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Q: I have really bad rosacea which has flared really bad over the last few months…I am currently using la roche posay cleanser but would rather a facewash …Is it the best for my skin and do u know of any supplements and stuff that i could use to get rid of all the lumps on my skin, dont want to go bck on medication. i hav subtype 2 roacea, gettin me really down please help. Answer

A: There is nothing to suggest that a facewash will improve your rosacea better than a cleanser. However, a facewash will generally be rather more gentle than a cleanser and so you may find a facewash has a better skin feel and leaves your skin feeling more refreshed. La Roche Posay Efaclar Foaming Wash would be ideal for your purposes. Another La Roche Posay product that you may find helpful is Rosaliac cream which is a daily moisturiser specially designed for reducing redness in the skin. As sunlight is a common trigger factor for rosacea, you may also benefit from using a sunscreen, even on cloudy days.

As regards supplements, Omega-3 supplements such as Eskimo Oil or Eye-Q are very valuable in improving inflammatory skin disorders. There is some benefit that green tea supplements can be of benefit.

You mention that you don’t want to go back on medication, and that is perfectly understandable. But are you aware that there are a range of topical therapies available on prescription, as well as oral medications? It may be worthwhile checking back in with your GP to discuss the range of therapies available.

Q: I have been getting migraines since my late teens, but over the past few months they have been getting more frequent and more severe. In the past I was able to take Migraleve and they would help, but lately they seem to have no effect and I have to go to bed with the pain. Is there anything more effective that I could take? Is there anything that a doctor could prescribe apart from strong painkillers? I am an otherwise healthy woman in my late 20s. Answer

A: The first thing I would recommend in your case is to go to your doctor for an accurate diagnosis. While the term “migraine” is often used simply to describe any bad headache, it actually refers to specific neurological disorder with specific symptoms and specific treatments.

Other illnesses with which migraine may be confused include tension headaches, cluster headaches or headaches caused by a separate illness which would need separate treatment. For this reason, it is important to have an accurate diagnosis that it is in fact migraine which is the cause of your headaches.

Migraine usually only affects one side of the head and is described as pulsating in nature. It will vary in intensity from moderate to severe and is often is associated with nausea and vomiting. Extreme sensitivity to light and sound can also be present. Some migraine sufferers may also experience what is called a prodrome in the hours or days before an attack which may involve mood changes, dizziness or other physical symptoms, and/or an aura immediately before an attack. The aura is usually characterised by visual disturbances but other senses can also be affected. However, only a minority of migraine sufferers experience an aura.

Assuming that migraine is indeed at the root of your problem, your doctor will also want to investigate what may be the underlying cause for the increase in the frequency and severity of your headaches. Perhaps you have changed contraceptive pill recently, your diet has changed or you have been under more stress. Altering any of these may cause a worsening of symptoms and hence, reversing these changes may form part of your treatment. Your doctor may refer you for further tests to see if there is any other underlying cause for your worsening condition.

While over the counter painkillers are often the first line of treatment, along with an anti-nausea drug (both ingredients are contained in Migraleve) they may only have limited success, particularly if the migraine is severe. Migraleve, or another paracetomol-based medicine can safely be combined with ibuprofen if it alone is not effective in relieving the pain and discomfort.

If over the counter painkillers are not effective, the next step would usually be a type of drug called a triptan. Currently, triptans are only on prescription in Ireland, although this may change in the future. They are generally highly effective in the treatment of migraines and will often greatly reduce or eliminate symptoms within 30 to 90 minutes. They should be taken as soon as the headache phase of the migraine begins and can be repeated if necessary, although it is important not to exceed the dose that you have been prescribed. They generally have little in the way of side effects, although they should be taken with caution if you are taking certain medicines such as anti-depressants or if you have a heart condition. There are a number of different triptan drugs available and you should ask your doctor or pharmacist if you want more information about a particular drug.

