If you are one of the 5.2 million people with asthma in the UK you may want to join us live online Tuesday 1st May, World Asthma Day, at 14.00 as we speak to Dr Sarah Brewer who will answer all your asthma questions.

Top of the agenda is the imminent withdrawal of some CFC-containing inhalers. Many people being treated for asthma will be affected when certain inhalers, containing environmentally harmful CFC gases, are removed from UK supply later this year. In an effort to keep people informed and streamline the transition to CFC-free inhalers, a new information website, www.ourasthma.com is now available online.

It may be surprising to learn that some asthma inhalers still contain CFCs, ozone depleting gases that have long been phased out from use in fridges and aerosols. Asthma inhalers, also known as ‘puffers’, are the most common medication prescribed by doctors to help control asthma, however, in accordance with the Montreal Protocol international agreement, certain inhalers containing CFCs are to be phased out in an attempt to reduce the release of these chemicals into the atmosphere.

There will also be plenty of advice for Mums and Dads on how the new inhalers will work for their kids and lots of general information about asthma so join us live on Tuesday 1st May at 14.00 to find out more.

H: Lis Speight, host
S: Dr Sarah Brewer, GP and author

H: Hello and welcome to the Healthcare Show, I’m Lis Speight. Now if you’re one of the 5.2 million people in the UK who suffer with asthma, you may be surprised to know that some asthma inhalers still contain CFCs. Now these are ozone-depleting gases which were phased out quite some time ago from fridges and aerosols, and now they’re going to be phased out from asthma inhalers as well. Now we’re all quite worried about the environment, so in line with international agreements, the asthma inhalers that contain CFCs are going to be taken off the market to try to stop these dangerous chemicals going into the atmosphere. But if you think this effects you, if you’ve got asthma and you’ve got an inhaler, then don’t panic because we have someone in the studio to talk us through it all, author and GP Dr Sarah Brewer, thanks for coming in Sarah, I know you’ve come in from Guernsey today, so thanks for making the effort for us

S: It’s a pleasure

H: And we’ll be talking to Sarah a little bit more about asthma and the causes of asthma, and also some more details about the CFCs in the inhalers and which ones are going to be taken off the market etc. But this is an interactive show and we’d love your questions, so if you’ve got any questions about asthma or inhalers, then all you have to do to take part is to type your name and your question in the box on the screen, put where you’re from as well, put your question in and then press submit and it’ll come through to us in the studio and we’ll try to get through as many as we can. But moving back to Sarah, explain to us a little bit more about asthma – 5.2 million people suffering from it, that sounds like an awful lot of people. Is it getting worse do you think, are more people suffering from it these days?

S: It is becoming more common, we don’t quite know why but it is an inflammatory condition and it does have an allergic element to it as well, and other allergic, inflammatory conditions do also seem to be becoming more popular, more common

H: And is this do you think because of the pollution in the atmosphere, I mean more people seem to get hay fever these days –

S: Well pollution may well play a role but other diet and lifestyle factors may also be involved so it may be linked with dust in the home for example. Being over clean is another factor. If you’re over clean you’re not exposing your body to the bacteria which are friendly bacteria, they help to prime the immune system against allergic reactions in youth and infancy. So if we’re over-clean in the home two things happen, one we don’t get the bacteria which might help to protect us and the other thing is it might allow dust mites to breed and conditions in modern homes and we can become allergic to them as well

H: And what exactly is asthma, you said it’s a – sorry I’ve forgotten the word you used now

S: Inflammatory

H: Inflammatory that’s the one, sorry. Explain exactly what it is and how you know you’ve got it

S: Well it causes inflammation in the airways which makes them very sensitive, so that they respond to certain triggers by squeezing up. So rather than having nice, wide tubes which you can breathe through and get lots of air going through, they become much more constricted which means the air flow is reduced and also you can secrete an awful lot of mucus in there which helps to gum them up even more, so what you might notice to begin with is just a mild cough, and the cough often affects children early in the morning, they wake with it. And then you can get tightness in the chest, you might wheeze, and you can become very short of breath. And you can have quite a severe attack that you can’t get enough oxygen into the body, your lips go blue, and that’s obviously a life-threatening condition

H: And it can be fatal can’t it?

