Psychosomatic illness

Psychosomatic means mind (psyche) and body (soma) and can have both mental and physical aspects.

 Psychosomatic related conditions can be separated into three classes.

Class1: those with both a mental and medical illness. Both illnesses complicate the symptoms and management of each other.

Class 2: those with a mental issue as a direct result of a medical illness or its treatment, i.e. depression brought on by having cancer and subsequent treatment.
Class 3, the most prevalent type of psychosomatic related condition is somatoform disorders. These are a group of mental or psychiatric disorders manifested as physical problems or feelings of illness with no apparent, identifiable medical issue. To put another way, the physical symptoms experienced are related to psychological factors as opposed to anything identifiably medical.

 Somatoform disorder are more common in females. Onset is usually before age 30. Common somatoform symptoms include digestive problems, headaches, pain, fatigue, menstrual problems, and sexual difficulties.

The exact cause isn’t known. Family history / genetic predisposition may be a contributing factor. Somatoform disorders may be triggered by strong emotions, situations or events, such as anxiety, grief, trauma, abuse, stress, depression, anger or guilt. Despite what anyone thinks, they are not intentionally producing physical symptoms or making up physical problems. These are real, but caused by psychological factors.

In the main, there are four main types: -

Body dysmorphic disorder is an individual’s obsession or fixation with a minor or imaginary physical flaw, or with the shape or size of their body parts, leading to severe anxiety impacting negatively on ability to function normally.

Conversion disorder: a condition where a person experiences neurological symptoms that affect their movement and senses not attributable to any physical cause. They may feel they’ve lost the use of a body part, however, no medical or physical reason can explain it. Conversion disorder can produce symptoms as debilitating as seizures, blindness or paralysis.

Hypochondriasis: a preoccupation with the fear of having a serious disease. Sufferers misinterpret normal body functions or minor symptoms as being those of a more serious illness or even, life threatening. For example, a person with hypochondriasis may become convinced that they have colon cancer whilst experiencing a bout of temporary flatulence after eating cabbage.

Somatisation disorder:a disorder where a person experiences physical complaints, with no apparent physical cause (e.g.)  headaches, diarrhoea, or premature ejaculation. A person may have a history of medical complaints with no organic foundation.

In the main, somatoform disorders are not considered life-threatening. With the right support and treatment pathway, sufferers can lead normal lives even whilst living with ongoing symptoms. That said, there is currently no cure and treatment can be difficult. The key to a successful outcome is based on the establishment of a consistent and relationship between the patient and their healthcare professional, in most cases in Ireland, their GP. In many cases, the GP will refer the patient to a mental health specialist such as a psychiatrist to help better manage their symptoms.

Symptoms

 

Somatoform disorders are the major forms of psychosomatic illness. Physical symptoms of these disorders are real and may appear to be those of medical conditions. However, they are psychological in nature rather than physical. Medical testing and evaluation may sometimes be required to establish that the symptoms are in fact, by elimination, psychosomatic.

Common symptoms of body dysmorphic disorder

Those with body dysmorphic disorder become fixated with physical appearance. The person sees minor flaws as a major issue or indeed, may see flaws where none exist. Common areas of focus include loss of hair; the physical size and shape of body features, such as the facial (eyes, nose, lips etc.); breast size / shape; weight gain; wrinkles.

Associated behaviours may include:

·         Anxiety, fear of what other people “see”.

·         Depression, perhaps related to low self esteem

·         Withdrawal from situations where there are other people, i.e. public, social

·         Mirrors: - either avoiding or the need to constantly check appearance

·         Seeking reassurance /validation from others about their appearance

Common symptoms of conversion disorder

Symptoms of conversion disorder usually look like neurological problems and can include:

·         Vision impairment (Sudden loss of vision, double vision)

·         Swallowing (can lead to tube feeding in severe cases)

·         Impaired balance or coordination, difficulty walking

·         Inability to speak (aphonia)

·         Loss of sensation

·         Paralysis or weakness, in a limb, or entire body

·         Seizures

·         Urinary retention or conversely incontinence

Common symptoms of hypochondriasis

Hypochondriasis is thinking that everyday normal body functions or minor symptoms represent a serious medical condition. In the mind of a sufferer, for example, a common headache may be a brain tumour or muscle soreness in the limbs may be a sign of impending paralysis. Typical behaviours include:

·         Anxiety and depression

·         Feeling that their GP has made an error in not diagnosing the cause of symptoms, or in some cases, not taking them seriously.