While triptans are usually effective at treating a migraine attack, they are not effective in preventing migraine. If you cannot take triptans, if they are ineffective or you need to take them more often than about once a week, you may benefit from taking medication to prevent migraines. There are a number of different preventative (also known as prophylactic) medicines. Most of them are actually more frequently used for other conditions but can also be taken to prevent migraine (e.g. beta-blockers are usually given to treat high blood pressure, but are also effective at reducing migraine attacks). Any of these medications need to be taken regularly to be effective and will not have any effect if taken in response to a migraine attack. However, if taken regularly they can markedly reduce the number of migraine attacks you get.

Q: Do you sell Canesten Pessary over the counter ? Answer

A: Yes we do sell them over the counter. There are several strengths.

Q: My 4 year old son gets frequent colds throughout the winter and sometimes develops a cough as well. My pharmacist usually recommends Actifed Syrup, Benylin Children’s Cough & Cold Syrup or something similar. However, last time I went to buy something for his cold, I was told that they shouldn’t be given to children younger than 6. I’m concerned that I may have been putting him in danger by giving these to him. Should I be worried? Is there any alternative available? Answer

A: Recently, the Irish Medicines Board (IMB) has issued new advice on the suitability of over the counter cough and cold medicines for children under six. Many of these medicines, including the two you mentioned, have now been re-classed as only suitable for children over six. The IMB are the body who regulate medicines in Ireland and ensure that any medicines licensed in Ireland are safe, effective and of high quality. They have recently undertaken a thorough review of the use of a number of drugs used to treat coughs and colds in children.

When they examined the issues closely they discovered that the evidence for these medicines being effective in children under 6 was not actually very strong. However, no new safety concerns came to light, so an important message to give is not to worry. There are no serious safety issues with these medicines when given to children aged two to six when given in accordance with the directions on the pack. So if you have given your child these medicines, there is no reason to be concerned.However, some of them can cause mild side effects such as sedation, hyperactivity, tremor or skin rashes. Also, they can potentially be dangerous if given in too high a dose or if more than one medicine is given, resulting in a “doubling-up” due to drugs of similar effect present in different products. Due to these factors, and the fact that coughs and colds in young children occur frequently and are usually self-limiting (i.e. they generally resolve within a few days without any treatment), it was decided that the risks outweigh the benefits associated with their use.There a still a number of medicines available that can be used to treat coughs and colds in younger children. Glycerine, Honey and Lemon is a tried and trusted remedy that will soothe the throat of a child with a cough, helping them to get a good night’s sleep and easing their discomfort. However, honey or products containing honey should not be given to children under one year old.For a child with a stuffy nose, an inhalation vapour can help to ease the congestion. Karvol Capsules or Snuffle Babe release a pleasant vapour which can make breathing through the nose easier. Either of these medicines is suitable for use from three months of age. A saline nasal spray or nasal drops can also help to wash mucus from the nose and wash away any irritants such as dust. By helping to remove mucus from the nasal passages, this can also help the symptoms of cough. Very often, if a child has a dry, irritating cough, this is caused in part by mucus produced in nasal passages running down the back of the throat. This causes irritation in the windpipe, causing an uncomfortable, unproductive cough.

If your child has a persistent fever that is not brought under control by a fever medicine such as Calpol, or develops breathing difficulties or any other symptoms that you are concerned about, you should take him to the doctor. However, for mild, uncomplicated coughs and colds, lasting less than about three days, simple over the counter remedies are all you need. Paracetomol liquid such as Calpol, or ibuprofen liquid such as Nurofen remain unaffected by the new recommendations and can still be used from 2 months of age in the case of Calpol and 3 months in the case of Nurofen.

A copy of the advice from the IMB and a list of the affected products can be downloaded here.

Q: My friend was recently diagnosed with scabies and she recommended I get treated. What treatment would you advise?. Answer

A: Assuming you have no other contraindications I would go with either lyclear or Derbac M.You would only treat yourself if you are showing symptoms yourself or if you were in close physical contact with person affected.

