Archive for the ‘Living with Allergy’ Category

Many countries have special schools for children with severe asthma and other allergies. Italian children are sent to one in the Italian Alps, where there is no trace of pollen, house-dust mite, or animal allergens. After nine months these children are a great deal healthier and more active - all their lung function tests are vastly improved. Blood tests show that they are actually less allergic to common allergens than before.
You may not be able to do quite this well at home, but all allergens and irritants can be avoided to some extent. Even if you can’t eliminate them completely, you can certainly reduce your exposure.
Before you start, it is important to be clear about exactly what affects you, otherwise you will be wasting a lot of effort. For example, people who are allergic to dust mite often think that a dusty house will necessarily be worse for them than an apparently clean house, but this is not so (see p. 115). Or they may say ‘Oh, I got asthma on holiday, because the roads were so dusty and I’m allergic to dust,’ forgetting that only house dust contains dust mites. The road dust may have acted as an irritant, and helped to spark the asthma attacks, or it may have contained pollen or mould spores - but it does not contain dust mites or their allergens. Blaming the wrong thing for the asthma attack means that the real culprit is not identified.
If you are not absolutely sure what causes your allergies, skin-prick tests (see p. 91) can identify the allergen. These are especially recommended if your reactions to the presumed allergen are inconsistent, or you don’t respond to the anti-allergen programmes described here. For example, a few people who react to house dust are not allergic to dust mites, but to something else in the dust such as wool fibres or mould spores, or particles from cockroaches, house
flies, carpet beetles or a long-departed cat. Even pollen that has accumulated in house dust can provoke allergic reactions - if you are not an over-keen duster, it can still be there long after the pollen season.
If you have hayfever, knowing which pollens cause your symptoms (and learning to recognise the plants concerned) is useful. You will probably need skin-prick tests to be sure. ‘Hayfever’ can even be a seasonal mould allergy in some people (see p. 27).
Tackling allergens is now big business. There are a lot of people out there competing for your money and false claims are common, especially for anti-mite products. Only a few manufacturers are deliberately misleading, and most false claims probably stem from ignorance or wishful thinking, but be very sure you know the facts about your allergen before you buy.
Air cleaners are a good example. A really good quality air cleaner (which uses a HEPA filter - a High Efficiency Particulate Air filter) is an expensive purchase and, as the advertising tells you, it takes out very small particles with staggering efficiency. But this is entirely irrelevant if the source of those particles is no distance at all from your nose - your mite-infested pillow, for example, or the cat on your lap.
Something else that advertisements for air cleaners rarely mention is that unless you reduce allergen production - tackling mould growth in the house, for example, or keeping the dog outside - the filter can’t help much. In short, air cleaners do have their uses for some allergens, but they can’t work miracles.
The products mentioned here, if not available in your locality, can be bought mail-order from specialist suppliers of anti-allergy products (see p. 255). Note that some offer both very good products and distinctly doubtful products, so judge each item on its individual merits. Ask to see scientific evidence that it works.
Don’t be taken in by vague statements such as anti-allergenic’ - get the facts. This label is often used on pillows with synthetic filling, for example, and people assume that it refers to dust-mite allergy, whereas it simply means that the pillow does not contain feathers. But unless you are allergic to feathers, there is no reason to avoid feather pillows. (In fact, if not covered with mite-proof covers, synthetic pillows collect more dust-mites than feather pillows, because the fabric used for the cover is less tightly woven and the mites and skin particles get in more easily.)
Bad advice is also a hazard. Some of it just wastes your time and effort, but some could actually increase your exposure to the allergen. Advice to vacuum floors daily, or to vacuum beds, is commonplace but this achieves little and it means breathing much more allergen unless you have the right kind of vacuum cleaner. One health magazine even advised its readers with dust-mite allergy to ‘air mattresses by regularly turning them’. This will not affect mite numbers at all, but it will shoot massive amounts of mite allergen out of the mattress and into the nose and lungs.
Ridding your house of allergens and irritants is, in itself, a hazardous procedure because more of the offending substances will be released into the air during the work. If you take up carpets or remove mattresses, dust-mite allergens and mould spores will be churned up in their millions. Just bundling up a duvet will produce invisible clouds of dust mite allergen - and cat allergen, if your pet once slept on the bed.
Ideally, the allergic individual should not do the work, nor be in the house until it is 100% complete and the house has been very thoroughly aired. This is particularly important for those with chronic sinusitis and mould growth in the house, because of the risk of fungal infections in the sinuses (see p. 32).
If you are an allergy sufferer and have absolutely no choice but to do the work yourself, or to be present, then you should get a good quality dust mask and wear it throughout - only take it off when you go outdoors. Those with atopic eczema and sensitivity to airborne allergens should cover their skin carefully -with clothing, not barrier cream.
An ordinary hardware-shop dust mask is not adequate for most allergens - it only takes out really big particles and lets through all the common airborne allergens except pollen. You need a more serious sort of mask, designed for workplace use and conforming to official standards. Before buying one, ask what is the smallest size of particle that it filters out (at 90% efficiency, or better). Compare this with the particle size of your allergen (given in the articles that follow).
You must be able to breathe well through the mask when physically active, and it must fit tightly against your face, forming a seal at all edges. Beards and moustaches tend to prevent this - as does stubble.
Masks that combine an activated carbon filter with a dust filter will take out gases and chemical vapours as well as particles. Cycle shops now sell such masks -or try an industrial supplier. Such a mask can be useful if you are affected by traffic exhaust or industrial pollution as well as an allergen, for example, or if you are exposed temporarily to wet paint or other fumes at home. Activated carbon masks should also filter out the irritant substances from oil-seed rape plants.
Some people who try the anti-allergen programmes feel much better quite fast. But generally these are long-term strategies - you may not reap any benefits for a few weeks, and the improvement may be small at first. Sometimes it takes several months for the full effects to be felt, so be persistent.

Suffering from a long-term illness, especially if it is severe and sometimes limits activity, can easily make a child feel different from other children, and ‘not good enough’. Children with allergies, especially those with severe asthma or food allergies, may also be very frightened and anxious. At the same time, such children often feel that they have to protect their parents by not revealing their fears.
Children may also think that their illness is a punishment for something they have done wrong. Their guilty feelings can be so powerful that they may not confide in you unless you spend time talking with them about their illness, and encourage them to share their feelings with you.
One of the most valuable things you can do for children with allergies is to build up their self-esteem. This is especially important when they first start school, because they have to adjust to other children there, and learn how to deal with questions about their illness, as well as some unkindness.
