CANADIAN NETWORK FOR RESPIRATORY CARE SPECIAL SUPPLEMENT • WINTER 2012

Annette MacLeod thought her asthmawas under control. But then she beganto experience symptoms at night. Aboutonce a week, she found herself joltedout of sleep, wheezing, and it wouldquickly progress to coughing and short-ness of breath, requiring her inhaler.And she found she needed her inhalerupon waking most mornings, too. After a particularly frightening night,

MacLeod, 42, of Whitby, Ontario, madea decision that enough was enough. Shebooked an appointment with her doc-

ALLERGIC LIVING | WINTER 2012 45

BY JACLYN LAW

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Night Symptoms continued on page 47

BY DEBRA MORRIS

Feline Foe

Don’t Let AsthmaSteal Your Sleep

There’s no doubt about it: cats makelovely pets – provided you’re notallergic. Within minutes of exposure,people with cat allergy can experi-ence itchy eyes, runny nose, sneezing,congestion, even hives – not to men-tion asthma symptoms such aswheezing and difficulty breathing. The trigger is not the cat’s fur, but

rather proteins from urine, sweat andsaliva that are carried on dander. Soregardless of length of hair, howmuch it sheds or even if the breed istouted as “hypoallergenic,” every cathas the potential to set off an allergy.Avoidance is the best means of

control if cats are your trigger. But if

Toronto. “With asthma, one single dis-turbance at night from respiratorysymptoms that include coughing,

you must be around one, don’t touchit! Take an antihistamine and, if youhave asthma, also your asthma med-ications before being around the cat.Ask the feline’s owner to move the petto another room while you’re there.You might consider immunother-

apy. A series of injections given over athree- to five-year period could makeoccasional exposures to cats far moretolerable. Ask your allergist whetherthis treatment is for you.The hardest situation is when you

or your kids develop an allergy toyour cat. No one likes to have toremove a cherished pet from theirhome. But it’s important to do so ifthe allergy triggers asthma. Yourlungs will thank you.

Debra Morris is a nurse and CAE atHalifax Allergy & Asthma Associates.

Wheezing atnight? Yourasthma isn’tunder control.

tor, who adjusted her medications andasthma action plan.A recent Canadian study shows that

about 20 percent of people with asthmahave trouble falling or staying asleep(compared to 13 percent of the generalpopulation). A few fitful nights mightseem insignificant, but don’t ignore thewarning signs, says certified respiratoryeducator Kathleen Frame, who’s also aregistered respiratory therapist and anasthma program coordinator at SouthRiverdale Community Health Centre in

46 ALLERGIC LIVING | WINTER 2012

suPPlement

Q&ACertified Educators take yourasthma and allergy questions.Send questions to: editor@allergicliving.com

Tracy Cushing

Q: Our son’s asthma is under control, except he still hasbreathing issues in frigid winter air. Would a scarf over hismouth help him?

Josie Luongo: A scarf over his nose and mouth would help. Ittraps heat and moisture when exhaling and subsequently mois-turizes the inhaled air so as to the minimize drying of the airwayand the narrowing that follows. Using his rescue inhaler beforegoing outdoors may also be helpful. It is important that he con-tinues to use his controller medication and refer to his asthmaaction plan to determine if increasing the dose is necessary.

Q: What is the effect of a woman’s menstrual cycle onasthma?

Julie Gaalaas: Hormones are an asthma trigger for some.Many women experience worsening asthma symptoms through-out different phases of their menstrual cycle. If you are noticingthese changes in your asthma, I suggest tracking your symptomsthroughout your cycle using a symptom diary. This way, you willknow in advance when your asthma is likely to deteriorate. Ensuring you have an asthma action plan will allow you to

deal with your symptoms in advance and prevent your asthmafrom worsening.

Q: I’m really allergic to dust mites, and worried about anupcoming visit to my mom’s place, where I sneeze andcough non-stop. (She has wall-to-wall carpets as well as

Josie Luongo Julie Gaalaas

antiques.) What should I do when I can’t avoid dust?

Tracy Cushing: Ask your mother to vacuum (with a HEPA fil-ter vacuum, if possible) and dust before your visit, especially inthe rooms where you’re likely to spend the most time. Alsorequest that she washes all of the linens on your bed with hotwater and dries them on the hottest setting. Bring along a dustmite-proof pillow cover with you for the trip.Speak to your asthma educator about your asthma action plan

and whether it needs adjusting prior to your visit. Be sure tobring an ample supply of your breathing medications with you.

