Better Breathing Winter 2023

PROTECT

What

UNDERSTANDING BIOLOGICS: a new type of asthma medication World Asthma Day 2023

Cough and continence

who doesn't let asthma get in the way of his goals.

Our Team In this issue...

Chief Executive

Letitia Harding

Research and Education Manager

Joanna Turner

O ce and Donor Appeal Administrator

Christina Goss

Grants and Fundraising Executive

Pam Francombe

PR and Communications Advisor

Charlotte Lee-Smith

Marketing & Communications Advisor

Sam Treseder

Māori Community Liason

Sharon Pihema

Corporate Sponsorship and Engagement Advisor

Amy-Rose Todd

Medical Director

Dr James Fingleton, BM, PhD, FRACP

Chief Cultural Advisor – Māori Sir John Clarke, KNZM, CNZM

Ground Floor, 85 The Terrace, Wellington 6011 PO Box 1459, Wellington 6140

04 499 4592 asthmafoundation.org.nz asthmaandrespiratoryfoundation asthmafndation

asthmaandrespiratoryfoundation

4. Community News

Catch up on what happened this World Asthma Day and nd out about our new teen art competition aiming to raise awareness of vaping harms.

5. Your questions answered

We share questions and answers from our recent webinar held on World Asthma Day when our expert panel gave their insights on how to help children manage their asthma.

6. Respiratory News

Read the latest respiratory news from New Zealand and around the world.

7. Asthma in NZ Survey

Check out the ndings from the Foundation's recent survey of New Zealanders with asthma, as well as our recommendations.

8. Your lungs at work

In this article, we explain how to protect your respiratory health in the workplace. We share the risks and what to do if you're worried about your lung health at work.

11. Understanding biologics

We explain this new type of medication for asthma and who can access this treatment.

12. Respiratory Achievers

We share the stories of Gary Syme and Umair Mohammed, two of the outstanding winners at the Foundation's Respiratory Achievers' Awards.

13. Cough and continence

Respiratory physiotherapist Zoe Manderson explains the causes of stress incontinence and what can be done about it.

15. Asthma Societies

Find out more about Tu Kotahi Māori Asthma Trust and get the details of your local asthma society or support group.

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Cover photo: A student from St Teresa's School in Wellington with one of the Foundation's Asthma Emergency Kits. Photo: Amy-Rose Todd.

Letitia’s Message

New Zealand. We have made several recommendations as a result of this report, including that Te Whatu Ora provides dedicated funding to ensure that everyone diagnosed with asthma receives an annual ‘Warrant of Fitness’ asthma review from a healthcare practitioner. We want these checks to include an asthma control test, peak ow measurements, inhaler technique checks and related updates to asthma action plans.

Kia Ora koutou,

It’s been a busy few months at the Foundation with our team working hard on a range of projects, including our Political Manifesto, a document outlining what actions we want from the next Government on respiratory health.

For too long, respiratory health has been under-resourced in New Zealand which is one of the reasons we continue to see such poor health outcomes for so many in our respiratory community. In our manifesto, which is now available on the Foundation's website, we are asking for some practical actions from the next Government, including the introduction of a National Respiratory Clinical Network. This type of network exists for other conditions, and it would mean better co-ordination of services and improved standards across the country. It would help ensure that every Kiwi can access the same level of respiratory care, no matter where they live.

Our rst ever Asthma in New Zealand Survey, will be released this month. We had almost 500 people respond to this survey sharing their experiences of living with asthma. What they told us was deeply concerning.

Our survey found more than half of our respondents had poorly controlled asthma, and that many Kiwis are not using basic asthma management tools or receiving adequate asthma care. Additionally, we found that 55% of people surveyed are worried about being able to access asthma treatment when they need it, and 39% are worried about the costs associated with asthma. You can read more about our ndings on page 7 or you can read the full report on our website.

This survey is yet more evidence that urgent changes are needed to respiratory care in

In some good news, we welcomed the announcement that the $5 pharmacy prescription co-payment is to be scrapped from 1 July. This will remove a very real barrier that has prevented many from being able to pick up regular medications and manage their conditions well.

The Foundation also applauds the recent decision by the Australian Government to ban recreational vaping. This is a bold move and one that will protect the lung health of future generations. In New Zealand, unfortunately, we are a long way from being able to implement something similar, but there are things that the Government could do immediately to make a di erence.

These include banning disposable vapes, reducing the maximum nicotine limit to 20 mg/ml and halting further approvals of specialist vape retail stores in New Zealand. The Foundation will continue to push for these changes.

Finally, it was my great pleasure earlier in the year to receive the 2023 President’s Award from the Thoracic Society of Australia and New Zealand for my advocacy and education work on vaping. Both the Foundation and I have come under a lot of criticism for our stance around the harms of youth vaping. Our motivation has always been to protect the respiratory health of Kiwis, and we remain committed to this goal.

Noho ora mai

Letitia Harding Chief Executive

The Foundation welcomed the recent decision to scrap the $5 prescription co-payment.

The Foundation is calling for a ban of disposable vapes in New Zealand.

