicine, “more studies are needed,” but with PAT and other shorter-term studies providing valuable evidence, allergists and parents should more often consider the option of immunotherapy in childhood. We know it leads to excellent symptom control of allergic rhinitis – and we are learning that it could, over time, slow or even stop the allergic march to asthma.
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 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 www.cnrchome.net or phone: 905-880-1092.
38 ALLERGIC LIVING | SUMMER 2012
Q. My son used to be great about tracking symptoms and using his peak ﬂow meter. But now he’s 17, and has to be reminded repeatedly to do so. Do you have any advice? Lora Miller: As children grow older, parents can often make more of an impact on their kids by giving them ownership of decisions regarding their health. In this case, I would ask your son why he is no longer monitoring his peak flows. If his response makes you think he is becoming complacent with his asthma control, you could ask him what he might miss out on if he has symptoms – a paycheque from missed shifts at work or maybe the basketball championship game. If he starts to see that his health is linked to things that he values, he will find his own motivation to keep his asthma under control. Q. We have identical twins and one has just been diagnosed with asthma. Is his twin equally at risk of developing it? Ellen Fleming Michaud: If having asthma was based solely on genetics, identical twins would be equally at risk of developing it. However, studies show the odds of identical twins both developing asthma are about 60 per cent. It is nearly impossible to predict whether your other child will inherit the disease, as there are environmental factors that come into play, such as exposure to air pollution, cigarette smoke and dust mites. Diet and exercise may even have a role. My advice: closely monitor your child for signs or symptoms of asthma and speak with your family physician about whether to have a spirometry test performed. Q. I’m going to be a bridesmaid at an August wedding. Since ragweed is a bad asthma trigger for me and the wedding is bringing on stress, what can I do to prepare? Trevor Shewfelt: Start with regular exercise, a good diet and lots of sleep. These will help you deal with stress. If you have a controller inhaler, use it as prescribed in the months leading up to the wedding to keep your lung inflammation in check. Ask your respiratory educator or healthcare professional about starting an antihistamine like loratadine (Claritin) a week before the wedding to lessen symptoms from ragweed. You might also ask about an omega-3 and/or vitamin D supplement, as both can reduce lung inflammation. Finally, you could speak to your doctor about taking a leukotriene inhibitor like montelukast (Singulair), in addition to your controller medication to further reduce inflammation. Q. My son is starting Grade 1 this fall, when should we start increasing his asthma meds to be ready for school? Lora Miller: I recommend marking your calendar a full two
Ellen Fleming Michaud
Certified Educators take your asthma and allergy questions.
Send questions to: email@example.com
Q. Grass pollen triggers my asthma. But I live on my own and need to mow the lawn. Any recommendations? Ellen Fleming Michaud: It would be best for you not to do the mowing, as cutting the grass distributes pollen into the air. However, as this is not an option, I strongly recommend that you wear a mask with HEPA filtration to block out dust, pollen, and mould (these are available at most hardware stores). After mowing, take a shower to remove any pollen and change into fresh clothing. Taking a non-drowsy antihistamine daily during allergy season can also help. Speak with your allergist about whether you could be a candidate for allergy shots and ensure that you take your asthma controller medicines (inhaled corticosteroids) daily. Your blue rescue inhaler should be available to you at all times. Q. A month ago, my 6-year-old had an asthma attack and we had to go to the hospital. Our doctor then changed controller inhalers and increased the dosage, but now my daughter’s symptoms seem worse. Could this be the wrong medication for her? What should we do? Trevor Shewfelt: It’s possible it’s the wrong medication, but
the more likely reason is incorrect inhaler technique. Inhalers are surprisingly difficult to use properly. I suggest getting your pharmacist to watch your child use her new inhaler. He or she will be able to help her with the correct technique. If the inhaler is the spray type with the pressurized canister, ask your respiratory educator or pharmacist about a spacer device. A spacer can make it much easier to get the medication deep into her lungs where it does the most good. Also, I would suggest visiting the Children’s Asthma Education Centre website (www.asthma-education.com) for demonstrations on using an inhaler.
