Practice A Patient’s Journey

Childhood asthma

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2889 (Published 01 September 2009) Cite this as: BMJ 2009;339:b2889
  1. Chantelle Down, patient1,
  2. Anna Chappell, practice nurse2
  1. 1Penzance
  2. 2Rosmellyn Surgery, Penzance TR18 4JH
  1. Correspondence to: A Chappell apldj{at}btinternet.com
  • Accepted 3 March 2009

This patient describes becoming increasingly adept at managing her asthma, particularly with the help of dance

I am a 15 year old girl, and asthma greatly affects my life and the lives of my family and friends. My mother also has asthma, but my sister has now grown out of the condition. I was only 18 months old when I showed the first signs of asthma. At first my mother thought it was a chesty cough, but it lingered for many weeks. In addition, I was extremely wheezy and tight chested at times. My GP repeatedly assured my mother that there was nothing to worry about and that it was only a cough. As my mother has had asthma all her life, she was not convinced of this. Dissatisfied with the GP’s diagnosis, she took me to see a locum doctor, who immediately recognised the symptoms of asthma. Because of our family history, he had me admitted to Treliske Hospital in Truro. Consequently my mother decided to change to a new GP, who still looks after our whole family.

I was put on a nebuliser twice a day for a week and given the steroid prednisolone. It was at this point that I was diagnosed with asthma. As I was only 2 at the time, I cannot clearly remember going into hospital or exactly what happened there. When I was first diagnosed it was an extremely stressful time as I did not know what was happening to me. It was very frightening for my family to watch me suffer and was by far the most worrying time for them. The staff at the hospital were all brilliant and offered as much advice as possible to my mother, who stayed in the hospital with me. When I left hospital about two weeks later I had my first home visit from an asthma nurse, who was a great support and provided helpful advice on how we should continue my treatment. She also spent a lot of time teaching me how to use my inhalers correctly through a spacer device.

At the age of 3 I started preschool, which did not cause any problems as the staff were made aware of my condition and were told how to supervise my use of my inhalers. However, when I started infant school, things changed slightly. Some of the other children did not understand about asthma. Going through junior school was extremely stressful at times as I was often bullied about my condition. Quite often members of school staff are unaware of how to deal with an asthma attack. Living with asthma has often made me feel out of place, and, in the past, I have had to take several days off school because of doctors’ appointments and an inability to breathe. In addition, doing sports has caused problems with coughing fits, breathlessness, and wheezing. The amount of exercise I could undertake used to be very limited, and I had to sit out during physical education (PE) lessons, which again made me feel different from everybody else.

How dance changed my life

During my last year of primary school I joined an after school dance club, which changed my life. The dance club took place just once a week at first, and I needed to use my inhaler more frequently than normal, but I loved it. I persevered, and over time I built up the number of lessons I took part in each week. Dancers are taught how to breathe and relax in a different way in order to enable them to take in enough oxygen to move quickly around the floor. Now at the age of 15, I have been dancing for five years. I train for 16 hours a week, and my breathing and asthma have improved dramatically. Dancing has acted as a natural therapy, enabling me to reduce the number of times I use my salbutamol inhaler. My dance teacher is fully aware of asthma in dancers and has taken courses on how to deal with the problems it could cause.

My journey with drug treatment

Over the years I have been prescribed many medicines to help with my asthma. Currently the only medications I take are salbutamol and Seretide. To begin with I was given salbutamol and beclazone to inhale through a spacer device. Originally, when I was very young, I found this difficult, but the treatment seemed to be a success. As I grew older, this treatment seemed to work less and less. I was then given a new type of inhaler—the Oxis Turbohaler. This was a complete failure, however, and I had to go back to salbutamol and beclazone. In addition, I was given Singulair tablets to take before I went to bed to reduce the number of times I needed to use my inhalers the next day. This was brilliant, and I soon found I was using my inhalers only twice a day, once in the morning and once in the evening. Later I tried a new form of inhaler to replace the beclazone—Seretide—which is easier to use and much more effective than beclazone. I visit my doctor or asthma nurse every three months for a check up, to review my medication, and to ensure it is still working.