Letitia with Professor Anne Holland, President of the Thoracic Society of Australia and New Zealand, and the President's Award she received from for her advocacy and education around vaping harm.

young people to use their creative talents to highlight the risks of vaping in our Don’t Get Sucked In poster challenge. Entries are now open for

200 SCHOOLS RECEIVE ASTHMA KITS THANKS TO WORLD ASTHMA DAY CAMPAIGN

Thanks to the generosity of New Zealanders over World Asthma Day, the Foundation has been able to supply 200 schools with asthma emergency kits ahead of winter.

Foundation Chief Executive Letitia Harding says the team are thrilled with the success of the campaign. “These asthma emergency kits are an essential resource and one that every school should have. Our campaign raised $9000 meaning that so many more schools, and importantly Kiwi kids with asthma, will bene t from these kits.”

Asthma remains a signi cant health issue for many New Zealand children. “We know that one in eight New Zealanders have asthma, and that asthma leads to almost 3,000 hospitalisations of children annually,” says Ms Harding. Asthma can also be very disruptive to everyday life, with an estimated 350,000 school days lost to asthma annually. “We know that poorly controlled asthma also a ects sleep, concentration and con dence for many kids.”

The Foundation would like to thank Green Cross Health who have generously supplied vouchers to o er savings on the asthma inhalers in each kit. A big thank you to our other generous sponsors for World Asthma Day: Daikin, Aesop, My Food Bag, Bunnings, Sanitarium and Miteguard.

critically about vaping and sharing their knowledge with others in a creative way,” explains Foundation CE Letitia Harding.

A panel of judges will select the ve top posters which will feature on the Foundation’s youth vaping education website, Don’t Get Sucked In. The four runners up will

at $100 plus a $50 Prezzy card, while the overall winner will receive an art pack and a $300 Prezzy card. The Foundation will also organise an interactive vaping education workshop at the winning artist’s school for up to 30 students.

The winning artwork will feature on the cover of Better Breathing magazine. Entries close on Friday 30 June.

www.dontgetsuckedin.co.nz/poster-challenge

The Foundation hosted a webinar for World Asthma Day for parents and caregivers, where our panel of experts shared advice on how to help children manage their asthma. Our panel featured Respiratory Paediatric Specialist Dr David McNamara, Sharon Pihema, the Foundation’s Māori Community Liaison and a mother of a child with severe asthma, and 12-year-old Liam Dulver, who is living his best life with asthma. Here is some of the advice they shared.

What’s happening in your child’s lungs when they have asthma?

David: Asthma is a problem of the airways. The airways start at the throat and branch down into the lungs. They spread out and branch like the roots of a tree and they get smaller and smaller. In asthma, inside those small airways, there is chronic in ammation. 'Chronic' means it’s always there and 'in ammation' means they are swollen. Also, the muscles around those airways sometimes become irritated and squeeze, narrowing the airways.

Your child always has that in ammation, so it’s very important to have preventer medication to control that. Every now and again, your child will get a virus, or they will breathe in smoke or do some exercise and those irritated muscles will squeeze shut. That’s when your child will become wheezy and need reliever medication.

How do I know when my child’s asthma is going downhill and I need to take action?

David: So commonly, your child’s asthma will start to get worse due to a cold or a virus. The rst things you might notice is your child is coughing a bit more, or short of breath and wheezy. Then you might give them their inhaler and nd they may need repeated pu s, or they might not be responding to their inhalers. At that point, you really need to get to the doctors for help.

Do you have tips or techniques for staying calm as a parent when dealing with asthma attacks?

Sharon: For us, rst, we had to get a good understanding of what asthma was. We had to learn the terminology and learn how the medication worked. Then we went and got a good asthma action plan with our doctor. Having a plan de nitely helped us stay calm, as it showed us what to do at di erent stages and what to do in an emergency.

Also, I would recommend getting an ambulance membership. It was one thing that really helped us to manage the fear of asthma attacks. We knew we could ring 111 and the ambulance crew would come into our home and give our child the nebuliser or whatever she needed. So, by the time she was being transported to hospital she was feeling a lot better already.

What tips do you have for helping kids take responsibility for managing their asthma?

Liam: For your preventer, I would recommend doing it with a routine. I do it with my teeth and it’s part of my routine every morning and night. And for the reliever, like Ventolin, then you might need to take it before active events, so you need to keep it with you.

How do I know if my child’s asthma is under control?

David: There is a series of questions that your doctor should be asking when you see them. These include: how often in a normal week does your child have a wheeze? How often in a normal week does your child use their reliever inhaler? How often does your child wake in the night with wheezing or a cough? Can your child take part in normal activities like sport? If your child is getting wheezy more than twice a week or needs to use their reliever inhaler more than twice a week, or they are waking more than once a week or unable to take part in normal activities, then their asthma is not under control.

What was the most useful advice in learning to manage your child’s asthma?

Sharon: Medication is really important. I would say take the medication as you’ve been told to take it, and if it’s not working then go back and get help. Don’t try and work it out yourself because there are lot of other options that doctors know about. I know for ourselves, that once our daughter got on the right medication things got so much better. She hasn’t had a hospital admission for four years, and that’s from previously being in hospital every week.

What would your advice be to someone your age who has just been diagnosed?