For children whose allergies limit what they can do physically, or restrict some normal activities, try to find other interests and hobbies that the child can do well. When talking with the child, always emphasise the positive things – the difficulties that you have overcome together in the past, the measures that the child can take to keep the symptoms under control (such as stopping scratching, applying creams, or using a preventer inhaler) and the areas of Iife where he or she is particularly successful. As the child gets older, introduce the idea that coping with illness makes you a stronger, kinder and more resolute person, one who can cope with any of life’s challenges. Show the child how much you value their maturity and perseverance.
Pay attention to what the child’s friends are
saying – a bit of eavesdropping is allowed – and be prepared to counteract any negative messages. Teach your child to be strong and self-confident about choosing their friends, and to prefer those who are sensible, understanding and supportive. Ask casually about what schoolteachers and other adults say when you are not around, because they can, without meaning any harm, undermine a child’s confidence with thoughtless remarks.
For children with problems that are potentially life-threatening, such as true food allergy, your natural anxieties as a parent can lead you to be overprotective. This can make the child feel smothered, but letting go is far from easy. You somehow have to find a middle path that works for you both.
With asthmatic children, focus on letting them live as normal a life as possible. Avoid saying ‘no’ automatically to things that might induce an asthma attack – such as running around outdoors in cold weather. Take some small risks, and let the child make the decision sometimes – he or she will gain a lot from taking the responsibility, especially if the decision is the wrong one.
This is the only way for children to learn how to manage their own condition. The sooner you can begin letting go, the better the child will cope in his or her teenage years, when it really will be necessary to make some difficult decisions without your help.
A pitfall for parents
In bringing up a child with allergies, remember that there should never be any ’secondary gain’ from illness – absolutely no advantages to having the eczema get worse (easily done by scratching) or starting an asthma attack (some children can bring one on by breathing in a particular way).
If your child has to take time off from school because of ill-health, ask the teacher for work that can be done at home, and check that it really is done. Children who are allowed to benefit from being ill can establish an unhealthy pattern for dealing with life’s difficulties (see pp. 94-5), which may be long-lasting. Such a mind-set can seriously limit a child’s development.
Incidentally, the ’secondary gain’ from illness may be quite altruistic in nature. It can include stopping parents from arguing, or from nagging a naughty brother or sister, as well as more obvious things such as getting a parent’s attention – so be aware of all the circumstances in the family that are affecting the child.
Sometimes a child realises, unconsciously, that attending to illness gives a parent welcome distractions from emotional problems and a comforting feeling of being needed and useful. The allergies can become part of the structure of a family, the glue holding everyone together.
Conversely, long-term illness can tear families apart: according to recent research carried out in the United States, divorce is more common in families where a child suffers from severe asthma.
Doctors frequently notice that severe eczema also can create a lot of tension in the home.
If you feel that a child’s illness is affecting the family badly – in whatever way – talk to your doctor, or someone else who you trust. You may need the help of a counsellor or family therapist to sort things out.
Children and medicines
Parents often feel very anxious about all the medication an allergic child uses. On the whole, the drugs prescribed for allergy are very safe, and only children with severe disease are at risk of significant side effects. These children will be carefully monitored by the doctor.
Needless to say, if you can cut down on the drugs by reducing allergen exposure, avoiding irritants (e.g. tobacco smoke) and implementing some of the other measures described in this book, you should do so. But if the child still needs drugs to control the symptoms, it is far better to accept them than to let the child struggle with all the discomfort, limitations and distress that the illness imposes.
Parents who are very concerned about drugs should talk openly to the doctor about their fears. If there are differences of opinion about drugs within the family, try not to expose the child to the disagreements. Sort out a joint policy in advance and always present a united front to the child. Be consistent and reassuring about drug use, otherwise the child may feel confused and anxious about the situation – or may even learn to manipulate it.
The asthmatic child
Children with asthma should have a management plan (see p. 96) and may benefit from using a peak-flow meter (see p. 97). Once your child is old enough to comprehend the difference between preventers and relievers, explain that using the preventer regularly keeps asthma under control, which means no sudden attacks and less need to use the reliever in public — something which most children find intensely embarrassing. You should oversee the child’s treatment closely until the age of seven or eight, then gradually let the child take over some of the responsibilities.
Coping with food allergy
The following concerns true food allergy (see p. 62), which can be life-threatening, not idiopathic food intolerance (see p. 74).
Protecting a child with severe food allergies is a major task. You will find it enormously helpful to be in contact with other parents who are facing the same challenge. The practical details are everything here, and you can benefit from other people’s ingenuity in solving day-to-day problems. Several support groups exist (see p. 255), offering a wealth of advice.
For very small children, the main task is to ensure that everyone who looks after the child understands exactly what can and can’t be eaten. Child-minders and baby-sitters should spend time with you as ‘apprentices’ seeing what is involved in preparing food for the child – this is far better than just giving verbal instructions. Also make sure that everyone knows how to use the adrenaline auto-injector (see pp. 98-9).
Once children start going to parties, you should always stay at the party for the whole time, and supervise your child closely. Take food that your child can safely eat, but which other children can also share. Some parents put a label on toddlers warning other adults that certain foods are taboo – for children under reading age this is probably acceptable, and does allow you to relax a little, but with older children the dangers of being teased or stigmatised should always be borne in mind.
Plan ahead all the time. Keep a snack box in the car containing food that the child can safely eat. Whenever you go on a trip, however short, have some safe foods with you, in case you get stuck somewhere and the child gets hungry. If you go out to eat, exert maximum caution about the restaurant food (see p. 111). Some parents take along a guaranteed-safe, but super-delicious sandwich or burger, and ask the restaurant to warm it up in a microwave (where appropriate) and serve it at the same time as the other food. If you do this, be sure the staff understand that the food must not touch any other food.
At home, some parents opt for everyone eating the same allergen-free food, on the basis that this makes for being ‘a real family’. Others, finding this too problematic or expensive, make a virtue out of the allergic child having a different meal. ‘I try to make her feel special about having her own food. The allergen-free dinner or cake always looks and tastes really good.’
As children get older, and more independent, you need to educate them thoroughly about avoiding the offending food. Equip them for difficult situations by role-playing. Act out being offered a tempting item of food by another child, and being jeered at for refusing. Act out suffering an allergic reaction to food and getting help quickly, even though people around don’t understand and are uncooperative.
