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Nicola - Interview 13

Age at interview: 24
Age at diagnosis: 7
Brief Outline: Nicola has moderate asthma and needs to take her inhaler everyday to keep her symptoms under control. She does not get many asthma attacks now, but is prone to developing bronchitis which can last for up to a week. Nicola recently saw an asthma nurse and found it most useful. It provided an opportunity to discuss her asthma and treatment in detail.
Background: Nicola studied journalism and public relations and now works for a PA consultancy. She shares a house with other young professional girls. In her experience most people know about asthma. Ethnic background/nationality' White British.

More about me...

Nicola first became aware of being asthmatic when she was about 7 years old. She had a mild form of asthma and was given an inhaler that she remembers using once every three or so months. Initially she felt breathless when running and doing exercise but it didn't really bother her that much. It was only later, when she was already at secondary school, that her asthma symptoms began to trouble her and she was prescribed a Becotide inhaler to use twice a day. 

Nicola does not get many asthma attacks now, but is prone to developing bronchitis which can last for up to a week. She says that actually, with bronchitis, you are wheezing all the time and it is like having a permanent asthma attack. So it can be a scary experience, particularly if you don't feel your symptoms are responding to the treatment. She usually gets a course of antibiotics and that clears her bronchitis but for at least the first two days she needs to stay in bed as she feels very uncomfortable and tired.  

In her experience asthma has not affected any aspect of her life. She has found that most people know about it because it is a common condition and providing she carries her inhaler with her, she is unlikely to need any help from others. Likewise, she is able to take part in any physical activity provided she uses her inhaler before starting to exercise. On average she tries to go to the gym twice a week.

Recently and for the first time Nicola has seen an asthma nurse and found it most useful. It provided an opportunity to discuss her asthma and treatment in detail. Nicola found out that her asthma wasn't as well controlled as she had thought and she needed to change the type of her preventative inhaler to improve the control of her symptoms. 

 

A review with a specialist nurse showed her that she was not using her inhalers correctly.

A review with a specialist nurse showed her that she was not using her inhalers correctly.

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I've only been a couple of times now but she does the peak flow measure and finds out where you are. And she just talks to you about your current medication. So I mean I was on Becotide and I was finding that it wasn't working as well as it had been so I was given Seretide, the purple inhalers [ha]. And I think, 'cause the first time I saw her I hadn't, I had, I did tell her that my, I didn't think my Becotide was working as well because I was taking it and I was still getting wheezy. 

And... I suppose at that point I thought it was ok to take my blue inhaler daily if I needed it. And apparently it's not because your symptoms should be more under control. And I think just because I was used to having to take it every day I thought that's what you were supposed to do. And no one had told me otherwise. So when I saw her and she said, 'Well you shouldn't be taking it daily. You should be taking it maybe when you're exercising and you know, when your triggers kick in  But you know just, you shouldn't wake up and have to take your inhaler every day' which is what I was doing at one point. So that was quite useful to talk about that and then for her to recommend a different inhaler. 

And then yeah we just talked about what my triggers were and so what I should stay away from. And then how my medication was working really.

What was her advice?

We also, we went through how to take your inhaler properly as well which I know it says on the leaflets but I hadn't, hadn't had anyone show me properly like that before. So I, I'll always remember that, the advice she gave me about how to take it properly 'cause I possibly wasn't getting the most from my, each dose anyway by the way I was taking it. 

Other advice? I think she said, she did say 'Take your inhaler an hour before you exercise rather than just before or as you're doing it because it takes that time to start working.' Yeah they were the main things that I remember.

Just because my, well I was given Becotide inhalers and I think my asthma was getting worse and so it wasn't working any more. But I just sort of, I don't know I just assumed that that meant I'd need to take my reliever more so I was just happy waking up taking my Ventolin and thinking that was the right thing to do.

Were you discussing this with your doctor or no?

No.

And this is why when I went to see the nurse this is what she talked to me about and that's when my dose changed. So I hadn't really spoken to my doctor about it. But he, he did know because I was ordering more inhalers he did know that my, I was taking it more than I used to. 

