Over the next few weeks I am going to share a series of articles that I have written for the Mountain Training Association on how to manage common medical issues when out on the hill.
These articles are targeted at lay people and outdoor guides, however they will hopefully also be useful as an aide-memoire for any expedition medics and wilderness first responders, whilst also being a useful resource for patients going into the wilderness. Please note the disclaimer at the bottom of the article and always consult a medical professional if you are unsure!
What is Asthma?
Asthma is a long-term condition which is usually diagnosed in childhood, although it can present later on in life as well. In asthma, the breathing tubes (airways) in the lungs become narrow as a result of inflammation and tightening of the muscles that surround these tubes. This is what causes the typical symptoms of coughing, wheezing, shortness of breath and a tight feeling in the chest.
Asthma is a common condition that affects the airways and lungs of around 5.4 million people in the UK. This is the equivalent of 1 in 12 adults and 1 in 11 children, and therefore it is highly likely that you will be joined by one or more asthmatics on your next activity.
Asthma symptoms tend to fluctuate in severity, and different people will experience varying levels of symptoms. Many people with asthma can be symptom free for weeks at a time, however their symptoms will often deteriorate if they are exposed to a trigger such as pollen, cold air or exercise: Most tend to know which environmental factors will affect their asthma and avoiding these will be a key part of their “asthma action plan.”
What about inhalers?
There is no cure for asthma, but effective treatment allows the majority of people with asthma to live a normal and active life. Inhalers are the most common treatment and these work by delivering medicine into the airways to relax the surrounding muscles. The most well-known and frequently used inhaler is salbutamol. This is a “reliever” medication, in that it is used when a person with asthma feels short of breath or tight in the chest. Some inhaler users, particularly children, may also have a spacer device: These are cylindrical clear plastic devices that help deliver the inhaled medication more effectively.
How can I decide whether someone with asthma should join an activity?
Asthma is by no means a barrier to participating in outdoor activities, however it is important to know what a potential participant means when they say: “I have asthma,” as this covers a large spectrum, from someone who might never need to use their inhaler to someone who has been admitted to intensive care.
This is not supposed to be alarming, but instead prompt you to consider two simple questions that can help you understand the risk and decide whether an individual can safely join your group. In the overwhelming majority of cases the answer will be yes, they can. In addition, participants with severe or more complicated asthma are often very clued up on its management and will usually have a well-developed strategy to manage this autonomously.
1. My first simple screening question to gauge severity and suitability would be “how often do you need to use your inhaler?” If the answer is never, or once a month, this suggests their asthma is reasonably well controlled. Alternatively, if they say they have to use it several times whenever they exercise, you might want to re-think summitting Ben Nevis with them until their asthma has been reviewed by their doctor.
2. My second question would be, “have you been to the hospital because of your asthma?” It is reassuring if someone has never been to hospital, whereas if they attended the emergency department with breathing difficulties last week, this would usually make you consider their suitability at that point in time. However, if such a visit was a long time ago, understanding what triggered that visit would be helpful to make a decision on suitability for the activity.
These two questions can give you a rough idea of an individual’s suitability, however the decision will also depend on the type of trip you are going on, the distance from a main road (for evacuation in a worst-case scenario), the distance from hospital and also your own knowledge and first aid skills. If at all in doubt, ask the participant to discuss any proposed activity with their own doctor. This is where sending medical screening questionnaires out in advance of an activity has obvious advantages as it allows adequate time for planning and discussion.
How to manage an Emergency?
You have probably heard of people having an “asthma attack.” Sadly, severe asthma attacks kill 3 people every day in the UK, and prompt recognition and action can be the difference between a positive and negative outcome. When someone with asthma has an attack it is a bit like trying to breathe in and out through a drinking straw, and it can be very hard for them to get enough air into their chest.
The most important thing is to remain calm and to try and encourage the participant to do the same. This may be easier said than done and counting to ten inside your head can be a helpful way of slowing things down. Next, remember where they keep their reliever inhaler and follow the steps below as advised by the NHS; it can be helpful to use a spacer device in this situation if the individual in question has one, and it is also important to note that some people with asthma may have a different management plan, in which case they should follow this instead of the standard guidance.
In summary, asthma is common and in the vast majority of cases it need not be a barrier to participating in outdoor activities. It is nevertheless important to ask a few questions if someone declares that they have asthma, so that you can gain a clear understanding of what they mean by this and discuss how you can safely support them during a day out hiking or climbing. This article has briefly introduced the topic and cannot comprehensively cover it in detail. If you want to find out more, please look at the following resources or consider purchasing the Oxford Handbook of Expedition and Wilderness Medicine.
- NHS Choices: https://www.nhs.uk/conditions/asthma/
- Patient UK: https://patient.info/chest-lungs/asthma-leaflet