Allergies and schools
When your child starts at a new school, creche, or kindergarten, request a meeting with staff and teachers to talk about the child’s allergies if there is any likelihood of these becoming a problem. Do this well before your child starts at the school, so that any necessary changes can be made. If your child has a serious food allergy or severe asthma, you may have to make several visits because there are usually a number of different people you should meet, and follow-up sessions may be needed with some staff. If all this sounds daunting and ‘not my style’ then you need, for the sake of your child, to develop your skills in dealing with people and being assertive. Talk to a counsellor, or look for suitable training courses.
In addition to ensuring that the school takes good care of your child’s health (see below), you should also discuss wider issues of adjustment to school life. Teasing or bullying can be a problem for children with any kind of health problem. Ask the teacher to keep an eye on your child and ensure that he or she is coping well – for example, that there is no difficulty about using an inhaler in front of other children when necessary.
Eczema
Ensure all staff realise that the skin rash is not infectious, and that they are aware of the need to communicate this to other children. The appearance of the skin can create a lot of problems with class-mates, and teachers need to be alert for taunting remarks or hurtful nicknames.
Unfortunately, children with eczema are very susceptible to infections caught from others, such as impetigo (see p. 44), but you can’t really protect children from such infections without isolating them socially. The best way to tackle this problem is to deploy all the available treatments so that your child’s skin becomes stronger and more resistant.
Food allergy
If your child has food allergy, go and see the catering manager personally. It may be helpful to take some printed material on food allergy with you, plus lists of synonyms for food ingredients (see pp. 172-4) where appropriate. Concentrate on building up a good relationship with catering staff, while ensuring that they understand how dangerous certain foods can be to your child.
Many parents feel more relaxed if they supply their child with a packed lunch that they know is allergen-free. This is often a good strategy, but don’t be complacent. Most allergic reactions in schools involve food given or traded by another child with entirely good intentions. Some schools with food-allergic children have set up a ‘no trading food’ policy, which seems to work well. Other schools establish milk-free or nut-free tables in the canteen, so that friends can sit together and trade food safely. (The mothers of the other children sitting at these tables need to be well versed in food avoidance, of course, so that their packed lunches are as safe as your own.) In the United States, schools have sometimes tried banning nuts or peanuts altogether, where there is a nut-allergic student, but this does not work well.
Some parents prepare a printed information sheet about their child’s food allergy, with a photograph of the child, and put these up at strategic points around the kitchen and canteen area. This information can include instructions on how to deal with anaphylactic shock (see below) and who to contact in an emergency.
Finally, include the art teacher in your rounds – foodstuffs are often used in art and craft projects.
Anaphylaxis
For children with severe food or insect-sting allergies which can lead to anaphylaxis, check that everyone at the school understands the potentially fatal nature of this condition. Key staff must know how to recognise anaphylactic shock and exactly what to do: show them how the adrenaline injector kit works. You could take along an old one, so that they can practise (see p. 150). Injector kits and adrenaline inhalers must be within easy reach, never locked in a cupboard.
Repeat this educational process at the beginning of each new school year, and before school trips. As an additional precaution, your child should wear a bracelet or pendant (see box on p. 95) that informs medical personnel about his or her allergies –this is also vital for children with latex or drugs allergies.
Asthma
If your child has asthma, ask what arrangements are made for inhalers. Children who can take responsibility for their own treatment should keep their inhalers with them. For younger children, the inhaler should be in the classroom, somewhere that is easily accessible (never locked away) and should be taken along during breaks and mealtimes. The child must always be able to get to the inhaler quickly: even a small delay in using it when an attack occurs can have dire consequences. Make sure everyone at the school understands this, that they know how to recognise an attack, and how to react. Assure the teacher that there is little danger of an asthmatic child overdosing, and if other children take a few puffs they will come to no harm.
If the teacher seems to believe that asthma is a psychological problem (some still do), go and see the head. Suggest that a local asthma nurse or doctor comes in and talks to the staff and pupils about asthma.
Ensure that the teacher knows about the effects of cold air and exercise on asthmatics. Talk to the games teacher or sports coach, and the playground attendants. It is vital that the games teacher is encouraging but understanding towards asthmatic children. They should never be told to continue exercising if they feel breathless.
Allergens and irritants in school
Schools today often have soft furnishings and carpets – these may be full of dust mites. If your child is allergic to mites, and if allergy symptoms are frequent at school, have a look around the classroom and see if this might be the cause. Before discussing the problem with the school, learn all you can about dust mites (see p. 114-117) so that you can assess whether proposed solutions to the problem would actually work.
Pets are common in classrooms and they can cause allergic reactions in sensitised children. Moulds flourish in many school buildings, and will affect a child with mould allergy. Poor ventilation is sometimes a major problem in school buildings, especially those where windows cannot be opened.
Irritants in school air include glue, paint, the solvents from felt-tip pens, disinfectants, air fresheners and the fumes produced during science lessons. Make sure the science teacher is aware of the risks and always uses a fume cupboard if irritant gases such as nitrogen dioxide or sulphur dioxide are likely to be given off during an experiment.
Applying sunscreens to children’s skin is now routine in many schools and preschools. Teachers probably won’t think to ask permission, so if your child is sensitive to any common ingredients of creams or sunscreens, let them know in advance.

Let’s hope it never happens - but if it does, knowing what to do could make the difference between surviving and not surviving. The sensible thing is to read these pages - or whichever parts are relevant to you or your child - before you encounter an emergency. It is often helpful to rehearse the procedure in your mind and actually imagine yourself going through the actions described here.
Find out in advance what the local ambulance service is like, and ask your GP for advice about who to contact in an emergency. (If you have latex allergy, check in advance that all local ambulances carry a latex-free kit.) These are the options:
• Call your GP.If the doctor is nearby and the hospital or ambulance station a long way off, this may be the best decision. Doctors in rural areas may have supplies of adrenaline for emergency treatment, and oxygen for those suffering a severe asthma attack.
• Call an ambulance. Where the local ambulance service is dependable, this is always the best option. The ambulance crew will have adrenaline and oxygen.
• Go by car or taxi to the nearest hospital
emergency department. This is not usually a
good plan, because your condition may quick-
ly get worse, and you have no emergency
treatment available. But there may be situa-
tions where it is a sensible decision. Emergencies can occur when you are away on holiday or business. Never stay anywhere without a phone – check that it is working as soon as you arrive. Make sure you have the number of a local doctor and know where the nearest hospital is. A remote holiday cottage can be a dangerous place to suffer an asthma attack or anaphylactic shock.
