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Camping is a great way to connect with nature and enjoy Canadas rugged beauty. But if you or your child has asthma, you may feel anxious about prolonged exposure to the great outdoors. You can manage asthma and spend quality time under the stars but it takes careful planning. Choosing where and when you go definitely needs to be pre-planned, says Julie Gaalaas, a Certified Respiratory Educator (CRE) in Camrose, Alberta. Your asthma should be well controlled before your trip; if not, refer to your asthma action plan for directions on
increasing your controller medication. While youre camping, I recommend doing a symptom diary or monitoring peak flows so you know how youre responding to your environment, says Gaalaas. Seasonal allergies can worsen asthma, so camp when your allergens are typically lower: tree pollen is airborne in spring, grass is most active in early summer, and ragweed causes misery in late summer and early fall. Check the
pollen count and the weather forecast before you go. (Damp conditions mean less tree, plant and grass pollen, but possibly more mould.) When picking a destination, keep in mind that beaches have less tree pollen than forests, and a beach, concrete pad or trailer helps with grass avoidance. Sites with showers will enable you to rinse off pollen before bedtime. See Smart Campers Tips on page 38
youve been directed, and check the Air Quality Health Index (www.airhealth.ca) daily a value of seven or above is high, but everyone responds differently, especially those with asthma. Decrease outdoor activity, keep your reliever puffer handy, and follow your asthma action plan, says Savage. These actions will help keep your breathing in good control during the heat of the summer. Jaclyn Law
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hen it comes to allergies, often a newborn will start out with allergic eczema. Then a food allergy will occur. Then the child may develop asthma with allergic rhinitis. One of the great hopes is to have a treatment that may prevent this allergic march. For patients with allergic rhinitis, allergists will advise trigger avoidance, followed by therapies such as antihistamines and nasal steroid sprays. We may then turn to immunotherapy allergy shots to desensitize to the allergen. An important discussion has emerged as to whether childhood immunotherapy could halt the progression to asthma. A few studies are, in fact, showing this outcome. The European PAT study is the most important in considering the longterm effects of immunotherapy. Children in the study received either allergy shots to birch and/or grass allergens or standard medical treatment for three years. The researchers then followed up seven years later. In the group that didnt receive immunotherapy, 45 percent of children developed asthma. In the group that had allergy shots, only 25 percent developed asthma. The children who got injections also had fewer nasal and eye symptoms. The significant difference in asthma emergence suggests we
could have a dramatic public health impact by simply using this readily available treatment. As we say in medicine, more studies are needed, but with PAT and other shorter-term studies providing valuable evidence, allergists and parents should more often consider the option of immunotherapy in childhood. We know it leads to excellent symptom control of allergic rhinitis and we are learning that it could, over time, slow or even stop the allergic march to asthma.
ABOUT US
Photo: RICK CHARD
The Canadian Network for Respiratory Care is a non-profit organization and registered charity that works to improve the lives of Canadians living with respiratory disease. We certify healthcare professionals as Certified Asthma and Respiratory Educators (CAEs and CREs). Our CAEs and CREs work to help patients with their asthma, COPD, allergies and smoking cessation efforts. For more information or to find a CAE or CRE near you, please see www.cnrchome.net or phone: 905-880-1092.
Q. My son used to be great about tracking symptoms and using his peak ow meter. But now hes 17, and has to be reminded repeatedly to do so. Do you have any advice? Lora Miller: As children grow older, parents can often make more of an impact on their kids by giving them ownership of decisions regarding their health. In this case, I would ask your son why he is no longer monitoring his peak flows. If his response makes you think he is becoming complacent with his asthma control, you could ask him what he might miss out on if he has symptoms a paycheque from missed shifts at work or maybe the basketball championship game. If he starts to see that his health is linked to things that he values, he will find his own motivation to keep his asthma under control. Q. We have identical twins and one has just been diagnosed with asthma. Is his twin equally at risk of developing it? Ellen Fleming Michaud: If having asthma was based solely on genetics, identical twins would be equally at risk of developing it. However, studies show the odds of identical twins both developing asthma are about 60 per cent. It is nearly impossible to predict whether your other child will inherit the disease, as there are environmental factors that come into play, such as exposure to air pollution, cigarette smoke and dust mites. Diet and exercise may even have a role. My advice: closely monitor your child for signs or symptoms of asthma and speak with your family physician about whether to have a spirometry test performed. Q. Im going to be a bridesmaid at an August wedding. Since ragweed is a bad asthma trigger for me and the wedding is bringing on stress, what can I do to prepare? Trevor Shewfelt: Start with regular exercise, a good diet and lots of sleep. These will help you deal with stress. If you have a controller inhaler, use it as prescribed in the months leading up to the wedding to keep your lung inflammation in check. Ask your respiratory educator or healthcare professional about starting an antihistamine like loratadine (Claritin) a week before the wedding to lessen symptoms from ragweed. You might also ask about an omega-3 and/or vitamin D supplement, as both can reduce lung inflammation. Finally, you could speak to your doctor about taking a leukotriene inhibitor like montelukast (Singulair), in addition to your controller medication to further reduce inflammation. Q. My son is starting Grade 1 this fall, when should we start increasing his asthma meds to be ready for school? Lora Miller: I recommend marking your calendar a full two
Trevor Shewfelt
Lora Miller
Q&A
Certified Educators take your asthma and allergy questions.
Send questions to: ask@allergicliving.com
Q. Grass pollen triggers my asthma. But I live on my own and need to mow the lawn. Any recommendations? Ellen Fleming Michaud: It would be best for you not to do the mowing, as cutting the grass distributes pollen into the air. However, as this is not an option, I strongly recommend that you wear a mask with HEPA filtration to block out dust, pollen, and mould (these are available at most hardware stores). After mowing, take a shower to remove any pollen and change into fresh clothing. Taking a non-drowsy antihistamine daily during allergy season can also help. Speak with your allergist about whether you could be a candidate for allergy shots and ensure that you take your asthma controller medicines (inhaled corticosteroids) daily. Your blue rescue inhaler should be available to you at all times. Q. A month ago, my 6-year-old had an asthma attack and we had to go to the hospital. Our doctor then changed controller inhalers and increased the dosage, but now my daughters symptoms seem worse. Could this be the wrong medication for her? What should we do? Trevor Shewfelt: Its possible its the wrong medication, but
the more likely reason is incorrect inhaler technique. Inhalers are surprisingly difficult to use properly. I suggest getting your pharmacist to watch your child use her new inhaler. He or she will be able to help her with the correct technique. If the inhaler is the spray type with the pressurized canister, ask your respiratory educator or pharmacist about a spacer device. A spacer can make it much easier to get the medication deep into her lungs where it does the most good. Also, I would suggest visiting the Childrens Asthma Education Centre website (www.asthma-education.com) for demonstrations on using an inhaler.
weeks prior to a risky season that will affect asthma symptoms, and start taking or increasing inhaled corticosteroids at this time. The so-called September spike for asthma is one issue, but there are other risky times as well. Taking action two weeks ahead of a trigger season will help to minimize reactions. Ellen Fleming Michaud is a respiratory therapist and CRE in Renfrew County, Ont. Trevor Shewfelt is a pharmacist and CRE in Dauphin, Man. Lora Miller is a respiratory therapist and CRE in Camrose, Alta.
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Parents Corner
Food Allergies:
CNRC thanks GlaxoSmithKline for helping to make Currents possible through an educational grant.
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