See link below to our website which has more information you may find useful.http://www.mccabespharmacy.com/health-advice/scabies/

Q: How do I claim tax relief on medical expenses?  Answer

A: 1.Get some tax back from your medicines, our pharmacist will be happy to do a print out of your family medicine for the calendar year – so you don’t need to save all those reciepts!To claim this tax relief, you must complete a Med 1 form (available from your local tax office) at the end of the tax year.For further details on what health expenses may be claimed for, visit revenue.ie.

2. Do you qualify for a medical card? If you do you are entitled to a range of health services free of charge.   This includes GP visits, prescribed medicines, hospital visits, and a range of other services and benefits.

Most people who qualify for this scheme do so as their income is below a certain level. You may also qualify if the cost of maintaining your health puts you at financial risk, or if you are entitled to it under EU Regulations.

Visit your local Health Office for more information or to apply, or visit hse.ie.

3. Over 70 years and have gross weekly income under €700 a week (€1400 for a couple)? You will qualify for a medical card. Also special consideration may be made for those with high medical expenses who have incomes higher than the normal limits.

For more information you can contact your local Health Office, or phone the HSE infoline on 1850 24 1850. A comprehensive list of information surrounding this area is available on the HSE Website.

From October 1st 2010, Medical Card holders are be required to pay a 50 cent charge on prescription items they receive under the scheme.  Pharmacies are obliged to collect this fee on behalf of the HSE.

For full details on these charges, please visit the HSE website by clicking here.

3. If you don’t qualify for a full medical card, you may qualify for a GP Visit card which allows individuals and families to visit their family doctors for free. Patients who are eligible for this scheme must still pay for their prescribed medicines and so are advised to also enrol on the Drugs Payment Scheme.

For more information or to obtain an application form, speak to your GP or your local Health Centre, or visit the HSE Website.

4. If you do not qualify for a Medical Card, ask us about the Drugs Payment Scheme (DPS). You may be able to save on your monthly medicine costs.

All Irish residents who don’t hold a medical card* are entitled to enrol on the DPS (*those holding GP Visit Cards can enrol). Under the scheme, each individual or family will never pay over €132* (*subject to change by HSE) per calendar month for their prescription medicines.

This doesn’t mean that you are obliged to pay €120 every month! Your pharmacy will keep a running total of the amount you pay for prescriptions and stop charging you once you have hit the €132 mark. It is advisable for the whole family to remain with the same pharmacy for each calendar month to ensure the total is kept accurately up-to-date.

You will receive your own unique DPS Card and Number which your pharmacy will add to your record. To download an application form for the Drug Payment Scheme click here.

5. If you suffer from illnesses or conditions listed below, you may be able to avail of the services of the Long Term Illness Scheme. This scheme allows you to obtain treatment, medicines and equipment directly related to your illness free of charge.  Treatment, medicines and equipment un-related to the condition will not be covered and must be paid for in the normal way. Therefore, many Long Term Illness patients will also apply for the GP Visit Card and the Drug Payments Scheme.

If you qualify for the Long Term Illness Scheme, you will be given a Long Term Illness Book detailing the type and quantities of the medicines you need. This will be signed by your doctor and will then need to be brought to your pharmacy for dispensing. If you are prescribed a medical or surgical device to treat your condition, this will be provided to you through your Local Health Office.

There is no income or means test for this scheme. If you suffer from any of the diseases/conditions listed below you should apply for this scheme.

Conditions covered include:

• Diabetes insi[idus and melitus
• Epilepsy
• Mental illness for under 16s
• Mental handicap
• Parkinsons
• Muscular dystrophies
• Spina bifida
• Muliple Sclerosis
• Cystic fibrosis
• Hydrocphalus
• Phenylketonuria
• Cerebral palsy
• Acute leukemia

 

For more information on Long Term Illness Scheme click here:

 

6. Is there a less expensive alternative? Generics are the equivalent of an original brand containing the same active ingredient, same strength, same effect and meeting the same high standards set by the irish medicines board

http://www.imb.ie/EN/Medicines.aspx

Ask our pharmacist or your doctor if this is appropriate for you.