S: It can yes but it shouldn’t be, it is a very preventable, treatable condition, and it’s very sad that so many people are admitted to hospital with it every year because really we should be getting on top of it and making sure that it isn’t affecting their life and it isn’t causing these serious attacks

H The inhalers then, we have the two types of inhalers – can you explain how they work?

S: Well broadly speaking there are two types, one is the reliever inhaler. That’s the one that you take when you’ve got the tightness and the wheeze, and what that does is it’s an instant acting drug which helps to widen up the tubes, helps them dilate so you can feel a lot better in yourself. If you have to use your reliever more than twice a week then you’ve got a lot of inflammation going on in your lungs, you need something to damp that down and therefore you need another type of inhaler called a preventer inhaler and the preventer inhaler you use every day, even if you haven’t got symptoms and that helps to damp down the inflammation so that you then don’t get symptoms

H: Right. And which of those has the CFCs in it, which one’s being phased out?

S: Well the reliever inhalers have already had their CFCs phased out

H: Right

S: So those are now CFC free, but there’s a type of preventer inhaler which contains a particular cortico steroid drug called beclometazone, and those are being phased out in the coming months to replace the CFCs with a different propellant gas

H: Ok. And would people know that this was happening do you think?

S: Well the doctors will probably say bring them in and say look the inhaler you’re on is being withdrawn so we’re going to change it to a different one, he might tell you why, he might not, he might just say there’s a new one available. You might not know until you go to the pharmacy to get your script, but you can go onto a website and look at a table to see whether or not your inhaler, preventer inhaler is one that contains CFCs and that will give you an idea of whether you’re likely to have a change

H: Right, ok.. Well it is a little bit confusing isn’t it for people, so if you have any questions about this then hopefully Sarah will be able to answer them for you. Any questions about asthma or inhalers, if you’re confused about which sorts you’re on then send them in to us, we’ll try to get through as many as we can. We’ve already got some questions coming in, and Jeremy wants to know, he says “so the authorities are saying that we’ve been using dangerous inhalers all these years. Is it just bureaucracy for its own sake?” Are they dangerous?

S: Well I think the thing to know is that they’re not dangerous for you dangerous, they’re dangerous for the environment if you like, because CFCs are known to harm the ozone layer and that’s contributing to global warming. So a lot of governments got together over 20 years ago now and signed something called the Montreal Protocol in which they pledged to withdraw the use of CFCs apart from essential uses. Now the asthma inhalers were one of those essential uses obviously, and it’s only now that we’re starting to get the technology in place to be able to find alternatives that can provide the drug that you need right down into your lungs but without at the same time releasing a gas which isn’t harmful to you, but which does harm the environment

H: And even though it might not seem like very much, a tiny little bit of gas, if they’re being used worldwide it all mounts up and we’ve all got to do our bit, haven’t we at the end of the day?

S: Well exactly, I mean compared to the amount of CFCs we used in refrigerant systems and air conditioning, really it’s a very tiny amount which is used in inhalers, which I think is one again another reason why we were allowed to continue to use them

H Yes but then why not get rid of them if you can I suppose

S: Yes exactly, get rid of them totally

H: An interesting question in from Martin actually, he wants to know “are the new CFC-free inhalers just as effective as the old ones?”

S: Very good question Martin, yes they are just as effective, they’re designed to get the drugs that you need right down into your lungs but because it’s a different propellant gas then you will notice certain differences. Now with the old CFCs when you use them you did get a very cold feeling at the back of your throat and you won’t get that with the new ones which are called HFAs - hydrofluroalcanes

H: Well done~!

S: You might notice that the spray’s coming out more slowly than before, it might be a lighter spray, but the same amount of drug will be released to be inhaled right down into your lungs, so you shouldn’t notice a difference in the efficacy, the way it controls your asthma, but you might notice a difference in the taste and in the feel

H: So people shouldn’t really notice their symptoms getting any worse or anything because it’s the same drug that’s being administered, it’s just a different way of actually giving it to you?

S: Exactly, but if you do notice changes or if you’re concerned then make an appointment to see your doctor to have a chat about it, or your asthma nurse, and it’s actually a very good opportunity to have an excuse to go and see your doctor and -

H: Yes and have a general MOT -

S: Discuss your asthma generally, because a lot of people do have questions or you might feel that your asthma symptoms are getting a bit worse, in which case you know don’t put up with it, go and see your doctor because you might need a treatment change

H: Yes I suppose people go on for years and years and years do they with the same sort of inhalers and what have you

S: Well they do and I think people as they get older they find that their symptoms do change and if they get a bit worse they might think oh well it’s just my asthma, but they should be thinking I’m not going to put up with this, I want it treated -

H Maybe try a different drug or -

S: Yes or even an increase in dose maybe, but if you can get an asthma action plan from your doctor which tells you exactly what to do, how to step up your treatment when symptoms get worse and how to step it down again afterwards, then you should be able to control your symptoms so it doesn’t affect your lifestyle or your sleep. You shouldn’t make any compromises for asthma - it’s totally treatable

H: Well there you are, stern words from the doctor! Now is there actually a cure for asthma?

S: Very good question I think if we had a cure it would be fantastic. We don’t have one at the moment. Obviously you know lots of research going into it. We’re understanding the inflammation that’s underlying more and more and there are new treatments being launched and when I first qualified as a GP 20 years ago, most – well a lot of the drugs that are available now weren’t available then so you know good strides have been made just in 20 years and I’m sure in another 20 years, who knows we could well have a cure

H: And Keith actually wanted to know that, whether there was a cure so thanks for your question Keith. Moving on now, Mary M wants to know “why were CFCs used in asthma inhalers in the first place?”

S: Very good question. To begin with we obviously didn’t realise that CFCs were harmful to the environment and they were used because they had the right consistency, they were able to be held in a container and then released in a certain way to release a spray which enabled you to breathe them down to the lungs. They were inert for us, they didn’t affect your asthma, they didn’t affect you but then we did unfortunately come to learn that they affect the environment so we needed to remove them and find an alternative and that has taken a little while

H: Ok. Now we’re about halfway through the show now and thanks to all of you who have sent in your questions, but keep them coming in, if you have any questions at all that you need to ask Sarah about asthma or this change in the inhalers, it is a little bit complicated, so send your questions into us and we’ll try and get through as many as we can, just type your name in the box on the screen, press submit, put your question in obviously, press submit and it’ll come through to us here in the studio and we’ll try and get through as many as we can. Now Katie wants to know “how to people know whether their inhaler is of a type that needs replacing?” Now we talked a little bit about this at the beginning of the show, if you’ve got one in your hands and you think is this an old type – how do you know?

S: Well the best thing to do is to go to the website, www.ourasthma.com and you’ll see a link there which says “is my inhaler a CFC free one?” and if you follow the instructions you’ll find a very nice table which both gives the name of your inhaler and it also gives all the colour codings, so if you look at the colour of the cap on your inhaler for example you’ll be able to identify very quickly which one you have and you’ll be able to see whether or not it contains CFC

H: Ok so that sounds quite straightforward then doesn’t it? Now Mary wants to know “hi there” she says, “hi Sarah. I’d rather not have an inhaler containing CFCs. Will my GP know all about this and can I ask him for a different inhaler?” Are GPs pretty clued up do you think by now?

S: I would hope that they were but I can’t speak for all GPs obviously Mary. What you should do, perhaps if you’re not certain whether or not your inhaler has CFCs and you can’t quite work it out from the website for whatever reason, you could ask a pharmacist, or next time that you need a new script, make an appointment to see your doctor and say that you would like to consider having a CFC free one and hopefully that should be quite straightforward, because over the next few months certain CFC containing inhalers are going to be withdrawn anyway, it’s going to be slowly one phased out and one type phased in. So it should happen automatically actually

H: And actually on that point of timings, Steve wants to know “when will my inhaler need to be replaced?” Is it different timings for different ones?

S: There are a couple of inhalers that are going to be withdrawn in June and a few more that will be withdrawn as the manufacturers decide to over the next few months. Probably by the end of the year then most people will have switched over, but there’s no definite deadline, the government haven’t yet set a definite deadline

H: But if you’ve got an inhaler that you think has CFCs in it, don’t stop using it?

S: Oh most definitely not, it’s not doing you any harm, and the small amount that’s being released when you use it isn’t really going to be an awful, you know have a major effect on the environment either, so don’t feel concerned. Your asthma is the important thing and you do need to have that well controlled

H: And it’s sort of a general phasing out isn’t it, so if you’re getting to the end of your inhaler, if you’re getting to the end of it then maybe the next one that you will be given will be a new one, you don’t necessarily need to go and change it straight away?

S: No and you’ve got to remember that the government’s agreed 20 years ago when they signed the Montreal -

H: Don’t panic!

S: Protocol, so it’s taken 20 years to get to this stage and yes you could argue that isn’t that a bit slow, but we’ve done what we could and we’ve now got suitable alternatives in place and in fact we wouldn’t be allowed to switch people until there were two alternatives in place -

H: Right

S: Because if there’s only one then anti-competitive legislation would be involved, so it’s all a bit political as well

H: So it’s taken a bit of time but we’ve got there in the end! Now Vicki wants to know “I’ve heard that asthma and eczema are linked – is that true?”

S: It certainly is true, they’re both allergic conditions. Now not everybody has an allergic type of asthma but that is the most common type, and some people might find that they’re so sensitive to pollen, for example, that they get both – they get hay fever, when pollen lands on their skin they get eczema -

H On their skin, I’ve never heard that before?

S: Yes some people are so sensitised to it – so some people who have eczema have asthma, some people have asthma have eczema and often the two go together and it – the tendency towards that, we call it atopy which is a posh word for allergic pre-disposition. It can run in families and these allergic type conditions are becoming more common

H: So is asthma inherited then?

S: The tendency towards it is yes, but it probably needs another sort of trigger to set it off

H: Right

S: Now that might be that you live somewhere where you’re exposed to certain things like dust mite or pollen that t riggers it off. It may be related to the diet that your mother ate when she was pregnant with you

H: Oh dear

S: There are lots of different factors involved. There’s no one to blame it’s just one of those things. The important thing to know if you do have either of these conditions, don’t put up with the symptoms of asthma, do get it treated properly

H: But talking about where you live and managing the condition, we’ve got an interesting question in from Mrs Mathews and she wants to know, well she says “my two kids suffer from chronic asthma” – that must be awful actually. “We’ve been advised to move out of London to the countryside where they are likely to have less problems, and will that actually help?”

S: Well there’s no guarantee obviously, I mean some people who live in the countryside have asthma because they’re sensitised to the pollens of something like oil seed rape, some people in cities might be sensitised to pollutants and to some of the particles released from cars for example, so no one can make any guarantees at all. What you might want to do is perhaps go on holiday to the countryside for a couple of weeks

H: Yes that’s a good idea

S: And just see if they do seem to be a bit better

H And would it have an instant affect like that do you think, would your body react that quickly to it?

S: Well obviously because you’ve got a lot of inflammation going on in the lungs again you can’t definitely guarantee but there are other things that you can do. You can change diet for example, there’s research that shows that children who eat the most fruit and vegetables have the less likely to have asthma-type symptoms, or they’re less likely to be less severe. Having fish oils can be very beneficial because they damp down inflammation in the body. Taking a probiotic, you know live bio yogurt or a probiotic supplement. The friendly bacteria in there do seem to help

H: They’re very friendly by the sounds of it, have an affect on asthma, that’s amazing

S: Most beneficial if they’re taken by the mother during pregnancy or if the infant is given them, so there are lots of things that you can try and obviously the things at home – reducing exposure to house dust mite, that’s also very important. You know switching your frilly curtains to blinds. Not having carpets, having click clock flooring or lino

H: So you can clean up easier and it doesn’t harbour dust

S: Exactly. Using a vacuum cleaner that has a filter to take the dust out of it. There are lots of other things you can do. It seems like a bit of a major upheaval to have to move home and have to take your kids out of a school they might be happy in. you know that can cause emotional problems which in turn can then make the asthma worse, so I would be very careful taking a very major step like moving home

H: Try and do everything else first

S: Exactly

H: Or maybe she’s already tried that

S: Yes I mean you can go onto the Asthma UK website and there’s information there about reducing dust exposure at home, or just Google that sort of thing

H: Yes

S: There’s lots of useful information out there

H Well good luck Mrs Mathews, I hope your children are feeling a bit better soon. Now talking about childhood asthma actually – do they actually grow out of it, are they likely to not be as bad when they get a bit older?

S: It’s very interesting actually because some children do seem to grow out of it. Now when you’re first born your immune system has to respond to lots of things in the environment, it has to know whether something’s a danger or whether something’s safe and it should tolerate it, and to begin with the immune system is very immature and it reacts appropriately, so it produces an allergic reaction against things when it should be producing an anti-infective type reaction

H: Right

S: So this is where the over-cleanliness hypothesis comes in. if you’re not exposed to certain friendly bacteria which teach your immune system to react in an anti-infective way, the immune system might go off and react in an allergic way instead. Now it was very, one very interesting example of this – when young children get a viral infection they often get pickled in a rash, whereas when an adult has that same virus they don’t. That’s because the immature immune system is responding to an infection in an allergic way. It hasn’t yet learned to respond in a different way

H: So they may well grow out of it?

S: You often grow out of it, yes

H: Fingers crossed. Right Jo wants to know “I’ve only recently been diagnosed with mild asthma”, so she doesn’t always carry her inhaler with her. She says “what should I do if I’m having an attack but she doesn’t have her inhaler with her? It’s quite scary isn’t it?

S: Yes obviously always try to have your inhaler with you and always try to make sure you’ve got enough to keep one perhaps at home, one in the car, perhaps one in the office, I mean that’s always a trick, but if the attack isn’t too bad you could try popping into the chemist and see if the chemist who might know you is prepared to give you an emergency inhaler and then get a prescription off your doctor later, or you can ring your surgery and see if they’ll ring through for a prescription, but if you are having a lot of difficulty breathing, if you can’t catch your breath, if you’re so breathless you can’t talk. Certainly if your lips are going blue you need to be going to hospital, but obviously try not to let it get that bad, you know make sure you’ve got your inhaler with you

H: I’m sure the more you panic the worse it gets as well

S: Well exactly if you get stressed out. Perhaps you could ring somebody whose at home who could bring your inhaler to you, but always try to make sure that you do have your inhaler with you, or at least you’ve got a spare so you can always get hold of one

H: It’s like carrying an umbrella isn’t it, if you take it with you it won’t rain -

S: Exactly

H It’s the same with your asthma inhaler! Well Lisa wants to know “my son’s just been diagnosed as asthmatic. He loves his sport, will he be able to carry on playing rugby and cricket?” That’s an interesting one isn’t it?

S: Well the aim of all asthma treatment is that you can lead a totally normal life. Now some children do find that their asthma is triggered by exercise, and the thing to do there is talk to your doctor who will probably recommend that he takes his reliever inhaler, uses that about 15 minutes before he’s due to go and do exercise and that should be enough to stop his airways from producing the spasm-producing symptoms. If that doesn’t control it then he might need to be on a different sort of medication, he might need to be on a higher dose, certainly don’t let his asthma stop him playing sport because it should be controlled well enough. Because exercise is so important for children

H: Exactly now we’re almost out of time but we’ve got time for one last question. Vicki wants to know “I’ve used the same inhaler for 10 years, now that I’m changing inhalers, will I notice a big difference?” We touched on this earlier didn’t we, if you could just sum it up quickly

S: Yes it’s very important to be aware of this Vicki because when you use the new inhaler if it’s got a different propellant in it, you might notice that it tastes different, it comes out more slowly, it has a lighter feel to it, you don’t get that cold feeling at the back of the throat, perhaps you’re used to, and some people might be concerned that it isn’t working properly or it’s not producing the right reaction, but don’t worry, they’ve all been specially designed so they give the right amount of drug to get down into your lungs to treat your asthma in the same way as the old inhalers

H: Ok now we’ve had an awful lot of questions in asking about where to find information on which asthma inhalers are changing and what they could do about it. Just before we go Sarah explain to us a little bit more about that

S: Well the easiest way is to go onto the website www.ourasthma.com and you can find information there. You can also ask your pharmacist, your doctor or your asthma nurse

H: Ok, well best of luck with that everybody. We’re out of time now but thanks very much for Dr Sarah Brewer for coming in and talking us through that and thanks for all of you out there who sent in questions as well, we hope we’ve been of some help to you. Os best of luck with changing over your inhaler if that’s what you end up doing, and if you need any more information just click the link on the screen, and as Sarah said you can go to www.ourasthma.com. Ok well that’s it from the Healthcare for now, we’ll see you next time. Bye bye

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