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Help For Asthma Sufferers

If you are asthmatic, you are not alone. Over 5.1 million people in the UK have asthma – that's around 1 in 13 people, 50% of whom are children with asthma. The figures for asthma sufferers are in similar proportions in most other countries.

Whilst there is currently no known cure for asthma, it is a scientific fact that 85% of people are allergic to the dust mite excrement and dust mite skeletons found in every mattress, even if only a few months old. It is also a scientific fact that if a pregnant woman inhales this dust mite excrement and the skeletons, which is inevitable, that this can cross the amniotic fluid in the womb and cause asthma in the unborn child.

Can the Mattress Doctor cure asthma? Well that depends upon your definition of cure. In a survey of 900 of our customers over the last 6 months, 87% reported a considerable, if not complete alleviation of their asthmatic symptoms. And in several cases there was no need for the continued used of any form of medication. That may not be a cure for asthma but it is certainly a great help for asthma sufferers. Click here to read what some of these customers said.

As a secondary preventative measure allergy sufferers should also consider sleeping with an anti allergy mattress protector as this will provide an impenetrable barrier between the sleeper and the dust mites and their allergens.

Here is some other information on asthma which could be useful to asthmatics, and there is also considerable further information available.

Vaccine: real hope for the future

From The National Asthma Campaign

Recent media reports have suggested that a vaccine for asthma is just around the corner. Initial results of the research, which focuses on a vaccine for people with a cat allergy, are encouraging, but an effective vaccine for asthma is still a long way off, say experts.

Professor Barry Kay and Dr Mark Larché are carrying out National Asthma Campaign-funded research at the National Heart & Lung Institute, Imperial College, London. They have developed a prototype vaccine for people with an allergy to cats, which could eventually be applied to a range of allergens including pollen and dust mites.

The researchers have designed a synthetic vaccine based on the structure of whole allergens. The approach is different to desensitising immunotherapy (sometimes referred to as 'allergy shots'), since it targets only the body's T cells, which direct the allergic response. Therefore instead of injecting the whole allergen, they use only the small parts of it that react with the T cells. This new approach reduces the risk of side effects and allows a much higher dose of treatment to be given, compared with conventional immunotherapy.

Sixty patients have received the prototype vaccine, with promising results. However, it is early days, warned Professor Kay. 'Far more work has to be done, including extensive clinical trials,' he said. 'People with asthma should not have their hopes raised at this stage because it is too early to say with certainty if the vaccine will pass all the rigorous tests involved in the development of a new therapy.'

The Campaign's chief medical adviser, Professor Martyn Partridge, called the vaccine an 'important development' and said: 'Hopefully this will lead to new treatments for people with asthma in the next five to six years.'

Worldwide, dust mites are the main causative agent of one of the worst ailments of the twentieth-century man.

Lilian R. Blanco, Ph. D., MOIF, D.G.

As there has been increasing prevalence of asthma which are mite-related in both adult and children not only in Western countries but also in Asian Pacific countries, there is an urgent need for mite education.

The fundamental thing to know is that mites are diverse small arthropods.The ones which are particularly linked to asthma are collectively called house dust mites having their permanent residency in house dust. That house dust contain allergens causing asthmatic symptoms was first suggested in 1921. However, analysis of dust did not come about until 1964 when a group of investigators led by Voohorst suggested that a mite may be responsible for the dust allergen. Results of such studies identified one mite species after another and showed variable distribution from one home to another, from one room to another of the same home, and from different home soft furnishings. Their predominance or survival depend on richness of their diet and suitability of temperature and relative humidity of their habitats. In general, humid homes have more mite and therefore more allergen.

Soon it was established that the faecal pellets which mites egest and accumulate in home fabrics are allergenic. When these become airborne following our domestic activities such as vacuuming or dusting, we inevitably inhale these particles eliciting from some of us, who are atopic, allergic reactions. Today, global studies aimed ultimately towards mite management have increased steadily.

