Dr Glenis Scadding : Hello, I'm Dr Glenis Scadding and I'd be delighted to answer questions on the Channel 4 Asthma experiment. One thing I would like to make very clear is that we are NOT suggesting that children should stop their asthma preventer inhalers. The preventer inhalers, which should be coloured brown or red or purple, contain a minute dose of corticosteroid. This is very similar to a natural body product and has been shown to save lives and to keep asthma patients out of hospital. These inhalers are necessary for anything more than mild intermittent asthma but are often not sufficient to completely control inflammation, which is why we suggest that asthma triggers are searched for and eliminated.
Fionas : I am really interested to know about "prevention rather than cure". What evidence is there that breast feeding, careful weaning and dieting can "prevent" asthma? How do children get asthma in the first place?
Dr Glenis Scadding : Very good question, Fiona. Children who get asthma are often genetically pre-disposed to develop it and they may have eczema beforehand. There's very little evidence that diet, weaning etc. make much difference. One thing that certainly can help is stopping all smoking in the home and breast-feeding is certainly recommended because of its many benefits in protecting against infection. Recent evidence suggests that early exposure to bacterial products may help reduce the development of allergies too. So, in fact, it may be better to bring a child into a home where there is already a dog or cat, or better still, bring them up on a farm and take them into a stable every so often.
lexr3000 : Can preventative measures be taken against virally triggered as well as allergen triggered asthma?
Dr Glenis Scadding : Very good question also, lex. A lot of asthma exacerbations start in the upper airway as viral colds, as yet we have no means of preventing this, but evidence shows that children who are allergic and exposed to their allergens are significantly more likely to develop severe asthma than those who are not exposed to allergens when they develop the cold. i.e. the infection and allergy summate.
LizSteel : Having watched the programme, I'm interested to know whether the allergy testing ever takes diet into account? I particularly wonder about dairy? Thank you.
Dr Glenis Scadding : In small children allergies are likely to foods such as egg and milk, later soya and wheat. Many of these food allergies are lost by the time the child is 3-5 years of age, to be replaced by inhalant allergies. Milk allergy is uncommon in older children and can be diagnosed by exclusion (briefly) followed by re-introduction, but this should be supervised by a dietician. The idea that milk makes mucous is a myth. Any fluid with similar viscosity gives a mucous-like feel at the back of the throat. Some food allergies do persist, especially those involving nuts and fish, these are, however, usually easily recognised as the reactions are immediate and severe. About 1 in 70 children in the UK is now peanut-allergic.
jayne Gledhill : A very interesting programme. I suffer from Churg-Strauss which has similar symptoms to asthma. I have a nineteen month son, who displays asthma symptoms, and one of the details I noticed in the programme was regarding damp. We do not have central heating, as I have always thought that it would be negative to my breathing, but would it benefit both my son and I to have warm dry air?
Dr Glenis Scadding : House dust mites cannot drink water so they thrive in damp surroundings. They are also helped by the presence of some moulds which digest skin cells so that house dust mites can eat them. I think the sensible thing would be to see how you both are if you go to somewhere warm and dry for a couple of weeks and then make a decision about your home. Sadly we do not know the cause of Churg-Strauss syndrome so I do not think that simple measures like allergen-avoidance are likely to prove very beneficial to you.
Amanda D : Would allergen avoidance lead to a more severe reaction when your child did come into contact with allergens, e.g. staying at a friends house, or is there evidence that they would react less than before?
Dr Glenis Scadding : It is likely that they would react less than before. Regular allergen exposure leads to inflammation which makes the airways more irritable and reactive.
JamieP : How much of a factor do you think Volatile Organic Compounds are in instigating asthma in children, such as those in air fresheners? Should air fresheners be taken out of the home if a child suffers from asthma?
Dr Glenis Scadding : This is a good question and there's very little evidence on the subject. I like to suggest that asthmatics are exposed as little as possible to irritating chemicals of all sorts and that includes air fresheners. Similarly I suggest that biological washing powders and fabric softeners are also avoided for the washing.
loulou170388 : Allergy testing is not available at our local surgery. How can I arrange testing for my daughter?
Dr Glenis Scadding : This is a big problem. In the UK there are only around 27 full-time consultant-allergists, so access to an allergy opinion is very limited. Fortunately some other doctors, such as consultant immunologists and some chest and gut specialists also undertake allergy testing. What is not recommended is to send off hair or blood to a laboratory and get back an answer in the post. Allergy testing requires accurate history-taking plus the test with an interpretation of the two together.
Well Being : Why was nothing mentioned about the use of air purifiers, good ones are effective at killing dust mites, mould and pet dander? Rather than getting people to rip up their homes this is a much more realistic approach that's easier to sustain in the long term.