Anaphylactic shock
This is an extremely serious emergency, requiring immediate medical help. The signs of anaphylactic shock are listed on p.58. In the case of food allergy, there are additional signs in the mouth, lips and throat (see p. 62). Use adrenaline (epinephrine) straight away if you have it – but get emergency medical help as well. With injectable adrenaline (an EpiPen or Anapen – see p. 150), remove the cap and jab firmly into the outer thigh, going straight through any clothing. Never inject into any other part of the body – this can be dangerous.
If you have an adrenaline inhaler (see pp. 155-6) you can use this first to treat symptoms in the mouth, throat and airways, and then use the injector if you still have symptoms. (Improvise a spacer – see p. 100 – if there is difficulty in inhaling the adrenaline.) Anyone whose reactions tend to be severe should use the injector first and follow up with the inhaler if necessary. Overdosing with adrenaline is possible, and can be fatal, but using the inhaler as well as the injector is safe as long as you don’t have a heart condition (see pp. 155-6).
If you do not improve after using the injector, a second one can be used, 10-15 minutes later.
In situations where medical help is not yet available and the symptoms are not abating, another shot of adrenaline can be given every 15-20 minutes. But the maximum number of shots recommended by your doctor should never be exceeded. Keep count of how many you’ve had, and tell medical staff.
An asthmatic who does not have an adrenaline inhaler can use a beta-2 reliever inhaler such as Ventolin (see p. 152) as well as the adrenaline injection, although it probably won’t help very much.
Suppose you know for sure that you have encountered your allergen, but you don’t have any symptoms yet? In Britain, the usual advice is to wait for symptoms, but doctors in the United States say go ahead and use the adrenaline injector if you have reacted very badly in the past. In general, for people with no other health problems, it is better to give an adrenaline injection which isn’t needed than to delay giving one that is needed. Delaying the use of the injector may mean that the reaction gets out of control. Some people put off using the injector because they think it should be saved for when they ‘really need it’. In fact the adrenaline works just as well if you have used it on previous occasions.
Following anaphylactic shock, you should be kept in hospital for 6-12 hours even when everything seems fine. Attacks have recurred as much as eight hours later. Corticosteroids reduce the chance of this happening – ask if these have been given. If you are discharged early and it is a long journey home, consider waiting in the hospital, or nearby, until eight hours after the original reaction.
First aid for anaphylactic shock
A badly swollen tongue or throat can cause suffocation. If there is visible swelling and the person is unconscious or turning blue, try to keep the top of the trachea (the main airway leading from the throat) open. Use the handle of a spoon – one that has very smooth edges. Slide it carefully over the top of the tongue and into the throat. Press down gently but firmly to open the airway.
Someone who is feeling faint or dizzy, or losing consciousness, or (in the case of a child) becoming very pale and floppy, may be suffering from a dangerous drop in blood pressure. He or she is more at risk of a fatal collapse if in an upright position, because not enough blood is reaching the heart. The worst thing is to stand up suddenly, or to move (or be moved) quickly from a lying to a sitting position –death can follow within seconds. The best thing is to lie down, preferably with the legs resting on cushions or a stool so that they are above the torso, and with the arms raised above the chest. Adrenaline can be given while in this position. A stretcher should be used to get the patient to an ambulance.
Latex allergy and emergency treatment
If you have anaphylaxis due to latex allergy, going to hospital can be alarming, as you may suffer further reactions to latex gloves or equipment. Some patients with latex allergy have had such bad experiences in ambulances and hospitals that they become fearful of using their adrenaline injector, since this means they must go to the hospital afterwards. They delay using the injector, which makes the situation worse. Some doctors are now giving such patients all the medicines and training they need to manage their anaphylactic shock themselves, so that they don’t need to attend hospital.
A person who has lost consciousness should be lying down on their side in case they are sick (this reduces the chance of them inhaling their vomit). The same goes for anyone who feels nauseous.
On the other hand, if the major problem at the outset is difficulty in breathing (as it generally is in children) a sitting position is better.
It is unusual for both faintness and severe breathing problems to be present at once. If this occurs, the patient should lie down, and if there is swelling in the throat, a spoon should be used (see left) to keep the airways open.
Insect-sting allergy
If you don’t have an adrenaline injector, get medical help immediately.
If you’ve had a cutaneous systemic reaction (see p. 60) in the past, use the adrenaline injector if there is any difficulty in breathing, hoarseness, stomach cramps, diarrhoea, nausea, faintness, dizziness or confusion. If you are unsure, remember that, unless you have a heart condition, it is usually better to overreact (i.e. use the adrenaline unnecessarily) than under-react.
If you’ve had a severe systemic reaction (i.e. anaphylactic shock) in the past, use an adrenaline injector at the first sign of any reaction other than immediately around the sting.
If there is a honeybee stinger left in the skin, scrape or flick it out sideways using a fingernail, knife blade or credit card – the venom sac is attached and will go on injecting venom for up to 10 minutes if you leave it there.
Don’t try to pull the stinger out – this squeezes the venom sac and pumps more venom into the skin.
Get emergency medical help, and follow the other measures for dealing with anaphylactic shock (see left).
Don’t go alone
If you suffer vomiting or diarrhoea during anaphylaxis, and have to go to the toilet, tell someone to call an ambulance and take someone else with youto the toilet. Do not go in alone and lock the door, in case you collapse.
Asthma attacks
Even those with mild asthma, who have never had a serious attack before, can quite suddenly get into difficulties and require emergency treatment. Don’t be over-anxious about this, because it is unlikely to happen – but do be prepared. Not having your reliever inhaler with you when a severe attack starts is a recipe for disaster – always take it, wherever you go.
Deal with an attack promptly. The sooner you act, the fewer drugs you’ll need in the long run to control the attack. Most asthmatics wait too long and then under-treat their asthma.
The important thing is recognising an asthma attack, and knowing when it is getting out of control. Not all attacks are the same – some come on fast, some come on slowly.
Rapid asthma attacks come on in a matter of hours. You may have been fine all day, but then start to feel very breathless and wheezy, or begin coughing badly. Less than an hour later, despite using the reliever, the breathlessness is worse and it is a struggle to speak or walk across the room. This is a severe attack: don’t delay in getting medical help.