But he didn't raise the issue with you?

No, don't remember him doing, no.

And because I mean that's the thing when you're not. That's why it's useful for somebody to talk to you about it because if I hadn't seen the nurse. I mean I, you don't really know what the normal thing is and what you should be doing. So when you don't have that information you don't know whether you're doing things properly or not. So I just assumed that it was ok to be taking, waking up and taking my Ventolin because, you know I knew that I was able to take it up to six times a day. So I thought as long as I'm not overdosing I'm not doing anything wrong which I wasn't but I was just not handling it in the correct way [ha].

 

Thinks that people should be given written information when they are diagnosed and also have...

Thinks that people should be given written information when they are diagnosed and also have...

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I think it would be useful to have some written information available because you know when people are diagnosed and maybe if they're given a pamphlet and then just quite regularly really because people as they grow older they might have different questions. And you know they might sort of discarded the information the first time. I think it's just important to keep giving people the written information but then also offer them the support of the nurse and you know people that they can actually talk to because people probably don't talk to their GPs about it. And the GPs probably don't ask those sort of questions, well the sort of questions that the nurse would. And give you all the information that you need. So yeah I do. I think it would be useful for people to be given more information at the outset and then sort of as they get older really.

Do you think that there are different needs or new needs as you grow older regarding managing asthma?

I suppose as you get older you, you do have different questions because you aren't, you don't really because you aren't. You don't really think about why it's happening and what your triggers are and things when you're younger. You just accept that that's happening and you just want a cure for it. And when you're older you want to understand about why it's happening and, so you can be in control of it I suppose. I think when you're younger your parents are the ones who are more interested and they look after you. And then when you're independent you, you want to know the best way of doing things really for yourself. So yeah.

 

Says that at the age of seven she was just a bit short of breath but that her physical problems...

Says that at the age of seven she was just a bit short of breath but that her physical problems...

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I was first aware of being asthmatic when I was about seven years old. Especially when I did sport I'd, I found I was a bit short of breath especially on colder days. And so I did go to see the doctor. And I wasn't specifically diagnosed as having asthma but I was given an inhaler to take. And at that time I only needed to take it probably once every three months. And then gradually I was taking it more and more. I remember when I went to secondary school and I did sport there I had to have my inhaler with me every time I exercised because I was finding, I was more dependent on it. And then gradually I was given a Becotide inhaler which I had to take twice a day to keep the symptoms under control. 

I think when I was younger when I was about seven it didn't really bother me too much because the symptoms, it only sort of happened when, when I was running and doing exercise. I found it did get worse as I got older. And I think there were sometimes when it did become a bit scary. You know I'd go away and I'd forget my inhaler and I'd wake up in the night and I won't be able to breathe and it's quite frightening. But I think it's rather than I don't have many asthma attacks as such I think. I do, I get a lot of bronchitis and I find I do wake up in the night wheezing. And sometimes even when I take my blue, blue Ventolin inhaler I still find I'm wheezing and you know it can be a bit frightening when it happens in the night. 

I don't know actually that was one question I did ask the nurse about. And she says because I wanted to know whether it would go away. And because my granddad was asthmatic as well and he only developed it in his later years but I know some people have it as a child and then it goes away. I don't think it's possible for them to tell actually whether it's, whether it's going to get worse or better. But yeah it has got a lot, lot worse since it started.

 

Thinks that GPs and nurses have different roles when it comes to help her with the long-term and...

Thinks that GPs and nurses have different roles when it comes to help her with the long-term and...

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Now regarding your GP how do you evaluate the kind of communication with him?

It's good but I think it's different with a nurse because when you go to see your GP it tends to be, you know oh this has happened this week and you know I need a fix for this. Whereas the nurse is more of a, more long-term care. You know I've gone to see my GP when and I've said, 'You know I can't breathe. I've, I think I've got bronchitis 'cause I always recognise the symptoms now'. And so he says, 'Fine you know give you some antibiotics'. And so you don't really get the sort of same care as you do with the nurse because the nurse talks to you about things in more depth and in a long-term sense. So you know, 'Are you feeling different this month to three months ago'. And you know looking at it like that rather than you know, 'Oh you're not very well today. Let's do something about it'. So sort of short-term fixes.