 

7. Some over the counter medicines are available on prescription schemes. See attachment.

Q: My six year old son has recently developed an itchy scalp and I'm worried that he may have picked up head lice. I'm not sure how since I wash his hair regularly. What is the best way to get rid of them?   Answer

A: The words “head lice” will send a shiver down the spine of most parents, although head lice infestation is very common in children and most children will get them once or twice. Head lice are not a sign of poor scalp hygiene as the lice have no preference for either clean or dirty hair. You mention that your son has an itchy scalp, but this does not necessarily mean that he has lice. There can be many causes of an itchy scalp, so the first thing that you need to do is check to see if he actually does have head lice.The only way to check for a head lice infestation is by thorough fine combing with a white fine tooth comb which you can get in a pharmacy. Do this after washing and conditioning the hair while it is still wet. Comb the hair over white paper, making sure to begin where the hair meets the scalp and paying particular attention to the nape of the neck and behind the ears. This should take about 10 – 15 minutes. You will be looking for live lice either in the teeth of the comb or falling onto the sheet of paper. Lice are about the size of a sesame seed and are grey to reddish-brown in colour.If you find live lice infecting the scalp, you will need to treat your child. It is not generally recommended to treat unless you find live lice, so the whole family will need to be checked in the same manner and if anyone else is found to have lice, they will need to be treated at the same time.Over the past few years there has been a move away from treating with products based on insecticides to other treatments based on a chemical that disrupts the water balance of the lice causing them to dehydrate and die. One such product is Hedrin which is available as a spray or as a solution. It is recommended that it is left on for 10 minutes before being washed out, although I think that the guidelines for contact times on packs should be regarded as a bare minimum and it is probably beneficial to leave it on for somewhat longer. Other more traditional products include Lyclear Cream Rinse and Derbac M Liquid. Whatever method is used, it is vital that the whole head is thoroughly covered in the treatment.All head lice treatments are more effective at eliminating live insects than they are at killing unhatched eggs. For this reason, I generally recommend re-treating with the same product after 7 days to kill any remaining insects that may have hatched in the meantime. Any eggs that have already hatched will probably remain stuck to the hair even after treatment. These are nothing to be concerned about and it should be possible to remove these by further fine combing.Due to problems with resistance, no one product will be effective 100% of the time. However, the likelihood of a treatment being successful is greatly enhanced by following the product instructions carefully. However, if you still find live lice after the second treatment, you should switch to another product containing a different active ingredient. Your pharmacist will be able to advise you if you are not sure.After treatment, or even for all school-going children, you may wish to consider using a repellent product such as Lane's Tea Tree Shampoo and Conditioner to help prevent future infestations.

Q: I suffer from frequent anxiety and have been prescribed diazepam by my doctor. I don't like taking them as they make me very groggy and I know they can be addictive.  Are there any alternatives? Answer

A: Diazepam (better known as Valium) is a sedative from a class of drugs called benzodiazepines. They are very effective at treating anxiety although side effects include drowsiness, poor co-ordination and impaired memory. They can also be addictive and so are generally only used for short periods (i.e. a few weeks).If you suffer from regular anxiety or panic attacks, there are some antidepressants that may help, even if you are not depressed. These generally have fewer side effects than diazepam and are more suitable for long term use. A range of herbal medications are also available without prescription which many people find helpful in combating anxiety. Kalms Tablets are a popular and effective remedy. Your GP may also be able to refer you to a counsellor or therapist who could  help you develop relaxation skills and cope better with anxiety. I would suggest that you return to your GP who will help you determine which course of action is best for you.