Slow asthma attacks come on over a period of days. At first you are more breathless and wheezy than usual, and your reliever inhaler is not helping much. Asthma wakes you up at night, and you are far more breathless than usual in the morning. This could be the beginning of a severe attack, so don’t delay in getting medical help. If you get to the point where your asthma is disturbing your sleep every night, and in the morning you have difficulty in speaking or walking about, this is a very serious situation – you must see your doctor or go to the hospital now.
A few asthmatics have great difficulty recognising when they are increasingly breathless, and for them, using a peak-flow meter (see p. 97) every day is essential. Indeed, most asthmatics find
Recognising an asthma attack in a very young child
With a young child, these signs indicate a severe asthma attack:
• the nostrils are flared
• the shoulders are unusually high
• the child can say only one or two words between breaths
• the ribs are pushed out, and the spaces between the ribs, and below the chest cage, are sucked in during breathing
• you can hear wheezing (a whistling noise)
• the lips, tongue or fingernails are blue.
If wheezing stops, without any other apparent improvement, this is a very bad sign — it may mean that the airways are now so narrow that no air is passing through them. This is called a ’silent chest’, and indicates an urgent need for medical attention.
that monitoring peak flow is a valuable way of spotting attacks in advance. However, if your peak flow seems normal, and yet you feel breathless and have a tight feeling in your chest, pay attention to your symptoms and get medical help.
Your response to your reliever inhaler is another helpful sign assessing asthma attacks. Things are serious if:
• the reliever inhaler does not seem to be working at all within 10 minutes of taking a puff
• it does not work as well as usual
• it works, but the effect wears off in less than three hours. If you have an asthmatic child, give everyone who normally takes care of the child detailed written instructions for recognising and dealing with an asthma attack. People forget verbal instructions especially in an emergency. A child who is exhausted or upset c. an attack should always be given medical care.
Taking action
If your reliever inhaler is not working well (see above), take another puff to open up your airways – and then take further action. as described below.
If you seem to be in the early stages of a slow asthma attack check your management plan, and if your peak flow has fallen below the recommended level, double the dose of inhaled steroids (twice as many puffs each time) now. Add any other medicines (e.g. steroid tablets) as recommended by the management plan.
Those who don’t have a peak-flow meter or management plan should double the dose of inhaled steroids and make an urgent appointment to see the doctor.
If you are suffering a rapid attack, or a slow attack that has got out of control, you need emergency medical help. Ring for an ambulance, ring your doctor, or go to the hospital – the ideal course of action will vary, depending on where you live (see p. 98).
Use your reliever inhaler until medical help arrives. You can take a puff every 5-10 minutes if needed, but keep a count of how many puffs you’ve had and stop after 30. Some doctors suggest taking up to 30 puffs all at once. (If you have a heart condition, this dose might be dangerous: follow your doctor’s advice.)
If it is difficult to inhale, use a spacer – this can make all the difference, especially for children.
You can improvise a spacer from a plastic cup, a plastic bottle, or a paper bag. Make a hole in the bottom of the cup or bottle, or in one corner of the paper bag, and insert the mouthpiece of the inhaler here. The open end of the cup, bottle or bag goes in or over the mouth – with the bag, you have to bunch it up and hold it around the mouth. Squirt the inhaler repeatedly into the improvised spacer, while breathing steadily in and out.
The six golden rules for asthma attacks
• Breathe as slowly as possible and concentrate on breathing out, not on breathing in. Exhale as fully as you can and your in-breath will follow automatically.
• Never panic – if you do, you may start hyperventilating, and this makes matters much worse (see p. 226). Panicky parents are the worst possible thing for an asthmatic child during an attack.
• Adopt a position that makes breathing as easy as possible. Propping your arms up at about shoulder height can help – for example, sit back-to-front on a dining chair, with your arms folded and resting on the back. Or put pillows on a table, sit in an upright chair, and rest your head and arms on the pillows. Don’t lie down, as this makes matters worse. Open a window, as long as the air outside is not cold, polluted or loaded with pollen.
• Avoid factors that can make an asthma attack worse, for example, vigorous activity, cold air, irritants and allergens.
• Drink plenty of water, fruit juice or other liquids as a lot of water is lost through the surface of the airways during an asthma attack, and you can become dehydrated.
• Don’t take anything to help you sleep, even herbal pills. If your asthma gets worse during the night, you need to wake up so that you can get more air.
After an attack
Asthmatics who have suffered a severe attack are occasionally sent home from hospital before they are completely better. A few people have died as a result of being discharged too soon. So if you feel breathless or otherwise unwell after you leave hospital, don’t hesitate to go back – or seek other medical help.
See your GP or specialist within a few days of any emergency treatment. Don’t be over-confident just after a severe attack – this can be a very vulnerable time. Take more rest than usual and drink plenty of fluids, as you may be dehydrated. Keep taking your preventer inhaler at the increased dose – reducing the dose now could lead to another severe, possibly fatal, attack. Keep taking steroid tablets if you have been given them.
If you produced a lot of mucus during the attack, try to clear it, but without violent coughing. Mucus can sometimes form solid plugs which block small airways. Treatment by a physiotherapist would help, and expectorants – drugs which help loosen mucus –can also be useful (ask your pharmacist about these). Don’t take ordinary cough medicine (see box on p. 163). There are also some breathing exercises which can help to clear mucus (see p. 231).
An asthma attack represents a chance to learn more about preventing asthma – so think about what went wrong. Had you forgotten to take your preventer inhaler regularly? How long is it since you had your medicines reviewed by the doctor or asthma clinic? Have you been using your peak-flow meter daily? Were you exposed to a high dose of allergen or an irritant?
A reaction to aspirin-like drugs
Aspirin sensitivity can begin quite suddenly in someone who has previously taken aspirin without trouble. If you have unexplained chronic urticaria, or polyps in the nose, plus asthma and/or rhinitis, the development of aspirin sensitivity at some time in the future is a distinct possibility (see p. 151).
A sensitivity reaction to aspirin or aspirin-like drugs usually begins between 30 minutes and two hours after the drug is taken. You will have some or all of these symptoms:
• a runny or badly blocked nose, and red eyes
• a feeling of warmth, flushing and sweating
• a general rash
• a sensation of tightness in the chest, a dry cough, increasing breathlessness
• malaise and exhaustion
• vomiting or diarrhoea
• swelling (angioedema) and/or nettle rash (urticaria). If you have such symptoms get emergency medical help immediately because the reaction can quickly develop into severe asthma, shock, collapse and unconsciousness.
