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GP Kevin Griffiths-Jones and children's respiratory nurse Liz Biggart, answered your questions and concerns...

From Anon
My grandson who has just had his second birthday (he lives in Italy, by the way) has parents who both have allergies. He was breastfeed for 15 months (exclusively for the first 6 months). Is there anything else that can be done to prevent him developing allergies like his parents (hay fever and asthma)?

Liz
I understand how important it is for your family to avoid the triggers which may switch on the disease of asthma. Unfortunately many of these triggers are around us in our everyday lives eg. House-dust mite, pets, and for some unfortunate children, cigarette smoke. There can be no certain way but avoiding the triggers which are known to be harmful will perhaps help.

Tessa
My doctor suggests I will need a nebuliser - his explanation has been unclear and I would like to know exactly what a nebuliser is and entails.

Liz
Your doctor should explain why you need a nebuliser. Perhaps there is a practice nurse who can help in your particular case. But there are many ways of taking inhaled medication which enables small doses to be directly applied to the lungs where the medication is needed.

From Susanna
My daughter was diagnosed as having asthma at the age of 5 she was 11 last week, we regularly see the practice nurse but have never seen a doctor since the initial diagnosis. She has always loved her sport, gym and dance but just recently her condition has become noticeably worse with exercise. Our lovely nurse has put her on the purple inhaler telling me that it was a mixture of brown and blue. I don't want her to live on steroids for ever. I would like to know where I can go for help. The surgery think they are doing the best for my child, I do not wish to offend them.

Kevin
Many parents and people with asthma have concerns about inhaled steroids. These group of drugs is our cornerstone of asthma management and has been responsible for greatly reducing the number of asthma deaths over the last few decades. The key to good asthma management these days is to keep the dose of inhaled steroids down to a bare minimum to keep asthma under control. For the vast majority of people this means using a dose which has very little or no harmful side effects on the body. The key fact for your daughter is to make sure that she is free of symptoms that asthma does not restrict her life in any way and that she is on the lowest possible dose of medication to enable her to do this. Hopefully your GP or practice nurse will be happy to help you to do this.

From Helen
Following the e-mail I already sent, when helping with sport in schools, I keep coming across children who've been told by their parents to try not to use their inhalers so start PE without and end up wheezing. Is their any medical based reason not to use inhalers if there is any chance of asthma?

Liz
Sport is very important in schools. Children with asthma should not be excluded from this as it both builds their fitness and their self esteem. Where you are involved you can inform the school that children with Asthma should have access to their reliever inhalers to enable them to participate in sport. You may wish to apply to the National Asthma Campaign for their schools pack (see website for details).

From Kate
I have asthma and find that the information and services available are more often than not directed towards children
There are lots of schemes to tackle childhood asthma, but it appears very few for tackling adult asthma. Surely adult asthma is as much of a problem as childhood asthma, and all the children with asthma will grow up to be adults with asthma anyway.

Kevin
You're absolutely right! Asthma is a huge problem in adults as well (1 in 20 of the population). The national guidelines for the treatment of asthma that doctors and nurses use, very much deals with adult asthma as well as children. The National Asthma Campaign has lots of useful information for adults and children.

From Sophie
I am currently 24 weeks pregnant with a child whose father has asthma (maintained fairly well on beclamethasone and salbutamol).
Is there anything that i can do (whilst pregnant and in the early years) to reduce the chances of my baby having asthma?

Liz
There are no sure ways that we know of yet to ensure your unborn child does not develop asthma in the future. Studies have shown that children exposed to certain triggers in their 3rd trimester also develop these as triggers to their allergies later in life. It is difficult to live in a bubble but you can try to avoid nuts and peanuts and most important, cigarette smoke.
There is no proof that breast feeding helps but it is always better to feed your young child this way. Good luck with the birth.

From Ruth
Once children begin using asthma medication (salbutamol) do they become physically dependent on it?

Kevin
Undoubtedly, a lot of people relay on their blue reliever medication to control their asthma. Many of these people may not be on regular preventative medication or, not taking their preventative medication properly as they do not feel that their preventative medication works for them. It is important for us as health professionals to work with the individual to devise a personal action plan so that they can take control of their own asthma treatment. This has been shown to reduce the use of reliever medication.

