Autumn 2021
Better Better Breathing Breathing Why you
should be
What’s new in respiratory research
using
a spacer
Find out inside!
Top Tips for
Exploring the art
Autumn
of breathing Understanding Respiratory Syncytial Virus Thunderstorm asthma - what it is, and what to look out for
at it a - wh asthm for m r o t t s der k ou . Thun hat to loo w Pg 10
Pg 5. Read abou t the link betwee n our vanishing natu re and asthma rates in our latest research bulletin.
Our Team Chief Executive Letitia Harding Research and Education Manager Joanna Turner
is, and
In this issue... 2
Office Administrator Dunia Cullingford
Community news Have you had your say in New Zealand’s vaping regulations yet? We share how you can get involved.
Donor Relations Coordinator Ruby Parker
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Grants and Fundraising Manager Harriet Cartwright PR and Comms - Head of Marketing Hannah Soult Marketing and Communications Advisor Victoria Fairweather Corporate Sponsorship and Engagement Advisor David Barclay Medical Director Dr Stuart Jones, MBChB, PhD, FRACP Chief Cultural Advisor – Māori Sir John Clarke, KNZM, CNZM Level 2, The Woolstore, 262 Thorndon Quay, Wellington 6011 PO Box 1459, Wellington 6140 04 499 4592 asthmafoundation.org.nz asthmaandrespiratoryfoundation asthmafndation asthmaandrespiratoryfoundation
ISSN 2703-4127
Thanks to the Foundation’s sponsors for supporting our ongoing initiatives.
Pg 11. Do you kn ow what a Passi ve House is? We explore this building spec wi th our Friends, eHaus.
Health professional news New Zealand’s first-ever COPD Guidelines are now published. We share how this will improve the diagnosis, treatment, and management of COPD in NZ.
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The environmental impact of inhalers Inhalers are a vital part of asthma management but what is the environmental impact of these aerosols?
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Thunderstorm asthma - what is it? You may have heard of this weather phenomenon but what exactly is thunderstorm asthma?
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Understanding Respiratory Syncytial Virus (RSV) Although RSV is so common that most children have been infected with the virus by age two, most of us haven’t heard of it.
Respiratory research bulletin In the first of an ongoing series, we discuss the latest in respiratory research, with this issues’s theme being research from New Zealand and Australia.
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Exploring the art of breathing Despite being somewhat a straightforward practice, correct breathing technique can be one that takes years to master.
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Top tips for autumn We discuss a few tips to help manage your respiratory condition as we enter the cooler months.
u y yo W h ld be u sho ing a us cer spa 12 p.
Key elements to building a Passive House Passive Housing is a revolutionary building specification taking the construction industry by storm. We chat to Passive House designers, eHaus, about what makes up a Passive House.
How to use a spacer If you use a MDI inhaler, then you should be using a spacer. We discuss the importance of spacers and how to use one here.
Coming up... 7 April 4 May 4 May 31 May
World Bronchiectasis Day World Asthma Day World Air Quality Week begins World Smokefree Day
Did you realise you can also read this magazine online? Head to the link below to view every issue of Better Breathing Magazine! issuu.com/betterbreathing
ARFNZ CE, Letitia Harding
Letitia’s Message I hope everyone managed to enjoy a much needed break over the festive summer season, and that you also took some time out to look after yourself and others. Now that 2021 has well and truly kicked off, the Foundation whānau are busy once again – key projects for this first quarter of the year included the relaunch of our updated online Fundamentals e-learning course, as well as publishing the first New Zealand Chronic Obstructive Pulmonary Disease (COPD) Guidelines, which we discuss on page 3. Following on from the new vaping regulations which came into effect last year, public consultation is now underway as part of the review process. Feedback is being sought on the restrictions surrounding vaping product displays in retail stores, the use of harm-reduction statements, and packaging requirements for vape products. Find out how you can have your say on page 2. The Foundation understands that people need to transition completely from smoking to vaping if they are to benefit, and that these people need a support plan with ‘quit smoking’ advice each time they purchase a vaping product.
These regulations are a chance to find a balance between supporting current cigarette smokers to quit, whilst also protecting our youth from vaping. Another long-standing project we are pleased to have completed this quarter is the launch our new online resource store. For some time, we have wanted to update and refresh the way health professionals order and download our health resources so that we can continue to aid in improving patient health outcomes. New features now include guest checkout, digital downloads, and order tracking. You may have also noticed that the Foundation has been quite vocal on the healthy homes front lately. The healthy homes standards became law on 1 July 2019, which introduced specific, minimum standards for heating, insulation, ventilation, and draught stopping in rental properties.
This was good news for our respiratory whānau who live in a rented property. Damp, mouldy homes lead to increased hospital admissions for respiratory related diseases such as asthma, pneumonia and bronchiolitis. The next big step is to raise the standards of new-builds around the country so that in 50 years’ time we aren’t seeing the same cold and damp homes becoming part of the New Zealand housing stock.
Our Chief Cultural Advisor - Sir John Clarke, and I after his recent visit to our office.
