THRIVE: Jeannie D is winning the fight against asthma

It was 4am and Jeannie D was in trouble. The muscles that surround these all-important pipes, the diligent carriers of oxygen rich air to our lungs, were swollen and inflamed. Distressed, those muscles began to contract; the airways, in response, produced extra mucus. Her bronchial tubes narrowed ...

Jeannie D couldn’t breathe. She was having an asthma attack, and she needed more help than the reliever pump even non-asthmatics may recognise from occasional brushes with bronchitis or other breathing complaints.

What the 38-year-old TV producer, presenter, radio personality, businesswoman, model and actress did next is, she knows, strictly against all medical advice: she drove herself to the Emergency Centre. There she received an adrenaline shot and was quickly nebulised; the device delivers medicine in mist form through a mask or mouthpiece.

As the combined effects of the injection and the nebuliser took hold, a nurse entered the room. She held a bag in one hand and a set of keys in the other. “Are these yours?” she asked. Jeannie nodded. “And is that your car, idling with the door open and the lights on, outside?” It was.

Telling the story in a chic restaurant in upscale Bantry Bay (she lives “around the corner” from where she’s now sipping a sugar-free cold drink), Jeannie laughs a little disbelievingly at the fact that she got herself to hospital during probably one of the scariest experiences anyone can have: unable to breathe and fading fast. But then, she’s a self-described “A-type personality” who has no qualms about going it alone.

This is a woman who’s done it all, and then some – and that part of that drive is channelled into understanding, managing and living with the asthma that was first diagnosed when she was 18 years old.

“Listen, I’ve gone wing walking on planes; I’ve skydived – I don’t want to go out because of something like an asthma attack.”

The good news, for Jeannie and the rest of the more than 339 million people globally the World Health Organization (WHO) says are living with asthma, is that with the right diagnosis and treatment, it’s a very treatable condition.

Unlike Jeannie, many asthmatics will first develop the condition in childhood; the WHO describes it as the most common chronic disease among children worldwide. Dr Pieter de Waal is one of the specialists you may encounter as the parent of an asthmatic child; in fact, if you live in the Free State, he’s the goto guy: Dr De Waal is the province’s only qualified paediatric asthma and allergy specialist. He operates from Mediclinic’s 3rd Avenue building in Bloemfontein, where he treats some adults, too – but for the most part, his patients are children grappling with what can be a very scary condition.

PROPER DIAGNOSIS

A proper diagnosis is the first weapon in Dr De Waal’s arsenal. So, how can you tell whether your child may be asthmatic? “Family history is a very sensitive marker [of asthma] in childhood; particularly the ‘first family’ – your mom, dad and siblings.” The reason for this is that, as the WHO reports, “asthma runs strongly in families and about half are due to genetic susceptibility and about half due to environmental factors”.

As many as 80 to 90% of asthmatics also have allergies of the nose, referred to broadly as allergic rhinitis. Dr De Waal says parents should look out for other signs of allergy like eczema, allergic dermatitis or food allergies. “Milk, egg and peanut allergies are common in kids,” he explains. Understanding food allergies is also a useful way to circumvent some common diagnostic tests that are “just too tough and intimidating for little kids”, he says. For instance, lung function testing – in which tests are conducted before and after a patient uses a bronchodilator that opens their airways – are hard for a child to understand and perform. And, like so much else to do with asthma, they can be scary.

“Emotional circumstances can also trigger asthma,” Dr De Waal says. “One feeds into the other: asthma and anxiety often go together.” That’s something even adult asthmatics like Jeannie D know all too well. As she puts it: “Being unable to breathe leads to radical panic.” She also wonders whether her first confirmed attack, back when she was 18 and likely triggered by her boyfriend’s family cats, was also linked to anxiety. After all, she’d just made a huge move, saying goodbye to her life and family in Johannesburg and striking out for Cape Town to pursue a career in a tough, hostile, hectic industry.

Understanding her condition has helped enormously in managing her anxiety around it. She’s a woman who’s made a living from her natural curiosity and openness to learning new things all the time. One of her most frustrating memories from that first attack when she was 18 was that nobody really told her what was going on. She was nebulised, then discharged clutching an inhaler. The doctor didn’t tell her how to use it. It took her years to find a specialist who keeps her in the loop and answers any questions she might have. But it’s tough for children to even understand what’s happening in their bodies, let alone know what sorts of questions to ask. Their parents, too, may feel intimidated by specialists. Dr De Waal knows this problem all too well and insists that medical professionals must remember “education is critical”. Happily, things are slowly changing.

WARNING SIGNS

“There’s a big movement [in asthma care] towards two-way discussion, not just the doctor talking at the patient and telling them what to do. Patients should be encouraged to talk about what scares them. What are their expectations from the treatment? Do they know what warning signs to look for in themselves, and when their asthma isn’t under control? That helps them to act in advance,” Dr De Waal says. These conversations should become a habit from the beginning, he says, though a little breathing space immediately after a diagnosis is important, too.