If you have asthma, use your reliever inhaler as much as required (up to 30 puffs) until medical help arrives. Anyone who has an adrenaline (epinephrine) auto-injector, or an adrenaline inhaler, can use this as well – up to 30 puffs of the inhaler, or whatever maximum dose is given in the instructions. Tell the ambulance crew and doctors exactly what you have taken.

Allergies and Pregnancy
Great care is taken in prescribing drugs during pregnancy. This is something that doctors are now exceedingly cautious about, but do tell the doctor as soon as you decide to try for a baby. The foetus is most vulnerable to damage by drugs during the first three months, and especially the first few weeks after conception.
Your prescription will be changed if the drugs you are currently taking could pose any threat to the unborn child. A drug that has not had sufficiently rigorous testing for safety during pregnancy, or lacks a long track record, will probably be withdrawn. New drugs are generally considered to be slightly more risky than the tried-and-true older drugs: rare side effects may not come to light during the testing which precedes release of a drug, but they do become apparent once the drug is in widespread use for a long time (see pp. 136-7).
If you are already pregnant as you read this, don’t worry too much. With a few notable exceptions – certain antihistamines and antibiotics – most of the drugs used for allergic diseases do not pose any major risk to the unborn child. There is probably nothing to worry about, but see your doctor as soon as you can – and talk to a pharmacist, in the meantime, if you are concerned. Don’t panic, and don’t stop taking your drugs unless you are absolutely sure that you can do without them. Do not stop taking your drugs if you have asthma.
Some non-prescription medicines are best avoided during pregnancy. Read the packet carefully, and talk to your pharmacist if you have any doubts.
From the moment you start trying for a baby, remember to tell any medical personnel who treat you, and any pharmacist you buy medicines from, that you could be pregnant.
Immunotherapy and skin testing
Immunotherapy should not begin during pregnancy, because of the risk of anaphylaxis (see below), but pregnant women who are already undergoing immunotherapy can continue.
The safety procedures described on p. 166-7 should be followed with meticulous care.
Most doctors continue immunotherapy at a steady ‘maintenance dose’ because there is always a small risk of anaphylaxis with immunotherapy when the dose is increased. Some doctors are even more cautious and reduce the maintenance dose during pregnancy, but give more frequent injections – this minimises the chance of bad reactions.
Many doctors do not give skin tests for allergy during pregnancy, as these also carry a very small risk of anaphylaxis. If you do have skin tests, there must be resuscitation equipment available. Intradermal tests (see p. 92) are best avoided.
Severe allergic reactions (anaphylaxis)
Special care should be taken to avoid anaphylaxis during pregnancy as this may increase the chance of a miscarriage.
Injecting adrenaline during the first three months of pregnancy may carry some small risk of malformation of the baby. But the evidence here is uncertain, whereas the danger to your own life, if you don’t use adrenaline when you need it, is both certain and substantial. If you have an adrenaline self-injection kit, talk to your doctor now about what you should do in an emergency. The best policy is to be ultra-careful about avoiding your allergen, so that anaphylaxis does not happen.
Women who suffer from exercise-induced anaphylaxis (see p. 59) generally play safe by exercising less strenuously while pregnant. The problem can get worse during pregnancy, but it does not usually do so. Labour itself is very strenuous of course, but problems during the birth are uncommon. If anaphylaxis does occur, the reaction is usually quite mild – nettle rash only – and the baby is delivered alive and well. However, many women find that the attacks of exercise-induced anaphylaxis are more frequent and severe when they start exercising again after the baby is born. It is best to resume exercise very gradually.
Eczema and other skin problems
Atopic eczema may improve during pregnancy, probably because the body produces slightly more of its own natural steroid, hydrocortisone. Contact dermatitis may either improve or flare up.
Stretch marks often itch a great deal, and widespread itchy skin, with or without a rash, is a common problem during pregnancy. These are not usually allergic reactions, and no cause can be identified in most cases. The skin tends to recover a few days after the birth.
If there is itching in the vulva) area, this could be due to a Candida infection (your doctor can prescribe a safe treatment) or it might be just another of those unexplained itches of pregnancy.
Hayfever and other nasal allergies
The natural hormone changes of pregnancy affect the nose, which can become more blocked. If you have allergic rhinitis this will add to your woes. See your doctor and make sure that your drug treatment is adequate (see p. 29). The nose-clearing exercises on pp. 230-31 might also help.
Asthma
Severe asthma can be bad for both the pregnant mother and the unborn child. Uncontrolled asthma increases the risk of the baby being born prematurely – and premature babies are more likely to develop asthma themselves. The death rate for newborn babies is also higher if the mother has poorly controlled asthma.
Treating a severe asthma attack promptly helps to prevent any damage to the baby, so don’t hesitate to call an ambulance –and tell the operator you are pregnant. The ambulance should be carrying oxygen which is particularly important for helping the unborn baby through the attack.
If you have asthma, don’t stop using your drugs or reduce the dose unless advised to do so by a doctor. Because it is so important to keep asthma under control during pregnancy, your doctor may want to add, or increase, preventer drugs such as inhaled corticosteroids or sodium cromoglycate (see p. 148). It
also makes sense to monitor your peak flow twice a day (see p. 97) so that you have advance warning of serious attacks.
Unfortunately, some asthmatics – usually those who have severe asthma to begin with – get much worse during their pregnancy. In such cases, careful monitoring and increased use of preventer medicines are essential. The symptoms usually increase from week 24 to week 36 of the pregnancy. The last four weeks tend to be much better, and things are back to normal by about three months after the birth.
Some women with asthma have fewer symptoms while they are pregnant, and for others their asthma stays about the same.
Asthma can also appear for the first time during pregnancy, and may be quite severe. However, a relatively mild breathlessness can be due simply to the fact that, as the pregnancy advances, the chest cavity, and therefore the lungs, become compressed. This is not necessarily asthma.
This simple physical effect can also add to the difficulties experienced by women who were already asthmatic before they became pregnant.
GER (acid reflux) – see p. 38 – can contribute to asthma during pregnancy, and treating this problem may help.
Asthma attacks during the birth
Severe asthma attacks very rarely occur during labour, but it is still important that all the medical staff in attendance know you have asthma. They should also be told if you have taken steroid tablets during the previous two years. A record of when you took steroids, how long for, and at what dose, will be valuable. You may need a low dose of steroid to get you through the physical stress of labour (see p. 142). Some doctors believe that patients who have been using high-dose inhaled steroids should be treated in the same way.