From Katherine
My daughter Laura is 8 and had her first asthma attack when she was 18 months old. She was admitted to hospital 7 times during her first 5 years and now, thank goodness has not had a serious attack for three years. However, she does have a preventer inhaler but I am aware we need to use her reliever ventolin at least 2 - 3 times a week which I feel is disappointing.
I wondered whether you had information about diet and asthma? I am very keen on good diet, non processed food and wondered whether research has shown true benefits?

Liz
A good balanced diet is important for all growing children. There are no direct links for most people with asthma and food triggers. It may be best that your daughters asthma control is reviewed to see if there are other triggers she may need to avoid like pets or smoking. It may be that at periods she may need more preventer than she currently is on.

Steph
What are the warning signs to look out for in babies - it's so hard at this time of year when they seem to have a constant cold anyway!! My 4 month old has had bronchialitus, lots of colds, and does generally cough at night, but some nights are worse than others. Are there other signs to watch out for? Is there any benefit to 'catching' it at a young age?

Kevin
It can be very difficult to diagnose asthma in infants. Many babies will cough and wheeze in response to viral infections. And like in adults and older children, there is no easy objective measurement (such as measuring the amount of 'puff' in a peak flow meter), to diagnose asthma. It is more likely that an infant has asthma if there is a family history of allergic disease like asthma, hayfever or eczema. If the child wheezes at other times other than when they have a cold.

In terms of looking out for danger signs in babies who are unwell with breathing problems, some of these are; a) the baby is breathing rapidly and has tugging inwards of the muscles around the neck and ribs, b) the babies lips look blue, c) the baby is struggling to cry (a pink baby who is crying lustily is a good sign!).

There is some evidence that the earlier that asthma is treated then the greater the improvement in the child's lung function in the long term.

From Liz
Very interesting programme, thank you. I have often wondered whether I should do more to keep my children away from smokers in public places - is there a time limit at which it becomes "dangerous" for a child to be exposed to smoke? They're not asthmatics.

Liz
You are quite right, passive smoking is dangerous for all children as their lungs are still developing. Unfortunately this is so even in open spaces. I would continue to avoid such exposure to your children.

From John
Does the panel think that the age of the housing stock in this country and the amount of fungal spores associated with damp, dry-rot etc. may be a cause of increasing levels of asthma suffering?

Liz
There are many different triggers to set off an asthma problem but I do think it is not well enough recognised that the homes we live in are full of those triggers - damp, central heating, poor circulation and indeed the fungi you mention are all factors that can make asthma worse. In British homes there are huge numbers of house-dust mite which can be reduced but not eradicated. The other major problem for small children is smoking in the home.

From Greg
Can failure to follow a prevention/treatment regime properly lead to long-term tissue damage, and perhaps other illnesses?

Kevin
This is the $64,000 question! Undoubtedly regular inhaled steroid use reduces the risk of dying of asthma. There is limited evidence that taking regular inhaled steroid reduces the risk of stiff airways and tissue damage. However, we are still waiting of the results of long term studies that will show if regular prevention or preventative treatment works over a number of years.

From Ruth
My 4 year old son has just been diagnosed with asthma, the doctor diagnosed on the symptoms I told her - breathlessness on exertion, dry hacking croupy cough. What concerns me is that there was no diagnostic tool used - peak flow meter etc. I realise at 4 years old this may be difficult but how can I be sure that her diagnosis is right?

Liz
Asthma can be very difficult to define and this is particularly so in young children. Your GP may have felt that he would not get a reliable peak flow. But he listened to your child and made a reasonable decision to treat. What is most important now is your child is reviewed to ensure that the medication he now takes is effective and brought down to a level which will treat at an optimal level. It is important if you feel your child continues to have problems with his chest that you communicate this to your doctor as there are other rarer problems that might present, like asthma.

From Bryony
Whilst listening I heard the mention of The Department of Health announcing a new priority in asthma care. Please could you tell me where I could find out some more about this new priority? Thanks.

