August 2011 Asthma Adviceline Case Study
Louise is the mother of 9 year old Sarah who has asthma. Sarah was diagnosed with asthma age 4. Between the ages of 4 and 7, Sarah was admitted to hospital four times and had numerous courses of oral steroids and antibiotics. However, for 2 years, Sarah’s asthma has been much better. She has had no need for her reliever inhaler all summer. As her asthma has improved so much, Sarah’s mother Louise has been less inclined to give her daughter the preventer inhaler and noticed her daughter is less inclined to take it. As her daughter’s asthma continues to improve, Louise called the Asthma Adviceline to ask if she could stop giving her daughter her inhalers completely.
Asthma Nurse’s Advice:
Asthma is not caused by one single factor. No one knows exactly what causes asthma but many factors come into play including family history, environmental factors, allergens and viral infections. A preventer inhaler works by reducing the inflammation in the lungs. As the protective effect of the steroid builds up, it is less likely that there will be asthma symptoms by day or by night and the reliever inhaler will not be needed as often, if at all.
It cannot be stressed how important medication compliance is with asthma. Sarah should continue to take the contoller inhaler every day, morning and evening even when she is feeling well. This is how asthma symptoms are kept under control.
When a person is symptom free for some time, they can be fooled into believing that their asthma has ‘gone’. When controller/preventer therapy is stopped there can be a ‘hangover’ period for one to two weeks where the person continues to feel well and then suddenly there is a rebound affect and the person can have a return of symptoms or even an asthma attack.
In some cases, it is true that sometimes children do seem to ‘grow out of asthma’. It may be OK to have a trial of reducing the amount of inhaler or stopping the treatment but that the Asthma Society would not recommend that Louise does this blindly.
All children should have a peak flow meter and an asthma management plan. Sarah does not. Before making any changes to the medication which has been prescribed to Sarah by her GP, Louise should take the following steps:
• Sarah has a check-up with her GP and Practice Nurse and informs them of how well the child has been and that Louise is interested in reducing or stopping the medication for a trial.
• Louise buys a children’s peak flow meter and ensures that Sarah knows how to use it.
• Louise keeps a daily record of Sarah’s peak flow measurement, her symptoms, and the medication Louise has taken.
• Sarah has an asthma management plan.
• Sarah returns to her GP after a few weeks with her asthma diary complete and discuss the possibility of reducing and / or stopping medication.