Q: I was diagnosed with depression in 2005 and my doctor prescribed me Lexapro.  I took them for about six months and they were an effective treatment. However, in late 2006 I became depressed again and this time the doctor prescribed Lexapro once again and recommended that i stay on them indefinitely.  I have been taking them since then, as they have worked well for me and cause me practically no side-effects.  However, my husband and I want to have a baby but I am concerned about the effect the Lexapro may have on the baby.  But I am reluctant to stop taking them as I'm worried about the depression coming back.  My doctor tells me that it is ok to take Lexapro right through pregnancy, but I am still concerned. Answer

A: Lexapro (escitalopram)is a type of drug called an SSRI and is an effective treatment for relieving depression and preventing its recurrence.  People who have more than one episode of depression have a high chance of developing the illness again and so it is often recommended that they stay on these medicines indefinitely.Other antidepressants from the same class of drug include Prozac (fluoxetine), Seroxat (paroxetine), Cepramil (citalopram) and Lustral (sertraline).There is no right or wrong course of action when it comes to taking SSRIs during pregnancy.  it is a decision that each woman needs to make in close conjunction with her doctor in order to best balance the risks and benefits, both to herself and her baby.

Discuss with the doctor

It is generally accepted that there is little to no risk to the baby from taking SSRIs in early pregnancy, with the exception of Seroxat which appears to make it more likely that the baby will be born with an abnormal heart.  If a woman is taking Seroxat (paroxetine) and is considering having a baby, it may be prudent to discuss with her doctor the possibility of switching to another anti-depressant.

However, with Lexapro there does not appear to be a significant problem.

However, if Lexapro is taken in the last trimester of pregnancy, a baby may have some problems soon after birth such as difficulty feeding, jitteriness, rapid breathing or a weak cry.  These problems, if they occur, will generally only last a short time (ie. less than 24 hours) and will resolve with no lasting problems.

A balance of risks

These risks must then be balanced with the risks of depression recurring if you stop taking the Lexapro.  Depression may lead to poor nutrition,  self-harm, alcohol or drug abuse and high levels of stress which can be damaging to both your own health and that of a foetus.

Perhaps you may consider a psychological treatment such as cognitive behavioural therapy which can itself be an effective treatment for depression.

Whatever option you do decide on should be discussed in depth with your doctor, ideally before you become pregnant.  It is important that you do not stop taking your medication suddenly.

Good luck!

Q: My son is 3 years old and has been prescribed Betnovate cream for eczema.  He has had eczema since he was a baby, but it has flared up quite badly lately.  I hear that there is a steroid in Betnovate and my friend told me that steroids shouldn't be used in children.  What do you think? Answer

A: You are right that Betnovate cream contains a steroid.  Children are more sensitive to the side effects of steroids and so we would be much more cautious about using steroid creams in children than in adults.  But having said that, it is not necessary to avoid using steroid creams in children altogether.

Eczema is an allergic, inflammatory disease of the skin that causes dryness, redness, swelling and itching of the skin and can cause blistering and oozing of the skin as well.  Steroid creams reduce the inflammatory response of the skin and can cause a dramatic reduction in symptoms of eczema.  However, they should only be used for the shortest period possible in children and generally for no more than three weeks at a time.  Longer term use can cause growth supression and irreversible skin thinning.  Apply the cream sparingly and exactly in accordance with your doctor's instructions.  it should never be used for longer than absolutely necessary.

The most important part of the treatment of eczema is regular moisturising of the skin.  Unlike steroid creams, you needn't be afraid of using moisturisers too often or using too much.

Q: I have heard that everyone should take an aspirin a day to help prevent heart attacks.  Can i just take something available without prescription, like Disprin? Answer

A: Although this was advice often given in the past, there are a number of reasons why you should not take aspirin every day on your own initiative.Aspirin affects the body in many ways.  Most people are familiar with over the counter medicines like Anadin or Disprin, which are used to treat pain, inflammation and fever.  Aspirin also has the effect of reducing blood clotting and so can help to prevent heart attacks and strokes in the susceptible people (eg. People who have already had a heart attack or stroke, or those with angina).

