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Posts tagged ‘Asthma’

Izabelle Easen asthma death followed ‘gross failure’ by paramedic

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Bella Easen had suffered from a severe form of asthma for about three years before she died

A paramedic failed to give basic treatment when he stopped trying to resuscitate a girl who died after an asthma attack, a coroner has said.

Seven-year-old Izabelle Easen died from a cardiac arrest at her home in Thorne, South Yorkshire, on 9 April 2008.

Paramedic James McKenna tried to revive her but pronounced her dead after no more than 11 minutes, an inquest heard.

Assistant coroner Michael Mellun said that was “a gross failure to provide basic medical treatment”.

Children ‘robust’

The paramedic was later struck off by the Health Professions Council which heard how ambulance service guidelines stated all children should be given life-saving treatment until they arrive at hospital.

Mr Mellun said he could not rule that the failures in the care of Izabelle, known as Bella, amounted to negligence because the chances she would have survived if she had been taken to hospital were so slim.

However, delivering a narrative verdict at a hearing in Doncaster on Wednesday, he said: “I am satisfied there was a gross failure to provide basic medical treatment.”

Consultant chest specialist Simon Taggart said there was a 5% chance Bella could have survived if resuscitation had continued and she had reached hospital.

“If she has a 5% chance, that failing contributed to her death,” he said. “I view it that children are robust and should be given every chance.”

Mr McKenna told the inquest that he got the protocol wrong as he believed at the time that the requirement to always take young patients to hospital only related to babies.

But he said there were no signs of life in Bella and he believed that taking her to hospital would not have saved her.

The court heard that Bella had suffered from a severe form of asthma for about three years and had been admitted to hospital numerous times.

Mary Ann Charles, the family’s solicitor, said: “The verdict brings an end to a period of unimaginable pain and distress endured for far too long by those who loved Izabelle Easen.”

She said that Bella’s mother, Lorna Robinson, spent years blaming herself for not doing enough for Bella.

“In fact she did everything she could,” she said. “It was the health services which had failed her daughter.”

via BBC News – Izabelle Easen asthma death followed ‘gross failure’ by paramedic.

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Asthma: Altering diet may ease symptoms

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Fruits, vegetables and whole-grains might be an unlikely treatment for asthma according to animal studies.

Tests on mice, published in the journal Nature Medicine, showed that a high-fibre diet could reduce inflammation in the lungs.

The extra fibre changed the nutrients being absorbed from the gut, which in turn altered the immune system.

The researchers argue the shift to processed foods may explain why more people are developing asthma.

The airways are more sensitive to irritation and more likely to become inflamed in people with asthma.

It leads to a narrowing of the airways that make it harder to breathe.

However, a possible solution may lie in another organ, the gut, and the bacteria which live there.

The cells of the human body are vastly outnumbered by the trillions of microbes that live in and on it.

There is growing evidence that these bacteria have a significant impact on health.

Gut bug fuel

A team at the University of Lausanne in Switzerland showed that the high and low fibre diets altered the types of bacteria living in the guts of the mice.

Bacteria which can munch on soluble fibre, the type found in fruit and vegetables, flourished on the high-fibre diet and they in turn produced more short-chain fatty acids – a type of fat, which is absorbed into the blood.

The scientists said these fatty acids acted as signals to the immune system and resulted in the lungs being more resistant to irritation.

The opposite happened in low-fibre diets and the mice became more vulnerable to asthma.

Their report argued that a dietary shift away from fibre in favour of processed foods may be involved in rising levels of asthma.

It said: “In recent decades, there has been a well-documented increase in the incidence of allergic asthma in developed countries and coincident with this increase have been changes in diet, including reduced consumption of fibre.”

Human treatment?

One of the researchers Dr Benjamin Marsland said some of the differences caused by high-fibre diets have already been observed in people by comparing diets in Europe and Burkina Faso.

He told the BBC: “There’s a very high probability it works in humans, the basic principle of fibre being converted to short-chain fatty acids is known.

“But we don’t know what amount of fibre would be needed and the concentrations of short-chain fatty acids required might be different.

“It is early days, but the implications could be far reaching.”

The team in Lausanne are also investigating the role of diet in long-term lung inflammation such as COPD, which is set to become the world’s third biggest killer.

An alternative to tweaking diets is giving the purified fatty acids themselves as a dietary supplement.

This worked in mice, but Dr Marsland warns there “certainly needs to be more work” before this is suggested in people.

via BBC News – Asthma: Altering diet may ease symptoms.

Tackle and control asthma

Asthmatics should be proactive in managing their condition and not merely think they can live with it, writes Nadia Badarudin

WHEEZING, coughing, shortness of breath and chest tightness — symptoms experienced by some 300 million people around the globe suffering from asthma, a chronic lung disease for which there has been no cure as yet.

