PRACTICE
ASTHMA’S IMAGE PROBLEM Pictures used by the media and healthcare providers to illustrate asthma treatment can be misleading. But a Twitter campaign is starting to rectify the problem, explain Emily GuilmantFarry and Sara Nelson.
picture is worth a thousand words – but what does the wrong image say? Professionals working in healthcare have long decried the poor images used to represent illnesses in the media and sometimes within their own sector. This is particularly true of asthma inhaler use. Asthma is the most common long-term medical condition among children and young people (CYP) in the UK. One in 11 children in the UK have asthma (Asthma UK, 2021). The image of asthma most often portrayed on screen or in print is a child spraying a blue reliever inhaler directly into their mouths from about four years of age, or a late-primary-aged child using a face mask spacer, both of which go against every medical guideline given in the UK (Global Initiative for Asthma, 2020; British Thoracic Society and Scottish Intercollegiate Guidelines Network, 2019; NICE, 2017). The concern over the type of inhaler in the images is linked to overreliance on a blue reliever rather than encouraging use of a preventer inhaler – commonly brown – and to the lack of a spacer in which to deliver it. Medical articles and healthcare providers aren’t immune from poor asthma inhaler image use, either. A search engine or picture library hunt for ‘asthma and inhalers’ reveals various images conveying an incorrect technique and message, and a poor selection of appropriate images.
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#RIGHTINHALERIMAGE CAMPAIGN For years, asthma professionals have been tackling the problem of poor images in isolation. But this year they joined up on Twitter to tackle the issue of the right images of inhalers and spacers available for media use. The #RightInhalerImage campaign team is supported by the clinical leads of the NHS England and Improvement Adult Respiratory Programme and Children and Young People Transformation Programme. The campaign aims to improve the quality of information for patients, healthcare professionals and the public about the use of inhalers by promoting the publication of images of inhalers being used accurately and appropriately. The long-term goal is to have a database of clinically excellent images freely accessible to the media and professionals. It also encourages media outlets and healthcare providers to sign up and pledge to remove poor images from their own databases and to use only appropriate images.
RELIEVER PREVENTER
WHY IMAGERY MATTERS
Incorrect images contribute to poor inhaler technique and counteract medical advice. Both these effects have been seen, occasionally but becoming more frequent, in the nurse-led asthma clinic in Newham, east London, where one author works. This trend is borne out in London generally, according to the Pan-London Asthma Nurses Network. CYP attending have changed their practice of spacer use, as they saw people they followed on social media doing something different – and the people they followed had more influence than healthcare professionals.
RECOMMENDED PRACTICE There are incorrect beliefs, among CYP and their families and also among some professionals, that blue inhalers are the ones that matter; that once CYP reach teenage years, a spacer is no longer needed; or that every child requires a face mask spacer. So what should the images represent? Inhalers: A reliever inhaler – most commonly blue – is not the most important inhaler to have, despite popular belief. It only relieves the symptoms of asthma (cough, wheeze, breathlessness, pain or chest tightness) and doesn’t treat the underlying cause. For that, you need an inhaled corticosteroid (ICS) preventer inhaler. These are most commonly brown, orange and purple. Why, then, do we almost always see blue depicted in articles or on television? Spacers: Only about 10% of adults can use a pressurised metered dose inhaler (pMDI) – the most common pump-action type – correctly without some kind of aid. Most people, whether old or young, benefit from using a spacer to use a pMDI. A spacer is a plastic holding tube with a one-way valve that slows down and holds the medication once depressed. This process allows normal tidal breathing to be used to get the drug contents into the lungs, rather than into the oropharynx or gastrointestinal tract – a
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