However, the dose of aspirin usually used for the heart is substantially lower than that used as a pain killer.  Taking aspirin every day is also quite harsh on the stomach and makes it considerably more likely that the person taking it will develop bleeding in the stomach.For someone who has a high likelihood of a heart attack or stroke, the benefits of aspirin will usually outweigh the risks, but for most people, taking aspirin every day is more likely to be harmful.

All over-the-counter aspirin drugs are only licensed for short term use for the treatment of pain or fever.  If you would like to discuss daily aspirin therapy you should consult your doctor who will be able to prescribe it if it is appropriate for you.

Q: I have a rather embarrassing problem.  I am a 26 year old woman and over the past few weeks I have developed a burning, itching sensation in my vagina.  There is also quite a strong smelling discharge and it is painful when I go to the toilet.  I think it may be thrush, but I'm embarrassed to ask about it in the pharmacy and I would prefer not to visit the doctor.  I am on the pill, but I am not currently sexually active.  Does this sound like thrush and if so,  how could I have picked it up?  I am not on any other medication although I was on a course of antibiotics a few weeks ago for a chest infection.  What can I do to treat  it?  Answer

A: From what you have told me, it sounds like it is probably thrush that you have.  However, there are some other conditions that can resemble thrush, so if you are unsure if it is thrush I would suggest that you visit your GP to have the diagnosis confirmed.

Thrush is a fungal infection caused by a yeast called Candida albicans.  This yeast lives naturally in the vagina where it doesn't usually cause any problems.  The body can generally keep its growth under control, but sometimes this control mechanism breaks down.So thrush isn't something that you "pick up", but rather something that occurs naturally inside you that sometimes manages to grow out of control. Although, this can occur for no apparent reason there are some situations that make this more likely to happen.  Among these are stress, poor diet, antibiotics, the contraceptive pill, diabetes or a weakened immune system. The fact that you are on the pill and have recently taken antibiotics would tend to support a diagnosis of thrush. But, like I said, some other conditions can resemble thrush and so if you are at all unsure you should visit your doctor. 

You mention you have strong smelling discharge. Although thrush can increase the normal odour of the vagina, if this is unusually unpleasant it may indicate a condition called bacterial vaginosis which needs to be treated with antibiotics prescribed by a doctor.Thrush can generally be easily treated using over-the-counter medicines.  I usually recommend Canesten Combi. 

Although most of the symptoms of thrush occur on the outside of the vagina, the infection is primarily on the inside surface. Canesten Combi contains an antifungal cream to help with the external symptoms and an anti-fungal pessary (like a tablet for the vagina) which is inserted to kill the yeast inside the body.Thrush can also be treated with tablets taken by mouth although at present these are only available with prescription. 

An uncomplicated thrush infection should generally clear up after a few days treatment, although I generally recommend continuing to use the cream for about 48 hours after the symptoms have cleared.  If there is no improvement within about 4-5 days you will definitely need to visit the doctor.

Q: I am a 25 year old woman and I was diagnosed with psoriasis about 18 months ago. I have it on my arms and legs and it sometimes appears on my torso as well. I am very self-conscious about it as it is quite unsightly. I have been prescribed Dermovate cream to treat it. This works fairly well, although if I stop using it, the psoriasis returns very quickly. Are there any alternative treatments that I could use? Answer

A: Psoriasis is a skin condition where the immune system sends faulty signals to the skin which causes the skin cells to grow much quicker than normal, leading to “plaques” of psoriasis. These plaques are raised areas of skin and are usually pink in colour and covered with silvery scales, although the exact appearance of the plaques can vary from person to person. It is most commonly found on the elbows and knees although it can occur anywhere on the body. It is a long term condition and although there is no cure, with the right treatment it can be managed effectively.