The American Academy of Allergy Asthma and Immunology states that asthma cases have risen substantially in the last 40 years, and with a projected additional 100 million asthmatics worldwide by 2025.

Asthmatics usually find their lives adversely impacted by recurrent attacks that cause fatigue and sleeplessness leading to school and work absenteeism, and limiting participation in sports and recreational activities.

Despite it being one of the most common chronic diseases, asthma remains under-diagnosed and under-treated.

According to a local study in 2012 — The Role Of Health Counselling In Relation To MDI Usage For Rural Adult Asthmatic Patients In Hulu Selangor by K. Selvam — prevalence of asthma in Malaysia is estimated between 10 and 13 per cent of the population, affecting approximately 3.25 million people, in which the majority are under-treated.

WHAT IS ASTHMA?
According to the MSD Global Asthma Fact Sheet, asthma is an underlying inflammation of the bronchial tubes (the airways leading to and from the lungs) which increase sensitivity to certain airborne substances. Once irritated, the sensitivity can trigger the narrowing of the airways and reduces the flow of air in and out of the lungs, resulting in an asthma attack.

Institute of Respiratory Medicine director Datuk Dr Abdul Razak Muttalif says asthma, which has become more common in urban areas, is triggered by various factors including genetics, outdoor and indoor allergens, as well as the environment.

“Besides genetic predisposition, the onset of asthma can be caused by allergens such as pollen, moulds, dust mites, animal dander or insects like cockroaches, as well as automobile emissions, toxic chemicals, viral infections, haze or changes in weather.

“Stress, anxiety, strenuous exercise and even laughter can trigger asthma attack.”

“There are also indications of exacerbations in a smoking environment. Studies show that smoking can influence the effectiveness of an asthma therapy and cause difficulty in controlling the disease,” he says, adding that males have a higher risk of asthma during their childhood but after adolescence, the risk is higher in females.

He adds that there are also cases of patients mistakenly thinking that their symptoms are merely allergic rhinitis (resdung in Malay).

“There is a close link between asthma and allergic rhinitis. About 80 per cent of asthmatics have concomitant rhinitis. Thus, it is important that if someone has ‘resdung’ and feels breathless, he or she should check for asthma,” he says.

NOT WELL-CONTROLLED
Medications prescribed for asthmatics fall into two categories — long-term control, and quick relief or “rescue” medications.

Inhaled corticosteroids are the preferred medicine for long-term control of asthma, while short-acting beta2-agonists are one of the options for quick relief.

In serious conditions, oral and intravenous corticosteroids may be required for acute asthma flare-ups or for severe symptoms. However, these can cause serious side-effects if used long-term.

“Although the awareness on asthma is high, and there are advances made in the asthma treatment in recent years, many patients have yet to manage or control the disease well,” says associate professor Dr Roslina Abdul Manap, Universiti Kebangsaan Malaysia Medical Centre consultant respiratory physician and head of respiratory medicine unit.

Dr Roslina says, according to the Asthma Insight and Management in Europe and Canada (EUCAN AIM) 2010 survey, most patients believe their asthma is under control, when in fact, it is not. “One in five patients was found to have needed acute care for asthma over the course of a year, with 6.7 per cent of the patients requiring hospitalisation.

“Approximately 41 per cent of patients needed a quick relief of an inhaler at least once a week. These figures underscore the need for proper treatment,” she says.

She adds: “The survey found that sudden, severe episodes were considered far worse by patients than day-to-day asthma symptoms.

“These symptoms can be so severe that more than half of respondents stopped exercising as a result, while more than a quarter left work or school, and almost 10 per cent had to enter intensive care.”

TOO POLITE TO DISCUSS
Dr Roslina says the Global Initiative for Asthma (GINA) Control Classification is a guideline that determines whether a patient’s asthma condition is under control or otherwise. GINA works with health care professionals and public health officials around the world to reduce asthma prevalence, morbidity and mortality.

The guideline defines a patient’s “controlled”, “partly controlled” and “uncontrolled” asthma based on five characteristics: daytime symptoms, limitations of activities, nocturnal symptoms/awakening, need for reliever treatment and lung function.

Dr Roslina says: “Based on the guideline, asthma is classified as under control when the patient can avoid troublesome symptoms night and day, as well as serious attacks.”

“A controlled asthma also means that the patient can use little or no reliever medication, have near normal lung function and most importantly, he can have a productive and physically active life.”

She adds that learning about asthma and talking to the doctor are the two simple ways to manage the disease. “Unfortunately, patients, especially Asians, are too polite to discuss their condition with the doctors.”

“The majority of them share the perception that it’s okay to have asthma symptoms and think ‘I can live with it’.”

