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Correspondence page:

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This is a 'moderated' correspondence page. In other words we decide what goes in, and in what form. Our aim is that the page should be as useful as possible to others. Views expressed may not be the same as our own.

PLEASE NOTE THAT EVERYTHING ON THESE WEB PAGES IS ONLY FOR YOUR GENERAL INFORMATION AND DOES NOT CONSTITUTE PERSONAL MEDICAL ADVICE. THE DOCTORS WHO SEE YOU WILL KNOW FAR MORE ABOUT YOU, AND THEIR ADVICE SHOULD BE FOLLOWED. WE CANNOT GUARANTEE THAT THERE ARE NO ERRORS IN THIS WEB PAGE OR WEBSITE. Your doctor's knowledge of the subject may also be better than ours. If you think that anything on this website may be relevant to you, the sensible thing is to ask your own doctor about it.


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Depression and steroid-dependent asthma.   (10 May 1998)

B.C. writes:

" As a 30 yr old brittle asthmatic who is now also battling with depression after 15 years of intermittent steroid use I would be very interested to hear whether other asthmatics have experienced similar problems. "

Depression is common in people without asthma, so if you have asthma and are depressed, asthma is not necessarily the cause. However, asthma hardly adds to the joys of life and can certainly add to depression or be the main cause. You are not alone.

Many doctors believe that steroid tablets (but NOT inhalers) can cause depression, or elation, or other psychological changes, but others, myself included, feel that this has been greatly overrated or may not even be a real problem. Rarely, people on high doses of steroids used for diseases other than asthma really do get 'steroid psychosis', which is sudden, severe, and quickly gets completely better when the dose is reduced. I have never seen this in asthma, and this is not at all the same as the emotional changes which many doctors believe happen with the milder treatment used in asthma.

The subject of depression caused by asthma is a big one, and I can't do justice to it here. The worst culprit is asthma which has a powerful effect on social life. Some people have such bad asthma that their marriage prospects, or family life are badly affected. Asthma in a child may keep not only the child but both parents awake, so that they have to get through the day and through work although deprived of sleep, and anxious about their child.

Other stresses add to this. There may be a bereavement, fear of job loss, stress at work, or marital strife. The whole situation can become too difficult to handle without help and sympathy.

Asthma can interfere with normal sexual relations. Naturally, people become very upset by this.

If people tell you that your asthma is caused by 'nerves', this is usually adding insult to injury. They may sound so convincing that you come to believe it. Emotional upset is NOT a true cause of asthma, though it can be an aggravating factor.

However, some people have breathing difficulty which mimics asthma and which is caused by emotional upset. This is not true asthma, but 'vocal cord dysfunction syndrome' and can happen in people who also do have asthma, or without asthma. Getting the diagnosis right is important because the treatment is different.

A good and experienced asthma specialist will be knowledgeable about depression in asthma, and should be sympathetic and helpful. A major problem is pressure of time in clinics. Talking through the interrelated problems which build up to depression in people with bad asthma takes a lot of time, and there are no short cuts. Not only does it take a lot of time for the patient to get any real help. A doctor who cannot spend this amount of time with patients, will not learn enough to be really helpful in this area. No book or lecture can replace what we learn from people with the problem. With health care increasingly managed like any industry for financial efficiency, pressure on time is a sharply increasing problem.

A psychiatrist or a good counsellor may also be very helpful.

You do have to recognise that asthma, depending on its severity, IS stressful. You have to recognise that other stresses in life are inevitable, and that people's ability to cope with stress varies greatly. But you can improve your ability to cope with stress in a variety of ways. Professional help is not the only way; you may find ways yourself, and a good friend or group of friends should not be underrated. Professional help can save you from misdiagnosis, can help greatly in seeing your problems more calmly and in a better perspective, and could lead to effective treatment even though it surely won't solve all your problems.

If your depression is ever so bad that you consider killing yourself, get professional help at once by consulting your family doctor. People practically always change their mind about wanting to end their lives; when you are depressed, the depression itself prevents you from seeing the good things in the future which most people do see.
In the UK you can ring the SAMARITANS on 0345 909090.

If the treatment of your asthma itself can be improved, you will be under less stress.