There are many innovative and energy efficient builds now on the New Zealand market, and we should be learning and embracing the way we can raise the bar when it comes to building new homes across the country. Take a look at page 11 to see a better way of building that’s also better for respiratory health with our Friends, eHaus. As we start to come into the cooler months, it’s time to start thinking about getting your influenza (flu) vaccine. Those eligible for a free flu vaccine include; pregnant women, people aged 65 and over, eligible people under 65 years of age with certain chronic respiratory conditions such as asthma and COPD, and children aged 4 years or under who have a history of significant respiratory illness. This issue, we also focus on a lesser known virus, RSV. This common viral infection infects most children before the age of two, and can cause bronchiolitis and pneumonia. Finally, we hope as always that you continue to support and value what the Foundation does. The Foundation receives no contract Government funding towards producing all of the information and resources that we continue to provide free of charge, and we can only do this through the generous support from our sponsors, donor whānau, and community grants, such as Pub Charity, that we are always so thankful to receive. Noho ora mai
Letitia Harding Chief Executive
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Respiratory Community News Sing your lungs our for COPD Recently, the Foundation attended the Porirua Sing Your Lungs Out (PSYLO) charity Christmas concert at the Pātaka Art Museum in Porirua. PSYLO is a community choir, made up of those who live with chronic obstructive respiratory disease (COPD). Singing is a proven method of pulmonary rehabilitation and helps to build lung strength through deep and steady breathing – it’s also a great place for people to socialise, as this can be limited due to the isolation of living with a chronic illness. The annual Christmas concert is a great way for PSYLO to raise vital funds to continue their work within the Porirua respiratory community. To find out more, search ‘Porirua Sing Your Lungs Out PSYLO’ on Facebook. There are also other SYLO groups throughout New Zealand.
Warm up your home this winter A warm, dry home is especially important if someone in your home has respiratory disease. Government initiated Warmer Kiwi Homes grants are available for lowerincome homeowners covering 90% of the cost of insulation and/or a fixed efficient heater (heater grants capped at $3000). Generous funding from organisations in the community means the cost to homeowners may be even lower in some areas. Warmer Kiwi Homes Manager, Eddie Thompson, says people should apply for a grant now to avoid waits for installs in winter. Find out if you are eligible and more details by visiting warmerkiwihomes.govt.nz or free call 0800 749 782.
Have your say on vaping regulations Recently, the Ministry of Health have announced public consultation on New Zealand’s recent vaping regulations. This process provides the public with an opportunity to have a say on where vaping products can be displayed, how they’re packaged and promoted, what safety requirements are needed, and how the ingredients are regulated. Public consultation is open until 5pm, 15 March 2021.
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To find out more visit www.health.govt.nz/publication/smokefreeenvironments-and-regulated-products-act-1990-proposalsregulations
Health Professional News NZ COPD Guidelines now available
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ew Zealand’s first-ever COPD Guidelines were published in the New Zealand Medical Journal recently, providing a national framework for the diagnosis and management of COPD in a New Zealand context. The guidelines were developed by the Foundation’s working group of respiratory health experts led by Dr Stuart Jones from Middlemore Hospital, and Professor Bob Hancox from the University of Otago. The guidelines aim to improve COPD diagnosis, and lay out clear recommendations for the assessment and management of this respiratory disease. COPD is often misdiagnosed in New Zealand and can be confused with asthma. There are also variances of care across New Zealand depending on where a patient lives – an issue that these COPD guidelines hopes to address through providing a framework based on evidence-based standards of care. The burden of COPD among Māori is one of the most significant health disparities in New Zealand, with hospitalisation rates 3.5 times higher than non-Māori and mortality 2.2 times higher. Similarly, Pasifika are disproportionately affected, with hospitalisation rates 2.7 times higher than those of other New Zealanders. Greater exposure to environmental triggers such as smoking and poor housing, as well as access to understandable health information, are key contributing factors.
Cultural considerations and the importance of nonpharmacological management of COPD are key aspects of the guidelines that make them relevant to New Zealand healthcare practice. You can view, or download these, and other respiratory guidelines at nzrespiratoryguidelines.co.nz. Here, you can also find additional resources such as action plans, and quick reference guides. If you would like to order printed resources these can be ordered via our online resource store shop.asthmafoundation.org.nz
New Asthma and COPD Fundamentals e-Learning course Do you want to learn the latest in asthma and COPD clinical best practice and gain 12 CPD points? To align with the newly released NZ Asthma and COPD Guidelines, we have updated our Asthma and COPD Fundamentals e-learning course. Developed by the Asthma and Respiratory Foundation NZ alongside Whitireia, the Fundamentals course is designed to provide health professionals with up-to-date education on asthma and COPD. The course can be completed at your own pace, and is split into the following four modules: - Asthma fundamentals - Asthma management - COPD management - Health promoting practice The course is designed for all healthcare professionals who work with patients who have asthma and/or COPD. The course is endorsed by the New Zealand College of Nurses, and awards 12 continuing professional development hours upon completion. Even better, the course can be completed at any pace, anywhere, and at any time.
Only9! 9
$149.
Fundamentals Relaunch Special
Study all four modules for only $149.99. Bulk discounts available. Limited time only! Visit cpd.whitireia.ac.nz to get started!