Q: My daughter was born when I was 34 weeks pregnant.She was only four pounds. Now she’s 7 and has asthma.Would her premature birth be a factor?

Josie Luongo: That depends on her respiratory health history.There are many factors associated with the development of asth-ma, including exposure to allergens and tobacco smoke, genetics,infections and airway size. In premature babies, especially those with a low birth weight,

the smaller airways put them at a higher risk for wheezing ininfancy and early childhood. Whether this wheezing will persistand be diagnosed as asthma at age 7 and beyond can depend ontheir lung function, family history and their personal history ofatopy (a predisposition to develop allergic reactions) or allergies.

Q: Is it possible that eating a big meal can trigger asthma?I’ve noticed this in myself.

Julie Gaalaas: There are many reasons why you experienceasthma symptoms after eating a large meal. Overeating can causepressure on the diaphragm, making it difficult to take a deepbreath. Eating a large meal may also cause acid reflux, which canincrease asthma symptoms if left untreated. Think about whereyou are dining; there may be triggers present, such as pets or cig-arette smoke. You may even have a food allergy. It’s important to ensure that your asthma is in control by using

your controller medication daily and following your asthmaaction plan. This way you will have fewer symptoms and needyour rescue inhaler less often.

Q: After being sick almost all the time, my 4-year-old wasjust diagnosed with asthma. I look forward to her beinghealthy; how long does that usually take?

Tracy Cushing: It may take a number of months to achieveasthma control. Two main factors come into play. The first isenvironmental control: learning about what triggers cause hersymptoms and how to help avoid them. The second factor ismedication dosing. Your doctor may adjust medications anddosing a number of times to ensure your child is receiving theappropriate dose for proper symptom control. Keeping a diary to review with your doctor or asthma educa-

tor is a great way to keep track of symptoms, medication time,exercise and other factors that may affect your child’s breathing.

Tracy Cushing is a respiratory therapist and CRE in Halifax. JulieGaalaas is a respiratory therapist and CRE in Camrose, Alberta.Josie Luongo is a pharmacist and CRE in Toronto.

ALLERGIC LIVING | WINTER 2012 47

The Canadian Network for Respiratory Care is a non-profit organization andregistered charity that works to improve the lives of Canadians living withrespiratory disease. We certify health-care professionals as Certified Asthma and Respiratory

Educators (CAEs and CREs). Our CAEs and CREs work to help patients withtheir asthma, COPD, allergies and smoking cessation efforts. For more infor-mation or to find a CAE or CRE near you, please see www.cnrchome.net orphone: 905-880-1092.

ABOUT US

N asal congestion, sneezingand drippy noses, andweepy or swollen eyes. The

symptoms of allergic rhinitis aren’tjust uncomfortable, they can have asignificant effect on quality of life.Fortunately, medications are avail-able that can bring you relief. Theseare recommended if avoiding yourallergens is impossible, or whenavoidance alone does not lead toadequate symptom improvement.The most common medication

for allergic rhinitis is an oral antihis-tamine. Non-sedating pills shouldalways be tried first. Most peoplefind these over-the-counter prod-ucts effective for mild nasal and eyesymptoms. The sedating antihista-mines are also effective, but may leadto significant fatigue. The impair-ment from these medications caneven affect learning in children ordriving in adults. If you have more significant

symptoms or if you don’t find anti-histamines effective, your doctorwill likely prescribe a nasal corticos-teroid spray. These medicationswork best when they are used regu-larly. Although your symptoms mayimprove within hours, the maxi-mum benefit is usually seen in five toseven days. These sprays are effectivefor the most bothersome symptoms

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Night SymptomsContinued from page 45

shortness of breath, tightness in the chestand wheezing is enough to have cause forconcern.”Sleep loss affects thinking, concentra-

tion and learning, but fatigue isn’t the onlyproblem. If left unchecked, asthma-relatedinflammation can change the structure oflung tissue, making the condition harderto manage. Frame likens inflamed lungs toa forest fire that must be completelyquelled – embers included – or the blazewill return. This may require weeks ofanti-inflammatory therapy. She recommends keeping notes about

symptoms and looking for patterns.Triggers could include irritants in the bed-room (dust, mold, an old mattress);daytime exposure to triggers; fumes andchemicals; and seasonal changes (springpollen and autumn mold spores). In win-ter, closed windows may lead to higherindoor mold exposure, says Frame. Forsome people, moving from standing tolying down causes symptoms. Colds andthe flu can also worsen asthma; in chil-dren, it has been reported that up to 90percent of attacks are triggered this way. If an asthma attack wakes you, use your

reliever medication. If you need it againwithin two hours, your asthma is “danger-ously uncontrolled,” says Frame. Use thepuffer every 10 minutes, and call 911 or goto the emergency room, then follow upwith a visit to your health-care providerand a certified respiratory educator.