Liam: Remember you are not alone, lots of other kids have asthma. Don’t let it stop you from doing what you want to do and stick to your asthma action plan.

The full webinar can be viewed at:

https://www.asthmafoundation.org.nz/stories/helpingyour-child-manage-their-asthma

Respiratory News

A study has shown that a trial vaccine given to pregnant mothers could greatly reduce the risk of infants being hospitalised with serious infections caused by respiratory syncytial virus (RSV). New Zealand researchers were part of the global trial, which found that the vaccine reduced the need for medical treatment for severe RSV infections by 82%.

RSV is a seasonal respiratory virus that a ects almost all children by the age of two years and is the leading cause of the lower respiratory tract infection bronchiolitis. While for many children the infection is mild, for others it can have serious effects and cause long-term lung damage.

The trial vaccine works by stimulating the mother’s antibodies, which are then passed onto her infant. The vaccine has yet to be approved for use in New Zealand. A separate study undertaken in the USA has found that children who had an RSV infection before they were one year old, were at increased risk of developing asthma by the age of ve years

Good sleep could cut asthma risk

Healthy sleep patterns could signi cantly reduce the risks of developing asthma according to a new study from China’s Shandong University. The researchers found that people with poor sleep patterns were more likely to develop asthma, and people who had a high genetic risk of asthma, plus poor sleep patterns, nearly doubled their risk. However, healthy sleep patterns lowered the risk regardless of people’s genetic susceptibility. A healthy sleep pattern was dened by researchers as sleeping for seven to nine hours, without snoring, insomnia or frequent episodes of sleepiness during the day.

Foundation urges govt: time to ditch disposable vapes

The Foundation has joined forces with the Thoracic Society of Australia and New Zealand (TSANZ) and the Lung Foundation Australia to call for a ban of disposable vapes in New Zealand.

"Disposable vapes are cheap, widely accessible products that are now popular with our non-smoking youth," explains Foundation Chief Executive Letitia Harding. "They are widely viewed as a gateway vaping product and are often marketed as easy to use for beginners. This is of grave concern, as these products can contain very high

quantities of nicotine, up to 50 mg/ml.

TSANZ President Professor Anne Holland points out that recent evidence from Australia suggests that heavy restriction of e-cigarette products, like disposables, would not act as a roadblock to smokers successfully using vapes as a quit smoking tool. "Disposables have no therapeutic value, are rarely used for smoking cessation e orts and even less so by the main groups who want to give up nicotine forever."

Another important reason to

ban disposable vapes is the impact they are having on the environment. "These are single-use plastic products which contain chemicals and heavy metals, that when not disposed of properly will pollute our environment. Eroding vape batteries can leak lithium into the soil and water, and the plastic casings end up in our waterways," explains Letitia.

"I think that once environmentally conscious young people are aware of the impact their vaping is having on the planet, they will support a ban on disposables."

The Foundation is encouraging people to talk to their healthcare practitioner about environmentally friendly inhalers at their next checkup.

Metered dose inhalers, like the familiar blue pu er used by many New Zealanders, have a high carbon footprint, equaling a 290km journey in a small car explains Professor Bob Hancox, one of the authors of a recent study into attitudes about the environmental impact of inhalers. “There are other options available, and for many

patients these inhalers may lead to better health outcomes, while also being better for the environment.”

Professor Hancox cautions that any treatment decision must primarily be based on what works best to control asthma. “Any decision to change your medication should be done carefully so that you maintain or improve your health. Poorly managed asthma or COPD is not just bad for your health, it’s also bad for the environment,” he warns.

The study found that most patients surveyed were unaware of the environmental impact of their inhaler, but also that most would be willing to change their inhaler type for environmental reasons if their practitioner recommended it.

The practitioners surveyed were more aware of environmental impacts and were willing to consider these impacts when deciding which inhalers to recommend.

RSV trial in pregnancy

Asthma in New Zealand Survey Worse than we think it is...

The Foundation’s rst ever survey of New Zealanders’ experiences of living with asthma has uncovered some concerning ndings; including that more than half of those surveyed are living with poorly controlled asthma and many of these people were not receiving adequate care and support.

“This survey showed clearly for the rst time, what we have been hearing anecdotally for years; many Kiwis are putting up with poorly controlled asthma and not getting the care they need. It is a real wake-up call,” says Foundation Chief Executive Letitia Harding.

Almost 500 people responded to the survey which was run over three weeks in late March to early April. The majority of respondents were adults living with asthma (81%), with the remaining 19% being parents responding on behalf of children with asthma.

The key ndings to come out of the survey were:

Our asthma is worse than we think it is; 74% of those surveyed believed their asthma was either always or mostly under control, but answers to further questions revealed that only 18% of respondents had well-controlled asthma and 51% had poorly controlled asthma.

Asthma is getting in the way of our daily life: 34% of respondents said their asthma had stopped them participating in daily activities like sport, exercise, work, school or socialising, while 26% reported that asthma signi cantly reduced their quality of life.

Over a quarter of respondents had never had an asthma review; asthma reviews are recommended annually, or more often if symptoms are worsening. Our survey found 26% of respondents had never had an asthma review.