·         Repeated GP visits until (in their mind) a correct diagnosis is made

·         Seeking constant reassurance / validation from friends and family about their symptoms and that they’re “ok”.

Common symptoms of somatisation disorder
Somatisation disorder is characterised by physical symptoms manifesting without an attributable physical cause. May include:

·         Digestive related symptoms, such as nausea, vomiting, abdominal pain, constipation, and diarrhoea

·         Neurological symptoms, headaches and constant fatigue

·         Pain, anywhere

·         Sexual symptoms, such as pain during intercourse, loss of libido, erectile dysfunction, and extreme menstrual problems in women

 

Potential complications of psychosomatic illness?

A person with psychosomatic illness, specifically a somatoform disorder are at increased risk of:

·         Difficulty functioning effectively

·         Physical Disability

·         Diminished quality of life

·         Major depression

·         Suicidal thoughts or actions (especially prevalent in younger people)

It can be hard to spot and especially in people we see every day. Indicative symptoms to look for may present as follows, if identified, prompt medical help should be sought

·         Noticeable changes in eating habits. such as overeating, bingeing or conversely, loss of appetite, desire to eat “alone”.

·         Inability to concentrate

·         Recall or memory issues

·         Constant lethargy

·         Feelings of despair, low self-esteem.

·         Irritability and restlessness

·         Activities and hobbies once enjoyed no longer interesting or important.

·         Persistent melancholy, desolate feelings

·         Problems sleeping (either too much or too little), the change from normal is key

Causes

The exact cause is not known, there may be a genetic link. Somatoform disorders represent the major form of psychosomatic illness. Somatoform disorders may be a coping strategy related to a previous life experience or trauma such as abuse or loss. It may be a learned behaviour, or the result of a personality characteristic. Research also indicates possible comorbidities with other mental health disorders, such as mood disorders, anxiety disorders, personality disorders, eating disorders, and psychotic disorders. Irrespective of causes, the symptoms are real to the person experiencing them, not imagined or made up.

A reaction to a particular emotional or psychological experience, past or present, may act as a trigger to the disorder.

Risk factors

It can be difficult to identify specific risk factors. If a family member has had a somatoform disorder in the past, a person may also be at risk. Other risk factors include:

·         Past sexual, emotional or physical abuse

·         A major childhood illness

·         Poor or reduced ability to show or express emotions

How is psychosomatic illness treated?

Diagnosis and subsequent treatment of somatoform disorders, can not only be challenging and can create stress and frustration for patients. Believing or feeling that there's no known explanation for their symptoms and getting nowhere can then lead to further increased stress and a vicious cycle ensues as they then become even more worried about their health. Once actual physical causes of symptoms have been eliminated, the focus of further treatment is based on a continuing, trusting, supportive relationship between patient and GP or lead health professional, in the mutual knowledge that there is in fact something to treat.  Once a treatment pathway has been agreed, close monitoring of progress through regularly scheduled follow up appointments is important for treatment success.

Psychiatric treatment of somatoform disorders

The GP may refer a patient to a psychiatrist or qualified mental health professional for help in managing their disorder. Psychotherapy and particularly “talking therapies” such as CBT (cognitive-behavioural therapy), may prove effective in dealing with those underlying psychological factors that are causing the physical symptoms and having a positive effect on both. Stress management techniques may also be part of the therapy. Learning to identify, anticipate and manage stress in a healthy way can help those patients where stress brought on by certain triggers is a particular issue.

If a mental disorder, such as depression, anxiety etc. is identified, then treatment with suitable medications may also be recommended and initiated as part of the overall programme.