Triggers

My asthma is triggered by a number of things, varying at different times in the year and depending on where I am and on my surroundings. One of the main triggers for me is pollen, which gives me hay fever, for which I have to take cetirizine. Now that I am getting older, my hay fever seems to be lessening in its severity. During the winter, sudden cold air can trigger an asthma attack. If I get a cold, it quite often goes to my chest, and I then need to take steroids and antibiotics. Possible other triggers include hairspray, dust, and aerosol deodorants. Recently some girls at school were spraying large quantities of deodorant in the changing room, which is small and windowless. In so confined a space, the hairspray triggered my asthma. I could not breathe and was gasping for air. My teacher would not listen to my cries for help and told me to be quiet. Fortunately, my best friend grabbed my inhaler from my school bag and took me out of the room. I very nearly had a bad asthma attack that day.

The need for education

This is just one example of the sorts of situation I have been in. Similar incidents occur frequently in schools and workplaces throughout the country. This is why my family and I feel that it is so important to publicise asthma and make both adults and children fully aware of it and of the problems it can cause. In schools all teachers should have relevant training in case someone in their class has an asthma attack, and asthma should be recognised as the serious condition it is. We fully support the work done by the charity Asthma UK to help improve awareness of this frightening and sometimes life threatening condition.

The clinician’s perspective

I have been Chantelle’s asthma nurse for the past 10 years. Her early experiences are very common because in children aged under 5 years it’s difficult to use a peak flow meter or spirometry to diagnose asthma.

There are many causes of wheeze in children, and it is important that health professionals do not label a child asthmatic when this may be an inaccurate diagnosis. Viral induced wheeze associated with upper respiratory tract infections is very common in children under 5; the wheeze, cough, and breathlessness are present only during the viral illness, and there are no persistent symptoms. Most of these children will grow out of these episodes by school age. Recent guidelines from the British Thoracic Society recommend recording the starting point at which the diagnosis is suspected and investigating further according to the probability of asthma.

Good history taking is paramount in a case such as Chantelle’s. Chantelle’s family history is very suggestive of atopy. She had eczema as a baby and didn’t tolerate cows’ milk formula. She was admitted to hospital at the age of 2 years with wheeze and respiratory distress after having three or four episodes of wheeziness previously. Her mother reported a persistent night time cough also at the age of 2 years. She was treated in hospital with bronchodilators and prednisolone, and these medications had a positive response.

Over the years Chantelle has been prescribed various inhaled therapies. Recently she has had a good response to the leukotriene receptor antagonist Singulair, which seems to work well in people with asthma who have atopy and exercise induced symptoms. Asthma is a chronic inflammatory disease of the airways with variability. As Chantelle has grown up, she has become more aware of her condition and has improved her general fitness. Dancing has helped her to control her breathing, and she has become more aware of the triggers that affect her asthma and tries to avoid these where possible.

Chantelle’s asthma is now well managed with a low dose Seretide Accuhaler used twice daily, and she rarely needs her short acting bronchodilator.

Health professionals working with patients who have asthma need to develop a good relationship with their patients. We need to educate them about the condition, explain the importance of regular maintenance therapy, and ensure that the lowest dose is taken to maintain optimal asthma control.

Anna Chappell, practice nurse with special interest in respiratory medicine

Useful resources

  • Asthma UK (www.asthma.org.uk)—Charity dedicated to improving the health and wellbeing of the 5.4 million people in the UK whose lives are affected by asthma

  • Asthma and Allergy Foundation of America (www.aafa.org)—Non-profit organisation dedicated to education and to finding a cure for and controlling asthma, food allergies, nasal allergies, and other allergic diseases

  • Asthma Foundations Australia (www.asthmaaustralia.org.au)—Aims to eliminate asthma as a major cause of ill health and disruption within the community by providing asthma education, information, research, community advocacy, and support to people with asthma and their carers

Notes

Cite this as: BMJ 2009;339:b2889

Footnotes

  • This is one of a series of occasional articles by patients about their experiences that offer lessons to doctors. The BMJ welcomes contributions to the series. Please contact Peter Lapsley (plapsley{at}bmj.com) for guidance

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally reviewed.

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