In New Zealand, around 1 in 8 Kiwi adults and 1 in 7 Kiwi children suffer with a respiratory disease. For children, asthma is one of the most common causes of hospital admissions.

On Average, 77 Kiwis die from asthma each year. Currently there is no cure for asthma, however there are lots of things you can do to manage it better so that it doesn't impact on your life too much. The first step is to learn as much as you can about the condition and the steps you can put in place to control it.

What is asthma?

Asthma is an inflammatory disease. The lining of the tubes/bronchioles in the lungs are very sensitive and become inflamed – red, swollen and full of mucous. The inflammation is caused by an irritant that is usually breathed into the lungs, eg pollen, fumes, cat dander etc or exercise induced asthma. Your preventer helps to protect those sensitive airways and prevents the inflammation, resulting in fewer, milder or no asthma flare-ups at all.

On exposure to an allergen or exercise (triggers, see below) the muscles on the outside of the bronchioles contract and become tight to prevent the irritant getting further down. The reliever medication relaxes the muscles so that your airways are opened and breathing becomes easier.

Illustration courtesy of Ophea Asthma Friendly website (CA)

Symptoms of asthma

There are 4 key symptoms of asthma. You may have only one of these symptoms, or you may have a combination. They may be continuous, intermittent or periodic:

Chest tightness
Wheeze
Cough
Shortness of breath

Remember, everyone who wheezes does not necessarily have asthma and everyone with asthma does not necessarily wheeze.

What is a trigger?

Triggers are the things that 'provoke' asthma. It is important that you try and determine what the triggers are so that you can try and avoid them, or take extra treatment/precautions before or at the time of exposure. Triggers can sometimes cause an immediate effect and other times they take effect over several hours.

Common allergic triggers include:

Animals (cats, horses)
Dust mites
Moulds
Pollens
Foods

Common non-allergenic triggers:

Cold/flu
Exercise
Cigarette smoke
Temperature changes
Medications
Dust
Perfumes
Chemicals
Food additives
Laughing/crying
Emotional stress
Occupational
Air pollution/smog/fumes
Strong smells
Pre-menstrual hormone changes

Is your asthma well controlled?

Do you experience shortness of breath, cough or wheeze with exercise?
Are you needing to use your reliever more than two times a week on a regular basis?

Take our quiz to find out if your child's asthma is well controlled

When asthma is well controlled:

There are no or minimal asthma symptoms
You know which asthma triggers to avoid
The reliever medication is used less than 2 times a week

You do not regularly wake in the night with a cough/wheeze
You do not miss days off school or work because of asthma
You are reviewed by your GP every 6 months

If your asthma is not well controlled please call us to discuss or make an appointment with your GP. Asthma shouldn't stop you from getting on with your every day tasks.

What is a reliever and what is a preventer?

You can choose between a metered dose inhaler (MDI) (sometimes called an aerosol inhaler) or a breath activated inhaler dry powder inhaler. There are many different types of asthma medications and many different brands. There are also different devices used to administer the medications. Talk to us or your doctor to determine the best device for you.

Reliever medication works quickly, enabling you to continue your daily routine. However, the reliever does not prevent the lining on the inside from becoming swollen causing risk of blockage and limitation of airflow.

Preventer medication works very slowly, over a period of days to months to reduce the inflammation and sensitivity. Preventers need to be taken every morning and night, every day, even when well to be effective. Preventers are a long term medication that should not be stopped but may be gradually reduced under your doctor's supervision.

Why too much reliever isn't a good thing.

Many people are overly reliant on their reliever (usually blue or grey) inhaler. But most do not realise that overusing this medication can actually cause more harm than good. It is a brilliant first aid medicine but doesn’t actually treat the underlying problem. And if you need to use it more than twice a week then this indicates your asthma isprobably uncontrolled. Have a watch of this video to learn more about this.

What is a spacer?

Spacers are clear plastic tubes with a mask or mouthpiece on one end and an opening to insert the inhaler into at the other end.

Spacers are not just for kids! Using an MDI (puffer) with a spacer delivers up to 50% more medicine to your lungs than using a puffer alone. Why? Because spacers slow down the speed of the medicine coming out of the inhaler, suspending it briefly in the chamber, making it easier to breathe in. Using a puffer without a spacer means the majority of the medicine ends up hitting the back of the throat, resulting in an increased risk of thrush and other oral problems. It also means a reduced amount of medicine is getting to the lungs where it is needed.

'With a Spacer' and 'Without a Spacer'.

Cleaning your spacer

They should be washed weekly and left to drip dry. This is important to reduce medicine build up on the inside of the chamber which hinders effectiveness.

If spacers are left to retain condensation, mould or mildew can grow creating a very unhealthy device to breathe through. If debri is inside the mouth piece and cannot be removed during washing discard the spacer and replace with a new one. You can request a replacement from your medical centre which you are enrolled in or purchase one at a pharmacy.

Remove base only from the spacer
Wash them in warm soapy water (nothing scratchy)
DO NOT rinse the bubbles out, DO NOT towel dry

Leave on the bench to AIR DRY
Replace base once dry
Spacer is now ready to use

Please note:

Spacers should be changed every 6 – 12 months. Tiny scratches and abrasions on the inside of the spacer can reduce the effectiveness of the medicine delivery
One puff in the chamber at a time, to 6 breaths. Numerous puffs in the chamber at once will cause the particles to clump together and become harder to breath in hence resulting in ineffectiveness.

Administration techniques

An MDI (Puffer Inhaler)

How to Use - Correct Technique:

Shake medication
Insert into base end of spacer
Place lips around mouth piece to create a seal
Press MDI once
Breathe in and out normally through the mouth 6 times
For further doses, repeat steps 1-5
Listen for the "butterfly" valve clicking when you breathe in and out (with the e-chamber model)
Replace after 12 months of use

When to wean off the mask and why

Children aged 1-4 generally use a mask with the spacer. During the ages of 2-4 transition to using the spacer mouthpiece directly in the mouth without the mask can begin. A good seal around the mouthpiece with the lips is essential. This transition is important as up to a third of the medicine can be lost on the face when using a mask, meaning less medicine reaching the lungs where it is needed. However, during this time of transition the mask may still be needed in times of acute flare-ups as a good seal around the mouthpiece may not be possible.

A Turbuhaler

How to Use - Correct Technique:

Twist – unscrew and remove the cover.
Hold the turbuhaler upright and twist the grip as far as it will go in both directions until you hear a click. The turbuhaler is now loaded with one dose of medicine
Breathe out away from the turbuhaler – do not blow directly into your turbuhaler
Place the mouth piece in your mouth and form a good seal with your lips and breathe in deeply.
When finished place the cover back on the inhaler and twist shut.

Remember - load like a rocket and inhale like a plane

The most common mistakes with the turbuhaler

Not holding the turbuhaler upright when priming
Covering the air inlets with lips
Breathing in through the nose instead of mouth
Shaking the turbuhaler to see how much is left
Storing the inhaler in a damp environment with the cap off.

Spacers are free at Asthma Waikato or your GP surgery (Pharmacies may charge).

Do you need to know more about Asthma? Need to see a Educator?

Are you struggling with your asthma? Alternatively, you have ideas of how we might be able to help you help us continue working with people and families in the Waikato with asthma or COPD? Whatever it is, please don't hesitate to get in touch.