Some asthmatics quit exercising or playing their favourite sports just to avoid getting the attacks. “And such attitude and perception need to be changed. The patients have to realise that they can be proactive and control the disease,” she says.

LIVING WITH ASTHMA
Former nurse, Bibi Mohd Zain, 69, from Taman Melati, Setapak, has been living with asthma for 28 years. In the early years after diagnosis, having frequent episodes of attacks and being hospitalised had become part and parcel of Bibi’s life.

“The attacks would usually occur when I was under stress, and the episodes were like dreadful routines. And asthma did affect my daily activities back then,” she says.

Over the years, Bibi has learnt to adapt and deal with asthma, simply by understanding and managing the disease.

“I got tired of the various treatments and taking medicines that kept changing over the years. So, I took the initiative to understand asthma, as well as learn what I could do to prevent the symptoms. It’s all about taking control of the disease,” she explains.

Bibi says identifying the factors that can trigger her asthma is crucial in managing the disease. Among them cigarette smoke, strong smells and certain foods such as watermelon.

“I’ll also try to stay indoors if the weather is too cold or too hot, and try to stay calm and relaxed to avoid stress.

“It has not been easy, but it has worked over time. Precaution is also key, so, if I want to indulge in certain asthma-triggering foods or exercise, I’ll take the necessary preventive medicine prior to eating or exercising,” she says.

Bibi has become less dependent on her inhaler and has been exercising regularly after learning to control her asthma. She shares her asthma-controlling tips with her daughter, Rahayu Amiruddin, who is also asthmatic.

“My daughter was diagnosed with asthma when she was in primary school. I taught her how to take proactive measures, and now at 39, her lifestyle is not affected by the disease. She is in fact a fitness instructor, ” she says.

TAKE CONTROL

ASTHMATICS can lead normal lives if they learn to control their asthma. Here are the ways:

1.    Take asthma medicines as prescribed by doctors.

2.     Stay away from things that trigger your asthma attacks.

3. Go to the doctor two or three times a year for check-ups. Most importantly, go even when you feel fine and have no breathing problems.

4. Ask questions. Your doctor is your partner in controlling your asthma. Tell the doctor about any problems with your asthma medicines.

5. Know the signs if your asthma is getting worse and how to respond.

6. Keep a handy asthma medicine plan:
•     Know what quick-relief medicines to take when you have an asthma attack.
•     Help remember what preventive medicines to take every day.
•     See if you should take asthma medicine just before sports or working hard.

7.     Always carry your quick relief asthma medicine with you when you leave home.

8.     Get help if you see any of these asthma danger signs:
•     Your quick-relief medicine does not help for very long or, it does not help at all — breathing is still fast and hard.
•     It is hard to talk.
•     Lips or fingernails turn grey or blue.
•     The nose opens wide when the person breathes.
•     Skin is pulled in around the ribs and neck when the person breathes.
•     The heartbeat or pulse is very fast.
•    It is hard to walk.

Adapted from GINA Patient Guide 2007

•     In the United States, asthma costs the country more than US$30 billion (RM94 billion) a year.
•     In Europe, the total cost of asthma currently hovers at approximately £17.7 billion (RM86.8 billion) per year, with outpatient costs accounting for the highest proportion at approximately £3.8 billion (RM18.64 billion).
•     In Malaysia, the direct cost of treating asthma is RM850 per year for adults, and RM577 per year for children (as of April 2013).
•     According to the EUCAN AIM survey in 2010, patients surveyed experience almost a 40 per cent decrease in productivity on days when their asthma was at its worst compared with a typical day.

Source: MSD Global Asthma

Read more: Tackle and control asthma – Health – New Straits Times http://www.nst.com.my/life-times/health/tackle-and-control-asthma-1.302083#ixzz2WcWFytYU

Hormones in menstrual cycle ‘affect asthma’

Period pain
Period pain is not the only symptom linked to a woman’s menstrual cycle, the study suggests

A woman’s menstrual cycle affects the severity of respiratory symptoms, potentially worsening conditions such as asthma, a study suggests.

Norwegian researchers studied almost 4,000 women, and found worse symptoms around ovulation.

Writing in the American Journal of Respiratory and Critical Care Medicine, they said it may be possible to adapt women’s medication.

Asthma UK said it could help women with asthma manage their condition better.

All the women studied had regular menstrual cycles lasting 28 days or less, and none were taking hormonal contraceptives.

Of those studied, 28.5% were smokers and 8% had been diagnosed with asthma.

Wheezing symptoms were worse between days 10 to 22 of cycles, with a slight dip near the point of ovulation for most.

Shortness of breath was worse on days seven to 21, again with a slight fall around ovulation.

The study found it was not just women diagnosed with asthma who experienced these symptoms and variations.