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Understanding
Respiratory Syncytial Virus A
lthough Respiratory Syncytial Virus (RSV) is so common that most children have been infected with the virus by age two, most of us haven’t heard of it. So what exactly is RSV? RSV causes infections of the lungs and respiratory tract. In healthy adults and older children, RSV symptoms are mild and are very similar to the common cold, however, in infants the virus can cause serious illness including bronchiolitis and pneumonia. In New Zealand, RSV is the most common cause of hospitalisations for lower respiratory tract infections for under two-year-olds, with influenza/flu admissions being much less frequent. Like many other respiratory illnesses, Māori and Pacific children are disproportionately affected having three-to-five times as many hospitalisations as other groups. Immunity to RSV develops over the first couple of years of life, however, it is never fully complete, and tends to decline again with age. This means elderly people can also be seriously affected with the virus.
Furthermore, the RSV virus has a significant health burden worldwide, with the World Health Organisation estimating that RSV accounts for more than 60% of severe respiratory infections in children and more than 80% in infants younger than one-year-old. Although there are vaccines in various stages of trials, there is currently no vaccine readily available for RSV. However, the COVID-19 lockdown last year had a significant impact on the number of New Zealand children hospitalised with the RSV virus. Figure 1: Rates of RSV detected in Australia 2020
A 2020 study led by Dr Adrian Trenholme and Dr Webb at Kidz First Hospital in South Auckland, demonstrated the impact of COVID-19 public health interventions on the burden of RSV in New Zealand. With the closure of New Zealand’s borders and other measures such as hygiene and mask wearing from March 2020, the hospital saw a significant reduction in hospitalisations of infants for respiratory illness. Even after easing of the national lockdown at the end of April, the reduction continued and the usual winter peak of RSV hospitalisations and Influenza infections didn’t occur in 2020. Furthermore, data from the National Virus Surveillance in New Zealand confirms the dramatic changes in influenza and RSV infections in all age groups.
It is evident that the New Zealand COVID-19 elimination strategy helped stop the spread of seasonal RSV and influenza virus, with similar findings having been reported in Alaska, Finland, and Australia. The study concluded that international border controls had the biggest impact on the absence of RSV and influenza during what would usually be the peak winter season. This included the 14-day mandatory isolation of arriving passengers, which limited seasonal viruses getting into the country. Physical distancing and hygiene measures undoubtedly contributed as well. However, the question remains, will we see the same outcomes this winter with New Zealand’s border controls still in place? Western Australia saw a large surge in RSV cases at the end of 2020 (see Figure 1); which was not expected, and outside the usual season. This could be due to Australia having RSV circulating all year round in some areas, with an outbreak not linked to international arrivals. However, New Zealand’s rates are very seasonal, and if RSV were to appear in our community, we now have a population group with no immunity who may be very vulnerable to it.
About Dr Adrian Trenholme Dr Trenholme is a paediatrician at Kidz First Hospital, South Auckland, and a clinician– researcher with a research interest in paediatric respiratory diseases, especially bronchiectasis, influenza, and RSV. Dr Trenholme also sits on Asthma and Respiratory Foundation’s Scientific Advisory Board, and spoke on the topic of ‘Immunisation and RSV’ at the New Zealand Respiratory Conference in November 2020.
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Respiratory Research Bulletin E
very year, millions of dollars is invested into research studies that aim to increase our knowledge of diseases so they can be better understood, diagnosed and treated. In this issue, we cover some of the respiratory health research projects that are currently being studied in New Zealand and Australia.
and follows earlier research that studied a group of 50,000 children over 18 years. The research team previously discovered that children exposed to more green space were about 6% less likely to develop asthma, and that effect was even stronger in places with plenty of native trees and plants about.
What does vaping really do to our lungs?
The explanation could potentially be found in kids’ gut microbiota, given the growing evidence that the mix of microorganisms living within us play critical roles in maintaining our health.
Dr Kelly Burrowes, a researcher and bioengineer from the University of Auckland, has now launched a study using human trials and stateof-the-art 3D computer models to get a precise look at what vaping does to our lungs. The study looks at what exactly goes into vaping aerosols, where these chemicals travel in the body, and what effect they have on everything, from cells to whole organs.
Their next project will investigate if changes in gut microorganisms over time are associated with loss of biodiversity or less access to green spaces. They’ll also compare samples from asthmatic and nonasthmatic kids in New Zealand, Ecuador, Brazil and Uganda, to see if there are differences in microbiota.
Using their world-leading 3D computer modelling, the team will demonstrate the link between changes occurring at a cellular level, to how the lungs work as a whole, to really understand the impact of vaping on our bodies.
If earlier findings are replicated, then the hope is that the learnings can be applied to the general population. For example, this could involve working with city councils to start providing more high-quality green spaces to help to reduce local asthma rates.
Exploring how Pacific children can better self-manage their asthma
Differences in fungi and bacteria in leaky and nonleaky homes and their effect on lung health
Led by Dr. Sunia Foliaki from Massey University, this research study will explore ways that Pacific children can effectively self-manage their asthma by using asthma action plans.
Led by University of Otago Wellington, the ‘EM³ Microbiota of New Zealand Homes’ study will look, for the first time, at the communities of microbes (fungi and bacteria) that inhabit our homes, and if there are differences in microbes in homes that have had leaks .