“Having the diagnosis can be intimidating. Patients [in his case, kids and their parents] can totally shut down and just not engage or express their worries. Often a quick follow-up appointment is useful. This gives people time to cool down a little, and to take the time to think about what they want to ask.”

Children also need to be helped to understand one critical truth that Jeannie D has taken to heart: “Asthma can be properly managed.” In her case, this means taking a daily steroid inhaler. Steroids and other anti-inflammatory drugs reduce inflammation, swelling and mucus production in the airways; that makes asthmatics less sensitive to their usual triggers. She still carries around the ubiquitous “rescue pump” that most asthmatics use in emergencies but doesn’t need to use it as often as she used to.

“It’s in here somewhere,” she says, rummaging in her handbag. “You know, there’s a psychological advantage to having it with me; knowing it’s there immediately makes me feel better. But I also know that as asthmatics, we become really over reliant on these pumps.”

She’s right: well-managed asthmatics don’t need to use their “rescue pumps” very often. Dr De Waal emphasises this to his young patients, who may feel awkward about carrying inhalers around with them. To combat this, he suggests that parents discuss their child’s diagnosis with their school and make sure that an inhaler is available, perhaps with a teacher or an on-site nurse, at all times. But children also need to be taught that “if your asthma is under control, you don’t need to walk around with your pump”.

For this control to be achieved, children should be taught the importance of using their daily steroid inhalers and any other prescribed medication – “most [asthma] medicines are now taken in the mornings, and again at night”, Dr De Waal points out. It’s also important that asthmatics, no matter their age, realise they’re living with a chronic condition: “You will get better, you’ll have symptom-free days, and then it can flare up and could be life-threatening.”

And chronic conditions require chronic medication, he emphasises: “You need to take your medication every day. You must adhere to the treatment regimen even if you’re feeling alright.” In this digital era, there are many resources available to help teach children about asthma and allergies more generally. Dr De Waal collects some on his website, doctorforkids.co.za, and says there are plenty more that can be accessed.

“Find a reliable asthma or allergy site tailored to South Africa, and to your and your child’s needs,” he suggests. “We also try to implement allergy awareness at schools: teach kids what allergies are, what asthma is. That’s educational to other kids and makes dealing with asthma a team approach, not something weird or alien.”

He’s also excited about the fast-moving technological shifts that are revolutionising asthma treatment. These include immunotherapy, biologics – drugs made from or containing living organisms – and inhaler devices that are “child-friendly, cool for them to look at, and use”.

UNDERSTANDING THE CONDITION

Jeannie D is also a fan of technology. That’s why she’s working with a pharmaceutical company as a product ambassador for a strap-on sleep monitor that allows asthmatics to gather data about how their lungs are coping while they snooze. It’s another way for her to harness her natural curiosity and learn more about the condition she’s come to understand so much better in the two decades since her first asthma attack.

Who knows – maybe this and other forms of asthma management and treatment will feature on her next big project, a lifestyle channel called Jeanius, in partnership with Naspers, that will cover topics from health to travel and everything in between.

Whatever the case, one thing is clear as Jeannie gathers up her bag, adjusts her mask and heads off to her next appointment: she has no intention of letting asthma control her – not when she and every other asthmatic can control it and live a full, active, happy life.

Asthma: Know the symptoms

Mediclinic Bloemfontein’s Dr Pieter de Waal suggests that parents look out for the following asthma symptoms in their children:

• Recurrent bouts of coughing and wheezing, where the child gets better in between attack.
• Waking up at night short of breath or wheezing.
• Attacks of coughing and wheezing brought on by physical exercise or activity, or the child getting easily tired and not being able to keep up with others.
• Frequent visits to emergency departments because of breathing problems. There, the child will usually be treated with a nebuliser and will immediately improve. In many cases when they’re discharged, parents will be told bronchitis or a similar respiratory complaint was to blame.

These are all common symptoms of asthma:

• Shortness of breath.
• Chest tightness or pain.
• Wheezing when exhaling, which is a common sign of asthma in children
• Trouble sleeping caused by shortness of breath.
• Coughing or wheezing.
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.  

How to use an inhaler property

Don’t let the name fool you – it’s not quite as simple as putting a pump in your mouth and taking a deep breath. Dr De Waal says without the correct technique, inhalers and the nasal sprays many asthmatics use to manage allergic rhinitis are ineffective. Ask your doctor to talk you through the correct use of these devices, to make sure you understand each one’s quirks.

1. Remove the cap.
2. For a single-use device, load a capsule.
3. Breathe out slowly (not into the mouthpiece).
4. Put the mouthpiece between your front teeth and close your lips around it.
5. Breathe in through your mouth deeply for 2-3 seconds.
6. Remove the inhaler.
7. Breathe out slowly.