Symptomatic treatment of somatoform disorders

Talking therapies such as CBT, whilst proven effective in a wide range of mental health management strategies, are not necessarily beneficial for everyone, so for some, symptoms may continue. In such cases, treatment will then be centred on providing symptomatic relief and helping people live normal lives.

Medication

As stated above, comorbid psychiatric disorders should be treated with the appropriate intervention. Medications can help to provide relief from symptoms, such as headache, fatigue, pain, and digestive problems etc. However, any medication should be used sparingly and always for an identified cause and in many cases may not be needed.

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.

Some light at the end of the tunnel at Midlands Rheumatoid Arthritis Event

More than 70 people took the positive step of attending the “Rheumatoid Arthritis” (RA) talk, hosted by Whelehans Pharmacy, Mullingar in conjunction with the Westmeath Branch of the Arthritis Ireland on Wednesday 12^th Oct at the Greville Arms Mullingar. There was an impressive line-up of 4 speakers.

The main speaker was Dr Killian O’Rourke, Consultant Rheumatologist at Midlands Regional Hospital, Tullamore. Dr O’Rourke delivered an excellent presentation which focused on two main areas:-

o   Update on Midlands Rheumatology Services to Oct 2016

o   Advances in RA treatment

Dr O’Rourke gave an overview of the extensive range of facilities now available at the service in Tullamore. One other really positive development within the unit was the extensive training programme for Midlands GP’s, hosted by Dr O’Rourke. On completion, each GP will have had around 400 hours of Rheumatology related training, which is then immediately relevant at point of first contact for most people (ie) the GP Surgery. This greatly assists with early diagnosis and subsequent quick referral.

New National Electronic Referral Form

To support the many recognised benefits of very early diagnosis, Dr O’Rourke outlined a new referral system of suspected IJD (Inflammatory Joint Disease) for GP’s using the new extremely detailed National Early Inflammatory Arthritis Referral form, developed in association with the charity Irish Society of Rheumatology and the HSE, full patient details along with supporting information (x-rays, pictures, history etc) can be sent electronically to rheumatology departments like Tullamore with a commitment to see referrals within six weeks.

Waiting list for Tullamore Rheumatology Department

Dr O’Rourke gave an update on the current waiting list position for new RA patients with recent improvements now sits at 15 months (down from 30 months), with those awaiting DEXA / MRI now at 12 months. In addition, whilst there has been recent positive progress in staffing levels, he outlined those shortfall areas that still exist to reduce the “waiting list” issue. The rheumatology department have a triage system which allows them to see more urgent cases quickly (eg) newly diagnosed early RA which needs early and aggressive treatment to prevent joint damage.

Risk factors for RA

Dr O’Rourke went on to discuss RA Risk factors. At the top of the group are two primary genetic factors followed by a list of over 12 “Higher Risk” factors….. of note here were:- Female Gender also Pregnancy and 12 months after giving birth; Occupational risks related to dust (mining, oil, woodwork, electrical, asbestos); Lifestyle factors (Smoking, High BMI, Coffee Consumption). Some developing evidence show that there may be a link between gum disease and development of RA.

Dr O’Rourke then gave an insight as to how RA is classified and the various systems that are used to evaluate severity. Two main organisations ACR (American College Rheumatology) and EULAR (European League against Rheumatism) have combined resources to produce a harmonised scoring system that provides some common classification criteria against which presenting symptoms can be measured, scored and which treatment pathway to take based on the outcome. The newly simplified scoring system aims: - Initially to REDUCE Disease activity, which through time PREVENTS structural damage, which then through remission, DECREASES disability. These factors are then translated into the recognised DAS28 scoring system which when used to indicate exactly where an individual lies within the goals above which dictate / prioritise immediacy and type of treatment.

Future of RA treatment

Looking to the future of RA treatment, the audience learned of a variety of current scientific initiatives and advancements that aim to help and assist with the earliest diagnosis of RA, perhaps even long before physical symptoms have appeared.

