Is it me or is this section not being used too much yet? I was really excited when I saw we would get a seperate section as I was hoping to get to know others around the country/world ( dare I say) to learn from you all. Particularly children's respiratory nurse specialist as I feel quite isolated at time. I have quite a few worries about types of treatment such as s/c infusion, large doses for children also concerns when I read the other discussion boards about what our patients appear to be going through with asthma. Anyone want to start off a topic?
Looking forward to hearing from you all.
Ann
20 Replies
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Hi Ann
shortage of members at present may be due tothe fact that the majority of people using the site suffer from asthma but are not medical professionals and medical professionals may not be aware of the site. Maybe it needs ""advertising"" in the professional journals to encourage the sharing of ideas and practise.
My prime reason for joining was my asthma, this section was a bonus. I have to say that I have learned a lot in all senses by reading the posts in various sections of the site including how mild my problem is.
Take care
Tricia
Hi Ann,
Although I don't specialise in asthma I do have an interest in it, probably as a result of having it myself and through doing the PEAK holidays. I also know of someone (also a PEAK volunteer) who is a specialist resp nurse so I may be able to persuade her join up! I am currently a GP registrar, just starting out in General Practice and currently part-time (along with part-time psychiatry, mmmmmm), so still learning the ropes of practically managing asthma in a GP setting. I'd be interested in discussing pretty much anything asthma-related!
Hi Ann, I did use this site before it was updated. Just come back to it! I have only been seeing asthma patients since Nov 05 after doing the NRTC Diploma Module and also feel quite isolated in the surgery as the GPs are not really that up to date with the guidelines and devices etc so are a bit cynical at times when I go to them. At the moment I do have a respiratory nurse advisor coming in for mentorship and support but it's the other occasions when I meet a really complex case with a patient so stuck in their ways and not willing to change. I have been to lots of study days and keep meeting up with the same people and it's great to be able to admit that you don't know it all and bounce off each other, and I hope that this site will provide the same opportunity to ask the silly little questions that are bugging you but you don't know who to ask - I always say no question is silly cos if you knew the answer you wouldn't ask it! Maybe I can use your expertise and knowledge in paediatric asthma patients as that is definitely my weakest area.
First silly question
I have been a Midwife for about 10 years, previously staffing in stroke rehab. From my General training I remember having it drummed into me that ""asthmatics"" sould carry out ""best of 3"" peak flows before and after inhalers/nebs. Recently, we have had a number of asthmatics admitted, mostly with obstetric problems and they have been amazed at being asked to do this. One doctor I asked about this said to do it when I thought it appropriate, which didn't really help very much.
Any suggestions please?
Tricia
Professional using this site
Hi there everyone. Glad to see that we are now getting a group of like minded people together. Yes I would be happy to share any knowledge I have with regards to children & asthma.
I often get parents saying that they don't need me to go through things with them but when I explain that it is more for me so I can say to our doctors I have done what we would like them to know they listen & without fail say ""I didn't know that, I was never told that, that still happens etc,etc"" This is parent who have either asthma themselve or have had a child with it for years.
I take about an hour going throught a check list I have devised covering basic anatomy of the lungs right throught to their asthma management plan.
I also do school visits to help them treat the child if they are ill but also to get them to understand what asthma is as many feel our chronic children don't really suffer from asthma attacks & possibley query that they actually suffer from asthma because with chronic asthma they are never free of symptoms but live with them.
Even a little change in how they administer their medication can make a difference to their control. We always use evidence based information mainly the BTS guidelines.
I ageree we should try to publisise this site. We have tried to form a local childrens nurse group in the North East but logistics are proving difficult so maybe this site may help.
What do others think?
Hi Ann,
I have just started using this site as a health professional. i am no longer practicing as my asthma is Brittle and no body wants to take the risk employing me but i still like to keep up to date,
i work with many children as a brownie/guide leader and am quite surprised at how blasee so many parents and children are about their asthma, i have many children who do not carry their inhalers or seem to take their asthma seriously.
is this because they are perhaps incorectly diagnosed or just poorly advised?
equilly i have had several children who i am almost certain have asthma but when i talk to their parents they are quite dismissive, despite their children spending most of each meeting coughing etc.
