General advice for caregivers

Caregivers are those who take care of someone - such as a parent, spouse, sibling or child - with a chronic illness or disease. Caregivers often provide emotional as well as physical support to the chronically ill and the job can be very taxing. Caregiver stress levels can run very high and there is a real danger of the caregiver also becoming ill if they do not take care of themselves. The tips below may help caregivers to balance their critically important caregiving role with their own health and well being.

Take care of your own health

It is critical to remember to take care of your own health as well as the health of the person you are caring for. Caregivers are at greater risk for contracting infectious disease than the general public. This is probably due both to the stress that being a caregiver entails, which can reduce the effectiveness of the immune system, and to a lack of time in a busy caregiver’s life to devote to one’s own health.

If someone is dependent on you for regular care, when you get sick both of you will suffer. Keeping up with your vaccinations and having yearly physical examinations and other appropriate medical surveillance (e.g. mammograms, prostate exams) are two things you can do to keep yourself healthy.

Depression is twice as common among caregivers as non-caregivers. While it is normal to feel down sometimes when taking care of a sick relative, it is important to pay special attention to your mood and seek out medical advice if you start to have symptoms of clinical depression. For example, if you find you are losing interest in the things you normally enjoy the most, or getting angry for no reason, or if you are avoiding friends and loved ones, you may want to see a doctor to be screened for depression.

Take time for yourself

Caregivers often have the responsibility of employment in addition to the large amounts of time spent caring for their patients. You should try to take some time for yourself every day. That doesn’t mean you need to watch a three hour movie; sometimes a hot bath is enough, as long as you have some respite from the day where the only person you are focused on is you. This can do wonders for your emotional well being.

Get some exercise

Physical activity often gets neglected when caregiving. Finding time to exercise, even for just twenty minutes a day, can help you maintain your physical health.

Eat healthy

When people are busy they tend to eat more fast food and junk food, or to skip meals entirely. However, even a little effort can improve your eating habits dramatically. Buy healthy breakfast foods that you can eat on the go. Get fruits and vegetables to eat as snacks - they are affordable and portable. Try to make dinner at home. If you don’t have time to make dinner, get takeout or delivery from a restaurant that has healthy menu options.

Learn how to manage stress

Learning how to manage stress can be difficult, but it can make all the difference for your own health. Stay in touch with your friends and family members. If you need to, ask them for help giving care. Asking for help doesn’t make you a failure; it just means you know your own limits.

Find caregiver resources in your area

Finding support is critical to sustaining yourself as a caregiver. Sharing your experiences with others in a similar situation, or hearing how other people deal with the same challenges that you face can help you gain perspective. See “Core Resources” for links to some caregiver organizations.

Asthma-specific issues for caregivers

Taking care of someone with asthma involves helping them avoid asthma attacks and helping them treat attacks when they do occur. Many asthma caregivers have a young child with asthma and may live in fear of their child having a severe asthma attack. Below are some tips to help better manage the job of caring for a loved one with asthma.

Asthma trigger avoidance

If you know that the asthmatic you are taking care of has specific triggers that provoke a reaction, the best thing you can do for them is help them to avoid exposure to those things. Even if you do not know all of the worst triggers for your loved one’s asthma, you can help them avoid the most common asthma triggers (See “What triggers asthma attacks?”).

While eliminating all exposure to asthma triggers is difficult, a few simple steps can reduce exposure to common triggers. Making sure the asthma sufferer is out of the home when the house is cleaned can help them avoid exposure to several common asthma triggers including dust, which gets into the air during cleaning, and fumes from household cleaning products. You can also use a vacuum cleaner with a HEPA filter and a sealed housing to avoid spreading dust around. Consider installing blinds or shades made of plastic because they can be cleaned easily. You may also need to consider discussing placement of household pets if they contribute to the asthmatic’s symptoms.

Removing bedding and pillows made with down from the asthmatic’s room will eliminate a major source of dust mites. You can also buy an allergen-impermeable cover to put around their mattress and pillows to help keep allergens from accumulating in their bed. Stuffed animals should be washed frequently or removed from the bedroom altogether as they tend to collect dust mites and other allergens. If possible, remove carpeting from the asthmatic’s bedroom because carpet tends to collect particles that can trigger asthma attacks. Upholstered furniture can also be a reservoir of possible triggers so limiting its presence in the home is helpful. Indoor air-cleaning or filtering devices may help but should not be substituted for the more-effective dust-mite controls described above.

Central air conditioning with high quality filters, when well maintained, can help keep the home cleaner. Using air conditioning also allows you to keep doors and windows closed, eliminating the entry points for asthma triggers like pollen. Central air conditioning also lowers humidity, which can control mold and also directly improves asthma symptoms. Be careful not to keep it too cold though because cold air can bring on an asthma attack in some asthma sufferers. If an air conditioner is not an option, a de-humidifier can be used instead for some of the same benefits.

For asthmatics whose symptoms occur only during exercise (exercise-induced asthma / bronchospasm), you can help them take measures before exercising that may reduce the impact of their symptoms. An asthma action plan provided by the doctor can help determine what measures to take. This may include administering medication only before the patient begins to exercise (e.g. SABAs or LABAs) or it may include long term control therapy for more frequent or severe symptoms. Reminding the patient to start exercise with a warm-up period and to wear a mask or scarf over the mouth in cold weather may also help reduce the frequency of their asthma attacks.