Gene screening to maximise treatment

Gene screening, currently in use in America, could help predict which drugs would be most effective for a given patient, which then enables the most effective treatment to be used right from the start.  Leading on from this, Dr O’Rourke suggested that at some time in the future, everyone could have their complete genome screened with the result showing what diseases or ailments they may be predisposed to. This is more likely to be reality in the coming years, something that would have been the realms of science fiction 25 years ago.

An RA vaccine?

Again, currently in progress is the possibility of a vaccine to prevent RA. Research in Australia is developing a vaccine to re-educate the immune system and the T-Cells (which currently attack in RA) to act in support of the immune system and prevent attack. Whilst an outcome may be a long way off and hugely expensive currently, it may be reality in within most of our lifetimes.

Cannabis based painkillers

To conclude, another therapy currently under evaluation (and common practice in many countries) is the use of Cannabis based Medicine (CBM) to treat and alleviate the symptoms of RA. Dr O’Rourke gave examples from USA and Israel of how CBM treatment has been proven to reduce and eliminate pain in RA. Medicine is administered primarily through tablets or sprays so that the purity and dosage can be guaranteed, CBM has been shown in clinical trials to reduce symptoms across a range of “traditional” RA measures. Cannabis based painkillers have been shown to have significantly less side effects than many traditional painkillers. Dr O’Rourke pointed out the CBM is not currently available in Ireland in any form.

Other health professionals

Next up was a presentation from Dr Siafullah Khan from Mullingar Dental Centre. Dr Khan is qualified in Special Care Dentistry. Dr Khan gave an overview of how Special Care dentistry can be of benefit to those with Mental or Physical challenges. He mentioned that something as simple as scheduling the “right” appointment time can be helpful for those that may, for instance, experience stiffness in the morning, making an afternoon appointment a better option.

Kevin Conneely, Chartered Physiotherapist from Health Step Physio based at Whelehans Pharmacy suggested that physiotherapy treatment can help maintain or increase range of movement for those with mobility issues. Physiotherapy can also help people understand the limitations that RA presents, which in itself can be a benefit in helping people help themselves.

To conclude, the final speaker of the evening was Eamonn Brady, MPSI, Pharmacist at Whelehans Pharmacy who gave an initial overview of medications used to manage RA. So, initially, looking at medication to reduce pain and then drugs aimed at slowing down the progression of the disease, pointing out that whilst there is no cure for RA, the correct and appropriate use of medication can have a significant positive effect on living with the condition. Supporting Dr O’Rourke earlier position that the earliest possible diagnosis is ideal and then the initial introduction of DMARD’s (Disease Modifying Anti-Rheumatic Drugs) to slow disease progression.

Eamonn highlighted that paracetamol is rarely effective against the pain of RA but may be used to augment other pain killers while waiting for longer term solutions like DMARDs to work. He cautioned however against the long term use of codeine based medications such as tramadol and Solpadeine^® and potential addiction risks.

Moving on to discuss NSAID’s (Non-Steroidal Anti-Inflammatory drugs), Eamonn indicated that whilst these offered relief, they would not affect the progression of RA and should not be used longer term. Giving examples such as diclofenac and etoricoxib, Eamonn stated that these should not be given to patients with heart problems or who had a high stroke risk.

Eamonn went on to discuss DMARD’s in more detail, giving an overview of how they work and, as they slow down the progress of the disease, the benefit of early referral. DMARD’s treatment can only be initiated by consultant, so, some of the initiatives mentioned earlier by Dr O’Rourke to speed the process of GP – Consultant referral will help massively.

Commonly used DMARDs include methotrexate, hydroxychloroquine and sulfasalazine. They can be slow to work, however Eamonn stressed the need to maintain the treatment as it can take some time to find the right one and for the benefit to materialise. A key point regarding Methotrexate was that it should only be taken weekly.

To conclude Eamonn discussed the various Biological treatment injections available. Traditionally, these would be a “last resort” for those with severe RA, however, with medical advances, these are now being promoted earlier to improve response to treatment overall. Mostly given by sub-cutaneous injection, can biologics can be used in conjunction with DMARD’s if needs be. In Ireland, Enbrel^® and Humira^® would be the most commonly used biological brands. More than 650 RA patients now take biological treatment at the Midlands RA Service.