Dr Glenis Scadding : There is absolutely no good evidence that air purifiers have any effect on house dust mites, which are very sticky organisms deep in carpets, mattresses, sofas, curtains etc. House dust mites’ droppings are not removed by air purification.
briony : Our 3 year old son has an asthmatic cough which is trigged on a daily basis by exercise and activity. It sometimes results in him bringing up a copious amount of phlegm. He has been prescribed a blue inhaler which seems to ease the cough but do you have any advice when it seems to be exercise rather than an allergen which is the trigger? (we don't have any pets)
Dr Glenis Scadding : Sometimes small children, especially boys, have a kind of asthma which is not allergic but is related to having small airways. This is something which they can grow out of. However, if your son is still having problems at the age of 3 and if he is using the blue inhaler 3 or more times a week, then I suggest that it might be sensible for him to try some form of asthma preventer treatment. This could be an inhaled corticosteroid or your GP might like to try him on a new, chewable medicine which is a new kind of asthma treatment called an anti-leukotriene. Please discuss this with your GP.
asquire : Why did the children not take antihistamines I have found these of great value all my life to combat the effects of allergies to cats, dogs, house dust and mites?
Dr Glenis Scadding : Antihistamines are effective for the running, sneezing and itching symptoms of rhinitis. They are also very useful for allergic-type rashes, but do not work for asthma.
Shaun Dolman : My 4 year old twins were born 12 weeks premature and have always needed ventolin and more recently seretide. My doctor has said it may develop into Asthma or they could outgrow it. Having watched the programmes none of the children developed symptoms until around the age of 4. Therefore has it ever been known for a child to be born with asthma? Many thanks for your advice, as I seem to be left in the dark whenever I ask my GP.
Dr Glenis Scadding : As I mentioned earlier, asthma-type symptoms can be present from birth, often in children who are small or born early. This is more likely if they are male and if there is a smoker in the home. With lung growth sometimes these symptoms disappear entirely.
Joanne M : Hi I have many allergies and asthma. I have heard that there are breathing techniques that can go some way to stop your asthma - is this true. I have also heard that taking your puffer too much can harm your lungs and it is better to go on steroids to minimise use of preventative puffers - is this true?
Dr Glenis Scadding : Yes there is evidence that some breathing techniques such as yoga and possibly the Buteyko method can hep asthma, possibly because many asthmatics also hyperventilate (that is breath too fast and too shallowly). The over-use of blue inhalers can be detrimental. If the blue inhaler is needed several times a week then preventive asthma treatment should be increased. Inhaled corticosteroids are very effective and safe in the vast majority of patients, even children.
Emily H : Can allergen avoidance work in adult patients with severe asthma?
Dr Glenis Scadding : There have been 2 large, good-quality trials of allergen-avoidance in adults, which have proved negative. However, the measures were much less intensive than we took in this programme and patients would still have been exposed to allergens at work, in their cars etc. There is certainly good evidence that avoiding latex allergens by getting rid of powder in latex gloves has reduced asthma and rhinitis considerably in healthcare professionals.
Ilsa : Are children of parents who are asthmatic likely to share the same triggers as their parents if they develop asthma? Or, could they have different triggers?
Dr Glenis Scadding : The triggers are, at least partly, genetically determined but environmental exposure and its timing almost certainly also plays a part. Therefore, there are often some shared allergens but others which are particular to individuals in the family.
Anna Creaney : If the advice is to open windows in the morning and allow fresh air in, what about children with hay fever? Is hay fever linked to asthma?
Dr Glenis Scadding : Hay fever is a form of rhinitis which is allergic, it is caused by pollens. In the UK spring hay fever is caused by tree pollens, often birch pollen, which is appearing now. Summer hay fever is caused by grass pollen. When the air cools in the evening pollens descend, even in cities, therefore it makes sense to shut the bedroom window before this happens. It is possible to buy blinds which can be fitted to an open window and act as pollen filters.
tpg : Hello. My daughter suffers from mild asthma. We live on a main road with heavy traffic (buses, lorries, cars, etc). What effect does living near or close to a main road have on someone with asthma? Should we consider moving to a better location with reduced traffic, or moving away from build up town centres to the quieter suburbs? PS we are considering moving anyway ;-)
Dr Glenis Scadding : There is evidence from Japan that allergies are more likely to occur where there is a combination of the allergen plus traffic pollution. Once asthma is established traffic pollution can make it worse especially if you live very close to a busy road. See how well your daughter is when you are staying somewhere further away from a road and then make your decision about moving.
Chat Ed Ok folks we have now come to the end of our half hour webchat. Thank you for joining in and thank you to our guest Dr Glenis Scadding.
Dr Glenis Scadding : Thank you very much for your questions. I hope that some of you have found the answers helpful. For those who have more questions can I suggest you approach www.allergyuk.org or www.asthma.org.uk. Medical professionals might like to contact the British Society for Allergy and Clinical Immunology and that's www.bsaci.org Good night everyone.
Dr Glenis Scadding leaves the room.
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