Living with severe asthma as a teenager

Anna Grosse, who has just reached her 17th birthday as The Lancet Respiratory Medicine goes to press, has spent all her life dealing with effects of asthma. She lives in East Lothian, on the outskirts of Edinburgh, Scotland, with her parents and younger sister, and is in her final year of high school and deciding the next steps to take in her education or career. “I was diagnosed at 2 years old”, Anna explains. “Some of my earliest memories are visiting my uncle, who had pets, and these could trigger attacks.” Back then, she would use her inhalers and also slowly inhale steam to bring things under control.

Fast forward to today, and Anna’s family actually owns a pet cat. “We did our research and discovered that female cats are less allergenic, and that I would be able to adjust better if we took her as a kitten, and that’s how it’s worked out. I just had a few minor flare ups when we first got her di lei. It was really important for me to have a pet. “

Anna’s treatment has involved various inhalers over the years, including the brown preventive inhaler familiar to all younger children; a purple preventive inhaler meant to be used twice per day using a spacer attachment; and the standard blue Ventolin inhalers of various designs used to control flare-ups. In recent years, Anna has switched the purple inhaler to a new Relvar alternative design inhaler that only needs to be used once per day. “This has made a big difference, only needing to use it once per day,” explains Anna. “It might not sound like remembering something twice per day would be difficult, but I’d often forget with the old purple inhalers if I’d had a long or busy day. Then not long after, a flare-up could occur, and I’d only realize then I’d forgotten to use the preventive inhaler ”, she explains.

Anna also takes montelukast maintenance therapy tablets once per day, which prevents her airways narrowing and helps avoid asthma attacks, and also cetirizine tablets to help manage allergies (which can in turn trigger flare-ups if not controlled).

Thankfully, Anna has grown up in an era where teachers and fellow students are very aware of asthma and its consequences. Her primary school teachers di lei were all well versed in the condition, while her secondary school di lei has health support staff (who both have asthma themselves) to deal with a wide range of health issues in the students. “I didn’t do much physical education in school, especially indoors, because there was often a lot of dust”, she explains. “In some of the classrooms too, there was enough dust to make me feel it in my breathing.”

One of the most difficult periods of Anna’s schooling was the first 3 years of high school, where she struggled to adjust to these sometimes dusty environments and there was the added trigger of science laboratories, where the odor of chemicals used in experiments could make her feel her symptoms worsening and trigger asthma attacks. “It meant I would need to leave school early and go back home quite a lot”, Anna recalls. She is also at a higher general risk of symptoms worsening during the winter period when temperatures drop sharply across Scotland and windy, rainy weather is much more common.

Occasionally, the outcome can be worse, with several hospitalizations during these years. “I’m not quite sure how, but I’ve been very lucky that none of these hospital visits needed an overnight stay so far,” Anna explains. “Sometimes I’ve been rushed to hospital very early in the morning, and stayed all day, but the doctors have always managed to get me under control again with additional oral steroids, without having to spend the night.” On one occasion in her early teens, Anna stayed with a family member who owned a cat and unfortunately, during Anna’s stay di lei, the cat managed to sneak into the bedroom. She woke up in the early hours with breathing difficulties, and it was no surprise when her symptoms began to worsen and she ended up in hospital again. Following these attacks or bad flare-ups, Anna, like others with asthma, is asked to implement the “4 × 4 × 4 strategy”, which means four puffs of the Ventolin inhaler four times per day, across 4 days.

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Currently, Anna is enjoying the most stable period of her life in terms of asthma symptoms — despite the COVID-19 pandemic. “I actually think the pandemic may have protected me from having more colds due to social distancing”, she explains. “I’ve always been happy to wear a mask, even though occasionally this can lead to some minor breathing problems.” Early in the pandemic (February, 2020) Anna suffered a very bad chest cold, with a fever — and looking back, she believes it could have been COVID-19. “Of course, I can’t be certain but if I had those symptoms again today, I’d think it was COVID for sure!”

Despite her relatively young age, Anna has been keen to do what she can to progress asthma research and is a volunteer for the public advisory group at the Asthma UK Center for Applied Research at the University of Edinburgh, UK, which has carried out multiple asthma studies and more recently has used patient data to track the COVID-19 pandemic and vaccine effectiveness across Scotland. Although not part of the advisory committee for the study on COVID-19 related hospital admissions across Scotland published in this edition of The Lancet Respiratory Medicine, Anna has read the study and believes it shows clearly that all children over 5 years old with asthma should be prioritized for a COVID-19 vaccine to prevent further hospitalizations. She herself has taken two doses plus a booster dose of vaccine, and is hopeful that the omicron variant surge could be the last major surge of COVID. “We’ve been here before”, she says. “But I’m cautiously optimistic this time!” She also wants to see developed nations donate far more vaccine doses to the developing countries that need them most. “If this doesn’t happen, then the pandemic could keep on surging”, she says.

Through her long-term asthma specialist nurse Ann McMurray, who is based at the Royal Hospital for Sick Children in Edinburgh and affiliated to the University of Edinburgh, Anna has had the opportunity to participate in two studies recently. One study looked at the use of electronic reminders with incentives for children to properly adhere to inhaler use, including possible rewards for themselves and their families. In the other study, the researchers are using artificial intelligence to improve inhaler techniques, to ensure the active drug goes into the person’s system properly. “This work will definitely help younger children, especially, to use the correct technique”, Anna explains. “It uses games and other technology such as camera apps to show you how you should be standing and breathing correctly.”

For the future, Anna is deciding now between becoming an air traffic controller (trying to enter as a trainee post-school) and studying psychology and economics at university. “Of course, I could go to university first and consider a career in air traffic control after that,” she explains. “I had thought about training as an airline pilot, but I am ineligible due to my asthma. So air traffic control is the next best thing. ” She also wants to continue working to improve understanding of asthma however she can. “Even though it’s now 2022, many people still don’t understand asthma or its consequences”, she says. She also wants people who smoke to be more consider of those with breathing difficulties, saying that “although things have improved massively since smoking was banned in public places, there are some smokers who think going outside for a cigarette means standing in the doorway of a shop or restaurant or other building. If I have to walk through that doorway, I can have breathing problems immediately “. And a new type of stigma has appeared since COVID arrived: people looking suspiciously at anyone coughing or experiencing breathing difficulties. “People are worried someone struggling could have COVID and keep their distance. “These are just some of the problems people who have asthma or respiratory problems can face every day. We need to increase awareness and remove stigma from these conditions. “

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