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Asthma queries: what patients want to know

Sally Rose illustrates the variety of nonclinical enquiries received by the Asthma UK Adviceline, and outlines a sample of telephone calls and emails received by the nurses, followed by their responses

Sally Rose
RN BSc(Hons)
Asthma Nurse Specialist
Asthma UK

Good asthma management is not only about providing effective, evidence-based clinical care to help patients achieve optimal control of their symptoms. It is also about recognising and acknowledging the nonclinical, practical implications that asthma may have on an individual's day-to-day life, and being able to respond to those concerns with appropriate information and advice.
Primary care nurses are well-placed to provide this type of holistic support, but they frequently have so many other work-based demands and priorities that there isn't time to accumulate the broad knowledge base that people with asthma may need. It is important, therefore, that nurses involved in asthma care know about sources of reputable and accurate information that can be accessed quickly and easily, both by themselves and by their patients. One such resource is the Asthma UK Adviceline.
The Adviceline is staffed by a team of asthma nurse specialists who provide independent, confidential advice and information to people with asthma, their families, friends and carers, and also to health professionals. Every year, thousands of people contact the Adviceline by telephone or email with a huge variety of enquiries and concerns. Evidence-based clinical guidelines, such as the recently updated British Guideline on the Management of Asthma, current pharmacological information, and developments in respiratory research are the foundations for Adviceline responses to clinical enquiries.(1) But many queries are nonclinical in nature, and are more to do with lifestyle. Through proactive and reactive research, the team has built up a wide-ranging resource of information and advice about these types of issues. Most enquiries (however obscure) fall into one of the categories outlined in Table 1.

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Q: Can I claim any benefits, such as Disability Living Allowance, if I have asthma?
A: "If you are unable to work because of your asthma, you should be able to claim an income benefit such as Statutory Sick Pay, Incapacity Benefit or Income Support. Your local Jobcentre Plus office will be able to advise you according to your particular circumstances. You can find the number on the Jobcentre Plus website at www.jobcentreplus.gov.uk or from your local telephone directory.
Whether you are in work or not, you may be able to claim Disability Living Allowance (DLA). This is a tax-free benefit for children and adults that is awarded according to how a particular condition affects your every day life; it is not necessarily based on the actual condition itself.
If you have severe asthma that significantly affects what you are able to do on a daily basis for an extended period of time, you may be entitled to DLA. If you are a parent or carer of a child with severe asthma you may be able to claim DLA if your child needs a lot more help or supervision than other children of the same age.
Completing a claim form for DLA can be time-consuming and difficult, especially when you have a variable condition such as asthma which may be worse on some days than others. Citizens Advice can help you complete a DLA form to give you the best chance of success. Contact them through their website at www.citizensadvice.org.uk or from your local telephone directory."

Q: I've seen adverts on the internet for devices that exercise your breathing muscles. If I get one, will it improve my asthma?
A: "Devices such as Powerbreathe™ and Youbreathe™ use a form of lung training called respiratory muscle training (RMT). RMT may sometimes be used by athletes to improve their lung function and capacity, and therefore their performance. Some manufacturers also claim their products can reduce asthma symptoms and improve breathlessness. There is some evidence to suggest that RMT devices may be helpful in treating certain lung conditions, such as chronic obstructive pulmonary disease.(2) However, there have been fewer studies into their effectiveness for treating asthma. Studies quoted by manufacturers tend to be small and are likely to measure perceptions of breathlessness by people using the device, rather than objective criteria.(3) Because the value of RMT devices for people with asthma is largely unproven at the moment, they are not something that can be positively endorsed. However, some people with asthma do report that training with an RMT device helps control their symptoms, and it is acknowledged that lack of evidence for the effectiveness of a complementary therapy does not necessarily mean that it doesn't work.(1)
As with any complementary therapy or product, RMT should not be tried until you have discussed it with your asthma nurse or doctor in case it isn't safe or appropriate for you. If your nurse or doctor is happy for you to try a complementary therapy or product, it should always be used alongside your usual, prescribed asthma medicines."

Q: My daughter is 16 and wants to join the army. She hasn't had any symptoms for a few years, but she did have asthma when she was younger. Will this be a problem?
A: "The Armed Forces are very cautious about accepting anyone with a history of asthma, and will definitely not recruit people who have had any asthma treatment or symptoms in the four years prior to application. This is because asthma can reappear after a symptom-free period. In addition, someone with a history of asthma may find that exposure to new environments and substances (such as gases) unexpectedly trigger their symptoms. This could be dangerous not only for the person with asthma, but also for their colleagues.
If you have been asthma-free for more than four years, you can apply to the Army, the Royal Navy or the Royal Air Force (ground crew), but selection will ultimately depend on an individual assessment by a service specialist. The RAF will not consider anyone with a history of asthma for aircrew service.
For more information about joining the Armed Forces, you can get in touch with the appropriate recruitment service."

Q: I've heard on the news lately that asthma medicines are banned in sport. Even though I have asthma, I play loads of football. My coach says I'm good enough to get trials with a big club, but now I'm really worried that I won't ever be able to play it professionally because I use inhalers.
A: "You will be reassured to know that there are many top athletes, such as Paula Radcliffe and Paul Scholes, who have asthma and are still able to take regular medicines (including preventer steroid inhalers and reliever inhalers) while competing at top levels.
Although the medicines in most asthma inhalers are on the World Anti-Doping Code 2008 Prohibited List, their use for treating asthma can be covered with a Therapeutic Use Exemption (TUE) certificate. You can get more information about the 2008 Prohibited List and TUE certificates from UK Sport at www.uksport.gov.uk and from the official body that governs your particular sport at competition level."