Kevin
This is great news to me! Although I don't have the details you can get them from the National Asthma Campaign website - the link will be posted at the end of the chat.

From Eva
I couldn't believe my ears this morning - did I really hear a discussion on asthma with absolutely no mention of smoking? It may not be a cause, but it was never even suggested that not smoking around asthma sufferers might be a good idea. I kept waiting for the speakers to say this, but not a word!

Liz
I know you sent your comment some weeks ago but I am aware following this recent broadcast that the damaging effect of smoking as a trigger for asthmatics was not mentioned again - for this I apologise - it was not directly part of the discussion. But I fully agree with you that smoking is one of the commonest and most pernicious causes and triggers of asthma.

From Sam
Sam asks about the Buteyko method...

Kevin
The original method of Buteyko involved teaching of breathing exercises plus the use of oral steroids. Cynics in the medical profession have said that the benefit of the Buteyko method lay with the oral steroid tablets! However, this is undoubtedly true that methods to improve breathing control do help people with asthma. These are maybe available via your local Physiotherapy dept.

From Deborah
My youngest son (8) has asthma. When at home he uses his reliever as and when he needs it and is accustomed to carrying it around in his pocket. I would like him to have the freedom to do the same at school, however the school are insistent that he keeps his inhalers in the office. This presents two problems: 1) that he is less likely to go to the office - stigma and 2) he is unable to get on top of his attack immediately which is something I try to promote.

Liz
Your problem is very common. Schools are nervous of medication in the classroom but children are often reluctant to go to the office to get the inhaler they need. It is best if you can talk with his teacher and ask for support from the school nurse to help them understand that each child must have easy access to their inhalers and perhaps they might revise their policy. You may gain support by applying for a schools pack from the National Asthma Campaign - details on our website. I should like to emphasise the safety of the blue reliever medication that these medicines can do no harm to any other child.

From Jenni
Jenni asks about the role of food allergy in asthma management...

Kevin
Undoubtedly many people with asthma are sensitive to certain food stuffs in the way that you mention. It seems sensible to try and avoid these, without completely making ones life a misery. However, please see my comments below about complimentary therapy.

From Peter
Is it dangerous to exercise - I have been diagnosed as an asthmatic and have since been relunctant to exercise vigorously on the squash court.

Liz
Exercise is the one trigger we try not to avoid as asthmatics. The fitter you are the better your chest health will be. To enable you to take exercise make sure that you take the preventer medication your doctor has prescribed and use the reliever medication before and during exercise if needed and exercise within your limits.

Dr Kevin Griffiths-Jones
We've had many enquires about the helpfulness of homeopathy in managing asthma. Sadly the scientific evidence for the benefit of homeopathy is lacking. However, undoubtedly many patients do get a great deal of benefit from homeopathy. I think it is extremely important to take regular preventative medication and that homeopathy should be looked at as a complimentary form of treatment which may well reduce the need for medication, but not act as an alternative.

Other forms of complimentary therapy such as acupuncture and specific diets have been similarly disappointing in formal clinical trials. However, they may help many people in addition to traditional medication. There is however good evidence for the effects of improved breathing techniques, losing weight, giving up smoking, improving asthma control.

From Claire
We lost our 10 year old son, Malcolm, to a sudden onset severe asthma attack which came on without warning. On the night concerned, Malcolm complained of feeling funny and became mildly agitated. This was not normal behaviour for him and concerned us, so I started to telephone the doctor but switched to the emergency services as his breathing quickly became shallow and he collapsed. Unfortunately, the first ambulance to reach us (12 minutes) did not have a paramedic on board who could intubate Malcolm; an ambulance with a paramedic arrived after 19 minutes. Malcolm died shortly after reaching hospital.

Liz Biggart
It is with great sadness I read your story about the death of your son Malcolm. There are indeed a few deaths each year which we hope should be prevented. Research into Asthma is constantly going ahead and we understand now there are different forms of Asthma. The inflammatory process in the airways which causes asthma is increasingly measurable and although this does not help you and your family we wish that the knowledge we gain through research will be spread throughout the population of asthmatics.

Retired? Downsizing? Moving home to be nearer the kids?