Kiwis with poorly controlled asthma may not be receiving the care they need: 73% of respondents with poorly controlled asthma had not had their inhaler technique checked at their last appointment, 52% either did not have or did not know about asthma action plans, and 35% had not received an asthma review in the last 12 months.

Many asthma check-ups may be inadequate: our survey found that many respondents are not being asked basic management

questions about their asthma symptoms or inhaler usage during asthma check-ups. 16% of respondents reported they were asked no management questions at their last asthma check-up.

Kiwis with asthma are concerned about access and costs associated with asthma: 55% of respondents were concerned about being able to get an appointment with a healthcare practitioner when needed, while 39% were worried about the costs of managing asthma (appointments and prescription costs). 12% had no current concerns about their asthma.

As a result of these ndings, the Foundation is calling for some urgent action from Government.

We want the Government to:

1. Implement a National Respiratory Clinical Network to provide a co-ordinated approach to respiratory care, improve standards and access to care.

2. Provide funding to healthcare practitioners so they can provide annual asthma ‘Warrant of Fitness’ checks for all people diagnosed with asthma. We want these checks to include an asthma control test, peak ow measurements, inhaler technique checks and update to asthma action plans.

3. Fund training of all healthcare professionals working with respiratory patients in New Zealand on the latest asthma guidelines, so our workforce is up-to-date with recommended best practice treatment.

4. Make spacers freely available to all pharmacies and asthma societies.

5. Fund a survey to investigate the lived experience of asthma of New Zealanders we know have the greatest burden of asthma: Māori, Paci c peoples and people living in areas of deprivation.

6. Ensure that asthma is ‘red- agged’ in GP patient management systems as a chronic long-term condition, so that regular reviews occur.

Read the full survey report at : www.asthmafoundation.org.nz/assets/documents/ ARFNZ-asthma-in-NZ-survey-2023-Final.pdf

Caring for your respiratory health at work

Airborne risks and the industries that produce them:

• Wood dust – woodworking activities

• Silica dust – stone cutting

• Flour dust – baking-related

• Concrete dust – construction jobs

• Mouldy crop dust – farming and agriculture jobs

• Welding fumes- construction, manufacturing or structural jobs

• Acetone, ethanol, chloroform, styrene and petrol fumes – science laboratories, factories, oil refineries, nail salons, car repair shops

• Paint mist – painting and decorating jobs

• Asbestos – building inspectors

Occupational respiratory disease, which is any lung condition that occurs as a result of being exposed to toxins at work, is one of the main causes of work-related mortality in New Zealand: accounting for 248 deaths per year. The types of jobs that are the most harmful to lungs include mining, manufacturing, construction, and agriculture; these lines of work often produce ‘airborne risks’, including dust, mists, vapours and gases that can damage lungs when inhaled.

For airborne substances to be harmful to the respiratory system, they must be inhaled into the lungs. Dust particles are too small to be ltered out by the respiratory system and instead they travel deep into the lungs, where they cause damage and scarring to lung tissue. Inhalation of certain gases, fumes and vapours causes in ammation of the small airways and scarring of the tiny air sacs in the lungs (alveoli).

It may take many months or years of exposure to harmful substances at work before symptoms of an occupational respiratory disease arise and the worker becomes aware that they have something wrong with their lungs. This can make it hard to know for certain that a respiratory illness was caused by inhaling harmful substances at work and even harder to pin-point what the harmful substance is.

Lung cancer, asthma and chronic obstructive pulmonary disease (COPD) are all examples of occupational respiratory diseases that can be caused by long-term exposure to airborne risks. Even short-term exposure to harmful substances can worsen existing lung conditions. For example, some people may nd that their asthma only ares up when they are at work.

What to do if you’re worried about your lung health at work

Workplace respiratory risks can be worrying for anyone, but if you already have an existing respiratory condition, you may be even more concerned. It is important you know what you can do

if you feel your lung health is being compromised at work. It is the employer’s responsibility to provide and maintain a safe working environment to reduce the risk of employees inhaling harmful substances. They can do this by providing well- tted masks and other personal protective equipment (PPE). They can also invest in air ventilation systems or HEPA (high e ciency particulate air) lters, which can remove airborne risks in the air including: pollen, dirt, dust and bacteria.

If you work in a job with potentially hazardous substances, lung health monitoring is essential, as it can show signs of harm to a worker’s respiratory health and may indicate the need to increase safety measures and reduce further exposure to airborne risks. It is your employer’s responsibility to ensure your lung health is monitored.

If you feel like your employer is not doing enough to keep your workplace safe, you must voice your concerns. Your rst step should be talking to someone at your workplace about your safety concerns; this could be a supervisor, a Health and Safety Representative or an occupational health specialist, if there is one present at your workplace. If you feel con dent to, you can even suggest an improvement that you feel would bene t your respiratory health. Remember, you are entitled to contribute to health and safety decisions at your workplace.

If you feel that your concerns are not being addressed, you can contact your union or WorkSafe, New Zealand’s primary workplace health and safety regulator, at 0800 030 040 Calls are taken anonymously. It is the job of WorkSafe to inspect the safety practices carried out in workplaces and ensure that a business is doing all it reasonably can to prevent harm to its employees.