Smoking
Smoking is a bad idea if you have allergies or any allergic tendency in the family. Smoking is a very bad idea indeed if you are pregnant, or a parent. This is the moment, if ever there was one, to give up.
Enlist your doctor’s help, and ask if counselling, psychotherapy or other forms of support are available. If you have tried all this before, and failed, then talk to your doctor about the possibility of using nicotine patches. Some doctors believe that, for pregnant women who smoke 20 cigarettes or more a day, the advantages of nicotine patches outweigh the risks to the foetus. Nicotine levels in the blood are lower with patches than with heavy smoking, and your baby is not enduring the hundreds of other toxins found in cigarette smoke.

Tony had suffered from hayfever since childhood but rarely took any medicines. Outside the grass-pollen season, he was fine, free of allergies and very fit. Then, when he was 35 he bought a run-down cottage in the country. The cottage was very damp and dirty.
The previous owner of the cottage, an elderly man, had died, and everything was much as he had left it. Tony moved in with his wife in late summer, and they began pulling out all the old carpets and furniture. Many of the windows would not open and there were dank musty cupboards and attics to be cleared. Dust filled the air – and Tony’s nose. He began to sneeze a little and within a few days he had a strange and unfamiliar feeling of tightness in his chest. During the following weeks, harvesting began in the surrounding fields, with several huge combine-harvesters working away all day and night. Tony noticed that, when out of doors, his eyes began to stream and the tightness in his chest became more noticeable. A few more days passed, and Tony found it harder to breathe, so he reluctantly went to see the doctor. The diagnosis was asthma. Skin-prick tests showed that Tony had allergic reactions to house-dust mite and moulds.
Tony’s case shows how someone who is already sensitised to an allergen – pollen in this case – may be vulnerable to developing new sensitivities, and new symptoms. It was almost certainly the dust mite and mould spores in the cottage that sparked off the trouble, followed by the mould spores from the cereal leaves, dispersed during harvesting.
For people with a tendency to allergies, the dangers of heavy exposure to potential allergens are something to bear in mind. It is surprising how many people with asthma had their first major attack while away from home, sleeping on an old sofa or in a friend’s dusty spare room. The dose of dust-mite allergen that you get from an ancient mattress or eiderdown can be massive.
Managing your allergy symptoms
As well as avoiding the development of new allergies, you need to manage your existing symptoms, and make sure that they interfere with your life as little as possible. For this you need good information and advice, support from your doctor, optimal drug treatment, and careful avoidance of your allergens.
Quite often people have all the information and drug treatment they need, but they still don’t stay on top of their health problems. There can be two distinct reasons for this: either they are not wholehearted about wanting to be well (ambivalence) – or they have never really accepted that they are ill (denial).
Ambivalence
Sometimes being ill has certain benefits – or being entirely well has certain disadvantages. Our state of health determines how people treat us, especially within the family, and the expectations people have of us. It may be comforting to be ill because others are more supportive then, or it may be less risky, because we are not forced to try things (such as sports or other physical activities) at which we might fail or look foolish. Being ill as a child often sets up a pattern for how we interact with the world, which revolves around caution, the comforts of familiarity, and holding back from new situations.
These habitual patterns can survive in the mind long after any real advantages have evaporated. Many people become stuck with a way of thinking and living where ill-health is a cornerstone of their existence. Doctors at the Chelsea and Westminster Hospital in London, who have developed a radical programme for treating atopic eczema (see pp. 46-8), have noticed this in their patients. ‘Old habits die hard and living with a little bit of eczema is a very tempting prospect for many patients, rather than clearing the skin completely…. As atopic skin disease begins for many in the first year of life, causing sometimes understandable alarm and despondency in the parents, the child learns how relevant their condition can be in their relationship with the external world, and with their parents in particular. Before they are able to speak, they have a powerful means of gaining parental attention which can have long-standing effects in the development of their personality. For some, to live without eczema is understandably a daunting prospect. This can be consciously appreciated and spontaneous-y referred to by some patients, while for others the issue will be buried from view, deep in their unconscious.’
If any of this rings bells with you, try to tackle the problem at source. Such mental blocks are not immovable. Indeed, simply recognising that the block is there can start to change things for some people.
Others may need professional help to overcome these longstanding habits of mind. Counselling or cognitive therapy can be very valuable, and your doctor may be able to help in locating a suitably qualified person for this.
Denial
At the opposite end of the spectrum are those who want to deny that they have any kind of health problem. Often these people cannot quite accept that they have a long-term disease, such as eczema or asthma, so they forget to take their drugs, apply creams to their skin, or carry their inhalers. Ironically, these people frequently wind up having far more trouble with their allergies than they need to, and a very poor quality of life, simply because they neglect preventive treatments.
To be really well, you first have to admit that you do have allergies, and then sort out your conflicting feelings about what this means. Again, counselling, cognitive therapy or some other kind of psychotherapy can be helpful.
Dealing with doctors
The decisions that your doctor makes about your treatment are ones in which you should be fully involved. Quite a few allergy patients don’t feel happy about their doctor’s treatment plan, but they never say so to the doctor’s face.
The usual pattern is to accept what the doctor prescribes without any argument, but then halve the dose of tablets, or only put the cream on once a day instead of twice, or not use the Inhaler at all. Some people stop and start their drugs in a random way because they never quite make up their minds about whether drugs are a good thing or not.
This approach to allergies invariably leads to worsening symptoms. The risks are greatest with complex problems such as
atopic eczema or chronic sinusitis, where a vicious circle can easily be set up if the disease is not brought under control, and for those with a life-threatening condition such as asthma. In the case of asthma, neglecting preventative treatment can be fatal.
It is far better to say what you think in the surgery, and discuss any misgivings you may have about drugs with the doctor. That way you can agree on a treatment regime that you are prepared to stick to – which may or may not involve drugs. Most doctors would far prefer a little plain speaking at the outset to having a patient who is half-hearted about following the treatment plan and never really improves.
A more serious form of communication breakdown occurs when a doctor stops believing what a particular patient says. This usually occurs because the doctor has decided that some or all of a patient’s symptoms are due to psychological rather than physical causes. (This is far more likely to happen to those with intolerance or unusual forms of allergic reaction than to those with classical allergic diseases.) Sometimes doctors say what they think, but often they don’t – they just start treating the symptoms in a different way, or acting impatiently, or saying rather puzzling things that leave the patient trying to guess what is going on.