So it's more like an assessment, a long term?

Yeah, yeah, exactly.

Based on your experience is there anything that they should improve regarding sort of how they relate to young people with asthma or?

It would have been useful to know about the nurse a while ago because I mean I only, I was only told  yeah I think it was a couple of years ago. So I didn't know about, I don't know whether that's a new thing that they're trying to do or whether it's being going for a while and I just didn't know about it. But there's, before that time there was nobody to really talk to about it and get that kind of advice. And I don't know with my GP I don't feel that I want to waste his time by talking about these things. Because I just, you know, they don't have a lot of time anyway so you just want to go in and say, 'Right this is wrong' and he can fix it so you don't go into depth and. And I don't think. They, they don't really volunteer that anyway. I think it's more of a nurse's role to give you that care perhaps [laugh].

 

Make sure that young people know what help is available and direct them to the right places.

Make sure that young people know what help is available and direct them to the right places.

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I don't know because in my experience they've, be quite good. I think the key with doctors is maybe to make sure that young people know that help is available and direct them to the right places because you know, I, I'm not familiar with Asthma UK for example and maybe I should be. And, you know maybe I should be more aware of it or at least given information about it. So I think it's about making sure that, you know, although they might not have the time to go into great depth about things they point people in the right direction. So they can, they know where to get information from 'cause people are happy to go away and do their own research and things but it's just making sure they know where to go I'd say. I don't. I can't think of anything else 'cause the people that I've spoken to in the past have been good and yeah.

 

From experience she knows that if she gets wheezy and does not have her medication with her she...

From experience she knows that if she gets wheezy and does not have her medication with her she...

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But socially it hasn't really affected me too much. I always have to remember to take it out when I go out in the evening and obviously if I do leave it at home I worry for the evening that something's going to happen 'cause it's not very nice being caught short. But apart from that I think it's under control [ha] and you just get used to it. And yeah it's fine it hasn't really affected my life in a particularly serious way other than. I think you just because I've had it since I was a child I'm just used to having to take my inhaler where I go, wherever I go. And used to being dependent on it I suppose.

Ok. So going out with friends hasn't been sort of a problem?

Not really I mean I've had a few instances where I've been short of breath when I've gone out and I haven't had my inhaler with me which is habit I've [laugh] tried to break. And that's been. It has been a bit scary and a few times people were threatening to call an ambulance 'cause I was just really it was out of control. 

Not really only the times when [name] and I went out and I couldn't breathe and I didn't have my inhaler with me and that was the time when someone wanted to call an ambulance and I wouldn't let them [laugh]. I think that's the only time where I've had any big problems. But I mean I have found that I've been at people's houses before though when I haven't got it with me and I've got wheezy and I've had to go home early. So it can interrupt an evening. But that's my fault 'cause I should have had it with me.
 
 

Her boss used to have asthma so he understood when she was off sick with bronchitis. Does not...

Her boss used to have asthma so he understood when she was off sick with bronchitis. Does not...

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At work when you were applying for jobs  did you put in on the application form that you have asthma, moderate asthma?

If they ask, if there's a particular space that says have you got any conditions then I'd put it on but otherwise I wouldn't bother.

Do potential employers raise the issue with you or not?

No I mean my current boss he knows that I've got it and he's, he used to have it quite badly and he's still got it a bit now. So if I've, when I. Well I've only once been off work with bronchitis but he completely understands 'cause he's had the same problems. 

I think it is, it tends to be asthmatics that get a lot of bronchitis actually 'cause I know I get it quite a lot and he's had it quite a bit. And a lot of people who are not asthmatic have never had it at all [laugh]. So but no it's not. No, he's quite understanding about it and I don't think it would. I think you need to tell potential employers but I don't think it would ever be an issue.

No.

Not in my line of work anyway. Maybe, maybe something a bit more active [laugh].
 
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