Local Support

Westmeath Branch of Arthritis Ireland supports a vibrant community of 17,000 people living with Arthritis in the County.  The committee is made up of people living with arthritis so they understand the challenges that a chronic condition brings.  Your local committee are here to support you and offers a wide range of activities, information and training that will help you to live well with arthritis. If you have any further queries, Westmeath Branch contacts are: Margaret Egerton, Chairperson 0857587171 or Secretary 0871413225 (Branch Phone). You can follow the Westmeath Branch of Arthritis Ireland on Facebook.

Check www.arthritisireland.ie or Locall 1890 252 846 for more information

Drugs in Sport (Rio Olympics Special)

With the Rio 2016 Olympics now underway, we’re coming into the business end of the event……track and field.  Many of the worlds elite athletes will be competing for gold, chasing personal bests, new world records and the ultimate rewards in their sport……… but not all. In the run up to these Olympic Games, you could hardly switch on the news without another drug / doping related issue making the headlines, with subsequent bans, exclusions (from individuals to whole countries!) before a starting gun had fired in anger. In this article I want to give you an overview of the current rules and regulations governing and working towards “drug / doping free sport”.

Doping in sport is nothing new…… perhaps since ancient times but more particularly in the last 40 years, the spectre of doping and the “clean or not clean” question has been ever present in global sport. In the Olympic context, for many, their first real awareness of doping came with the banning of Ben Johnson following his winning gold in the Olympic flagship event, the men’s 100m at Seoul in 1988. Stripped of his medal following a positive test for steroids this led many to start asking questions about all athletics. Over the intervening years since there have been many high profile drugs related issues in many sports with athletics, cycling (Lance Armstrong being the most infamous) and swimming being the most prevalent, but present at some level in many more.

Why to people cheat in sport

Why do sports people and athletes in particular take drugs? There is no simple single answer to this question. However, given the risks, to health, career, lifestyle vs the potential rewards to be gained for success and victory at the highest level: prestige, money, status etc, this is most likely at the root of it.

For some, drugs offer faster recovery, harder training, for others, it’s a way to level the field in the belief that others are using drugs. Perhaps an athlete has been injured and needs to “catch up” or maybe simply a lack of knowledge or education regarding drug use or the mistaken belief that the chances of getting caught are comparatively small. Whatever the reason, where there is competition, there will always be those that are prepared to cheat to be the “winner”

Who tries to prevent drugs in sport?

It follows therefore, that where cheating through doping is present, there must be regulation to try to prevent and ultimately eliminate it. In sport today, this role falls to an organisation called WADA (World Anti-Doping Agency).  Formed in 1999, WADA is an international independent agency funded by sports authorities and governments with the overriding vision of “a world where all athletes can compete in a doping-free sporting environment”. Operating across all competitive sports and geographies, WADA monitor and enforce their World Anti-Doping Code (new 1^st Jan 2015) via the various individual countries sports regulatory authorities, which in Ireland is the Irish Sports Council.

The “banned list”

WADA also produce “The List” each year. First produced in 2004, it is the definitive guide to substances or methods which are prohibited. Compiled and reviewed annually by a panel of 13 experts, it is issued each January 1^st. It was this review that Maria Sharapova fell foul off in January this year when she tested positive for a substance (Meldonium) which was a new addition since the 2015 list, although advisory notices had been issued in September 2015. This resulted in a two-year ban for the Russian tennis star.

The list is divided into 9 sections across 7 main classes: -

–         Stimulants (e.g. caffeine, amphetamines, cocaine)

–         Build Muscle / Bone (e.g. anabolic steroids, human growth hormone)

–         Relaxants (e.g. Alcohol, Beta-Blockers, Cannabinoids)

–         Mask Drug use (e.g. diuretics, epistestosterone)

–         Reduce Weight (e.g. diuretics)

–         Increase Oxygen Delivery (e.g. EPO, Blood Doping)

–         Mask Pain (e.g. Narcotics, Cortisone, local anaesthetics)

The above is purely indicative to show the differing areas covered. The actual list itself is a comprehensive and detailed description of exactly what is prohibited and is available for download or perusal from the WADA website (www.wada-ama.org).

