Better Breathing Magazine - Winter 2021

Page 1

Winter 2021

Better Better Breathing Breathing What’s new in respiratory research

How to use

your turbuhaler

Busting common asthma myths

Find out inside!

Top Tips for


Understanding Idiopathic Pulmonary Fibrosis We speak to Nick Ashill, who is running across America to raise awareness

. Pg 10

Pg 5. The latest respiratory rese arch from the University of Auckland, and how Kōwhai trees may help smokers quit.

Our Team Chief Executive Letitia Harding Research and Education Manager Joanna Turner Office Administrator Dunia Cullingford Donor Relations Coordinator Ruby Parker Grants and Fundraising Manager Harriet Cartwright PR and Comms - Head of Marketing Kate Davidson Marketing and Communications Advisor Sam Treseder Corporate Sponsorship and Engagement Advisor David Barclay Medical Director Dr James Fingleton, BM, PhD, FRACP Chief Cultural Advisor –­­ Māori Sir John Clarke, KNZM, CNZM Level 2, The Woolstore, 262 Thorndon Quay, Wellington 6011 PO Box 1459, Wellington 6140 04 499 4592 asthmaandrespiratoryfoundation asthmafndation asthmaandrespiratoryfoundation

ISSN 2703-4127



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Pg 11. Partnering with our new Fri ends of the Foundation Pu lse Energy to he lp Kiwis breath e easier.

In this issue... 2

Community news Did you know last month we held the first annual New Zealand Asthma Awareness Day - Te Rā Whakaarohia te Huangō? We share some details from the day.


Health professional news The Global Initiative for Asthma recently released their new strategy framework. Find out how it draws on a key recommendation from ARFNZ’s own guidelines.


Top tips for winter We share a few tips to help manage your respiratory condition at the coldest time of year.


Respiratory research bulletin We discuss the latest respiratory research, including a study from the University of Auckland on children with asthma, and how Kōwhai trees might help smokers quit.


Busting asthma myths The theme of World Asthma Day 2021 was ‘Uncovering Asthma Misconceptions’. We look at some common asthma myths, and find out where the truth really lies.

Thanks to the Foundation’s sponsors for supporting our ongoing initiatives.

12 use Howyour ler uha b r u t


Understanding Idiopathic Pulmonary Fibrosis (IPF) IPF is a rare but devastating respiratory disease. We look at what it is, and speak with Nick Ashill, who lost his mum to IPF and is running across America to raise awareness.


Exploring the art of breathing Breathing Physiotherapist Tania Clifton-Smith shares insights into how to breathe well.


Launching our partnership with Pulse Energy Pulse Energy partners with the Foundation to help Kiwis breathe easier.


How do I use my turbuhaler The turbuhaler is the most common dry powder inhaler used in New Zealand. We look at how to use it, and some common mistakes.

Top Picks... Page 5 Read about inequities in the health outcomes of Kiwi children in our latest research bulletin. Page 9 Long-distance runner Nick Ashill’s remarkable story. Page 11 Pulse Energy partner with the Foundation

Did you know you can also read this magazine online? Head to the link below to view every issue of Better Breathing Magazine!

ARFNZ CE, Letitia Harding

Letitia’s Message I hope everyone is managing to stay warm and dry as we head into the cooler months of winter, especially as we know that cold, damp air can trigger numerous respiratory health issues. The Foundation whānau have been extremely busy with key projects, including the update of our online Asthma & COPD eLearning course. We are now running the course in-house so we can engage with people who enrol much more effectively, addressing any questions you may have. We also hope to be able to enhance and build on our educational offering. Joanna Turner, our Research & Education Manager (and resident pharmacist), is overseeing this programme, along with our ever present and engaged Scientific Advisory Board (SAB). For those health professionals required to undertake CPD points/hours-based learning, this eLearning is accredited for 12 CPD hours. We would encourage every health professional to include the latest asthma and COPD best practice in their reflective practice accounts and professional development plan. At the end of this course, you will receive a Certificate of Completion and an official ‘ARFNZ Asthma & COPD Trained’ badge. You can find more information on page 13.