Coughing was worse following ovulation for those with asthma, those who were overweight and smokers.

‘Pronounced’ variations

When an individual woman has her period is determined by complex hormonal processes over the course of her cycle.

This research is really interesting, and could help women with asthma to manage their condition better ”

Dr Samantha Walker, Asthma UK

Throughout, levels of different hormones rise and fall – and body temperature rises around ovulation.

The researchers suggest that these fluctuations may have direct effects on airways. and indirect effects on inflammatory responses to infection.

Writing in the journal, the researchers led by Dr Ferenc Macsali, of the Haukeland University Hospital in Bergen, Norway, said: “We found that respiratory symptoms varied significantly during the menstrual cycle.

“There were large changes in symptom incidence through the cycle for all symptoms.”

They also found “pronounced” symptom variations during the menstrual cycle in women with asthma, and say the findings suggest women might need tailored medication regimes.

“Adjustment of asthma medication to the menstrual cycle may potentially improve the efficacy of asthma treatment and reduce disability and health costs related to asthma in women.”

Triggers

Dr Macsali added: “Our results point to the potential for individualising therapy for respiratory diseases according to individual symptom patterns.

“Adjusting asthma medication, for example, according to a woman’s menstrual cycle might improve its efficacy and help reduce disability and the costs of care.”

Dr Samantha Walker, of Asthma UK, said: “This research is really interesting, and could help women with asthma to manage their condition better.

“Asthma can be triggered by many different things, and this varies from person to person – but we always encourage people with asthma to be aware of things that trigger their symptoms so that they can take steps to control them.

“If women with asthma notice that their symptoms are worsening at key times of the month then they can take preventive measures such as having inhalers that are within date, working and contain enough doses of medicine to see them through the times when they are most affected.”

BBC

Hope to breathe easy

source: NST

New online test tries to cut deaths from asthma attacks

The website will also advise people what they can do to minimise that risk and how to stay well.

At the same time a national review of all asthma deaths over the next year is also getting under way.

It aims to reduce the number of deaths through asthma attacks, which claim the lives of three people in the UK a day.

The online test is called Triple A: Avoid Asthma Attacks.

It asks simple questions about factors which have been linked to increasing the risk of an asthma attack that could lead to a hospital admission.

According to the charity Asthma UK, which is behind the new website, about 75% of asthma-related emergency hospital admissions could be prevented.

Traffic lights

Those taking the test will fall into one of three categories, colour-coded like traffic lights.

The red category means the person runs a highly increased risk of a serious attack, while green would mean no increased risk.

Each category is linked to advice on how to control the symptoms and what to do if someone does have an attack.

Dr Samantha Walker, director of research and policy at Asthma UK, said asthma attacks put someone in hospital every seven minutes and kill over 1,100 people every year.

The UK has a higher death rate from asthma than other similar countries and we have been unable to reduce numbers significantly in recent years”

Neil Churchill Asthma UK

“The test is designed to make people sit up, take notice and make changes to the way they manage their asthma if they are shown to be at an increased risk of an asthma attack.

“This kind of test for asthma has never been done before but we’re confident it will prove an effective motivator to help reduce frightening and often unnecessary hospital admissions.”

At the same time the Royal College of Physicians is launching a 12-month review of asthma deaths in the UK.

The review will collect details of all asthma deaths from hospitals, GPs and families to try to identify how to improve care and reduce deaths in the future.

Dr Mark L Levy, the clinical lead of the National Review of Asthma Deaths, said it was important to learn from every death.

“For 50 years, research has shown that the majority of asthma deaths are potentially preventable.

“This first UK National Review of Asthma Deaths offers clinicians and sufferers an opportunity to learn from these sad events and find ways of improving care for people with asthma in the future.”

Asthma is one of the most common conditions in the UK, affecting around one in 10 children and adults.

Life or death

The Care Services Minister Paul Burstow said: “Asthma can be a matter of life or death. That is why the government is funding this work to help front-line professionals improve the management of the condition.

“Led by front-line staff over the next 12 months, staff from across the NHS will be reviewing asthma deaths and collecting evidence which will provide invaluable insights to delivering better care.”

Neil Churchill, chief executive officer at Asthma UK, said: “The importance of this national review cannot be underestimated. The UK has a higher death rate from asthma than other similar countries and we have been unable to reduce numbers significantly in recent years.

“This review will establish any patterns and risk factors that will help us prevent asthma deaths in the future. We’re already working with healthcare professionals in key asthma hotspots such as the north-west of England to encourage people to manage their asthma and avoid unnecessary hospital admissions.

“The review is a once-in-a-generation opportunity to achieve a step change in reducing deaths and we urge all healthcare professionals to take part.”

BBC

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