What if an athlete needs a banned substance for a medical condition?

At some point, it may be necessary for an athlete, participating at international level or who is part of a registered testing pool in the Anti-Doping programme, to be treated with a medicinal product contained within the list, for legitimate medical reasons. In this case they may apply to WADA (via the Irish Sports Council) for a TUE (Therapeutic Use Exemption). There are a number of criteria that are used to determine whether a TUE will be granted. Irish Sports Council (ISC) policy regarding TUE’s is that the applicant should first consider any alternative treatment or medication that may be permitted rather than using a prohibited substance. If no suitable alternative is available, then the applicant should be guided by ISC policy to ensure compliance with TUE. Worth noting here that with Asthma being such a common condition, most of the commonly used inhaled medication is now permitted either in full or up to certain levels. The only time a TUE is required would be for Terbutaline (Bricanyl^® inhaler), which is better known as a “reliever” or “blue” inhaler to asthmatics. Terbutaline is a similar drug to Salbutamol in Ventolin^® inhalers.

The ISC also lay out a TUE policy for lower levels sports, (i.e. GAA Senior, national athletes in cycling, swimming, boxing etc.) that enables them to take the prohibited substance for genuine medicinal purposes and then if necessary, complete a “Post Test TUE”.

As you would expect, all TUE applications must be fully supported with the relevant medical history and information with details of health professionals involved.

Testing

The key to the success of any Global Anti-Doping programme is the gathering, storing and sharing of information. WADA maintains a system known as ADAMS (Anti-Doping Administration & Management System), a web based database management system which securely collects data such as an athlete’s whereabouts information, testing history (blood and / or urine), lab results and TUE management. The Irish Sports Council use a customised version of this called SIMON. All the information gathered then creates the athletes’ biological passport within the WADA infrastructure.

Top level elite athletes, subject to in or out of competition testing, are required to participate in the programme. Athletes have to provide a quarterly report of their “whereabouts” (time and place) to their relevant anti-doping agency, which is the ISC in the case of Irish Athletes. Once the information is within the database, the random testing programme is in place. So, based on the athletes’ whereabouts report, anti-doping authorities can turn up and test. It is vitally important therefore for any registered athlete to keep their whereabouts information up to date with changes via web, or even text etc as the penalties for a “missed test” can be severe, with whereabouts violations bans of up to 12 months can be enforced. There was a furore over the participation in the Women’s Cycling Road Race event in Rio of the British cyclist Lizzie Armitstead due to the fact that she was allowed to participate, despite 3 “missed test” violations last year.

There is an abundance of mis-information around these days for athletes trying to find out information about or indeed obtain drugs, supplements etc. From magazines to friends or fellow sports people or from gyms to coaches, whilst some might be valid, as a general rule of thumb, it’s always best to check information with the proper authorities.

With nearly every category of prescription drug available for purchase online without a prescription, as well as performance-enhancing drugs, taking this route can be a minefield as it is completely un regulated and you really have no clue what you are buying or any guarantee of quality. In addition, it is a criminal offence to import prescription only drugs into Ireland or indeed to be in possession of prescription only drug without the relevant prescription. Customs and Excise have ramped up their vigilance on illegal drug imports and convictions are increasing also.

Dangers of supplements

In addition to drugs, there are many dietary or nutritional supplements advertised that appear to offer amazing results in terms of performance improvement, again, many recommended by someone in the gym or a fellow competitor. In most cases, there is absolutely no actual evidence to support the claims made.  As they are not medicines, they are not subject to the same rules when it comes to description of ingredients or labelling. There have been incidences where supplements have contained an undeclared prohibited substance, which then show up as an adverse finding in a test.