Q: Is there anywhere in the UK where it is best for people with asthma to live?
A: "There isn't really a specific area in the UK that is best to live when you have asthma. Even in the least polluted parts of the UK, such as the far north of Scotland, the percentage of people with asthma is about the same as that elsewhere. Nowhere in the UK has a significantly low level of asthma and so, unfortunately, there is nowhere that is likely to be good for all people with asthma.
The reason is that not everyone has the same asthma triggers. So while pollution may be one person's trigger, it won't necessarily trigger symptoms in someone else. You will need to consider your own, personal asthma triggers and where you are less likely to be exposed to them, if you are thinking about moving house. The indoor environment is also important. For example, if you know that dust and mould trigger your asthma, it wouldn't be wise to move to an older building.
Bear in mind that a person's asthma triggers can change, so you may feel better in a new area for a short while, then become sensitive to different triggers there, such as a particular species of plant or tree. Except in a few circumstances (for example, if you live in damp housing or next to a heavily polluted road), moving house is not usually a recommended solution for reducing asthma symptoms."

Examples of less common enquiries
The questions and answers on page 70 and 71 are a very small sample of the more common issues that the Adviceline deals with on a daily basis. Other enquiries may be more specialised and unusual - here are a few examples:

Could exposure to human nail dust trigger my asthma? (from a podiatrist)
Studies suggest that nail dust can indeed trigger asthma symptoms in podiatrists and manicurists. It seems the problem isn't the nail dust itself but exposure to fungal spores that are contained in the dust, primarily spores of Trichophyton rubrum.(4) Research shows that using a nail dust extractor helps to reduce exposure to the spores.(5)

How effective are ultrasonic dust mite controllers?
These devices work by emitting ultrasonic sounds not heard by humans or pets. The sounds interfere with the feeding and reproductive cycles of the dust mite, which leads to a reduction in numbers of house dust mites (HDMs). However, as with all HDM control measures, there is very little objective evidence that they lead to a reduction in asthma symptoms.6 Anecdotally though, some individuals with asthma do report that HDM control helps reduce their symptoms.

Is it safe to live in an area with high radon levels if you have asthma?
Radon is a naturally occurring radioactive gas that is found in many parts of the UK. It is a known risk for lung cancer but there doesn't appear to be any research linking it with asthma. In some areas of the UK, homes and buildings may have a particularly high level of radon. You can have your home tested for radon levels and if they are high, radon reduction measures can be taken. For more information contact the Health Protection Agency Radiation Protection Division on 0800 614529.

Can the results of a Breathalyser test be affected by asthma medicines?
Some propellants in metered-dose inhalers contain alcohol and these can register on some Breathalysers. The effects last no more than about 15 minutes, although some sources say less.(7) In the UK, police forces may delay a Breathalyser test for that time if they know that an inhaler has been used.

My wife has asthma. What type of cavity wall
insulation should I use in our house renovations?
Some insulation materials contain formalin and formaldehyde which are known asthma triggers. It is important that the skin containing the insulation is not cracked, as this can leak fumes into the house. Micafil is free of these chemicals.

Could the fish food I use for my tropical fish be triggering my daughter's asthma symptoms?
Fish food can trigger asthma symptoms although it is very uncommon. It is made from dried crustaceans, other fish and worms, and may, therefore, cause an allergic response in sensitive individuals.

Conclusion
The Asthma UK Adviceline is not just a source of up-to-date clinical information, but is also a useful resource of advice about nonclinical issues that may affect people with asthma. If you or your patients would like to contact the Adviceline with any query related to asthma, you can call on 08457 01 02 03, Monday to Friday, 9am to 5pm. Alternatively, you can email your enquiry via the Asthma UK website at asthma.org.uk

NB. Numbered references are provided because of the context of the responses within this article, but were not part of the original reply

NB. When responding to email enquiries to the Adviceline on behalf of Asthma UK, the nurses usually add the following after an external weblink: "Please note that we are not responsible for the content of any external sites, nor should selection be seen as an endorsement of them."

References

  1. British Thoracic Society & Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. 2008. Available from: http://www.sign.ac.uk/pdf/sign101.pdf
  2. Lotters F, Van Tol B, Kwakkel G, et al. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J 2002;20:570-6.
  3. Weiner P, Berar-Yanay N, Davidovich A, et al. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled ß2-agonists. Chest 2000;117:722-7.
  4. Davies RR, Ganderton MA, Savage MA. Human nail dust and precipitating antibodies to Trichophyton rubrum in chiropodists. Clin Allergy 1983;13:309-15.
  5. Harvey CK. Comparison of the effectiveness of nail dust extractors. J Am Podiatr Med Assoc 1993;83:669-73.
  6. Gøtzsche PC, Johansen HK. House dust mite control measures for asthma: systematic review. Allergy 2008;63:646-59.
  7. O'Connell O, Beckert L. Asthmatics: too drunk to drive? The time curve of exhaled ethanol levels after use of Salamol in normal subjects. NZ Med J 2006;119:U2282.