What is asthma?

Asthma is a chronic disease in which sufferers have repeated attacks of difficulty in breathing and coughing. There seems to be an increase in the amount of asthma all over the world, especially in children. To understand what happens in asthmatic attacks it is helpful to visualise the basic structure of the airway tubes of the lung (bronchi).

The main airway (windpipe, trachea) of the body is about 2-3cm across. It divides into its main branches (bronchi), which lead to the right and left lung, which divide further, like the branches of a tree, to supply air to all parts of the lungs. The smallest tubes (bronchioles) are only millimetres wide and they are made up of ring-shaped muscles that are capable of contracting or relaxing. Anything that makes them contract will narrow the passages, which makes it more difficult for the air to pass through and also gives rise to the characteristic wheezy noise. Asthmatics tend to be sensitive to various types of irritants in the atmosphere which can trigger this contraction response from the bronchial muscles.

The bronchi also have an inner lining that becomes inflamed in asthma, which makes the lining swell and produce an excess amount of the mucus (phlegm) which it normally makes. All of these processes contribute to the airway narrowing and the treatment for asthma is aimed at reversing them as much as possible.

People of all ages get asthma but 50 per cent of sufferers are children, mostly boys, under 10. Among adults, women are more likely to develop asthma than men.

How do you get asthma?

Asthma can be triggered by external agents, such as irritants in the atmosphere which are breathed in, or by internal reactions within the body that have been caused by an external influence. The kinds of provoking factors can be divided into two groups:

  • non-specific factors: all asthma patients are affected by a number of things that are referred to as irritants. They include exertion, cold, smoke, scents and pollution.

  • specific factors: these are irritant or allergens in the form of pollen, dust, animal fur, mould and some kinds of food. A virus or bacteria, chemical fumes and other substances at the workplace and may also cause asthma.

To acquire asthma, people seem to need to have been born with a predisposition to the disease. It may not reveal itself until they have been exposed to some asthma irritants. Smoking mothers, low birth weight, a lack of exposure to infection in early life and traffic fumes have all been associated with the increase in asthma. Less draughty houses resulting in a higher concentration of house dust mites and cooking gases may also be part of the problem. Currently, a great deal of research looking for the genes that allow asthma to develop is being carried out. But until we can prevent asthma, we have to suppress the symptoms and try to avoid the triggers where possible.

What does asthma feel like?

  • It is difficult to breathe and there is shortness of breath.

  • Wheezing when breathing out.

  • Coughing, especially at night and with a little mucus.

What are the warning signals of worsening attacks?

  • Inhaled medicines appears less effective than usual.

  • Symptoms of cough or wheeze on exertion.

  • Night-time wakening with wheeze or cough.

  • Fall in the peak flow meter reading (a peak flow meter is a simple device that measures the maximum speed at which a person can breathe out).

When it appears that your asthma is becoming less well controlled, you should consult your doctor for advice on what to do.

What are the danger signals of severe attacks requiring immediate medical attention?

  • Bluish skin colour and gasping breath.

  • Exhaustion so severe that speech is difficult or impossible.

  • Confusion and restlessness.

What can you do to help yourself?

  • Avoid the substances you are allergic to, if possible. It can be difficult to know which specific factors may give you trouble, but general irritants like tobacco smoke should be avoided.

  • It is important to take your prescribed preventive medicines, even if you feel well.

  • If you get a serious attack, contact your doctor or the emergency services.

  • Discuss your treatment with your doctor or practice nurse. You should know what to do if, for example, you get a bit worse during a cold. This will usually involve a temporary increase in the dosage of your treatment.

  • Be familiar with the use of a peak flow meter, which can help you judge your asthma during spells when it is worse.

  • Make sure you use your inhaler device correctly. If you are unsure your practice nurse, doctor or pharmacist will be able to help and advise you.

How does the doctor make the diagnosis?