If you work, or have worked, in an industry where you think you have

been exposed to airborne risks without adequate protection or you develop symptoms like a new cough and wheeziness, you should visit your healthcare practitioner and ask them to carry out lung tests. It is better to get your respiratory health checked out, than to leave a potential lung condition untreated.

If you believe that you are currently being exposed to a serious health risk, you have the right to stop work until the hazard has been removed or safety measures have been put in place to prevent you from coming in to contact with the hazard in a dangerous manner.

Silicosis: an ever-growing concern

Recently, concerns have been growing around the use of silicacontaining arti cial stone, which is used to make benchtops for kitchens and bathrooms. As the stone is cut by workers, silica dust is produced. Once inhaled, the dust can begin to cause permanent damage to the lungs and a respiratory illness, called silicosis, can develop.

The symptoms of silicosis include a persistent cough, shortness of breath and fatigue. As the disease progresses, healthy lung tissue will be replaced by scar tissue, which will make it hard to breathe. Silicosis can severely reduce quality of life, and in extreme cases it can be fatal as the lungs stop working properly. It can take up to 10 years after exposure for symptoms of silicosis to appear, meaning people who have worked with silica-containing substances must now play a worrying waitinggame to see if they develop symptoms.

As more is learnt about the dangers of exposure to silica dust, pressure has been put on both Australian and New Zealand Government ministers to ban the domestic use of silica and prevent further cases of work-related silicosis.

eHaus: redefning the way that Kiwis live

Passive House design and building innovator, eHaus, is setting a new standard for living in New Zealand where comfort, energye ciency and the health of Kiwis and the planet are the priorities.

eHaus was created by three New Zealanders who shared a vision for creating high-performing homes that improved the health of both people and the environment. Jon Ili e joined forces with Baden and Glenda Brown in 2010, to establish the specialist design and build company.

For Jon, the interest in alternative building methods grew out of his own family’s experience of living in a cold home. “I think my family’s story is typical of many of us here in Aotearoa. We had a cold home and were reliant on a wood burner to heat the main living area, which then struggled to heat the rest of the house. This became a huge worry when we had children and struggled to keep their rooms warm. Despite our best e orts, our rst child developed asthma as a result of that cold environment.”

After researching alternative building and design methods, Jon discovered Passive House building technology, and worked with Baden and Glenda to adapt these principles to the New Zealand climate, creating the eHaus model. Jon built his own eHaus and immediately experienced the bene ts. “After moving into our eHaus, we noticed a signi cant improvement in our son’s asthma. It was the best thing we ever did for our family’s health,” Jon says.

This experience was one of the reasons that eHaus signed up as the rst ever sponsor in ARFNZ’s Friends of the Foundation programme in 2020. “Living in a warm and dry environment is good for everyone, but for people with a respiratory condition it is vital for them to stay well. Constructing the healthiest, energy-e cient homes is our goal, and the work the Asthma and

Respiratory Foundation does, is a perfect t for eHaus,” explains eHaus National Marketing Manager Sarah Carson.

eHaus is a Silver Sponsor and a key supporter of the Foundation’s ongoing research, education and advocacy e orts.

What is Passive House?

Passive House is an international building standard that delivers a home that uses very little energy for heating or cooling, and provides a warm, comfortable living environment. Passive Houses consume between 75-90% less energy than a conventional house, while keeping a constant temperature throughout the home ranging between 20 – 25 degrees all year round.

eHaus uses specialist design tools and high performance building materials to deliver homes that are warm, dry and completely airtight. Air ow is controlled by an air ltration system which removes up to 98% of pollutants, while ensuring minimal heat loss. eHaus homes also use insulation suitable to the di erent climate zones across New Zealand, and double or tripled glazed windows. Discover more at: www.ehaus.co.nz

UNDERSTANDING BIOLOGICS

Currently, using an inhaler is the most common way of treating asthma, but new treatments are emerging for people with severe asthma. These treatments are known as biologics or monoclonal antibody therapy.

Understanding biologics

For the majority of people, using inhalers (or “pu ers”) keeps their asthma under control and allows them to live a healthy and active life. Some people have severe asthma, which is a type of asthma that is hard to control even using high doses of standard asthma medicines. For these people, a di erent medication is required.

A relatively new way to treat severe asthma is to use a class of drugs called biologics. Biologics are medicines that contain substances that have been isolated from a natural source. These sources include: human cells, microorganisms, plants or animals. Apart from asthma, biologics have been developed to treat many di erent diseases, including: cancer, rheumatoid arthritis and psoriasis.

The biologics that have been approved to treat severe asthma in New Zealand are called omalizumab (brand name: Xolair), mepolizumab (brand name: Nucala) and more recently benralizumab (Fasenra). Omalizumab is used to treat severe allergic asthma, whereas mepolizumab and benralizumab are used to treat people with severe eosinophilic asthma: a type of asthma caused by high numbers of white blood cells that cause swelling and in ammation in the lungs. All these medications work by recognising and blocking substances in the lungs that cause lung in ammation and asthma symptoms.

Biologics are administered by regular injection every four to eight weeks, depending on the biological medicine used, your weight and asthma severity. Injections can be given by healthcare providers in a healthcare setting or self-administered at home if your healthcare practitioner deems it safe. For some people, who struggle to remember to take their inhaler daily, an injection every month or two is a huge bene t of biologic treatment. Most people will need to continue to take their inhalers, along with the injections.