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Asthma and menstruation.   (13 May 1998)

W.T de L. writes:

" What is the link between asthma and the menstrual cycle? "

Although 30 to 40% of women with menses have lower lung function results in the week before the menses or at the time of the period, this reduction is so small in most that they are not aware of being worse. However, a small proportion of women with asthma have severe worsening during these times. In this severe group standard anti-asthma treatment is usually not enough, and hormonal treatment, such as high doses of progesterone, has to be added to the treatment. Collaboration between an endocrinologist or gynaecologist and a good asthma specialist is usually the best approach. We don't know why some women differ in this way; I certainly do not understand the mechanism and have not seen anything in the medical journals which would explain it. There is no known link with premenstrual tension or with medication used for menstrual symptoms.

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Asthma and Work

C.A. writes:   (17 May 1998)

" I would like to share my thoughts on WORK. As I try to better my asthma, I wonder who will hire me. Not to long ago I showed up for an interview with one of the few companies that considered me for a position. As I walked into the interviewer's office, I went into a massive attack. I guess it's safe to assume I wasn't first on their list! "So now what?" That is what I asked myself as I sat in bed the next day. How do I convince the company that I'm fine and can go back into the work force. I guess I can't! I called. The position has been filled, they said. Is this going to happen again? Should I screen them over the phone? Was it the woman's perfume? Dust? Well, I can ask millions of questions. The only answer I come up with is that I must go on. I've had several interviews since. They are always hesitant to even consider me, but nice enough to send me away with "We still have many applicants to interview, but your on the top of our list!" "

We are keen to hear from others with experience on asthma and job prospects.

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Headaches on 'relievers'.

P.K. writes:   (21 June 1998)

" Every long term 'reliever' medication I have been prescribed gives me dreadful headaches. Serevent, Foradil, Singulair, etc. I keep being prescribed new ones, but they all seem to have the same effect. In the meantime, I survive on Bricanyl and Flixotide and my breathing remains unstable.

Has anyone else had a similair experience ? Is it a case of putting up with one ailment to sort another ? "

I have not encountered this, even in clinical trials where we are looking for side-effects. Singulair is completely different from the others, which makes this even more odd. As your breathing is unstable, are you having enough Flixotide, and are you seeing an asthma specialist? If your inhaled treatments are at a maximum, has everything been done to find and avoid causes of your asthma?

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Peak flow dropping faster than expected.

R.P. writes:   (8 July 1998)

" I'm an asthma sufferer (occupational asthma due to teaching in a school workshop) and found this site while looking for info on what my PF should likely be; despite medication (2000ug fluticasone), it has dropped from 690 to 520 l/min in the space of a year. Your PF graph has helped me realise that this is a quicker drop than I should expect! So, back to my doc... "

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Asthma triggered by perfumes.

Betty Bridges, RN (USA) writes:   (4 August 1998)

" I have respiratory sensitization to a common fragrance chemical. When trying to pinpoint the specific chemical I was sensitized to I became very interested in the effect fragrances have on health.

I have put the information I have gathered at a web site, the Fragranced Products Information Network . The URL is http://pw1.netcom.com/~bcb56/fpin.htm . I would be interested in hearing from others that have asthma triggered by perfumes. Email to: bcb56@ix.netcom.com "

This is a definite problem in substantial numbers of people. Unfortunately, people feel they have a 'perfect right' to use excessive perfume and to spray perfumes, particularly in shared workspace. Please support Betty Bridges in her effort to collect information which may help people who are made ill by inconsiderate use of fragrances. Her website is informative.

Visit our perfume allergy correspondence page.

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New bedding material kills dust mites

K.F. writes:   (12 Oct 1998)

" The following is an article I read in my local newspaper dating back to September 19 1998. I was wondering if you would know when and where to get this product ?
LONDON ( Reuters)---British scientist have developed a new bedding material that kills dust mites, tiny bugs that doctors believe may be behind an increase in the incidence of asthma.
New Scientist magazine says the new fibre, called Amicor Plus and made by researchers at Britian's Courtaulds, contains a fungicide that is harmless to humans but deadly to the mites that live in bedding.
"What makes the new material so unusual is that it attacks the fungi on which the mites depend, not the mites themselves, " the magazine reports.
Scientist tested the fabric on a bed covered with human skin scale and mites and found the tiny bugs could not survive without the fungi. "

This idea is far from new, and last time it failed to prove worthwhile. I suggest you wait until there are clinical trial results showing that people with asthma actually improve compared to people using non-fungicidal control material. So many of these ideas turn out to be hot air. Meanwhile the producers are often perfectly willing to take your money.

