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Responses by subject

What questions do parents/carers and patients ask of you?

Angela Boque (Spain):

Usually it's a diagnosis that they don't accept. The first thing they say is that they don't believe it can be asthma. They refuse to understand that it's a chronic disease and there may be problems in the future. It's important to help them understand what asthma is. Personally, I don't have any difficulty with this if I have time; it's difficult to do if you're rushed. I use drawings; I have three tubes as examples, explaining what happens to the bronchi when in a crisis, when not. I explain that there are athletes and Olympic athletes who have asthma. The only thing is that you need time. Primary care settings are often full and have to solve many other health problems.

Svein Høegh Henrichsen (Norway):

Obviously they are concerned about the diagnosis because they have heard a lot about asthma, that it's dangerous, that it's chronic. They also ask about the prognosis. They wonder how they can lead a normal life with their asthma.

Chris Hogan (Australia):

Are you sure it's asthma? Will it seriously affect my child's health or development? Are the drugs safe? Will they grow out of it?

Alexandre Holanda (Brazil):

The first time they hear the word 'asthma,' they ask what is it? Is there any cure? If they come in during an attack, they are just afraid of dying, feeling as though they're under water. When patients ask what asthma is, I pick another chronic condition well known to the public, as an example that this is chronic. I do not use the word 'chronic' of course. I explain that this is a disease that has control but no cure, plain and simple, and I have to tell them this, that's for sure. Even though this is frightening, I have to tell them. Then from that point forward, I push the topic of 'this has control, this has control,' that's the major thing, even though they're under an attack at that time. Then when they come back when they're a little bit better without the attack, I would explain what really happens to the body: allergens, triggers, trigger avoidance. But this is usually a second visit. During an attack they're afraid and, secondly, there are time constraints.

Alan Kaplan (Canada):

Will my child outgrow it? Are steroids bad for me? Is my child going to die from this? What do the medicines do to them? Are they going to get shorter? Are they going to grow? Are you sure it's asthma? Could it be something else? Should they take herbal medications instead because they're natural and they won't hurt my child? Can I stop the medicines when Johnny's well?

Dermot Ryan (UK):

What shouldn't they do? Should they miss school? How often should they take their medication? Will they need it for life? What do I do when it gets worse? Are there any side effects of any of the medications?

Björn Ställberg (Sweden):

I think one of the most important questions is about pets. In Sweden it's very popular to have cats, so they ask can I have the cat? Can I keep the cat? Can I keep the dog? There's a lot of discussion around pets. Of course there's also a lot of discussion around the prognosis of their asthma. Also about medication, practical things. And also discussion about what will happen in 1 year, 2 years, 3 years. What happens if we still have problems in 2 months? Can you add any medication? I think it's important for the parents to know that if the child still has problems in 1 or 2 months you can add medication. And that it's important to come back.

Hakan Yaman (Turkey):

They are of course very worried about the asthma. They ask for information. Is it going to last very long? Will the child outgrow this problem after a certain period? They sometimes have certain ideas about asthma; they come to the office after reading articles or the encyclopaedia. And what is the impact of this problem on the children?

Osman Yusuf (Pakistan):

Are you sure it's asthma? That's a very common question. And the second is, is it going to remain all his life? Everyone is looking for a cure. And if you go on to mention inhalers as part of the treatment, then automatically the conversation changes to inhalers: Are they addictive? The patients come in with a lot of fallacies that they've heard about inhalers. Misconceptions include that they're addictive, they're the last mode of treatment and nothing else works after that, they're damaging to the lungs, etc. etc. We've put a lot of material to counteract these misconceptions on our website, in the press, and through other fora. Patients here in Pakistan have several misconceptions about diet and asthma; the four foods that people blame as causing asthma are milk, yoghurt, banana, and rice. We've done multiple allergy tests and never found a histamine reaction to those. However, banana actually contains serotonin, which can trigger an allergy attack and increase production of mucus as it's related to histamine. So there could be some weight in the anecdotal evidence.

Basically patients are concerned about when will the asthma finish? When will the medicines stop? That's the bottom line of all the questioning.