Perhaps the main bene t however, is that treatment with biologics can improve the quality of life of people with severe asthma and reduce the frequency of asthma are-ups and hospitalisation. Biologics also replace the need for high doses of corticosteroids, which can cause unpleasant side e ects.

The number of people eligible for treatment with biologics is relatively small; only people with speci c types of severe asthma

that cannot be controlled with high doses of corticosteroids can be prescribed omalizumab, mepolizumab, and benralizumab in New Zealand. In order to be prescribed biologics for asthma, your healthcare practitioner will refer you to a respiratory specialist or a clinical immunologist, who will run tests to determine if you are eligible for biologic treatment.

As asthma is one of the most common chronic diseases across the globe, research in to the condition continues to be relatively well-funded globally. In the future, we hope to see more biologics and other medicines on the market to further improve the quality of life for people with asthma.

SEVERE ASTHMA

People with severe asthma have persistent symptoms including: constant breathlessness, continuous coughing, di culty speaking in full sentences and a heavy feeling in the chest. As these symptoms cannot be alleviated by taking standard medication from a reliever inhaler, instead people with severe asthma are often given higher doses of medication and longer-lasting medication in order to keep the airways open for extended periods of time. Antibiotics can also be used for people with severe asthma.

Often, people with asthma mistakenly assume they have severe asthma because they experience lots of bad asthma symptoms. However, it is most likely that their asthma is just not well controlled. If this is the case, their healthcare practitioner can alter their treatment regimen and the patient will feel better as they regain good control of their asthma.

If changing a treatment regimen doesn’t improve symptoms, a patient will be referred to specialist asthma care where they may receive a diagnosis of severe asthma. A variety of tests are used to diagnose severe asthma, including: lung volume tests, spirometry, imaging scans and gas transfer tests. A severe asthma diagnosis may sound scary but it will allow a patient to gain access to the help and support needed to manage their condition properly.

Meet the winners: Gary Syme & Umair Khan

If you had asked a young Gary Syme what he had imagined for his retirement, he would not have pictured receiving a national award honouring his services to the respiratory community.

Cantabrian Gary, received the 2023 COPD award at the Respiratory Achievers' Awards for his community service to those with chronic obstructive pulmonary disorder (COPD).

Gary was diagnosed with COPD ve years ago and explains this marked a new chapter in his life: “It was a surprise diagnosis, although my father had experienced similar issues later in his life. My GP sent me along to the eight-week breathing programme run by the Canterbury Clinical Network (CCN) and that was what got me started on my journey.”

Having not been particularly physically active previously, the course opened Gary’s eyes to the bene ts of exercise in managing his condition and getting more out of life. “COPD can make you very tired and exercise combats that tiredness. If you do nothing, it

makes it so much worse physically and you can fall into a deep, dark hole mentally. But if you push through that malaise barrier, you feel so much better,” he says.

As well as working on his own tness, Gary began to share the bene ts of exercise by volunteering to run a community exercise group set up for people with COPD in the Christchurch suburb of Bishopdale.

“Initially it was ve people in a small hall and then over COVID it was disbanded,” Gary recalls. “We got funding to restart it in 2020 and it began to grow.” The group now has 20 to 25 regular participants and is self-su cient after losing funding last year.

The group participants collectively nominated Gary for the COPD category of the Respiratory Achievers’ Awards, and they credit its ongoing success to his welcoming, friendly attitude and dedication to running varied, fun sessions. Gary says the group, in return, gives him a lot of enjoyment, as well as a something to keep him busy in his retirement.

“It has become my passion. I’ve enjoyed

researching how to make the group as bene cial as possible. It’s become a wellbeing group; we do brain games, hand exercises, yoga, anything that improves overall health.”

The group also attracts people who don’t have COPD but want to exercise in a nonjudgemental space.

“I want it to be open to everyone. I understand it can be hard to get moving, but it’s so rewarding when you see those people who are struggling, keep coming back.”

Apassion for football has driven Mohammed Umair Khan’s determination to control his asthma and achieve his goals. The passion has also seen him recognised at the Foundation's national Respiratory Achiever Awards earlier this year, in the Teen Asthma category.

"I realised I needed to learn to live with asthma, and not try and stop it,” Umair explains. “I knew that I would have to train harder than my football team mates to get to the same level. I needed to do more in my personal time to build up my lungs so that I could play a full game.”

Through regular training, persistence and consistent use of his medication, Umair is now not only able to play a full game, he was also the top goal scorer for both his football club and his school football team last season. He plays attacking mid elder, a position where running and keeping up with the pace is essential.

Umair was diagnosed with asthma at age six and says as a younger child, it was a barrier for him. “It caused struggles for me. I couldn’t do school sports sometimes and kids would make fun of me.” Another issue was sleep. Umair’s asthma was waking him throughout the night, leaving him exhausted during the day. After improving his tness and lung capacity, he sleeps better and has more energy.

Umair’s dad, Tabrez, says after witnessing his son’s struggles to breathe he was initially concerned about letting Umair play sport. “It was advice from our family GP that changed that for us. She told us that lifestyle was as important as medication in managing asthma. That was a pivotal point for us.”