Nobody knows what causes psoriasis, although you can be assured that it is absolutely not contagious. There are some things that can aggravate psoriasis and managing these can help to manage your condition. Cold weather generally worsens psoriasis so wrapping up well outside and keeping your home warm in winter may help. High humidity also helps so you may find it helpful to buy a humidifier from your pharmacy. Stress makes psoriasis worse so managing stress in your life is important. If you suffer from chronic stress or anxiety, speak to your doctor who may be able to prescribe medication to help with this. Smoking and excessive alcohol intake are also known to worsen psoriasis so if you smoke, stop. Your pharmacist will be able to recommend a range of products which can help you give up smoking.

Ultra-violet light also helps to improve most cases of psoriasis. However, caution needs to be exercised as a minority of cases will be made worse by ultra-violet and it is well known that ultra-violet light can increase the risk of skin cancer. Speak to your doctor if you wish to pursue this rather than just deciding to use sunbeds.

No matter what treatment is used for psoriasis, probably the most important aspect of treatment is keeping the skin moist. Frequent use of a moisturising cream or ointment is essential, even if prescription treatments are also being used. E45 Cream and Oilatum Emollientare an ideal combination although there are a wide range of options and your pharmacist will be able to advise you on the best products to use. Wrapping the area with a bandage after applying the cream or ointment will help the cream penetrate the skin better, although you should consult your doctor before trying this with any prescribed treatment.

As regards prescription treatments, you have been prescribed Dermovate creamwhich is a strong steroid cream. Steroid creams work very well for psoriasis, although it tends to worsen again quite quickly after the cream is stopped. Another option that may be more beneficial is Dovonex Cream. Dovonexgenerally works about as well as steroid creams (although results may vary) but the remission will generally last longer after this cream is stopped. Dovobet Ointment is another option, which combines the active ingredient in Dovonex(calcipotriol) with a potent steroid, and is particularly useful when flare-ups occur.

There are also some oral medications which can be used for psoriasis, although these are generally reserved for more severe cases due to potential side effects.

Q: I was diagnosed with asthma about 12 years ago, when I was a child. Since then I have been using a Ventolin inhaler, which I use about twice a day, sometimes more often. A few years ago my doctor also prescribed me a steroid inhaler. My doctor says it is important to use it, but I just don't find it as good as the Ventolin. The Ventolin relieves wheeziness very quickly, but the steroid inhaler doesn't seem to have any effect when I use it. Is there something stronger than the Ventolin that would be suitable for me to use? I find that the effect doesn't last as long as it used to. Answer

A: Ventolin is a type of drug called a bronchodilator. This means that it opens up the airways, relieving the wheeziness and shortness of breath that you experience with asthma. It is very effective at this and will generally have its effect within a matter of seconds. Asthma is an illness that involves narrowing of the airways, so if we have something that opens up the airways quickly and effectively,that's all that's needed. Right? Well, not really.While the end result of asthma is a narrowing of the airways, causing wheeziness and shortness of breath, the underlying cause of this is an inflammation of the lungs. Although a drug like Ventolin opens up the airways and provides quick relief from the symptoms it does not tackles the underlying cause.In mild cases of asthma, a drug like Ventolin or another bronchodilator (what we call reliever medications) may be all that's needed to effectively treat the illness.

As a general rule, if you only need to use a reliever a couple of times per week, and your asthma symptoms don't keep you awake at night or prevent you engaging in activities such as sports, then that's probably all that you need to treat your asthma.In more severe cases, if the reliever medication needs to be used most days, or if asthma symptoms wake you up at night or interfere with your normal day-to-day activities, a preventer inhaler would usually be recommended. This would usually be a steroid inhaler. A steroid inhaler will reduce the inflammation in the lungs and so help to tackle the root cause of your asthma symptoms. Unlike a reliever, your preventer needs to be used regularly (usually twice a day) to be effective and will not provide any immediate relief from your symptoms, which is probably why you think it is not as effective as your Ventolin.