Asthma self-management plans that are simple and readily available are proven to be effective at controlling asthma and reducing asthma mortality. However, the process of delivering and supporting Pasifika asthma patients has proven difficult in the past. This study will explore the understanding of asthma among Pacific children and their families, and how they are being informed and educated about the management of asthma. It will also explore the perspectives, knowledge and experiences of asthma healthcare providers when working with Pasifika patients. The findings will be integrated with previous research to develop recommendations, which will inform policies and guidelines to improve asthma control for Pasifika people in New Zealand.
The link between vanishing nature and asthma rates A team of researchers from Massey and Otago Universities are investigating whether the loss of green spaces is linked to asthma among Kiwi kids. The study takes a deeper look at the connection,
Researchers will also investigate whether any of these microbes found in house dust or the traces of chemicals they produce may have an impact on our lung health.
Dietary supplement for asthma management Researchers at Melbourne’s Monash University have found commonly used dietary supplement L-Tyrosine could help significantly reduce the severity of an asthma flare-up. The study hopes to move to human trials next year, and if successful, researchers hope GPs will be able to prescribe the molecule to those with asthma in the near future.
Want to know more?
We have collated leading peer-reviewed respiratory research from across the globe on our research portal. Check it out today at www.asthmafoundation.org.nz/research
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Exploring the art of
Breathing M
ost people do not think about how, or how often, they are breathing. However, for many people, breathing – a fundamental of life – isn’t as easy as it seems for a wide range of reasons. There are many examples of why a person’s breathing may be affected. These can include anything from breathing pattern disorders, such as ‘mouth breathing’ and anxiety or stress, to chronic nasal obstruction and respiratory disease. So what happens to the body when we breathe? Well, we each have two air passageways to your lungs – the nose and the mouth. Breathing through your mouth is only necessary when there is nasal congestion (for example due to allergies or a cold), or when exercising, as breathing through the mouth gets oxygen to your muscles faster. The correct way to breathe is in and out through your nose. This enables the nasal passages to warm and moisten the air you inhale, and allows the oxygen to reach deep into your diaphragm. The little hairs in your nose, also known as cilia, are one of the biggest air filters in your body, and breathing through your nose also helps your body defend itself from bacteria and allergens such as pollen. Air exhaled through the nose creates a back flow of air (and oxygen) into the lungs. Because we exhale more slowly through the nose than we do though the mouth, the lungs have more time to extract oxygen from the air we’ve already taken in. The optimum breathing rate is 5.5 breaths per minute. This involves 5.5-second inhales, and 5.5-second exhales deep into your diaphragm. If you breathe too quickly, or only in your chest, your airways cannot absorb oxygen, or participate in gas exchange. Breathing shallowly will mean that only approximately 50% of the breath that is taken in is being used, compared to approximately 85% if breathing properly. The sacred power of breathing is one that is repeated in many cultures across the world. For example, yoga and meditation both
heavily use shamanic breathwork within their practice. The Sanskrit word, ‘pranayama’, is translated to the “expansion or manifestation of energy,” with many people believing that once you have control over pranayama, you can transform yourself physically, emotionally, and spiritually. Another technique is anapanasati, which is the meditation system taught by the Buddha, in which mindful breathing is used to develop both samadhi (a serene and concentrated mind) and vipassana (see the true nature of existence). Concentrated breathwork can relieve stress, anxiety, and over-thinking. It is also a way to improve posture, heart rate variability, remove negative energy or blockages, ease an overstimulated nervous system, and reduce blood pressure by adding more oxygen to the body. With more oxygen going to the brain, the mind opens up new networks. This raises your level of consciousness. The path to a higher self starts with the physical breath, then control of breath, and finally understanding of breath. Breathing slower, and with more control has also been shown to reduce the ‘sympathetic’ nature of the nervous system and supports a more calmer and ‘parasympathetic’ state of being. Depending on the reason for a person’s breathing troubles, there are various avenues for support, education and training to improve breathing. Respiratory physiotherapists, for example, can teach people how to breathe with your diaphragm and provide at-home exercises to help develop healthier breathing habits. But even for those without respiratory disease, being conscious of breathing, and practicing controlled breathing techniques, have both been shown to reduce stress, improve sleep, increase alertness and boost our immune system.
Breathlessness and COPD
Breathlessness Strategies for COPD
Chronic obstructive lung disease (COPD) is an umbrella term that covers emphysema, chronic bronchitis and chronic asthma, and affects approximately 15% of New Zealand adults over 40 years of age. The damage to the lungs is most often caused by smoking, exposure to smoke, or exposure to other noxious substances. Unfortunately, the damage is not reversible, and symptoms include coughing, wheezing and shortness of breath. COPD diagnosis is confirmed by spirometry – a test to determine lung function.
CONSERVE YOUR ENERGY & PACE YOURSELF Plan your day: Will I have time for a break? Prioritise tasks: What’s most important? Adapt tasks: Can it be done easier? Delegate: Can someone else help?
USE A FAN
The diseases under the COPD umbrella affect the lungs in different ways. Emphysema for example, causes the inner walls of the air sacs to weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.
Use either a hand-held fan, free-standing fan, a desktop fan, or the breeze through an open door or window. Hold the fan about 15 centimetres from your face so you can feel the air on your top lip.