As a health professional with my Guiding hat on it can be hard to look after these children and fortunately so far i have not had any child have a severe attack to act as an educator as i feel the GP/Practice nurse who locally is diploma trained should be looking after these kids, Is the system still not really working?
sorry you are no longer able to work georgie. i was getting concernedabout my job too for a while but am now finding that work is very supportive. i can't be the only trained nurse on duty just in case i have a severe attack but they are getting quite used to me disappearing off to take my inhaler or going down to the MIU for a while to see if i can get it under control enough to finish my shift. i have been sent home a few times. the boss has a continual report going to monitor the situation which includes every time i need to leave the ward and the end result each time, it also includes all my asthma appointments or those related to my allergies. it does get a bit tedious and frustrating at times but at least i am able to carry on with my job at the moment.
i, too, run a children's group. i lead the 5-8 year olds in Girls' Brigade, but am needing to take a break because i am having attacks when trying to look after the children and that is difficult. it causes a problem with child protection issues leavingf the children with inadequate adult supervision, never mind scaring the children when i am struggling to get my breath because i am coughing so much. like you we have girls who are so obviously asthmatic but the parents don't want to know and others who never bring an inhaler with them. 1 parent, when asked about it, said there is no point because the child will not use her inhaler anywhere except at home. it is hard to get them to understand at such a young age that if they did use their inhaler they would be able to enjoy themselves so much more because they would have a lot more energy and be able to join in everything. lets hope they realise that before they miss out on too much fun.
work
Hi All,
am very excited at the moment, had a job application form come in the post this morning to do opd clinics at a new treatment center opening up near by. i have done loads of clinics in the past so i am keeping my fingers crossed that they give me a chance to show what i can do , not what i might not.
it is for full time on the application form, i would prefere part but dont want to mention that on form for now, get foot in the door first!!
George xx
Hi there Angela & Georgie,
For me this is subject really get me on my soap box. We regualarly see children who have had their asthma cared for in the community for years but have obviously not been controlled for years either. Some, as a child I have seen only yesterday, end up coming to us only after being admitted to ITU. I spend at least an hour & a half talking to the patient & parents about everything to do with their condition. I have a check list which I have devised & am continually altering it to suit the needs of the service. I talk about what asthma is, what happens to the lungs in an attack, what is an attack, the drugs & how they work, check the tecnique, change devices if needs be after assessment on to how to use the asthma management plan we have written. I also do home & school visits where needs be involving the school nurse as well. This takes a lot of time which I appreciate GP's & practice nurses may not have. They may not have that much experience or skill in dealing with children despite the fact that the population is made up of 1/3 under 16 years olds. I feel the like of me should be out there letting everyone know about this illness & how it can be controlled. When I read some of the posts on the other discussion boards I get depressed for what they are going through. But obvioulsy we only hear one side of the story. However, so much anedotal evidence cannot all be wrong. I have applied for a grant to enable me to go out to some of my local health centres to try to do some session to improve education but even if I get it my time is limited with all the other things I do & I often feel that other professional either don't really believe me or some of the things I advice are not that important ie only 1 dose per 20/30 seconds from an MDI not multy doses etc. I am sure that if the time can be spent with patient either on a 1 to 1 basis or in groups to give them the information they need to help control the child's condition it would go a long way to affecting the morbidity of some patients.
Still we can only work within our own sphere of control. THis site however is a great site to get thechildren on to see how they should use the device etc. Sorry for the rant.
Hope the application is successful, Georgie.
Hi all
I agree that the level of education is shocking. I asked a gentleman with COPD to show me how he used his inhaler just yesterday. He was squirting into the back of his mouth much the same as an angina patient might put a squirt of GTN under their tongue - no inhalation etc. No wonder he said his inhaler was ""not doing much doc"".
It only took a few moments to get a placebo MDi and a spacer out of the drawer and show him how to use them; otherwise his brand shiny new atrovent inhaler that I had just prescribed for him wouldn't have been much good either.
Little things like this we can do; unfortunately much of the rest of it is simply too much to fit in. Ideally I would love to sit down with every newly-diagnosed asthmatic and fully educate them, but I guess as you say Ann it would take upward of an hour. A significant proportion of people simply aren't motivated to empower themselves either, which is a big problem. And resources - talking educational materials on paper, placebo inhalers etc etc - are another factor.
Well, we can dream, can't we? Until then we can still rely on patients to find out for themselves and via Asthma UK. And dubious programmes on Channel 4 about dustmites.......
