DR ELLIE CANNON: A cold has made my asthma worse, so how can I control it? 

I have had asthma all my life and it’s usually relatively well controlled with two types of inhalers. But I developed a bad cold a month ago and I’ve really struggled to breathe since. I’m on the highest dose of steroid inhaler. I find exercise helps but I can’t do much when I’m so short of breath. What can I do?

It is very common for asthma symptoms to worsen after a chest infection or cold, but if this happens it is always important to see a GP or a specialist nurse.

Sometimes this can lead to a change in treatment.

The priority is to get the lungs checked, as the underlying problem might not be the worsening of asthma but an untreated infection which can eventually lead to pneumonia.

Other conditions, such as heart problems and anaemia, can also make you short of breath, which is why it is crucial to have a thorough examination.

Patients will be asked to perform what’s called a peak flow test, where they blow into a tube that measures the volume of breath coming out of the lungs.

Inhalers are the go-to for asthma treatment, but there are many different types. It may be that a patient needs one with a higher dose or another that opens the airway further. These are prescribed as medications called salmeterol, or Serevent, and can be used with other inhalers.

This is also a good chance to speak to a GP or nurse about the way in which you use the inhaler. Many patients think they use them correctly but don’t actually have the correct technique. The charity Asthma And Lung UK also has excellent advice about how to use inhalers on its website, asthma.org.uk.

I am a 67-year-old woman and have a sore, bumpy rash on my nose. At first, it was red and blotchy but it then turned white. I was prescribed hydrocortisone cream, but I’ve noticed broken veins appearing and stopped using it. I’ve had pre-cancerous cells on my face before so I’m really worried. What could it be?

There are lots of reasons why bumpy rashes develop. However, when it’s sore, affects the nose and happens in a female patient over 30, it is most likely to be a skin condition called rosacea.

Other symptoms include a flushed face, broken veins and sore eyes. As well as the nose, it can also affect the cheeks, forehead and the central part of the face.

People with rosacea don’t usually experience all the symptoms at once. Instead they often find that one is the most prominent, such as a spotty or swollen nose or very red cheeks.

There is normally a trigger behind the flare-ups. Typically it can be hot weather, wind, sunlight, spicy food, alcohol or heavy exercise. This can make the skin very sensitive and cause it to react to cosmetic products such as cleansers, face scrubs, make-up and sun cream.

There are lots of reasons why bumpy rashes develop. However, when it’s sore, affects the nose and happens in a female patient over 30, it is most likely to be a skin condition called rosacea

It is important to keep a log of products used so you can identify these triggers.

Steroid creams, such as hydrocortisone, are not what we use to treat rosacea. Instead we’d begin by moisturising the area using a calming, non-perfumed emollient cream which can be bought at chemists. Pharmacists can also recommend calming creams that camouflage the redness, while prescription creams can help to settle the spots and redness. Some GPs suggest taking antibiotic tablets.

It is common for skin cancers and pre-cancerous cells to appear on the face, as this area is frequently exposed to sunlight. If patients have even the slightest suspicion this could be the case, they should go back to their GP.

A few years ago I had a prolapse – a type called a rectocele. I had a successful operation to treat it, but I’ve been left with a fissure. It is very painful, but I read that little can be done to help. Is this true?

Injuries that affect the back passage can be extremely painful, but few people seek help due to embarrassment.

Fissures are very common – it means there is a tear or a crack in the lining of the back passage which causes tremendous pain when going to the toilet. If a fissure has been there for a while, doctors would refer to it as a chronic fissure.

Often the cuts develop as a result of underlying problems such as bowel disease, cancer or bad constipation. It can also be a side effect of previous surgery and even childbirth.

In most cases, fissures resolve spontaneously within a couple of months. But for about four in ten, the problem becomes chronic.

It is essential to make the process of opening the bowels as easy and as comfortable as possible by drinking plenty of water and eating more fibre in foods such as wholemeal bread and fruit.

This will hopefully reduce the amount of straining, which can irritate the broken tissue. Bathing in warm water can relieve pain, and it might be worth taking the painkillers paracetamol and ibuprofen.

A GP can prescribe a specific local anaesthetic or a cream called glyceryl trinitrate ointment, too, which is only suitable for some patients. Otherwise, there’s an ointment called diltiazem which can be helpful.

In worst cases, an operation may be needed on the wound. Although uncomfortable, these procedures are typically successful.

Would seeing this on the train make you squeamish? 

Apparently some people don’t approve of diabetes patients administering their lifesaving insulin injections in public. That’s according to a pretty shocking letter I read last week in a local newspaper about how members of the public reacted to sufferers injecting themselves on a train.

Let’s be clear: diabetics do not always have the luxury of choosing where and when to inject their insulin.

Let’s be clear: diabetics do not always have the luxury of choosing where and when to inject their insulin

Most need to do it several times a day and in a very short period before or after they’ve eaten. Sometimes they have to do it to stop their blood sugars becoming dangerously low, which can cause them to fall unconscious. I worry that patients may be put at risk if they feel they have to hide away to inject.

I’m interested to know if you get squeamish watching people self-inject. Or perhaps you’ve felt shamed by a member of the public. Write and tell me using the email address below.

Get your skates on for a booster

If, for whatever reason, you’re yet to have your third Covid jab, today is the final day you can get it.

Most people had their booster at the end of 2021, but a third of Britons still haven’t.

After today, Covid jabs will be available only to those who need top-up doses, such as older adults or people at greater risk of serious illness.

High-risk people who are due a fourth or fifth dose, but never got round to getting it, will still be able to.

But if you’re one of those who hasn’t yet had their third jab, there are still a few pharmacies and walk-in vaccine centres that will be open today to provide that vital dose of protection.

Most will be operating for only a few hours and are likely to be busy. You can check which sites are open to walk-ins and their opening times at nhs.uk.