If you have moderate to severe asthma and rely mostly on your reliever to treat your asthma symptoms, you are putting yourself at much higher risk of chest infections, serious asthma attacks which could result in hospitalisation, and your asthma is also more likely to interfere with your daily life. You will probably also find that your reliever medication becomes less effective over time and that you need to use it more and more often.If you have been prescribed a steroid inhaler, there a few things you need to know to get the most out of your treatment:

• A steroid inhaler will need to be used regularly to be effective. It will not provide any immediate relief from your symptoms. This does not mean that it is not working.
• It is important to rinse your mouth out after using a steroid inhaler. Failure to do this can cause oral thrush and hoarseness.
• If you have been prescribed a preventer and you still find you need to use your reliever most days, you should go back to your doctor as you may need a more powerful preventer or tablets may need to be added to your treatment.
• While steroids are powerful drugs, a steroid inhaler will generally have minimal side effects as only very small amounts of the drug will be absorbed into the blood stream.
• A major cause of treatment failure is incorrect use of an inhaler. If you are unsure that you are using your inhaler correctly or want a reminder of how to use it properly, call into your pharmacist for a demonstration

Q: I am a 19 year old girl and I have developed a runny and congested nose during the spring and summer for the past few years. I put it down to hayfever and took antihistamines in previous years which worked reasonably well. But this year, the antihistamines have not really been working. Also my friend has said that you can't get hayfever as an adult, only as a child. Is there anything else I can do? Answer

A: The symptoms you describe could well be hayfever. Although hayfever most commonly develops in children, it can develop at any age. A number of conditions such as chronic sinusitis (long term inflammation of the sinuses) can mimic some of the symptoms of hayfever. The fact that it seems to only affect you in the spring and summer  would tend to indicate that it probably is hay fever, but it is probably a good idea to visit your GP to have the diagnosis confirmed and rule out any other cause.Hayfever (more properly called seasonal allergic rhinitis) is caused by an allergy to pollen, usually grass pollen but sometimes weed or tree pollen. These plants generally only release pollen in the spring and summer which explains why hayfever sufferers are only affected at this time of year. The body mistakes the pollen grains entering the nose for “invaders” and mounts a response to try to rid them from the body. So the symptoms of hayfever (runny nose and eyes, nasal congestion, sneezing) are essentially the body trying to flush out the pollen as it thinks the pollen is trying to attack it. Hayfever can also cause quite bit of irritation to the nose and eyes and really make the summer a misery if it is not treated.

The first line treatment for hayfever is usually antihistamines. There are a number of antihistamine tablets available over the counter, but it is generally best to get one that doesn't cause drowsiness such as Clarityn. While antihistamines will generally provide some relief within a few hours, they need to be taken for up to ten days to reach their maximum effect. While antihistamines will usually relieve the runny nose and itching streaming eyes, they are less effective at relieving the congestion that can accompany hayfever.

If antihistamines on their own are not effective, you could add a steroid nasal spray such as Beconase or Flixonase to your treatment. These sprays greatly diminish the allergic response and reduce inflammation in the nasal passages. Although they are administered to the nose, they are actually quite effective in relieving eye symptoms as well. They need to be used regularly to be effective. Antihistamines can be given to children over the age of two, but steroid nasal sprays should only be used in children on the advice of your doctor.

Other treatments include sodium cromoglycate eye or nose drops. These also need to be used regularly (four times a day) and are less effective than the steroid sprays but are for all intents and purposes free of side effects. A new product on the market called Prevalin Spray contains a solution of a special clay which can help to absorb pollen grains, preventing them from interacting with the body. It may be useful for someone who prefers to try a drug free option. There are also a number of other treatments including sprays, tablets and injections available on prescription.If you are using a nasal spray, it can help to use Neilmed Sinus Rinse beforehand. This is a high volume rinse that help to wash out the nose and the sinuses, flushing any pollen away and washing away any mucus so that the spray can is not obstructed in absorbing into the nasal lining.

There are also some oral medications which can be used for psoriasis, although these are generally reserved for more severe cases due to potential side effects.