Umair’s determination has also brought him academic success. He was the top male student in his year and received an endorsed excellence in Level One NCEA. He is also a devout Muslim, who is memorising the Qu’ran. “We recite the Qu’ran aloud, so you actually need strong lungs to do this,” explains Tabrez.

enrol now

learn.asthmafoundation.org.nz

Umair says having asthma has taught him some useful life lessons. “I am proud that I have overcome my fear of having a respiratory condition. I know that if I work hard, I can cope with other problems.”

Umair hopes to continue his run as top goal scorer this football season and would like to become a health professional specialising in respiratory conditions.

Gary Syme

Umair Mohammed Khan

Sometimes when you cough it can make you leak a bit of urine accidentally. This is known as stress incontinence. We are going to explore why stress incontinence can occur and what you can do about it.

Your bladder and bowel sit within your pelvis. The pelvic oor muscles line your pelvis and stretch from your pubic bone at the front to your tailbone at the back. The outlets for your bladder and bowel pass through these muscles. The pelvic oor muscles support your pelvic organs and assist bladder and bowel control i.e. they help prevent leakage of urine from the bladder and wind or faeces from the bowel.

Sometimes your pelvic oor muscles can become weak. This can happen when they are put under prolonged or repetitive pressure, for example chronic coughing, heavy lifting, straining to pass bowel motions (constipation), pregnancy and childbirth. Weak pelvic oor muscles don’t do their job as well as they should, and the result can be stress incontinence. Having a chronic lung condition, which causes a lot of coughing, can weaken the pelvic oor muscles and result in stress incontinence.

Stress incontinence is more common in women but can also a ect men. The good news is you don’t have to su er in silence.

Pelvic oor muscles can be strengthened like any other muscle in the body. It can be a bit tricky to learn, because we can’t see our pelvic oor muscles working, but, with practice we can feel them.

in your tummy or hold your breath when doing this exercise.

To begin with, you may only be able to manage a couple of contractions, but as the muscles get stronger you will be able to progress. Work towards doing ve to ten quick squeezes followed by ten “holds” of ve seconds.

Aim to practice these pelvic oor exercises several times per day. At rst, it might be quite di cult but with practice it should get easier. Always remember to contract your pelvic oor muscles every time you cough, sneeze or lift anything heavy – squeeze before you sneeze!

To locate your pelvic oor muscles, imagine that you are trying to stop yourself passing urine or wind. That sensation of a gentle lift is your pelvic oor muscles contracting. Hold for a moment, then let go. You should feel the muscles relax. Don’t squeeze your buttocks together, pull

If you have been taught pelvic oor exercises in the past, it is important that you continue doing them; they should be a lifelong habit. If you haven’t been taught pelvic oor exercises before or feel you need more help with these exercises, ask your GP or health professional to refer you to a continence service. Alternatively, you can go directly to see a private pelvic health physiotherapist; you don’t need a referral.

For further information: www.continence.org.nz

About the author Zoe Manderson is a respiratory physiotherapist in Taranaki for Te Whatu Ora and a member of the Asthma and Respiratory Foundation’s Scienti c Advisory Board.

INFORMATION FROM RESPIRATORY PHYSIOTHERAPIST ZOE MANDERSON

Nick Ashill shares his inspiring journey with the Comfortech team ®

Comfortech Building Performance Solutions® is a proud partner of the Asthma and Respiratory Foundation New Zealand (ARFNZ), and ultramarathon runner Nick Ashill.

Nick Ashill is a key advocate for those living with respiratory illness, running across America to raise awareness and funds for the Foundation and UK-based Pulmonary Fibrosis Trust, in memory of his mother who died from the rare respiratory disease, Idiopathic Pulmonary Fibrosis (IPF).

In 2017, Nick set out to run from Los Angeles to New York for IPF. Over halfway into his 5,000 km journey, when just outside Columbus, Ohio, Nick was deliberately hit by a truck - the driver has never come forward nor been identi ed.

As part of Comfortech’s recent Health, Safety, and Wellbeing campaign, Nick shared his inspiring story with their employees, across Auckland, Wellington, and Christchurch, as well as at Fletcher Building.

“Health, safety, and wellbeing are of huge importance to us here at Comfortech®, so to have Nick share his story and o er key takeaways for looking after your mental health, wellbeing, and physical health directly aligns with our core values and what we work towards every day”, says Comfortech® Marketing and Innovation Manager, Melissa Semmens.

Nick talked about the struggles that he faced, both physically and mentally and his journey to forgiveness. Because of the severity of his injuries, Nick spent four months in hospital recovering from the accident. He was told that he would only ever walk with assistance and never run again, however, he de ed all odds and is back to running six days a week.

In 2022, he successfully completed his run across America, and is more committed than ever to supporting initiatives that help to reduce respiratory illnesses, including the Asthma and Respiratory Foundation New Zealand.

He is already planning his next run, which is set to take place next year in Australia, from Perth to Sydney. At approximately 4,000 kilometres, the run will take around 60-70 days to complete and will present a series of challenges including extreme temperatures.