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Side effects of asthma drugs; are regular tests needed?

D.H. (USA) writes:   (18 Oct 1998)

" I am an asthmatic presently on Singulair, Azmacort and Intal. During times when my asthma is out of control I have taken just about every kind of inhaler and Prednisone. I have a nebulizer for those times. I would like to know more about adverse symptoms from having to take these drugs, including what kind of periodic tests I should have on a regular basis. "

I am working on a set of pages on asthma treatment, a glaring shortcoming of my site at present. But if I'm to get it done I may have to stop answering email for a while!

In my own opinion Intal (Cromolyn, inhaled sodium cromoglycate) does nothing when added to Azmacort (triamcinolone acetonide inhaler) or similar drugs; there is trial evidence, old now, which shows this. Does the combination of drugs mean that your asthma control is less than it should be? If so, I would be considering inhaled fluticasone propionate (Flovent in USA, Flixotide in UK), which makes it easier and probably safer to give a larger dose which may improve control. However, this is why you have a physician locally; he or she will make such judgements. Personally I make a lot of use of peak flow charts to optimise treatment. Are you doing all you can with allergen control, if appropriate for you? I trust you don't smoke!

ALL medical treatments have side effects; we use them because we believe the benefit greatly outweighs the risk. As a matter of fact, everything we do carries some risk. I can't elaborate too much, but Intal is the safest drug I know and has been around since 1968; extremely rare significant side effects exist, but you would soon know, and stopping the drug cures the problem; so forget about it if you don't notice anything serious. Singulair (montelukast) is a new drug; so far it has an excellent safety record (trials did not reveal any side effect which could convincingly be attributed to the drug), but as with all new drugs there is a possibility that side effects as yet unknown will surface in future. The small risk of this has to be balanced against the benefit you gain. I would routinely withdraw any drug which did not produce demonstrable benefit in a patient, for this kind of reason. With all new drugs it is particularly important to report possible side effects to your doctor. Singulair is being adopted rapidly, so anything really serious is likely to show up soon: "there is safety in numbers".

No regular tests other than monitoring of your asthma is needed for most of the treatments. The exception is prednisone; if you have that frequently or continuously, then your bone status should be checked in order to spot any osteoporosis early, and you should be checked for diabetes and high blood pressure from time to time. Some doctors would ensure you were having enough calcium and vitamin D, but not give supplements if a check of your urine calcium output showed that this was already high. There would also be some sense in having your eye pressure measured once in a while by an optometrist. None of this is usually considered necessary if you only have prednisone occasionally. PLEASE NOTE THAT THIS, LIKE EVERYTHING ON THESE WEB PAGES, IS ONLY FOR YOUR GENERAL INFORMATION AND DOES NOT CONSTITUTE PERSONAL MEDICAL ADVICE. THE DOCTORS WHO SEE YOU WILL KNOW FAR MORE ABOUT YOU, AND THEIR ADVICE SHOULD BE FOLLOWED. Your doctor's knowledge of the subject may also be better than mine. If you think that anything I have written may be relevant to you, the sensible thing is to ask your own doctor about it.

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Where in the USA would it be good to retire to if you are allergic to house dust mites?

L.M. (USA) writes:   (24 Feb 1999)

" My husband suffers from dust mite allergy, and will retire in 2 years. We are thinking of moving and would like to know geographical areas that might be better suited to his problem. We live in Oregon, USA which we understand is not a good place to be. Thank you for any information you can give. "

Your question is sensible, but I am not the right person to advise, being based in the UK. However, very dry areas, or areas which are very cold for a long period in winter, tend to be free from significant numbers of house dust mites. See if you can get an answer from the American Academy of Allergy, Asthma and Immunology (AAAAI). Even if they don't have an 'off the shelf' answer, it would make sense for them to include some information on this in their advice materials. A local Fellow or Member of the Academy would be able to give better advice than I could.

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This page is maintained by Martin Stern
Last update: 7 March 1999. Copyright © 1998 Asthma and Allergy Information and Research and M. A. Stern