This April, we also saw the public consultation ‘Proposal for a Smokefree Aotearoa 2025 Action Plan’ released, with some bold ideas on how we can truly get to a Smokefree Aotearoa. Hopefully you all submitted on this proposal. Remember, it is only through active engagement of the community that we can see positive health policy changes. We have also seen the changing of the guard with the appointment of a new Medical Director – Dr James Fingleton. James is a respiratory physician and Clinical Leader for Respiratory at Wellington Regional Hospital. He is also a Senior Clinical Lecturer at the University of Otago and Honorary Research Associate at Victoria University of Wellington. James has been a member of the Asthma and Respiratory Foundation’s SAB since 2020, and as Medical Director he will take on the Board Chair role. James took over from Dr Stuart Jones, who served as the MD for the Foundation for the past 4 years. During this time, Stuart’s achievements included leading the development of the new COPD guidelines alongside Professor Bob Hancox, and contributing his expertise to the Foundation’s campaigning and advocacy around vaping regulations. It was my pleasure to present Stuart with the Foundation’s inaugural MD award for significant contribution to the Foundation’s work, and we look forward to Stuart’s valuable input as a continuing member of our SAB.

Dr Stuart Jones, who served as the Foundation’s Medical Director from 2017 - 2021.

World Asthma Day (WAD) was an incredibly special occasion for the Foundation this

year, with Aotearoa Te Rā Whakaarohia te Huangō - New Zealand’s inaugural Asthma Awareness Day being launched. This day will be held on the first Tuesday in May of each year to coincide with World Asthma Day, an international event organised by GINA (the Global Initiative for Asthma). The name was gifted to the Foundation by the wonderful Sir John Clarke, KNZM, CNZM, the Foundation’s Chief Cultural Advisor, Māori. New Zealand’s asthma statistics are among the worst in the world, with Māori tamariki, mokopuna and whānau disproportionately affected. The 2019 Global Burden of Disease reported the rate of death due to childhood asthma in New Zealand as nearly four times higher than the global rate for children aged 10-14 years. The recent University of Auckland study published in the NZMJ and highlighted on page 5 showed that Māori children are hospitalised for asthma at twice the rate of non-Māori. Finally, as always, we hope that you continue to support and value what the Foundation does. Please provide us with feedback, the positive and the negative, as we welcome engagement from you - our readers. Remember, the Foundation receives no contract government funding towards producing all the information and national resources that we continue to provide free of charge, and we can only do this through the generous support of our sponsors, donor whānau, and community grants that we are always so thankful to receive. Noho ora mai

Letitia Harding Chief Executive

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Respiratory Community News World Asthma Day 2021 wrap-up World Asthma Day is the annual awareness campaign hosted by the Foundation to educate Kiwis about one of New Zealand’s most prevalent respiratory diseases. This year, we launched a dedicated New Zealand Asthma Awareness Day: Aotearoa - Te Rā Whakaarohia te Huangō, which we held on Tuesday 4 May. New Zealand’s asthma statistics are among the worst in the world, and we believe it’s time for Aotearoa to take asthma seriously and do it our way! Our Friends of the Foundation and other partners donated some great prizes for the day, including an air purifier from Daikin, a signed Highlanders Jersey from Pulse Energy, and a $300 voucher from Shoe Clinic. The money we raised will help to get Asthma Action Plans into the hands of New Zealand children, so they can manage their asthma better and enjoy life to the full. Find out more at

Life memberships for Breathe Easy volunteers The Horowhenua Breathe Easy Support Group has awarded life memberships to volunteers Jean Wells and Barbara Timms, acknowledging their contribution over the 13 years the organisation has been running. At their annual Christmas party, President Lynne McKenzie and patron and local nurse practitioner Tui Hancock presented Jean (pictured) and Barbara with the first ever life memberships. Jean and Barbara were founding members of Horowhenua Breathe Easy, which now has over 70 members.

Fashion for a cause

Healthy Homes Standards Nearly 600,000 households rent in New Zealand, and research shows that rental properties are generally of poorer quality than owner-occupied homes. Cold, damp and mouldy homes can contribute to negative health outcomes, particularly for those with illnesses such as asthma and cardiovascular conditions.

The clothing store Blue Illusion in Palmerston North organised a fashion show on March 25 to raise money for the Foundation. We’d like to say a big thank you to the team at the store, who managed to raise a fantastic $301.