"We’re extremely proud to be Nick’s main sponsor, supporting him as he embarks on this incredible and inspiring journey across Australia,” says Melissa Semmens.

Comfortech’s purpose is to create New Zealand’s most comfortable living and working spaces, and through our partnership we can achieve positive social outcomes, by providing education, training, and research to support respiratory health best practice.

To learn more, visit Comfortech.co.nz

Asthma NZ - Auckland

Monday-Friday, 9am-5pm

09 623 0236

0800 227 328

anz@asthma.org.nz

581 Mt Eden Road, Auckland www.asthma.org.nz

Asthma Waikato

Monday-Friday, 9am-4pm

07 838 0851 info@asthmawaikato.org.nz

18 Claudelands Road, Hamilton East, Hamilton www.asthmawaikato.org.nz

Asthma and Respiratory Management BOP Inc

Monday-Friday, 9am-4pm 07 577 6738

0800 ARM BOP or 0800 276 267 reception@asthmabop.org.nz

254 Chadwick Rd, Gate Pa, Tauranga 3112 www.asthmabop.org.nz

Asthma NZ - Rotorua

Monday-Friday, 9am-5pm 07 347 1012

rotorua@asthma.org.nz

1290 Eruera Street, Rotorua 3010 www.asthma.org.nz

Gisborne and East Coast Asthma Society (Inc)

06 868 9970 lynlolohea@hotmail.com

14 Kennedy Street, Gisborne 4010

Breathe Hawke’s Bay

Monday-Friday, 8.30am-3pm 06 835 0018 admin@breathehb.co.nz

199 Dickens Street, Napier www.breathehb.co.nz

Tu Kotahi Māori Asthma Trust Lower Hutt

Monday-Friday, 8.30am-5pm 04 939 4629 / 0800 939 462 anne@kokiri-hauora.org.nz

7-9 Barnes St, Seaview, Lower Hutt 5010

Asthma NZ - Wellington

Monday-Friday, 9am-5pm 04 237 4520 wellington@asthma.org.nz

Level 2, 120 Featherston Street, Wellington 6011 www.asthma.org.nz

Meeting whānau needs in the Hutt

Tu Kotahi Māori Asthma Trust provides free respiratory services to Māori of all ages, from babies to kaumatua across the Hutt Valley. The team is made up of two asthma nurses; Anne Webster and TJ Ranga who regularly have up to 200 people in their care.

The Trust is based at Kokiri Marae which has a full range of hauora services available to whānau. “We are a one-stop shop for whānau health and wellbeing,” Anne explains. “The advantage of that is we can connect our clients to a whole range of other services they might need like the Well Homes (healthy homes) programme, quit smoking programmes or our diabetes service.”

Anne and TJ receive referrals from local GPs, the children’s ward at Hutt Hospital and local schools. People can also self-refer. The team o ers up to six home visits where they initially

Marlborough Asthma Society

Any messages will be responded to during o ce hours Monday to Friday.

03 579 1609 0272057244 asthma.marlborough@xtra. co.nz

Nelson Asthma Society

Monday, Tuesday, Wednesday and Friday, 9am-2pm 03 544 1562 asthma.nelson@xtra.co.nz

9 Cambridge Street, Richmond, Nelson 7020 nelsonasthma.co.nz

CanBreathe Canterbury

Monday-Friday, 9am-4pm 03 386 0278 o ce@canbreathe.org.nz

196 Hills Road, Edgeware, Christchurch 8013 www.canbreathe.org.nz

Otago Asthma Society

Monday-Friday, 9am-12pm 03 471 6167, 027 471 6160 otagoasthma@xtra.co.nz

Dunedin Community House, 1st Floor, Cnr Moray and Great King Street, Dunedin 9016

give a full respiratory health assessment and then follow up on clients’ progress. Anne explains that home visits are an important part of the Trust’s service as it builds strong connections and trust with their clients. “From there, we can connect with GPs, other health providers, Kainga Ora or landlords, to sort out whatever is needed,” she explains.

Anne and TJ also spend time developing resources to meet needs they see in their community, like their bronchiolitis kit for families and personalised asthma school kits for tamariki. TJ runs a regular clinic at Wainuiomata College, while Anne is involved in a kaumatua medication optimisation programme run through a local pharmacy.

They also co-ordinate regular clinics for their clients with a respiratory nurse practitioner and specialist physicians.

SUPPORT GROUPS

Eastern BOP Asthma and COPD support group

07 307 1447 or 0800 227 363 copd@drct.co.nz

C/O Karen Couchman, Disabilities Resource Centre Trust, 141 King Street, Whakatane 3120

Manawatu Breathe Easy 027 242 0669 owenped@xtra.co.nz

Horowhenua Breathe Easy Support Group 06 368 8069

Porirua SYLO Choir

Thursdays 11.30 - 12.30pm 027 405 6458

Supper Room, Mungavin Hall, Mungavin Avenue, Ranui, Porirua

Wellington SYLO Choir

Tuesdays 10.30am 027 817 1136

All Saints Church, 90 Hamiltons Road, Haitaitai

Is your support group missing? Let us know: info@arfnz.org.nz

Purifies and heats the whole room1 this winter

With whole machine sealed HEPA H13 filtration 2 to capture dust and allergens