Chronic bronchitis affects the lungs slightly differently, by inflaming and irritating the linings of the airways. Over time, chronic bronchitis causes the lining to get thick and inflexible, making it difficult for your airways to clear themselves of excess mucus and making it hard to breathe. For those with COPD, breathlessness is one of the most common, and perhaps the most alarming symptom to manage. Sometimes COPD patients may get breathless even from just sitting down and relaxing – it can often seem to come on for no apparent reason or with very little exertion, which has a significant effect on daily life. COPD patients can also have blood oxygen levels (or saturation) within the normal range, but still experience shortness of breath. It’s easy to assume that being breathless would mean that a person was also short of oxygen, but that’s not necessarily the case for people with COPD. This is because oxygen saturation measures the amount of oxygen in the blood, not the amount of oxygenrich blood that is being pumped through the body by the heart. Lung disease can cause strain on the heart causing it to pump less effectively. An inefficient heart means that a lesser amount of blood is sent out of the heart to the rest of the body with each beat – this is what leads to the feeling of shortness of breath.
DISTRACTION & EXERCISE Regular activity should be done in moderation. Ask to be referred to your local pulmonary rehabilitation program. Focus on light activity with things that bring you pleasure or calmness, such as mindfulness or meditation.
CHANGE YOUR POSITION •
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TAKE YOUR MEDICATION Use your prescribed medication as directed. If you have difficulty managing your breathlessness, talk to your healthcare professional as there may be other medications that may help.
Therefore, having supplemental oxygen is not helpful for patients who are short of breath but have normal levels of oxygen in their blood (oxygen saturation). Oxygen doesn’t reduce the feeling of breathlessness in patients that don’t have low oxygen saturation levels in their blood (known as being hypoxic). This is why non-pharmacological (non-drug) management strategies are so important for people with COPD to help manage symptoms including breathlessness. Prescription medicines and inhalers are an important part of managing COPD, however research has shown that most people benefit from pulmonary rehabilitation classes, or by learning breathlessness management strategies – which can have a significant impact on the quality of life.
PRACTICE YOUR BREATHING •
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These strategies are outlined in New Zealand’s first ever COPD Guidelines which aim to improve the diagnosis and management of COPD in New Zealand. The key non-pharmacological management strategies and recommendations are to stop smoking, continue physical activity, take part in pulmonary rehabilitation classes, learn breathlessness management strategies, and create a healthy lifestyle and living environment.
Lean forward with arms resting on your knees or the sides of a chair and position knees slightly apart. Lean forward over a table or surface resting on your arms up on some pillows or similar. Lean forward with arms resting on a surface e.g supermarket trolley, or back of a chair. Alternatively rest standing with your back against a wall.
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Breathing Control/Tummy Control: Place hands on tummy, breathe in (tummy goes out), breathe out (tummy goes in) Pursed-Lip Breathing: Breathe in through your nose, breathe out like through a straw Blow as you Go: Breathe in before exerting effort, breathe out while making the effort Paced Breathing: Breathe in for a few counts, breathe out for a few counts Breathe around the rectangle: Breathe in along the short side, and out along the long side
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Top Tips for Autumn W
ith the weather starting to cool down, and a change of seasons on the way, we have put together a few tips to help manage your respiratory condition as we approach the cooler months.
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you’re relying on your reliever inhaler more than usual, you should consult your healthcare provider. It is also important that your child has a reliever inhaler at school, kept in a safe place, and their teacher knows what to do if symptoms start to worsen. Sharing your child’s asthma action plan with their teacher is also a good idea.
Get immunised Those with respiratory conditions are more at risk of the flu than most people. Remember, influenza is not the same as the common cold; it’s a serious viral infection that can make pre-existing conditions like asthma, bronchiectasis, or COPD, even worse. To make sure you are protected, get your annual flu vaccination. People with respiratory conditions are prioritised, and may receive the vaccine for free – these are usually available in New Zealand from April each year.
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Breathe in through your nose
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Wash your hands
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Chat with your doctor
Create a healthy environment As the weather becomes colder and wetter, it is the perfect environment for the asthma trigger mould to thrive. To help reduce the impact of mould in your home, it is essential that you create a warm, dry indoor environment. This means airing out your home frequently during the day, and wiping down any build up of condensation on your windows.
Avoid smoke Autumn brings colder weather, and with that many households use log burners to keep their homes warm. If smoke is one of your triggers, try to avoid it as much as possible. It may help to keep windows and doors closed when neighbours have log fires burning. You could also consider purchasing an air purifier with a HEPA filter to help improve the indoor air quality of your home.
On colder days, try breathing through your nose as this will warm up the air before it travels down your lungs, limiting the irritation to your lungs.
It’s important to emphasise the importance of correct handwashing as this can limit the spread of viruses. Make sure you practice good hand hygiene and regularly wash your hands for at least 20 seconds with soap and warm water.
Creating an asthma action plan with your healthcare provider is the best way to manage your asthma, as it provides a clear plan to manage your symptoms when they are getting worse. You can download action plans from our website or use the digital plan on the ‘My Asthma’ app. Having an action plan in place means that you can take control of your asthma and not let it control you. You will also feel more confident in managing triggers that may arise as the weather cools down and we enter a new season.
Have your asthma action plan on you at all times with the...
Keep exercising Exercise is a good way to keep fit and healthy. If you are exercising outdoors, we recommend that you check the outdoor temperature first, as the cold air can irritate your lungs. Exercising indoors can be a good alternative on these cooler days. Also, making sure you warm up thoroughly prior to exercise will help reduce the strain on your lungs throughout your workout.