If you find yourself in such a situation, the main thing to do is stay very calm and be very rational. Getting upset, or challenging the doctor’s opinion in a manner that seems at all aggressive, instantly confirms the ‘psychological’ diagnosis. Unfortunately, insisting firmly that the symptoms are not psychological also confirms the diagnosis as far as many doctors are concerned (see p. 237) which can be extremely frustrating. To begin with, deal with the situation by informing yourself about your illness. Be tactful and patient but persistent with the doctor, trying all the time to keep the relationship pleasant and the channels of communication open. If, after giving it a fair try for some weeks or months, this approach isn’t working, you should look into the possibility of changing doctors (see p. 88).
Emergency alerts
An emergency alert bracelet or pendant should be worn by anyone who:
• is allergic to latex rubber, or to drugs such as penicillin
• has a severe allergy to insect stings
• suffers from exercise-induced anaphylaxis, or anaphylactic shock as a result of food allergy
• has very severe asthma attacks.
Key information is engraved on the bracelet, along with a telephone number which gives medical staff access to a computer database containing vital medical data about you. This valuable service is provided by a non-profit-making company called Medic Alert.
As everyone knows, a little knowledge is a dangerous thing. You can use the information in this book to help yourself, but it’s important to remember that there is no substitute for the comprehensive understanding of the human body that your doctor gained during many long years at medical school. Always check with your doctor before changing your diet, stopping your drugs, practising breathing exercises, taking a non-prescription medicine or trying any other experimental treatment.
The information about disease, diagnosis and treatment in this book falls into four categories:
• basic information about the disease that no doctor would disagree with
• the findings of new research, or research that has not become widely known, but which falls within the accepted medical model of the disease concerned. Your doctor may not know about some of this research (there is a terrifying amount of new information bombarding doctors every week, and no one can keep up with it all) but he or she won’t find it unbelievable.
• evidence from research that is entirely valid, but which is widely ignored or dismissed because it falls outside the accepted medical model of the disease concerned (see pp. 86-7)
• information based on the repeated observations of doctors, or of patients – this does not amount to scientifically valid evidence, but it’s included here if it seems plausible and if it could be useful to some readers.
You should be able to tell, from the context in which it is presented, which category any item of information falls into. When talking to your doctor about items that belong in the last two categories above, be prepared for a certain amount of scepticism or possibly outright dismissal.
The important thing to ask the doctor is if there is good reason why you should not try the suggested measures, in addition to your usual treatment – is there any risk involved, given your particular state of health? Make it clear that you want to try the additional treatment with an open mind and will drop it if it is not helping. Ask for the doctor’s help in assessing the effects of the treatment objectively.
Managing asthma
Of all the diseases described in this book, asthma is among the most difficult to live with, especially severe asthma. Learn to recognise asthma symptoms before they get out of hand, and take immediate action.
Studies of patients who die from asthma attacks find that the deaths could, in almost all cases, have been prevented. Factors contributing to fatal attacks include:
• heavy exposure to allergens just before the asthma attack
• cigarette smoking
• failure to use preventer drugs
• repeat prescriptions for inhalers being given without the patient seeing a doctor
• delays in seeing an asthma specialist
• depression in the asthmatic leading to neglect of treatment.
For the day-to-day management of asthma, you should have a written management plan prepared by your doctor or asthma nurse.
This should tell you how often to take your drugs under normal circumstances, and what to do if your symptoms change or you develop a cold or chest infection. The actual brand names of your drugs (or the colour of the inhaler) should be included on the management plan. Assuming you have a peak-flow meter – and you really should have one –specific peak-flow values should be included on your management plan, with instructions for how to respond if your peak flow falls to these levels.
Your plan should tell you how to recognise a severe attack coming on, and what to do at the various stages of the attack. (This personal management plan is specifically geared to you or your child. Although pp. 100-101 give generalised advice, your own plan is invaluable.)
Be sure that you know exactly how the advice in the plan relates to the sort of real-life situations you experience. No matter how good your plan, real life can sometimes be far more complex than anyone anticipates, so there may be times when it is difficult to know what to do. When this occurs, make a note of the situation, and the reasons why you are unsure how to implement the plan. Call your doctor immediately if your asthma is getting worse, and get the asthma attack under control. Save your notes and, at the next opportunity, check with the doctor what you should have done in those circumstances. This will help you to build up your detailed knowledge of how to manage your asthma, or that of your child.
Research shows that asthmatics can, with training, develop a greater awareness of how narrow their airways are – this helps you to detect worsening asthma before things get too serious. You can train yourself in this art by guessing what your peak flow will be and writing your guess down before you use your peak-flow meter (see right) each day. Over a period of weeks, you should find your guesses getting closer to the true value.
A key part of asthma control is having everything with you that you need in case of an attack. It’s tedious, but you have to do it. You should take your reliever inhaler with you wherever you go. Those with severe asthma can also benefit from carrying a collapsible spacer (ask your pharmacist or see p. 255 for contact details of suppliers).
For a long day out, or a stay away from home, check that you also have:
• your management plan
• your peak-flow meter
• your preventer inhaler
• steroid tablets, if you sometimes need these
• your doctor’s phone number.
A little lateral thinking may be needed regarding the problem of carrying all this kit around. One asthmatic friend of mine carries his inhalers in a trendy-looking camera bag that goes everywhere with him. Mothers of asthmatic children have solved the problem by making an ‘inhaler pouch’ from a sunglasses case and attaching it to a favourite belt or by enlarging the pocket in a teenager’s jacket to accommodate inhalers.
Anyone with severe allergies to food or insect stings should take similar steps, so that carrying their auto-injector everywhere is a simple matter.
Peak-flow meters
A peak-flow meter can detect narrowing of your airways – the beginnings of an asthma attack – before there are any obvious symptoms. It measures the maximum speed at which you can force air out of your lungs. The signs of worsening asthma include:
• a morning reading which is less than 75% of the evening reading
• average readings less than 75% of your best-ever reading. (If they get to less than 50% of your best reading, this is a severe and possibly life-threatening attack.)
To use a peak-flow meter:
• push the pointer to zero and hold the meter horizontally
• keep your fingers away from the scale and the pointer
• breathe normally before you start
• stand up and take a deep breath, but don’t puff your cheeks out and don’t hold your breath before you blow
• seal your lips tightly around the mouthpiece
• blow hard into the meter, as if blowing out candles on a birthday cake; don’t move your tongue while doing this
• repeat three times, and record the highest reading of the three.
You must learn how to use a peak-flow meter from your doctor or asthma nurse, who should also check your technique regularly – it is very easy to get into bad habits.