Allegedly, it was just such an adverse finding that resulted in the boxer Michael O’Reilly being eliminated and sent home from the Rio Olympics following a positive test for a prohibited substance on 4^th August. According to him, it was in a supplement he took.

In general, the ISC advise against the use of supplements believing that correct diet and balanced nutrition should provide anything a supplement claims to offer.

Creatine

One substance that often comes up in the “supplement” discussion is Creatine. Widely promoted via health and fitness publications and websites as a muscle, stamina and power builder, (kidney) it is not a prohibited substance. General advice would be to view and assess its use in the same way as supplements. Direct effects of consumption include weight increase and water retention. There is no evidence that long term use would have any adverse effect, there is some slight concern on the possible long term effect on renal function. The Irish Sports Council website offers comprehensive advice and information regarding the anti-doping programme and enforcement in Ireland. (www.irishsportscouncil.ie)

No shortcut to success

If you are engaged in sport, at whatever level, like anything in life, there is no shortcut to success. In general terms, you get out of it what you put in. If you are in any doubt at all about what you can and cannot take, it is always best to consult a health professional, either your GP or your Pharmacist or perhaps a specialist in Sports Nutrition before you take it!!! or indeed check out any of the online resources outlined above.

Updated by Eamonn Brady MPSI in Aug 2016 to coincide with the Rio Olympics.

Whelehans Pharmacy, 38 Pearse St, Mullingar (Opposite the Greville Arms Hotel). Tel 04493 34591. www.whelehans.ie or info@whelehans.ie. Find us on Facebook

Asthma: get the facts

Asthma is a long-term condition that can cause coughing, wheezing and/or breathlessness. With asthma, the airways become over-sensitive and react to things that would normally not cause a problem, such as cold air, exercise, animal fur, pollen or dust. Muscles around the wall of the airway tighten up. The lining of the airways swells and sticky mucus is produced.

Approximately 470,000 people have asthma in Ireland. Ireland has the fourth highest prevalence of asthma in the world after Australia, New Zealand and the UK. Asthma in children is more common in boys than in girls. Children who develop asthma at a very young age are more likely to 'grow out’ of the condition as they get older.

There is no cure for asthma. Treatment is based on relief of symptoms and preventing future symptoms and attacks. Successful prevention is through a combination of prescription only medication, lifestyle changes and identification and avoiding asthma triggers.

Short-acting beta 2-agonists inhalers work quickly to relieve asthma (eg) Ventolin^® inhaler. If an asthmatic needs to use their beta agonist inhaler too regularly (three or more times per week), they should have their therapy reviewed. Excessive use of short-acting relievers has been associated with asthma deaths. This is not the fault of the reliever medication, but is down to the fact that the patient failed to obtain treatment for their worsening asthma symptoms.

Preventer inhalers reduce inflammation in the airways and prevent asthma attacks. The preventer inhaler must be used daily for some time before full benefit is achieved. Preventer inhalers contain an inhaled corticosteroid. (eg) Becotide^® inhaler

If short acting beta 2-agonist inhalers and preventer inhalers are not providing sufficient symptom relief, a long-acting reliever (long acting beta 2-agonist) may be tried. Inhalers combining an inhaled steroid and a long-acting bronchodilator (combination inhaler) are more commonly prescribed than long acting beta 2-agonists on their own. (eg) Seretide^®, Symbicort^® inhalers.

If treatment of asthma is still not successful through use of inhalers alone, options include oral leukotriene receptor antagonists (eg. Singulair®) and oral theophylline (eg. Uniphyllin®, Phyllocontin®). If asthma is still not under control, regular oral corticosteroids may be prescribed.

Asthmatics who are pregnant should manage their asthma in the same way as before pregnancy. Most medicines used for asthma have been proven to be safe to take during pregnancy and when breastfeeding. The exception is leukotriene receptor antagonists (eg. Singulair®).

This article is shortened. More detailed information and leaflets on Asthma is available in Whelehans or at www.whelehans.ie. Tel 04493 34591

Disclaimer: Information given is a very general overview of asthma; ensure you consult with your healthcare professional for specific advice

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie