Author Archives: Jackie Aim

Parents and transition

Transition from child to adult asthma services will mean changes for you as well as your child.

As a parent you will naturally be anxious.
You have managed your child’s asthma well for years.
It can be a frustrating time.
You might get angry at your teenager’s attitude to their asthma.
Most teenagers don’t want to be “fussed over” drawing unwanted attention to their asthma around their friends.
Parents need support to let go.
There should be a gradual handover of responsibility.
Parents still have a legal responsibility until your child is 16 years old.
Parents are still needed, but in a different role to support your child in their decision making rather than telling them what to do.

Smoking

Your team should ask about smoking

Active? Is your child smoking?
Passive? Is there someone at home who smokes when your child is in the house?
Friends? Are they being exposed to second hand smoke from their friends?
Family? Are they exposed to smoke when visiting other family?
Does your child like smoking?
Has your child tried E-cigarettes? Have they tried cannabis or other drugs?

What is the effect on asthmatic lungs?

Cigarette smoke is a trigger for your child’s asthma.
Smoking can reduce the effect of inhaled asthma medicine.
Long term effects of smoking are well known but short term effects of smoking include increased heart rate and blood pressure due to release of adrenalin. Nicotine causes the brain to release dopamine a chemical in the brain which creates an addictive response. The more you smoke the more short nicotine hits and the more addictive smoking becomes.
Cigarette smoke also contains thousands of chemicals, poisonous tar and gases. Many are know to cause cancers not only in the lung. Other parts of the body can be affected as the chemicals enter the blood supply.
The long term effects of using E-cigarettes is not yet known. They contain nicotine and are often flavoured to attract young users.

Advice on how to stop smoking should be given both the teenager and their family.

Careers with asthma

Baker

Timber worker

Spray painter

Chemical worker

Armed forces

Animal handler

You should discuss your young person’s career hopes with them and the healthcare team early on (age 12 – 14 at latest).

You should have realistic discussions as some jobs or occupations can affect their asthma.

Entry to the armed forces is limited to those with no asthma symptoms for at least 4 years.

Careers such as joinery, plumbing, mechanics, hairdressing etc. and any other work environment where dust or chemicals may be a trigger for asthma are to be avoided for young people with asthma.

Asthma consultations

Health professional listening to teenagers lungs

The young person, you the parent and the healthcare team should be in partnership.
Your healthcare team should give the young person the opportunity to be seen alone from the age of 12 years old.
The team start the consultation with young person. As they get older and more confident they should ask the questions they need to know about their asthma.
Careful explanation and discussion is needed with young person and you the parent. This may take several attempts.
The young person will build up confidence, independence and communication skills for the consultation.
Health professionals should listen to get the young person’s honest and unbiased perspective.
This way of working is recommended in National Guidelines.
You can join the review to summarise and discuss the health teams observations.
Everyone should agree on the next steps.
The young person may need you the parent to help them arrange their appointment, get them there and help arrange their prescriptions.

Teenagers & transition to adulthood

Definitions of transition:

The Oxford English Dictionary defines transition as “the process or a period of changing from one state or condition to another”.
The World Health Organisation defines adolescence as 10 – 19 years old.
Adolescence is a period of emerging independence
Transition is NOT the same as transfer. It happens gradually.
Transition is about your dependent child becoming an independent adult.

Hospital and community team

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All families in the UK have a family doctor as the centre of your health world
They take a medical history.
Make the diagnosis of asthma and explain what this means.
Listen to your child’s lungs.
Refer to the practice nurse for follow up appointments, inhaler technique and action plan
Prescribe medication – inhalers as appropriate.
Refer & communicate with consultant paediatrician at the hospital if needed. Most of the treatment your child will need can be done by the GP. Ask if one of the GP’s at your practice has a special interest in asthma care.

Practice nurse

Most practices have a nurse
They take general observations
Teach inhaler technique
Provide personalised asthma action plan
Perform simple peak flow tests if over 5 years
Provide advice support and education to families about their child’s asthma
They can also prescribe some medications and inhalers

Health visitor

Every family with children under five has a named health visitor
Their role is varied, including prevention, helping people to stay healthy and avoid illness.
Health visitors are qualified registered nurses with specialist qualifications.
They offer support and encouragement to families through the early years from pregnancy and birth to primary school and beyond.
They work closely with GP’s and cover the geographical area of the GP practice.

School nurse

Every family with school aged children has a named school nurse linked to your child’s school.
The school nurse serves as a link between families, school staff and your child’s health team.
They do a great deal of health promotion activities in school including obesity awareness, sun sense and sexual health.
They carry out health screenings.
The school nurse works with education staff to develop school health policies and programs.
They provide guidance for the delivery of health services in schools.