The diagnosis is made on the basis of the patient's history of symptoms and on simple tests of the lungs' function but it is not always easy to come to a diagnosis of asthma if the symptoms are mild and intermittent. For those people whose asthma is associated with eczema and hay fever it can be helpful to take blood samples and skin tests to look for hypersensitivity towards specific substances.

What should I do?

Be active. If you get attacks during intense activity it may be a good idea to take 'reliever' medicine before you begin to exercise. These medicines, properly known as bronchodilators, have a relaxing effect on the muscle surrounding the bronchioles. Swimming is probably the best form of exercise for asthma patients but the most important thing is to stay active.

What are the prospects for asthma suffers?

  • Although asthma cannot be cured it can usually be well treated so that the symptoms give little trouble.

  • Half of the children who get asthma 'grow out of it'.

  • It is vital to stop smoking to avoid developing long-term lung damage (chronic bronchitis, 'smoker's lung'), which will reduce the lung function drastically.

  • Join NetDoctor's free 90-day Stop Smoking Programme.

  • Severe attacks of asthma can be fatal but only if they are treated inadequately or not soon enough.
    Medicine

Medicines for asthma are generally thought of in two main groups.

  • Relievers (bronchodilators): these are quick-acting medicines that relax the muscles of the airways. This opens the airways and makes it easier to breathe. They are used to relieve symptoms.

  • Preventers: these act over a longer time and work by reducing the inflammation within the airways. They should be used regularly for maximum benefit. When the dosage and type of preventive medicine is correct, there will be little need for reliever medicines.

Relievers

There are three groups of these.

Beta-2 agonists
Beta-2 agonists act on molecule-sized receptors on the muscle of the bronchioles. The medicine fits the receptor like a key fits a lock and stimulates the muscle to relax. Examples of those which act for a short time (three or four hours following a single dose) are salbutamol and terbutaline. These medicines are inhaled from a variety of delivery devices, the most familiar being the pressurised metered-dose-inhaler (MDI). They are used when required to relieve shortness of breath.

Longer-acting beta-2 agonists include salmeterol and formoterol. Their action lasts over 12 hours, making them suitable for twice daily dosage to keep the airways open throughout the day.

Anticholinergics
One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles. The nerve impulses cause the muscles to contract, thus narrowing the airway. Anticholinergic medicines block this effect, allowing the airways to open. The size of this effect is fairly small, so it is most noticeable if the airways have already been narrowed by other conditions, such as chronic bronchitis. Examples of anticholinergics are ipratropium and oxitropium. They have a maximum effect 30 to 60 minutes after inhalation, which lasts for three to six hours.

Theophyllines
Theophyllines are given by mouth and are less commonly used in Britain because they are more likely to produce side effects than inhaled treatment. They are still in very wide use throughout the world. All three types of reliever can be combined if necessary.

Preventers

There are three main groups of these.

Corticosteroids
Corticosteroids (or 'steroids') have made an enormous difference to the management of asthma. They work to reduce the amount of inflammation within the airways, reducing their tendency to contract and have allowed many patients with previously troublesome asthma to lead almost symptom-free lives. They are usually given as inhaled treatment, although sometimes oral steroid tablets may be required for severe attacks. Although steroids are powerful medicines with many potential side effects, their safety in asthma has been well established. It is also important to balance the problems that arise from poorly treated asthma against the improvement in health which occurs when the condition is well treated.

Cromones
There are two medicines in the cromone group: sodium cromoglicate and nedocromil. They also act to reduce inflammation of the airways. They tend to be best for mild asthma and are more effective in children than adults. The medicines are given by inhalation and are usually very well tolerated.

Leukotriene receptor antagonists
Leukotriene receptor antagonists are compounds released by inflammatory cells within the lungs and which have a powerful constricting effect upon the airways. By blocking this effect with these antagonist medicines the constriction is reversed. There are two such medicines currently available: montelukast and zafirlukast, both of which are taken as tablets.

Based on a text by Dr Carl J Brandt and Dr Finn Rasmussen.

 

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