Keep medication on hand Always carry your reliever inhaler with you (if prescribed) and make sure it is readily available for fast relief of symptoms. If
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My Asthma app
ith the My Asthma App you can have your asthma action plan on you no matter where you are - even with no internet connection! The My Asthma app offers all your asthma management information at your fingertips, with customisable asthma action plans, information on triggers, and steps to follow in an asthma emergency. Download the My Asthma app free today from the App Store or Google Play.
The environmental impact
of inhalers I
t may be surprising, but asthma inhalers have a significant carbon footprint – in particular metered-dose inhalers (MDIs) which make up over 70% of the inhalers prescribed for asthma management each year in New Zealand. MDIs contain hydrofluorocarbons (HFCs) – a propellent that pushes the medication out of the inhaler device so it can be breathed in. However, HFCs are also known to contribute to global warming as they contain climate-change gases. For example, the carbon footprint of a standard (200-puff or 100-dose) salbutamol inhaler amounts to approximately 28kg of carbon dioxide per inhaler.
A recent Pharmacy Today article described each inhaler as being “approximately equal to driving a new Toyota Corolla (with carbon dioxide emissions under 100g/km) for over 300km under typical road conditions.” In comparison, dry-powder inhalers (DPIs) have a much smaller carbon footprint of approximately 1kg per device. DPIs rely on the patient inhaling, or sucking in, the medication from the inhaler, and therefore do not require a propellent, hence much less of a carbon footprint. Because of how prevalent asthma is, and how common these medications are in the treatment of the condition, the overall carbon footprint is significant. For example, in the UK, MDI carbon emissions are estimated to account for four percent of the entire National Health Service (NHS) emissions budget. Here in New Zealand, healthcare is responsible for approximately 5 percent of New Zealand’s overall carbon emissions, with primary and community care prescription medication making up over two-thirds of our climate footprint - MDIs being the number one culprit. Our rates of asthma are much higher in New Zealand in comparison to global figures, with 1 in 7 children and 1 in 8 adults suffering with asthma, compared to 1 in 11 children, and 1 in 12 adults in the UK. The new NZ Adolescent and Adult Asthma Guidelines, developed by the Foundation’s working group of respiratory health experts led by Professor Richard Beasley, state “The lower carbon footprint of drypowder devices (less than 10 per cent of [pressurised metered-dose inhalers]) should be considered...”
The guidelines’ updated recommendation is to use a single 2-in-1 budesonide/formoterol DPI inhaler, containing both a preventer and a reliever medicine to treat asthma symptoms. This means that DPIs (or dry-powder inhalers) are now the preferred first-line treatment for adult and adolescent asthma, instead of the traditional MDI - therefore potentially reducing the carbon footprint of asthma medication in New Zealand. Furthermore, there are currently only two budesonide/ formoterol inhalers funded by Pharmac in New Zealand - which happen to both be DPIs. Professor Beasley recommends that health professionals recall patients who solely use a ‘blue’ reliever inhaler, and replace it with a combination inhaler, and that this should be the immediate priority for health professionals in New Zealand.
However, despite how increasingly important it is becoming to consider environmental factors in all industries, it’s important to remember that there will always be a place for MDI inhalers, especially for patients who may not have enough breath to inhale from a DPI. To summarise, those who need to use an MDI should continue to do so, as DPIs are not suitable for everyone. It is also important to note that patients should never alter what is prescribed to them without the advice of a healthcare professional. Source: Dermot Coffey; Pharmacy Today - ‘New asthma guidelines support use of environmentally friendly inhalers’; October 2020
So what’s the difference? Sometimes, it can seem overwhelming at just how many different inhalers there are. ‘Puffer’ inhalers (also called metered dose inhalers or MDIs) are the most common inhaler device and these are generally used with a spacer. Metered Dose Inhaler (MDI)
However, there are also other types of inhaler devices, depending on which inhaler medication you have been prescribed, some of which contain a dry powder that is sucked in, ratherDry powder inhaler (DPI) than delivered via an aerosol.
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What is Thunderstorm Asthma? T
hunderstorm asthma had previously been considered unlikely to occur in New Zealand due to our weather patterns not thought to pose a risk. However, recent climate changes have challenged this perception, with New Zealand experiencing its first thunderstorm asthma event in 2017. So what is thunderstorm asthma and what can be done to prepare for another event here in the future? Thunderstorm asthma begins when a significant thunderstorm coincides with a significant amount of pollen in the air, usually in spring or summer. Pollen grains are sucked into the storm clouds, where they absorb moisture and burst, shattering into smaller pieces. These very tiny pollen particles are spread by the storm’s downdrafts. These pollen particles are so small that they pass straight through the nose and into people’s lungs, where they can trigger an immediate asthma flare-up. Usually ordinarysized pollen grains are big enough to be caught by nasal hairs, however it’s these much smaller pollen fragments that are the cause of thunderstorm asthma.