Hi there CathBear,
There is obviously quite a few of us who feel & think the same way. What else can we do about it? What do others feel? I suppose unlike conditions such as HIV, breast cancer & childhood illness like heart & cancer, boring ol' asthma which 'everyone has' does not attract some much attention & more to the point, money. I know there is a national day for asthma but is lobbying of MP's the route? I would be really keen to get involved more on a macro level if I knew how.
Ann
hi all,
i seem to spend far too much time in hospital as a patient but when i am in a bay do often use this valuable time ""talking to patients"" this is another time when i see a lot of ignerance, and the scary thing is none of the ward notice for instance how poor patient technique is or question their knowledge, it is often left to clinic for patients to get followed up and i hope management plans.
On another not having discussed this at length with our hospital lung function tester we have both been surprised at the amount of referals he gets from doctors and opd nurses who have done basic spirometry and not really understood the results, we cannot even be sure the tests were even carried out properly! spirometry is such a great tool but only if you know how to perform and interpret them.
thats my rant, hopefully if i get this gob i will be able to do the spirometry and give good respiratory advise, fingers crossed
George xx
Georgie,
Yes I am sure you are right about spirometry. I started the course at the end of last year & was due to take the exams in August but due to only getting a band 6 I have now put it on hold. But that's another story!
However, once I did the study days, I also realised how little people seem to understand it. Also I have to say how medical staff actually ignore best practice when I started to highlight it to them such as patient should be sitting down to do it - it doesn't matter, need to do 3 blows that are within the correct % - it's not important. I have said to them at those points why is there a recognised course & why am I doing it if we are just going to ignore thing?
It it much with same with MDI doses. My colleague & I inform all patient that it is one puff every 20-30 seconds. Even this week with a child who just come out of ITU, a consultant said he wasn't too bothered when I told him ITU staff were multly dosing his Salbutamol i.e. 2 puffs back to back with 5 breaths not one per 20-30 secs. Some time its like 'what we say is important but what you say isn't really' & i get frustrated. I frequently get calls from people who are not or no longer our patients wanting advice & it does put us in a difficult situation because of profession conflict. I am always expecting a call from a GP or another consultant demanding who I think I am. But I alway stick to the BTS guideline so it's not wrong. Back to we can only work in our own sphere of control but it is a shame.
Hi ann,
i do see where you are comming from but as you are sticking to the BTS guidelines and your guns you are fine, it is reassuring that ex patients are calling you up, they must have a lot of respect for your knowledge,
keep it up!
george xx
Hey thanks for that.
We proberbly don't think of it that way enough. What with the trauma of not getting the banding I expected & with this months pay slip bringing another round of disappointed & disillutioned staff, we can let things get out of proportions really.
Where are all the health professionals? There have been no new postings on this site for ages. Being a staff nurse with atopic brittle asthma who feels she is fighting a battle to remain in work I would value any tips and advice I can get.
hello there Angela,
I know what you mean about the lack of HCP using this site. I think it is an excellent opportunity to share knowledge & help each other out. Lots of the parents I deal with use the other discussion sites & come to me with things they have picked up which helps me. The latest was Soft sets for terbutaline infusions.
I am interested in the definition of brittle as it is felt by our consultants that children are not brittle, more that their worsening condition is not noticed or appreciated & that they slowly deteriorate to being quite poorly rather than being very well with no symptoms & then sudenly & quickly, acutely unwell.
What education have you been given about your condition? I don't mean to be rude but I have spoken to parent who have been GP's & even they said they did not appreciated all the in's & out's of the condition. Who monitors you're condition, apart from you ofcourse? How does it effect you at work? Have you always had asthma or has it developed later in your life?
I was diagnosed asthmatic when I was pregnant 20 years ago but, in hindsight, I had been symptomatic for at least 10 years before that but 3 GP's said it definitely wasn't asthma or they wouldn't diagnose it unless they actually saw me when I was wheezing. The only problem being you can never get an instant appointment so by the time I saw a doc I was always better. Once diagnosed I just had salbutamol for years with the occasional blip that meant I took becotide for 3-4 months at a time.