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In 2019, the Residential Tenancies Healthy Homes Standards were introduced to ensure rental properties meet a minimum standard for heating, insulation, ventilation, draught proofing, moisture ingress and drainage. From next month (July 2021), all private rentals must comply with these standards within 90 days of a new or renewed tenancy. Read the full requirements at

Health Professional News International asthma guidelines follow the Foundation’s lead


INA, the Global Initiative for Asthma, has released its strategy framework, and their recommendations have changed to follow a similar approach to the Foundation’s asthma guidelines. The international strategy now has a separate algorithm based on the preferred option of 2 in 1 reliever therapy for people living with asthma. Last year, the Foundation was the first to recommend a separate stepwise approach like this in its guidelines. GINA have now followed the recommendation. The 2 in 1 reliever therapy, in which patients receive both a preventer and reliever treatment at the same time, allows close titration of both components of treatment in response to changes in asthma control.

ARFNZ Medical Director James Fingleton says that the 2 in 1 reliever therapy is considered the biggest paradigm advance in the management of asthma for decades. “The ARFNZ guidelines were the first to recommend a separate algorithm with this as the preferred approach, and it is a real validation of our guidelines that the global recommendation is now similar.” The guidelines were heavily influenced by research undertaken by Professor Richard Beasley, Director of the Medical Research Institute of New Zealand (MRINZ) and lead author of the NZ Adolescent and Adult Asthma Guidelines 2020. Three large randomised controlled trials of the safety and efficacy of this novel approach were conducted, with two of the studies funded by the Health Research Council of New Zealand, representing the only independent trials in the field. To read the GINA report, visit For the New Zealand Respiratory Guidelines, visit

Asthma & COPD Fundamentals e-learning course Visit to register now!


**Course only available to healthcare professionals. Promotion valid until June 30th, 2021.

Fundamentals Relaunch Special Study all four modules for only $149.99. Course usually $180.00. Use PROMO code BETTERBREATHING at checkout




New Medical Director for ARFNZ Dr James Fingleton, BM, PhD, FRACP, has taken on the role of ARFNZ’s Medical Director. Dr Fingleton is a respiratory physician and Clinical Leader for Respiratory at Wellington Regional Hospital, where he runs the severe asthma service. He is also a Senior Clinical Lecturer at the University of Otago and Honorary Research Associate at Victoria University of Wellington. Dr Fingleton’s research interests focus on the treatment of airways disease, particularly severe asthma and COPD, with a particular interest in personalised medicine. He has been a member of the Asthma and Respiratory Foundation’s Scientific Advisory Board since last year, and as Medical Director will take on the Board Chair role. “I’m excited about taking on the Medical Director role,” says Dr Fingleton. “With the COVID-19 pandemic ongoing, it’s more important than ever for New Zealanders to have the tools and knowledge they need to look after their respiratory health. I look forward to supporting the Foundation to continue to be the leading New Zealand authority on respiratory conditions.” Dr Fingleton takes over the role from respiratory physician Dr Stuart Jones, who held the role for four years.

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Top Tips for Winter W

inter can be a difficult time for those with a respiratory condition, as the cold can exacerbate symptoms. We’ve put together a few tips to help you manage your respiratory condition through the winter months.

1. Get your flu vaccine

The flu vaccine is available at your GP and local pharmacy, and is free for those over 65 years of age, pregnant women, or those with eligible medical conditions. Having a respiratory condition doesn’t make you more susceptible to getting the flu - but it does mean that if you get the flu, you may have more severe symptoms.

2. Know your triggers

If you know your triggers, try to avoid these if possible, or take steps to reduce their impact. One common trigger that can be a bigger issue in the winter months is damp and mould. If this is the case for you, try to avoid drying clothes inside, and use extractor fans in the kitchen and bathroom.

3. When outdoors, breathe through your nose

When you are outdoors in the cold winter air, be sure to breathe through your nose instead of your mouth, as this heats up the air before it travels into your lungs.

sure you take your maintenance medication (if prescribed) even when you are feeling well, as this will reduce your reliance on your reliever medication.

a healthy lifestyle 7. Maintain It is important to fuel your body with vitamins and nutrients. Fruits and vegetables are both rich in these and will help boost your immune system. Exercising is also a great way to maintain a healthy lifestyle. Make sure to warm up properly and monitor your breathing throughout.

Action Plan 8. Asthma To better manage your asthma, you can work with your healthcare practitioner to prepare an Asthma Action Plan. The plan acts as a quick reference guide with details regarding which medication to take when you are experiencing certain symptoms, and helps prevent an asthma emergency. You can downland your own plan in Te Reo Māori, Samoan, Simplified Chinese or English for free on the resources tab at

Have your asthma action plan on you at all times with the...

My Asthma app

4. Wear a scarf

Wearing a scarf over your mouth can also be helpful when you’re out and about in cold weather, as it helps to prevent asthma symptoms. As the cold air evaporates, the thin layer of fluid that lines your airways dries faster than it can be replaced. Dry airways become irritated and swollen, which can worsen asthma symptoms. Having a scarf over your mouth helps the air to warm up before it enters your airways.

5. Invest in a humidifier

Sometimes even the air indoors can be dry, so a humidifier may help you breathe more easily. To see a range of humidifiers that benefit those with asthma and allergies, you can visit

6. Take your medication

Ensure you are taking your medication, as prescribed and directed by your healthcare provider. It is important to make

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ith the My Asthma App you can have your asthma action plan on you no matter where you are - even with no internet connection! The My Asthma app offers all your asthma management information at your fingertips, with customisable asthma action plans, information on triggers, and steps to follow in an asthma emergency. Download the My Asthma app free today from the App Store or Google Play.

Respiratory Research Bulletin T

he research into respiratory health that takes place in New

were given an inhaler containing budesonide to use twice a day. This

Zealand and internationally plays a vital role in helping us to

group recovered on average three days sooner than another group

better understand, diagnose and treat respiratory disease. In this

given normal care (advice to rest and take paracetamol). A third of

issue, we share some interesting findings from New Zealand and

those taking budesonide recovered within the first 14 days of using it,


compared to less than a quarter of those in the other group.

Māori children hospitalised with asthma at twice the rate of non-Māori

These are interim results from the trial up to the end of March, which have not yet been peer-reviewed or published in a journal.

A study by the Liggins Institute at the University of Auckland highlights clear inequities in the health outcomes of New Zealand

Can Kōwhai help you quit?

children with asthma.

Researchers from the University of Auckland have found that a chemical that occurs in native New Zealand plants may help smokers

The study documented trends in the number and cost of hospital

to quit.

admissions and asthma prescriptions for children aged 0-14 from 2010-2019. It showed Māori children were hospitalised with asthma

Cytisine, found in Kōwhai trees, is already used in cessation treatment

at twice the rate of non-Māori children (7.2/1,000 versus 3.5/1,000),

in European countries, but has not yet been approved in New Zealand.

and a larger proportion of Māori children had an asthma readmission within 90 days of their first admission (18% versus 14%).

The study found cytisine to be more effective than nicotine replacement products like patches. Some 12 percent of study

Asthma admissions for children living in the most deprived areas

participants who took cytisine pills weren’t smoking six months later,

were, on average, 2.8 times higher than in the least deprived areas.

compared to 8 percent in the group who took the Government-funded

It’s estimated that the combined cost of asthma hospitalisations and

medicine varenicline. Cytisine also had fewer side effects.

prescriptions was $165m.

Early life experiences and COPD risk While hospitalisations and prescriptions attributable to asthma have

A study by Joon Young Choi and Chin Kook Rhee in the Journal of

declined, the research indicates that many New Zealand children are

Clinical Medicine examined diagnoses of COPD in people under 50.

not receiving levels of primary care for asthma that are consistent with prevention.

They discovered common risk factors from childhood that can increase a person’s risk of developing COPD included being born prematurely

Asthma drug may speed COVID recovery

and having a low birth weight, suffering from asthma and respiratory

A trial by researchers at the University of Oxford has found that

infections as a child, and exposure to air pollution and biomass fuel.

budesonide can help people recover more quickly from COVID-19 at home. The trial involved more than 1,700 people at high risk of becoming severely ill with COVID-19 - aged over 50 with an underlying health condition or aged over 65 with no health problems. During the first two weeks of experiencing symptoms at home, 751

Want to know more? We have collated leading peer-reviewed respiratory research from across the globe on our research portal. Check it out today at :

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Busting common

asthma myths


he theme of World Asthma Day 2021 was ‘Uncovering Asthma

For those just starting their exercise journey, it’s important to start


small and build fitness gradually. If the activity is too strenuous for your

Throughout history, there have been various myths around asthma --

fitness level, or you’re not monitoring your asthma properly, you might risk an attack.

for example, cigarettes were once considered an effective treatment for asthma attacks! While that myth has thankfully fallen by the wayside,

Myth #2 - People outgrow childhood asthma

there are still plenty of misconceptions that remain widespread. Sadly,

While some children’s symptoms do improve over time, you mustn’t

these misconceptions can prevent people from getting the support

assume that your child doesn’t need asthma treatment anymore.

they need to keep their asthma well controlled and to live life to

Sometimes, symptoms recede and then return in young adulthood.

the full.

Asthma can also develop in adults who never had asthma as children. This can be triggered by obesity, allergies, or exposure to toxins.

So what are some common asthma myths, and where does the truth really lie?

Myth #3 - I should only use my inhaler when I really need it, or the medicine will stop working

Myth #1 - Avoid exercise if you have asthma

There are two types of medications prescribed for asthma: preventers

It was once thought that physical activity could make asthma worse,

and relievers. The preventer is taken daily to control airway swelling,

but experts now recognise the importance of exercise for people living

and the reliever treats symptoms of an asthma flare-up.

with asthma. Studies have shown that sports and exercise can have a positive effect on asthma symptoms.

There is no evidence that taking regular asthma medication long term reduces its effectiveness. Prevention is better than cure, so taking your

It’s possible that asthma may flare up during exercise, particularly in

preventer medication regularly is key to managing your asthma well.

cold, dry air. Many sports people with asthma find their symptoms worsen with the change in weather. It’s important to have an Asthma

When you do have an asthma attack, this doesn’t mean your daily

Action Plan in place so that you can continue to enjoy sports while

medication is no longer working. It might be that the air quality is

keeping your symptoms under control.

worse, or you’ve been exposed to a new trigger.

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Myth #4 - Asthma medication is dangerous and addictive Some people believe you can get addicted to asthma medication because it contains steroids. However, the corticosteroids in asthma medicines are very different from the anabolic steroids bodybuilders take to build muscle, which can be addictive. Corticosteroids are in fact very similar to the cortisol your body produces naturally. There have also been reports about corticosteroids stunting children’s growth. In fact, the reverse is true – children with

Asthma and winter sports While it’s a myth that people with asthma can’t take part in winter sports, sports like netball, hockey, and rugby involve a lot of ongoing activity and are therefore more likely to induce asthma symptoms than shorter bursts of exercise. What’s more, exercise-induced asthma, where people who do not otherwise experience asthma start to get symptoms during physical exertion, is surprisingly common in cooler conditions. One study found that half of all cross-country skiers surveyed had exercise-induced asthma.

poorly controlled asthma tend to be shorter than those whose asthma is well controlled, and untreated asthma can delay puberty.


Inhaled corticosteroids are effective and safe when taken at the

Slow deep breaths through your nose with the right breathing pattern will warm and moisten the air that enters the lungs.

recommended dose, and are a vital part of keeping your asthma under control.

Myth #5 - You only have asthma when you have trouble breathing. Unfortunately, not having symptoms of asthma doesn’t mean that your asthma has gone away. Asthma is unpredictable, and even if you are not displaying any symptoms, you will still have underlying inflammation in your airways. This is why using a preventer medication regularly is so important - it helps to reduce this inflammation and prevent an asthma attack from happening.


For most people, if you get asthma symptoms when you exercise it is a sign that your asthma is not well controlled. See your healthcare professional for a review of your asthma and inhalers.


If you’re experiencing symptoms whenever you exercise in cold air, it might help to use your reliever inhaler shortly before exercising to prevent an attack.


Get the asthma facts The Asthma and Respiratory Foundation website has a wealth of reliable, up-to-date asthma information and resources. To learn more, visit

If your asthma is less predictable, just keep your reliever inhaler handy rather than using it beforehand. Always have your inhaler available so you can use it as soon as you feel symptoms coming on.


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Idiopathic Pulmonary Fibrosis I

diopathic Pulmonary Fibrosis, or IPF, is a rare and serious condition that affects the delicate tissues of the lungs. Normally lung tissue is soft and flexible, making it easy to breathe, but IPF causes lung tissue to stiffen and become scarred. Once this happens, the tissue can’t recover.

What happens as IPF progresses? People can experience more mucus secretions, interrupted sleep, and increased breathlessness. It is important for people to discuss a plan with a doctor or respiratory specialist to get clear guidelines on when and how to seek help.

What causes IPF? There is no known cause. Several factors are seen as potential triggers, including viral infections, gastroesophageal reflux (‘heartburn”), exposure to occupational dusts and chemical fumes, and smoking. Occasionally more than one family member develops IPF, suggesting genes may play a part.

Having support from a team of health professionals, such as physiotherapists, occupational therapists, social workers, dieticians and clinical psychologists can help make things easier.

Most people develop IPF when they are over 60, and it is extremely rare in people under 50. Men are affected more commonly than women.

What treatments are available?

Treatment for IPF is a complex area, and it’s important that people get the right advice from their healthcare team. While there is no cure, there are two drugs licensed for use in New Zealand (pirfenidone and nintedanib) that may slow the progress of IPF.

What are the symptoms?

IPF symptoms include breathlessness, a chronic dry or hacking cough, discomfort in the chest, finger “clubbing” (a change in the shape of the fingernails), fatigue, loss of appetite and weight loss. Because these symptoms are not specific to IPF, it can be difficult to diagnose. Symptoms often only become evident when the disease has already caused substantial lung damage. How many people have IPF? There is no clear data on this for New Zealand, but a reasonable estimate is around 5 cases per 10,000 people – meaning most GPs may encounter a new case about once per decade of full-time work. What’s the outlook for people with IPF? Some people with IPF stay stable for many years, while others deteriorate quickly. Unfortunately, IPF is a terminal disease with an average life expectancy of about 3-5 years following an early diagnosis.

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Lung transplantation can be an effective treatment in the right circumstances, but it is a major undertaking and only works for certain people. Transplants become much more difficult in patients over 60, and it is highly unlikely that a patient over 65 would be offered transplantation for IPF, as it is unlikely to succeed. Are there ways to manage your IPF symptoms? There are several ways that IPF sufferers can maintain or improve their quality of life. These include stopping smoking, gentle exercise, good diet, and getting plenty of rest.

Want to know more? For more information and resources about IPF, visit

Running America

for IPF awareness W

hen Nick Ashill’s mother was diagnosed with IPF in 2012, he and his family knew nothing about the condition. The Wellington-based marketing professor remembers the shock of realising that the illness was incurable. “I think the way the news is delivered to families is so important, and the availability of support networks,” says Nick. “The communication from the doctor to our family was very clinical. We realised that there was no cure – the drugs are better now than they were then, but unless you’re younger and can handle a lung transplant it’s terminal. IPF is associated with certain risk factors, but none of them applied to mum. We still don’t know why it happened.” Nick’s parents had been married for over 50 years, and had quite traditional gender roles, but these reversed as his father became his mother’s carer. “They took the decision for mum to stay at home and

say goodbye in her own home rather than going to a hospice,” says Nick. Nick’s mum passed away in 2015. As an ultra-marathon runner, Nick decided to realise his dream of running across the US from LA to New York, and to use this opportunity to raise awareness and funds to support those living with IPF. As his mother lived in the UK, he chose to support the UK-based Pulmonary Fibrosis Trust. “My family received so much love and support during the last years and months of mum’s life, and I wanted to use the run to give back,” says Nick. “Awareness of IPF in the general public is very low, and families often don’t know where to get the support they need.” Nick started his run on 14 May 2017. By August 2, he was 3,949 km into his 5,000 km journey when disaster stuck just outside Columbus, Ohio. Nick was hit by a truck, smashing his right leg and pelvis and throwing him into a ditch. The driver sped on, and sadly has never been identified. Thankfully, Nick was on the phone to his wife Sarah at the time, who alerted the emergency services. Less than an hour later, Nick was located by state police and paramedics. He was flown to the hospital which would become his home for the next five months as he underwent multiple surgeries and embarked on a gruelling recovery.

Because of the severity of Nick’s injuries, he was told that he would probably never run again. However, he has defied the odds and is back to running six days a week. Now, he is determined to return to the US to finish his run. While the COVID-19 pandemic disrupted his plans to complete the run in May of this year, he is optimistic that the vaccine rollout will enable him to return in September 2021 at the earliest, or in May/June 2022. And it’s his hope that three of the doctors who helped him recover will be at the start line in Ohio to cheer him on. For more on Nick’s story, visit

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exploring the art of breathing W

e breathe in and we breathe out; it sounds simple but breathing is complex. There are many things that affect the way we breathe and the way we breathe will affect many things. Much of the information that is available to the public is too simple and too general.

Generalised breathing protocols do not fit everyone, especially if there is a respiratory disorder. If this applies to you, you probably need an individualised, tailor-made programme from a cardio-respiratory physiotherapist who is highly skilled in your specific condition or disorder. Breathing well at rest for an adult involves breathing in and out of the nose and into the belly with a rate of 10-14 breaths per minute. For some, this may be too hard. See this as a general guide. There are many types of breathing therapy and breathing retraining approaches. The quoted 5.5 breaths per minute in the Autumn magazine is for a specific advanced breathing technique called resonant breathing. This should not be attempted unless you have had guidance in this technique. There is also mindfulness / meditation / yoga breathing. These are exercises, and are NOT how we should be breathing at rest or during movement. They often involve advanced techniques that are not tailor made for you and may cause more harm than good. Breathing well at rest should be the first step. If you can breathe well then you may benefit from these other practices, but if not, they will not be effective. For this audience we suggest focus on your out breath. To all of you with a respiratory condition, try pursed lipped breathing to gain control and try to slow your breath. This involves breathing in through the nose and out through puckered lips, as if you are blowing out a candle. It slows your breath and helps reduce the

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amount of air trapped in the lungs. Breathing more slowly with more control has also been shown to reduce a stimulated nervous system and help induce a state of calm and reduce breathlessness. That is why we advocate the pursed lipped breathing exercise for you to try on your own. It is safe and can be used in any situation, whether you are climbing a flight of stairs, mowing lawns or jogging and becoming breathless. Our Advice - Talk to your GP and see a cardiorespiratory physiotherapist or join a pulmonary rehabilitation class.

Want to know more about breathlessness strategies? Visit to download our breathlessness quick reference guide.

About the author Tania Clifton-Smith has 30 years of experience in the field of breathing dysfunction, breathing pattern disorders and hyperventilation syndrome and Tania Clifton-Smith - Breathing Physiotherapist physiotherapy. She co-founded the Breathing Works clinics in 1998, which have treated over 30,000 people with breathing pattern disorders and breathing dysfunction. Tania also established the BradCliff Breathing Method in 2008, a physiotherapy treatment programme for breathing dysfunction.

Pulse Energy partners with Asthma and Respiratory Foundation NZ to help Kiwis breathe easier On April 1, electricity retailer Pulse Energy became an official sponsor of Asthma and Respiratory Foundation NZ (ARFNZ) to help raise the awareness of respiratory disease in New Zealand and to help the 700,000 Kiwis living with respiratory disease breathe easier. “As a 100% community-owned business, we’re delighted to have the opportunity to support the respiratory health of New Zealanders through our partnership with ARFNZ,” says Sharnie Warren, General Manager of Customer Experience at Pulse Energy. The newly formed partnership with Pulse Energy will enable ARFNZ to reach new audiences, improve health literacy and raise the national profile of respiratory disease - all of which will ultimately help more Kiwis to breathe easier. Pulse Energy is a 100% community-owned electricity retailer that provides electricity, gas, broadband and solar to homes right across New Zealand. Research shows that living in a damp, cold house can lead to colds, flu and allergies, which can aggravate existing respiratory conditions and potentially trigger a serious flare-up. Respiratory disease is particularly common among low-income families, who may not have access to healthy housing or adequate heating.

Programme, ARFNZ saw that, like us, Pulse Energy is there to support New Zealanders.” Pulse Energy is committed to improving the lives of New Zealanders through initiatives such as the Pay it Forward Programme, as well as by providing flexible low-cost electricity plans such as the Pulse Lifestyle prepay plan to suit the needs of all families.

Pulse is heavily involved in local communities; supporting the Highlanders and Crusaders Super Rugby teams, various recreation events across NZ, Asthma and Respiratory Foundation NZ and their award winning Pay It Forward Programme. The Pay it Forward Programme is a joint initiative between Pulse Energy and its customers that provides financial support to families facing energy hardship. The Programme – which recently won the Canstar Blue Innovation Excellence Award 2021, enables vulnerable households to heat their homes and create a healthy living environment, which is crucial for those who suffer from a respiratory disease. “Our partnership with Asthma and Respiratory Foundation NZ is another great way for us to give back and support an organisation that’s making a real difference to the lives of everyday Kiwis” said Warren.

According to ARFNZ Corporate Sponsorship and Engagement Advisor, David Barclay, the decision to partner with Pulse Energy was simple. “We saw that there were shared values. With Pulse Energy being community-owned and providing initiatives like the Pay it Forward

For more information about Pulse Energy visit

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How do I use my.... In this series, we highlight a range of respiratoryrelated devices and explain best practice on how to use them. In this issue, we look at how to use the turbuhaler dry powder inhaler.


What is a turbuhaler?

The turbuhaler is the most common dry powder inhaler used in New Zealand. It has no propellant or carrier to deliver the medicine and is ‘breath-activated’. You will hardly notice any powder in your mouth.

How do I use my turbuhaler? 1. Unscrew and remove protective cover. 2. Hold the turbuhaler upright. 3. Twist the coloured grip as far as it will go in one direction and then back again until you hear a click. -Your turbuhaler is now loaded with a dose of medication. 4. Breathe out gently. 5. Place the mouthpiece between your lips: •

Suck in deeply and forcefully through the turbuhaler. You may not taste or feel the medication.

Remove the inhaler from your mouth and breathe out. Do not breathe back into the mouthpiece as you will make it damp inside.

If more than one dose is required, repeat the steps above.

When you are finished, place the cover back on the inhaler and twist shut.

6. Your turbuhaler has a dose indicator window just below the mouthpiece, when you see red in the window it is time to get a new turbuhaler. 7. Rinse mouth and spit out after using a turbuhaler containing a corticosteroid.

What common mistakes should I avoid when using a turbuhaler? Common mistakes when using a turbuhaler include: • • • • •

Not holding the inhaler upright when priming. Covering the air inlets with your lips. Breathing in through the nose instead of the mouth. Shaking the inhaler to see how much is left - this doesn’t work because the sound you hear is the powder that keeps the medicine dry, not the medicine itself. Storing the inhaler in a damp environment with the cap off.

For more information on turbuhalers and other dry powder inhalers, visit

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Find your local Society! Did you know that ARFNZ is affiliated with many asthma societies and groups across New Zealand who are here to provide you with support, rehabilitation and nursing assistance with your respiratory condition?

Horowhenua Breathe Easy Group LEVIN 0279521439 06 3688069

MahiTahi Hauora 28-30 Rust Avenue WHANGAREI 09 438 1015

MahiTahi Hauora 182 Commerce Street KAITAIA 09 408 3142

Asthma NZ 581 Mt Eden Rd AUCKLAND 09 623 0236 0800 227 328

Manawatū Breathe Easy Palmerston North 0272420669

Eastern Bay of Plenty & COPD Support Group Disabilities Resource Centre 141 King Street WHAKATANE 0800 227 363

Asthma Waikato 18 Claudelands Road HAMILTON 07-838 0851

Southland Asthma Society Federated Farmers 70 Forth Street INVERCARGILL 03 214 2356

Asthma NZ Level 1, Salvation Army 125 Johnsonville Rd JOHNSONVILLE 04 237 4520 0800 227 328

CanBreathe 196 Hills Road, Edgeware CHRISTCHURCH 03-386-0278

North Otago Asthma 0277535711 Asthma Otago Dunedin Community House Cnr Moray Place & Gt King Street DUNEDIN 03-471-6167

Gisborne & East Coast Asthma Society

14 Kennedy Street GISBORNE 06-868-9970

Asthma NZ C/- Korowai Aroha 1292 Hinemoa St ROTORUA 07 347 1012 0800 227 328

Nelson Asthma Society 9 Cambridge Street RICHMOND 03 544 1562 Asthma Marlborough Inc Marlborough Community Health Hub 22 Queen Street BLENHEIM 03-579-1609

Asthma & Respiratory Management BOP 254 Chadwick Road TAURANGA 0800 276 267

Breathe Hawke’s Bay 199 Dickens Street NAPIER 06-835-0018

Tu Kotahi Māori Asthma Trust 7-9 Barnes Street Seaview LOWER HUTT 0800 939 462

About ARFNZ Asthma and Respiratory Foundation NZ (ARFNZ) is New Zealand’s principal authority for all respiratory conditions. The Foundation’s purpose is to lead respiratory health knowledge through research, education, and advocacy, with the goal to reduce respiratory related hospitalisations, and improve respiratory health outcomes for all.