weeks prior to a risky season that will affect asthma symptoms, and start taking or increasing inhaled corticosteroids at this time. The so-called September spike for asthma is one issue, but there are other risky times as well. Taking action two weeks ahead of a trigger season will help to minimize reactions. Ellen Fleming Michaud is a respiratory therapist and CRE in Renfrew County, Ont. Trevor Shewfelt is a pharmacist and CRE in Dauphin, Man. Lora Miller is a respiratory therapist and CRE in Camrose, Alta.
ALLERGIC LIVING | SUMMER 2012
Avoidance Alone Isn’t Enough
BY SUZANNE MURPHY
Soothing Tiny Eyes and Noses
BY INGRID BAERG
Kids with asthma often also have
seasonal allergic rhinitis or pollen allergies, such as summer grass pollen reactions. The symptoms include itchy, watery eyes and a runny or stuffy nose, which can make kids feel miserable. Inflammation in the nose may Treating runny nose contribute to inflammation in the symptoms helps kids with asthma control. airways of the lungs. Therefore treating the nose is important in managing asthma, but doing so can be difficult at a young age. Here are some tips to get help you get it right. Nasal Sprays: Young children aren’t keen about a solution being sprayed up the nose. Use books, pictures or even a model of a nose to show kids the anatomy and what the spray does. Aim away from the bony middle part of the nose. Don’t expect immediate relief, since getting control of “stuffiness” or inflammation with a nasal corticosteroid spray can take several weeks. Be persistent. Eye Drops: Have the child lay the head in a parent’s lap or on a pillow. Do not place drops directly on the eye. Rather, gently pull the lower eyelid at the cheekbone, creating a pocket. Place the dropper as close to the pocket as possible without touching, and insert one drop at a time. Oral Medication: Non-drowsy antihistamines such as Aerius, Claritin and Reactine are the most appropriate as they have fewer side effects and last 24 hours. Benadryl should be avoided for rhinitis since it is sedating, and its effect only lasts four hours. Ingrid Baerg is a CAE and nurse at the Asthma Education Clinic at the BC Children’s Hospital in Vancouver.
Photo: iStockphoto.com / IMGORTHAND
Many children with asthma also have food allergies and as a
Certified Respiratory Educator, I often talk to families about prevention and being prepared for a food allergy reaction. I am alarmed by the number of parents who do not have an epinephrine auto-injector for children at risk for anaphylaxis. These families rely on being able to avoid allergens as a prevention strategy. That is dangerous. Children with uncontrolled asthma who are exposed to a food allergen are at an increased risk of death from an anaphylactic reaction. Asthma medication, such as Ventolin, can’t halt the breathing difficulties of an anaphylactic reaction. An experience with a 5-year-old patient of mine reinforces the point. The girl ate a piece of a store-bought cake that was labelled as free of her allergens. After a few bites, the girl’s face swelled and she had difficulty breathing. Her parents called 911 and gave her epinephrine while waiting for the ambulance. She made a full recovery. However, if the parents hadn’t had an auto-injector available, it may have ended differently. I encourage all families dealing with asthma and anaphylaxis to follow their asthma action plan, ensure that they have an auto-injector available at all times and know how to use it. Suzanne Murphy is a nurse and CRE at Credit Valley Hospital in Mississauga, Ont.
POLLEN QUICK TIPS
• Close doors and windows, especially in the bedroom. • Avoid drying clothes outside as pollen will accumulate on the laundry. • Discourage kids from playing on freshly cut grass. If they can’t avoid, shower and change clothes afterward. • Take a non-drowsy antihistamine prior to activities like picnics, soccer and baseball games.
CNRC thanks GlaxoSmithKline for helping to make Currents possible through an educational grant.
40 ALLERGIC LIVING | SUMMER 2012
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