Last autumn my boss, who is also asthmatic, got fed up of me having such frequent attacks at work and pressured me to go back to my GP. I hadn't had an asthma check for about 5 years at that point. From then on it has been downhill all the way as I finally admitted that my asthma was far from being under control and I was put on becotide, then had it increased, then tried adding serevent but had awful cramps so had it changed to fomoterol which was better. In January I finally got it under control again until March when I had a massive anaphylactic reaction to lilies, followed soon after by a slightly milder one to lilies again, and then hyacinths. I have known for years that certain flowers, particularly lilies and hyacinths as well as christmas trees and some animals and feathers, and most perfumes/after shaves triggered my attacks but never that severely. Since then my lungs have been extremely brittle, reacting to the slightest contact with any of my triggers. I also take singulair and cetirizine 10mg BD.
I have been seeing my asthma nurse 2-4 weekly since November and the GP in between if necessary. I have also seen the immunologist. On top of that I have had several trips down to MIU at work when I am nebilised and then sent home. My asthma nurse had just given me a 3 month reprieve from check-ups as I seemed to be stabilising a bit when road works started outside at home meaning that I now need salbutamol on a regular basis and then to top it all an absent-minded HCA sprayed a patient and the rest of the bay that we were working in with perfume to the extent that the whole ward could smell it. That triggered yet another severe reaction and so am now on prednisalone for the 2nd time in a few weeks. Work are very good generally. I have had endless meetings with the bosses and various precaustions have been taken regarding use of perfumes/chemical sprays when I am around - they are supposed to give me warning to leave the bay first, and monitoring the flowers that come in stopping the known trigger ones completely and monitoring the effecrt of others on me. It works well until I have days off and hen some are so vigilant so I do a flower check as soon as I arrive on duty - or that is the idea anyway. I am being closely monitered by occi health and have to complete an incident form on each occasion that I get an attack that means leaving the ward. I had to be rik assessed by our personnel health ands safety representative. I am not allowed to be the only trained nurse on duty nor should I be working with one member of staff down. In these days that does have its implications because it means them having to go to agencies to cover sick leave if necessary. It doesn't always work as it should. I am fortunate to have an MIU so close and they all know me well and have been well prepared for me just turning up. I always have to be escorted downstairs now in case I do something daft, like collapse, on the way.
There was a point when I found it all too much and felt that the bosses were trying to get rid of me. Unfortunately I work full time, or try to, as I am the primary wage earner. Work is now very supportive and give me time off for appointments, chest physio etc. as necessary but I do try to arrange most things for my time off. I have sought the advice of the RCN as well in case things do get to the point of work being difficulty but currently I have actually had less sick leave than the majority of staff on the unit as I always try to get back to work as soon as possible. Everyone has now bween trained in using an epipen, including the HCA's in case of a real emergency.
Sorry it was such a lengthy reply but does that answer your question.
Ange
Angela,
Sound like you have had a right old time!
I hope now that you are some substantion ICH like Flixotide. Has your technique been checked & being checked to ensure you are getting the optimum amount via your inhaler? I worry re neb's then home. Certainly in paeds we would expect even a short admission if the child is so ill they need a neb. O2 via nasal cannulae & your Large volume spacer for your Salbutamol should be as good as well. So if you need O2 then you need some observation for some time.
Interesting about the Serevent I will remember that for our patients as I did not really appreciate that.
It is amazing what people are allergic to & when I do my home visits & tell folks about the plug in smellys etc they are suprised.
Hope you have your hand held device for Salbutamol handy when you are at work for thsoe occasions when 'accidents' happen.
Thanks Ann. Not on flixtide and never tried it. I have had my inhaler technique checked several times and seems to be quite good but then when I am really bad I do struggle a bit. I use the aerochamber spacer both at home and at work. The boss insists on it being kept in the office even if it actually go elsewhere to use it just so that they can monitor me more easily at work. MIU don't send me straight home after nebuliser I always stay for about 1-2 hours afterwards and am only allowed home if someone is there to atay wirh me. I suppose that is a slight difference between adults and paeds. Although when my daughter was nebulised as a child she was sent straight home afterwards both times. I also get checked out by my own GP/asthma nurse within 24 hours if possible.
Last week was a really bad week for me and I am still stuggling after my bad reaction. I have now had to double my becotide but am still using salbutamol more than I should but am just about manging to stay at work. I am aware that it puts more pressure on my colleagues though because I am working under par. They are all very patient and tolerant with me and most very protective when I just want to get on with my job and live as normal a life as possible.
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