However, despite being in recent headlines, thunderstorm asthma is not that common. In fact, it requires the perfect combination of factors to occur. This includes, the right type of thunderstorm, a strong up-draft, during pollen season, and at a time when many people are outdoors. Thunderstorm asthma can affect people of any age, and is more likely to cause flare-ups in people who have asthma or have had asthma in the past. It may also impact those who get seasonal hay fever that is triggered by pollen (also known as allergic rhinitis). The risk of thunderstorm asthma is highest in adults who are sensitive to grass pollen and have seasonal hay fever (with or without known asthma). What is concerning, is that a significant proportion of people severely affected by thunderstorm asthma have undiagnosed asthma, and as a result, may not have access to medication to treat an asthma flare-up, or be slower to seek medical attention as they do not recognise the symptoms of asthma. These people are unfortunately often at a greater risk of having more serious complications from a thunderstorm asthma event. Thunderstorm asthma is a well-known phenomenon in other parts of the world where the weather conditions are more likely to produce thunderstorm asthma events.
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In Australia, thunderstorm asthma is so prevalent that public health warnings are issued when there is a likely chance of an event occurring. When this happens, the impact can be very serious. For example, a storm in Melbourne in November 2016 sent 8,500 people to emergency departments, overwhelmed ambulance services, and resulted in at least 10 people dying of asthma-related causes from this event. Despite having thought the risk to of a New Zealand thunderstorm event was minimal, a Waikato storm back in 2017 brought about New Zealand’s first-ever recorded thunderstorm event. The event saw an sudden increase in severe asthma cases presenting to Waikato Hospital, with these people becoming the first to be diagnosed with thunderstorm asthma in New Zealand. A study of this storm published in 2020 – ‘Thunderstorm-related asthma can occur in New Zealand’ – showed that this event resulted in 14 people presenting to Waikato Hospital’s emergency department with asthma symptoms within 48 hours of the storm, some of which had never experienced asthma symptoms before. In addition to this, during the same time period, Anglesea Accident and Medical Centre, an urgent 24-hour clinic in Hamilton, saw 24 patients with asthma symptoms. GPs interviewed by the authors of the study also reported an increase in people presenting with asthma symptoms in the four to five days following the thunderstorm. It is also likely that many other people experienced milder respiratory symptoms as a result of the storm, but chose not to seek medical attention. Accurately documenting thunderstorm asthma events is an important first step in making a plan that would enable paramedics and emergency facilities across New Zealand to respond to any larger scale events here in the future. However, prevention is also key – people who have asthma or hay fever should ensure that their condition is well managed and that there is a plan in place for emergency situations. Plans should include what preventive medications you can take to manage your condition and what you should do when symptoms worsen. Additionally, medication should always be on-hand in case of an asthma emergency, or thunderstorm asthma event.
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Key Elements to Building an eHaus Redefining the home environment with Passive Housing
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he decision to build an eHaus shouldn’t be one just based on the architects and builders in the team, or the region they operate from – it’s about the health and wellbeing of your family. TM eHaus builds Passive Houses, as well as high performing homes. All eHaus are modelled using the International Passive House Planning software (PHPP). Building an eHaus means having a home free from pollen, mould, and stale air, and a home that is warm in winter and cool in summer – perfect for those who live with respiratory illness.
An eHaus has a very small footprint on the planet, and the team are committed to sustainability, and protecting our environment and the families that live in the homes that they build.
Five key elements of an eHaus
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Mechanical heat recovery ventilation: Ventilation systems are the lungs of an eHaus. It filters the stale air, allowing for clean fresh air to permeate the home all day and night, and works quietly in the background without you even knowing about it. The ventilation system has outlets throughout the house so that each room has a consistent temperature. The days of the old New Zealand home where one room is heated, and the rest of the house is a fridge, are no more! Insulation: All housing requires some form of insulation, but an eHaus is packed tight with double the amount of insulation, so you can be assured that the home will be comfortable all-year-around.
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Air tightness: An eHaus is completely wrapped and leak-free. This stops any chance of energy leaking out. We know this, because twice during the building process, the team performs an airtightness test to ensure the home meets the high standards of a Passive House.
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Energy modeling - PHPP: All eHaus homes are put through the thermal modelling calculation during the design phase so everyone knows how each room in the house will perform. If a room will be too warm in the summer, then together the team will work through some options to change this, ensuring you end up with a home that is comfortably warm no matter the season.
Your eHaus is a space where you can quietly go about your day, with the knowledge than you are providing the most healthy environment you can for your family. eHaus have a variety of offerings available: • Euro - Internationally recognised Passive House standards • Pacific - Developed by eHaus for the NZ market • The People’s House Collection - beautiful build ready plans For more information on Passive Housing, chat to eHaus today! 0800 434 287 | www.ehaus.co.nz
Thermally broken windows and doors: All of the windows and doors in an eHaus are considered by thermal performance. As we all know, much of the energy in the home escapes through the windows, so by using these high performing windows and doors, you are assured that the heat in the home, stays in the home.
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How do I use my.... In this series, we will be highlighting a range of respiratory related devices and explaining best practice on how to use these. This issue, we demonstrate how to use a spacer, and why it is important to use one.
What is a spacer?
Spacer
Spacers are clear plastic cylinders with a mouthpiece or mask at one end, and an opening for your metered dose inhaler (MDI) at the other. MDIs contain aerosol medications that are inhaled. So instead of inhaling directly from the inhaler, a dose from the inhaler is puffed into the spacer, and a valve in the spacer mouthpiece opens as you breathe in, and closes as you breathe out. As many adults and most children find it difficult to coordinate the inhaler with their breathing, using a spacer is recommended for everyone who is using a MDI, especially preventer medications.