Controlled exposure to allergens and irritants

If a loved one is newly diagnosed with asthma, especially allergic asthma, you may not know all of the things that will trigger their asthma symptoms. The doctor may then recommend detailed allergy testing with an allergist to determine the allergens that are likely to trigger asthma attacks. Since asthma symptoms are always subject to change, it is important to be careful and observant when exposing an asthmatic to any new environments. Noting these changes in symptoms in an asthma diary that you then give to the doctor can provide valuable information about the patient’s triggers.

Peak flow testing

A peak flow meter is a device that can be used to test lung function. As a caregiver of an asthmatic, you can help your loved one remember to do this often and help them keep track of the results in an asthma diary. There are even pediatric peak flow meters that you can use with a small child. When the meter shows a decline in peak flow rate from the patient’s normal values, this can be a sign of worsening asthma symptoms and an impending asthma attack. When values decline, you can help the patient use their fast-acting inhaler or other quick-relief medication, which may prevent the attack from becoming severe. If you notice declining peak flow values you can reflect on how these might be associated with recent environmental changes or changes in medication use and record this in an asthma diary. The doctor may be able to use this information to counsel you about the patient’s worst triggers or to adjust the amount or type of medications he or she prescribes.

Know the asthma action plan

As a caregiver, you should have a copy of and be completely familiar with the written asthma action plan that the doctor and patient devised. It is important for you to know everything the patient needs to know about their disease and treatment. If you are taking care of a child with asthma, you should help them learn how to recognize the early symptoms of an asthma attack on their own. If quick-relief medications are administered early, the reaction may be stopped before it progresses to the point of being severe. Using a peak flow meter is the best way to check for early symptoms of an asthma attack so help the patient learn how and when to use it. Especially for children, you should help them learn to tell an adult right away when they are first experiencing symptoms. If they are old enough to administer their own medication, teach them how to use and tell them to use it when they feel an asthma attack coming on. Wearing a Medic Alert bracelet can help them remember what to look out for and also allow them to get help more quickly.

Medication management

Several medications can help prevent the symptoms of asthma. Many of them need to be taken daily, whereas others should only be taken during or just preceding an asthma attack. The asthma action plan provided by the doctor should include information about tall the medications including when and how they should be taken and the side effects of each. As a caregiver, you should have a system to make sure that the asthmatic patient takes their medications when and how they are supposed to be taken. You can use alarms or timers to remind them when to take each of their long-acting pills and weekly pill dispensers to make sure they only take the dose that is prescribed. For quick-relief medications, you should help make sure that the patient knows when and how to use each medicine and that they only use it when necessary. You may want to keep a medicine calendar and note every time the patient takes a dose, or have them do it themselves. You may also want to refill prescriptions before the patient runs out, so keep track of the supply of each medicine. Caregivers of children and other active asthmatics may want to arrange is so quick relief medicines are available in a several locations (e.g. backpack, car, school locker, etc.) just in case

Medication side effects

The side effects of some asthma medications can be dangerous and as a caregiver, you should monitor your asthmatic patient for signs of trouble. Corticosteroids, both long and short acting, have several side effects including decreased resistance to infection. When inhaled, they can cause infections in the mouth or throat. The LABAs may increase the risk of severe asthma attacks and possibly death from such an attack so be sure to monitor the patient closely if they are taking this type of medication and call 911 if an attack becomes severe.

Leukotriene modifiers may cause gastrointestinal problems and sleep disorders so these should be monitored. Theophylline can cause a rapid heartbeat so you should pay special attention to patients with possible heart trouble on this medication. The short-acting beta- 2 agonists can cause tremor or palpitations, while the anticholinergics can cause upset stomach and blurred vision. Make sure the asthma patient follows the guidelines for all of their medications and note any changes in behavior or worsening of symptoms.

Emotional support

Perhaps the most important role of a caregiver is providing emotional support. Simply being there to listen to the patient’s concerns and to provide encouragement can keep their spirits up and improve their overall health. Especially when you are taking care of a child with asthma, letting them know that you are there for them and making them feel safe despite their asthma can help them deal with the disease. You can also provide them with suggestions about how to explain their condition to their friends.

Know the symptoms of a severe asthma attack

If you are a caregiver for someone with asthma, you need to be on the lookout for symptoms that indicate a severe asthma attack. This condition, if not treated properly, can result in unconsciousness and even death. The symptoms of a severe asthma attack include:

• severe wheezing, when breathing both in and out
• using neck and /or chest muscles to assist breathing
• coughing that just doesn’t stop
• severe chest tightness or pressure
• shortness of breath
• feeling anxious or panicky
• blue skin coloration (cyanosis)

During a severe asthma attack symptoms rarely respond to medication. If the attack progresses to this point, it is a medical emergency. CALL 911 IMMEDIATELY.

For adults or children with asthma, it may be a good idea to get them a Medic Alert bracelet that lists their condition in the case that they are hospitalized unexpectedly or lose consciousness in public. This helps medical professionals quickly diagnose the problem and administer medication more quickly.