Pharmacist

Every family needs a local pharmacist (chemist)
Review current medication
Dispense medication
General advice about medicines and inhalers
Advice about inhaler technique
Explain what your medication is for and any side effects
Can help with repeat or regular prescriptions

Consultant paediatrician

Not every child with asthma will need a hospital consultant
Your GP will discuss with you and refer to hospital service if needed
They review your child’s medical history
They listen to your child’s lungs
They can change or prescribe new inhalers or tablets
Refer to children’s asthma nurse specialist
Refer for breathing tests if needed (over 6 years old only)

Children’s asthma nurse specialist

If your child is referred to the hospital asthma team they may also meet the specialist nurse.
Nurse review medication and inhaler technique
They can also prescribe some medications and inhalers
Provide personalised asthma action plans
Review any problems family may be having
Home visit if the child has difficult to control asthma
Point of contact between appointments
General observations
Perform simple peak flow dependant on age (over 5 years only)

Paediatric respiratory physiologist

Some children who come to the hospital service might need to see the physiologist
Only for children over 6 years old as younger children can’t do lung function tests well
Assess full lung function
Assess effectiveness of inhaled treatment
Assess hypersensitivity using challenge tests
Report findings to respiratory consultant

Paediatric respiratory physiotherapist

Occasionally, some children may need to see the respiratory physiotherapist.
They can provide specialist advice and treatment for dysfunctional breathing such as hyperventilation.
They can teach your child how to relax and retrain their breathing

Paediatric psychologist

Occasionally some children and families find that their health makes them feel worried, anxious, low mood or angry
Children’s clinical psychologists can reduce emotional distress caused by a health condition.
They promote psychological well-being.
Psychologists work with children and families to help them understand these feelings and give them ways to cope with these feelings.

Social Worker

Occasionally, some families need extra help because their health is impacting on their social circumstances
Social workers may help families to get to appointments
They can also help families to understand any benefits or grants which they may be entitled to
They can help support housing applications

Tips to help you quit

Remember all smokers are different.
Prepare to quit- make a plan.
Involve family and friends if this helps.
Know the triggers that make you think about cigarettes (e.g. first thing in morning or after a meal).
Be prepared to change your habits around smoking behaviour like – what to do with your hands, how to cope if you are with others who are smoking.
Plan healthy alternatives.
Pick support and therapy that suits you- there are lots to choose from!
Reward your success- be good to yourself!

CHSS supports the Charter for a smoke free generation in Scotland by 2034 to protect young people and support positive health choices.

Varenicline (Champix®) and Bupropion (Zyban®)

Champix® is a non nicotine based medicine that reduces cravings and reduces withdrawal symptoms and can be four times more effective in helping you to quit than on your own.

To work it has to be started about two weeks before your “Quit date”.
Champix®:

Is not used in combination with Nicotine Replacement Therapy.
Is not suitable for some people so discuss with your GP, practice nurse or smoking cessation group leader.
Can be used for adults over 18 years.
Can be issued from selected community pharmacies.

Zyban®:

Reduces craving and can double your chance of succeeding.
Changes your brain’s response to nicotine.
Is available on prescription from your doctor.
Is not suitable for everyone so it is best to discuss with your doctor your options.

Nicotine Replacement Therapy

Nicotine is the addictive substance found in cigarette smoke. NRT helps you to quit by making you in control as you reduce your craving of nicotine by gradually reducing the amount of nicotine in your body.

Nicotine Replacement Therapy is:

Safe, effective and clean version of nicotine.
Nicotine patches are long acting (16 or 24 hours).
Gum, sprays, inhalators, micro tabs and mouth strips are short-acting and can be used along with a patch.

E-cigarettes also contain nicotine but are not yet licensed in the UK as a quit smoking product and are not available via NHS clinics. Long term effects of using E-cigarettes are not yet known. More research is needed on the safety and effectiveness of E-Cigarettes in long term use studies.

Support available to help you quit

You are 4 times more likely to succeed if you get specialist support and therapies from an NHS Stop Smoking Service. They offer a range of help to suit you. You do not have to join a group if that is not for you. All NHS Stop Smoking Services are free.

Group support.
Individual support.
Home visits if you are housebound.
Support in hospital when attending a regular clinic (e.g. asthma clinic).
Hospital In-patient support.
Local Pharmacy.
Apps for your smart phone.

Stop smoking services:
Quit Your Way Scotland Telephone: 0800 84 84 84. Quit Your Way can be contacted Monday – Friday from 9am until 5pm. Taking action on smoking and health (ash)