Royal Brompton and Harefield hospitals are supporting World Asthma Day, an annual campaign to improve asthma awareness and care around the world.
In this blog, Professor Andy Bush, consultant paediatric chest physician, talks about asthma care, the importance of young people asking questions, and what he enjoys most about his job.
Why is it so important for children and young people to ask about asthma?
Asthma is a disease which can be treated really well, but if we get it wrong, can lead to very serious attacks. So, if you have asthma, it’s essential you ask questions about it, understand it, and know how to manage it. You need to take control of your asthma, not let it control you.
If you have breathing problems that are affecting your daily life, it’s important to ask the question: ‘Could I have asthma?’ Of course, there are many reasons for being short of breath on exercise, like being unfit but you should at least consider the possibility of asthma.
It’s also worth considering that a child or young person who is always last in a race, is wheezy or breathless may have asthma that they don’t know about or is not well controlled. I would always encourage anyone in this situation to go to their GP to check.
What are the most important questions children or young people should ask their healthcare professional?
Anything that worries you is important – the only silly question is the one that’s not asked. If you don’t understand the answer to your question, please say so. Speaking as a doctor, if I have not explained something so a young person can understand it, it does not mean they are stupid, it means I have not done my job properly. Your doctor must explain clearly until you understand.
As a doctor, I can’t second guess what is important or most concerning to you, but some of the common questions I get are about medication side-effects, why my patients have to take inhalers, what causes asthma, what will happen if I don’t take my medications, and will my asthma get better or be cured? Whatever is on your mind, please ask.
It’s often easy to forget questions when you are with a doctor or nurse, so don’t be afraid to write a list. I personally find this very helpful, because I can check off everything and know that when we’ve gone through it, we have covered everything that is bothering you.
Above all, if you think you may have asthma, do something about it. Get yourself seen and tested for asthma.
What three tips can you give a child or young person living with asthma?
- Listen to your dreams, not your fears, and live your dreams. Do not let asthma get in the way of them as your symptoms can be well controlled if you take your inhalers regularly.
- Find a way of remembering to take your preventer inhaler regularly that works for you. Doctors can suggest ways, but you need to find a system that is most likely to work for you.
- Be open with your healthcare team – they are there for you. If you don’t remember inhalers, or you don’t think you need them, say so, and work with the team to find a way forward. Remember we treat lots and lots of patients with similar health issues – however shocking you may feel what you are saying is, it will have been said many times before.
What do you consider to be the most significant development in asthma care/research at the moment?
The effects of Covid-19 have taught us a lot. To our surprise, children with asthma are not at a higher risk than children without asthma of the same age. It is not merely safe but essential to keep taking asthma treatments; they do not make Covid-19 worse, and if anything are protective against the effects of the virus.
We have also learned that asthma outcomes have been much better during lockdown, with far fewer people coming to hospital with asthma attacks. There may be several reasons for this. One is likely to be the reduced frequency of other respiratory viral infections, because masks, hand hygiene and social distancing will have prevented their spread. Another may be that people are finding it easier to remember medications when there is not the pressure to rush out of the house and get to school and work. Finally, levels of pollution have dropped dramatically during the pandemic. The challenge for us is to try to maintain these good outcomes as lockdown restrictions are eased.
It is impossible to mention pollution without thinking about the tragic death from asthma of 9-year-old Ella Adoo-Kissi-Debrah. After a legal battle that has gone on for years, her family ensured there was an inquest into her death, which found that air pollution made a significant contribution to her dying. UK levels of pollutants are more than twice as high as suggested by the World Health Organisation. Air pollution damages the lungs of unborn babies and young children, stunts lung growth, and leaves children wide open to lung diseases such as COPD, and also premature death from cardiovascular and metabolic disease. Our children have the right to breathe clean air, and we all need to hit the campaign trail to fight for this.
What inspired you to get into respiratory care?
Measuring things! We can learn so much from breathing and other tests about what works and what doesn’t and understanding these sorts of tests is an endless fascination.
What do you enjoy most about your job?
Where do I start? I qualified 43 years ago and have been a consultant at Royal Brompton Hospital more than 30 years. I cannot imagine a better job, and if the clock was turned back, I would not want to do anything else.
The mix of research, teaching and interacting with students and trainees, meeting children and young people and their families, trying to unpick causes of disease and optimising treatment, and trying to push forward with new developments in care is just fantastic.
But if I had to choose one, it would be growing old with families, working with them for years, earning their trust and seeing a baby develop into an adult and being a small part of their life story – that would be the best thing about my job!
A previous version of this piece was published on 15 September 2020.