Why should I use a spacer? Many adults and children are unable to use their MDI effectively, so using a spacer reduces the need to have a perfect inhaler technique. Spacers are designed to deliver up to twice the medication of an inhaler alone, this means that 50% more medicine enters the lungs when a spacer is used. This also means that less medicine gets left in the mouth and throat, which reduces the chance of side effects from your preventer medicine, such as hoarseness, or oral thrush. However, it is still important to always rinse your mouth out after using your preventer medication. Another advantage, is that less medicine is swallowed and absorbed from the intestine into the rest of the body. A spacer can help when you are short of breath, and is a smaller, convenient alternative to a nebuliser. In fact, studies on adults and children, show spacers work just as well as nebulisers for acute asthma.
How do I use a spacer? 1- Remove the cap and shake the MDI inhaler. Fit the inhaler into spacer opening (opposite the mouthpiece).
2- Put the spacer into your mouth ensuring that there are no gaps around the mouthpiece. Press the inhaler once only — one puff at a time into the spacer.
3- Breathe in slowly and deeply through the spacer mouthpiece and hold your breath for 5-10 seconds OR take 2-6 normal breaths, keeping the spacer in your mouth all the time. You can breathe in and out with the spacer still in your mouth as most spacers have small vents to allow your breath to escape rather than going back into the spacer.
4- If you need more than one dose of medication, wait one minute and then repeat these steps for further doses making sure that you shake your inhaler between doses.
Using a spacer with a mask Using a spacer with a mask can be helpful for small children who struggle to take the breaths required when using a traditional spacer. If you are using a mask together with a spacer for your child, place the mask on your child’s face, covering the mouth and nose, ensuring there are no gaps. Masks are commonly used for babies and infants who cannot seal their lips around the mouthpiece. Most children should be able to use the spacer without a mask by the age of four years. If you are using a mask with preventer medication, wash the child’s face after use.
How do I clean my spacer Wash your spacer (and mask if using one) once a week with warm water and dishwashing liquid, and don’t rinse - drip dry. This reduces the electrostatic charge so that the medicine does not stick to the sides of the spacer. Check your spacer regularly for cracks. If used often, your spacer may need to replaced every 12 months.
Where can I get a spacer? You can access a free spacer from your healthcare provider or asthma society. For more information on spacers visit: asthmafoundation.org.nz/your-health/living-with-asthma/spacer
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New Asthma & COPD Fundamentals e-learning course Study the latest clinical best practice Updated to align with the new NZ Asthma & COPD Guidelines
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Designed for registered health professionals
• Aligned for NZ context including current funded medications, and best practice in treating Māori and Pacific peoples •
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Find your local Society! Did you know that ARFNZ is affiliated with many asthma societies across New Zealand who are here to provide you with support, rehabilitation and nursing assistance with your respiratory condition?
Horowhenua Breathe Easy Group iandlmckenzie@xtra.co.nz LEVIN 0279521439 06 3688069
MahiTahi Hauora 28-30 Rust Avenue WHANGAREI 09 438 1015 MahiTahi Hauora 182 Commerce Street KAITAIA 09 408 3142
Asthma & Respiratory Management BOP reception@asthmabop.org.nz www.asthmabop.org.nz 254 Chadwick Road TAURANGA 0800 276 267
Eastern Bay of Plenty & COPD Support Group COPD@drct.co.nz Disabilities Resource Centre 141 King Street WHAKATANE 0800 227 363
Asthma Waikato info@asthmawaikato.org.nz www.asthmawaikato.org.nz 18 Claudelands Road HAMILTON 07-838 0851 Manawatū Breathe Easy sjorgi64@gmail.com Palmerston North 0272420669
Gisborne & East Coast Asthma Society lynlolohea@hotmail.com 14 Kennedy Street GISBORNE 06-868-9970
Nelson Asthma Society asthma.nelson@xtra.co.nz 9 Cambridge Street RICHMOND 03 544 1562
Breathe Hawke’s Bay admin@breathehb.co.nz www.breathehb.co.nz 199 Dickens Street NAPIER 06-835-0018
Asthma Marlborough Inc asthma.marlborough@xtra.co.nz Marlborough Community Health Hub 22 Queen Street BLENHEIM 03-579-1609 Southland Asthma Society southlandasthma@xtra.co.nz Federated Farmers 70 Forth Street INVERCARGILL 03 214 2356
Tu Kotahi Māori Asthma Trust anne@kokiri-hauora.org.nz 7-9 Barnes Street Seaview LOWER HUTT 0800 939 462
CanBreathe office@canbreathe.org.nz www.canbreathe.org.nz 196 Hills Road, Edgeware CHRISTCHURCH 03-386-0278
Asthma Otago otagoasthma@xtra.co.nz Dunedin Community House Cnr Moray Place & Gt King Street DUNEDIN 03-471-6167
North Otago Asthma sec.noasthma@gmail.com 0277535711
About ARFNZ Asthma and Respiratory Foundation NZ (ARFNZ) is New Zealand’s principal authority for all respiratory conditions. The Foundation’s purpose is to lead respiratory health knowledge through research, education, and advocacy, with the goal to reduce respiratory related hospitalisations, and improve respiratory health outcomes for all.