THE ASTHMA EXPERTWith Dr. Harold Kim

of rhinitis, including nasal conges-tion and even eye symptoms.Allergen immunotherapy, also

known as “allergy shots,” should beconsidered when nasal corticos-teroid sprays are not effective or notwell-tolerated. Allergy shots requirea significant time commitment, andthere is a small risk of systemic aller-gic reactions. This type of treatmentshould be prescribed by an allergist. So my message is: don’t suffer with

allergic rhinitis, take action. It’s wortha visit to the doctor to find out whichof these widely available treatmentswill have you breathing easily again.

Quiz answers, page 48

True or False: Mouth breathinghelps minimize the effects ofcold, dry air on asthma.

True or False: Pet dander is lessof a problem in winter months.

True or False: People with exercise-induced asthmashould avoid too much exertion.

QUIZ

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CNRC thanks GlaxoSmithKline forhelping to make Currents possiblethrough an educational grant.

48 ALLERGIC LIVING | WINTER 2012

QUIZ ANSWERS from page 47

1. False: Mouth-breathing can make asthma worse. Breathing through yournose helps to warm and humidify theair before it reaches your lungs.

2. False: Pets and people spend moretime indoors in the cold wintermonths, increasing exposure.

Kids’ Corner

Gym class is a great place to learn sports and team-work, have fun and get exercise. But too many kids withasthma are sitting out instead of taking part. Asthmaeducator Paula Smith has tips to get you off that bench:

• If you can’t exercise with-out symptoms, your asthmais not under good control.It’s time to visit your doctoror asthma educator.

• If your asthma is undercontrol except for symp-toms during gym class, askyour doctor if you shouldincrease your controllermedication, or maybe useyour reliever puffer 15 min-utes before exercising.

• Don’t assess sports individ-ually. Some are harder, butyou should be able to enjoyjust about every type of exercise without symptoms.

• If you know you’ll be in an environment where yourasthma is triggered – for example, a track meet where thegrass is being cut and grass is your trigger – then you maywant to sit out. (If this happens often, you may want tolook more closely at your asthma control with your doc-tor.) If you have a cold, you might also need to sit out toavoid a flare-up.

• If you don’t enjoy sports, asthma can become anexcuse to avoid participating. Work to get past this.Remember, exercise improves how your lungs work, itgives you more endurance and makes your musclesstronger. It even improves your mood and ability to relax.You’ll feel better for it – and then it will become fun.

Paula Smith is a registered respiratory therapist andCertified Asthma Educator at Orillia Soldiers’ MemorialHospital in Orillia, Ontario.

Get in the Game

Kids with asthmashould be able toenjoy all sports.

Women with asthma often get anxious about how the diseasewill affect a pregnancy. Pharmacist and CRE Rachelle Dickie– who has asthma and is pregnant with her first child – dispelsthe myths and offers up the facts.

MYTH No. 1: Pregnancy won’t affect my asthma.In fact, one-third of pregnant women’s asthma improves, athird worsens and a third stays about the same. There’s noway to predict which category you’ll fall into.

MYTH No. 2: Taking asthma medications could harm my baby.Reliever puffers and corticosteroid inhalers are safe to take dur-ing pregnancy. It’s far better for the baby if mother is feelinghealthy and breathing well.Long-acting beta agonists and leukotriene inhibitors may

also be used if control is not achieved with steroid inhalersalone. (Never take any medication without first checking withyour doctor, pharmacist or asthma educator.)

MYTH No. 3: A flare-up isn’t a huge deal when pregnant. Uncontrolled asthma can increase the risk for pre-termlabour, pre-eclampsia, intrauterine growth restriction, prema-ture birth, low birth weight and stillbirth. Make sure youupdate your asthma action plan in case pregnancy requires anadjustment in your medications.

MYTH No. 4: If I experience breathlessness during pregnancy,it’s just the baby pressing on the diaphragm.It could be, but it could just as likely be your asthma. Discussthis with your doctor to make sure.

3. False: Exercise-induced asthmacan be managed effectively (see“Get in the Game,” at right).

Maria Muirhead, CRE, is the author of My Asthma Book and Smoking= Problems (Big Problems!).

Pregnancy & Asthma: 4 Myths

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