Q Why are there different types of inhalers? What do they do and does it really matter which one I keep with me?
A There are a number of inhaler types and they serve different purposes. They are colour-coded to identify the type of medicine they contain. Blue inhalers contain a rapid-acting bronchodilator such as salbutamol, which acts to relax the muscle around the main airways, and thus open the airways and relieve breathlessness. They are often called ‘relievers’ and users are advised to keep them with them at all times. Brown and orange inhalers contain a corticosteroid (e.g. beclometasone), which acts to settle the inflammation affecting the airways in asthma sufferers. They are taken regularly, usually twice a day, and are called ‘preventer’ inhalers. They also act to prevent exercise-induced bronchospasm (narrowing of the airways), which affects many asthmatics. Combination inhalers (purple or white/red) contain a long-acting bronchodilator and a corticosteroid and are designed to be used twice a day regularly. When used regularly, asthma should be well controlled so that there is no need for emergency use of a reliever inhaler.
Q I remember my mum telling me years ago that her father died from a lung disease caused by his budgie. Can this be true and if so, are all birds dangerous? Or is it just budgies?
A Birds, both domestic and feral, as well as other mammals, can be hosts
for a bacteria called Chlamydophila psittaci. In humans it causes a respiratory illness called psittacosis. Transmission can be by inhalation or contact with infected birds. Birds may be unwell, but usually appear well, then shed the bacteria when stressed. Most cases arise in people who keep birds but even so the disease is not common. Psittacosis begins with flu-like symptoms followed by pneumonia, which can be fatal, but responds to antibiotics.
Q My daughter had a blood clot on the lung a few years back. Can you explain what causes this and how she can avoid it in the future? Does it cause long-term damage to the lungs?
A Blood clots in the lung can either be ‘provoked’ or ‘unprovoked’. Provoked clots are those where there is a recognised factor that promotes the development of a blood clot either in the leg, where a piece breaks off and travels to the lung, or in the lung itself. Factors include prolonged immobility (e.g. long-haul flights or car or train journeys, immobility due to a stroke), active cancer, the oral contraceptive pill, major surgery and inherited disorders. Unprovoked clots have no recognisable factor that predisposes development. Prevention of a new clot can include not using the Pill, avoiding prolonged immobility (e.g. getting up and walking around on long flights), early mobilisation after surgery and, in some cases, taking medicines to thin the blood (low molecular weight heparins or aspirin). A specialist hematologist would usually provide advice tailored to the individual.
Q I was vaccinated against TB a few years back. I keep reading in the press about it making a comeback. Do I need a booster?
A TB is making a comeback but most cases are in recognised groups within the population. These groups are more vulnerable to infection. They include people who have suppressed immune systems, either because of infection (e.g. HIV), or drugs (immunosuppressants such as those used in the treatment of several types of arthritis), or suffer from diabetes or alcoholism. It is also more common in people who live or have lived in countries with a high background incidence of TB, for example India.Vaccination against TB provides significant protection against TB and is long-lasting. Boosters are not required, although may be considered in high risk groups such as healthcare workers.
Q We all know about the damage to the lungs that smoking cigarettes causes and I’ve never touched them. I do, however very occasionally smoke cigars. I don’t inhale the cigar smoke. Is it really that bad?
A It is not possible to say that there is a level below which cigarette or cigar smoke does no harm to the lungs. Thus the advice would always be never to smoke.