Asthma:
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What Is Asthma?

Asthma is a chronic, inflammatory disease characterised by recurring seizures of shortness of breath accompanied by wheezing and whistling sounds; allergens cause the small air tubes 'Bronchioles' of the lungs to constrict, narrow down, overfilling the Alveoli, the air cells of the lungs; this causes an inability to force air out of the lungs, even though inhalation is unimpaired,
the extent of the constriction and how long each episode lasts, can vary greatly.

Asthma can start at any age, but it most commonly starts in childhood and at least 1 in 10 children and 1 in 20 adults, have Asthma; it is congentital and runs in families, although, there are also many people with Asthma who have no affected family members.

What Are The Symptoms Of Untreated Asthma?

The common symptoms are coughs and wheezes; you may also become breathles, and develop a feeling of chest tightness; symptoms can range from mild to severe between different people and at different times in the same person; each episode of symptoms may last just an hour or so, or persist for days or weeks unless treated.

What Are The Symptoms If You Have Mild Untreated Asthma?

You tend to develop mild symptoms from time to time, for example, you may develop a mild wheeze and a cough if you have a cold or a chest infection, or during the hay fever season, or when you exercise; for most of the time you have no symptoms; a child with mild Asthma may have an irritating cough each night, but it is often fine during the day.

What Are The Symptoms If You Have Moderate Untreated Asthma?

You typically have episodes of wheezing and coughing from time to time and sometimes you become breathless; you may have spells, sometimes long spells, without symptoms; however, you tend to be wheezy for some of the time on most days; symptoms are often worse at night, or first thing in the morning; you may wake some nights coughing or with a tight chest; young children may not have typical symptoms and it may be difficult to tell the difference between Asthma and recurring chest infections in young children.

What Are The Symptoms Of A Severe Attack Of Asthma?

You become very wheezy, have a tight chest and have difficulty in breathing; you may find it difficult to talk because you are so breathless; severe symptoms may develop from time to time if you normally have moderate symptoms; however, occasionally severe symptoms develop suddenly in some people who usually just have mild symptoms.

What Causes Asthma?

Asthma is caused by an inflammation in the airways; it is not known why the inflammation occurs, but the inflammation irritates the muscles around the airways and causes them to squeeze 'constrict', which causes a narrowing of the airways; it is then more difficult for air to get in and out of the lungs; this leads to the wheezing and breathlessness; the inflammation can also cause the lining of the airways to make extra mucus, which causes more coughing and further obstruction to the airflow.

What Can Make Asthma Symptoms Worse?

Asthma symptoms may flare up from time to time and there is often no apparent reason why symptoms flare up; however, some people find that the symptoms are triggered, or made worse, in certain situations; it may be possible to avoid certain triggers which may help to reduce the symptoms; things that may trigger Asthma symptoms include the following:


Infections, particularly colds, coughs, and chest infections.

Pollens and Moulds; Asthma is often worse in the hay fever season.

Exercise; however, sport and exercise are good for you if you have Asthma; if necessary, you can use an inhaler before exercise to prevent the symptoms from developing, but, as a rule, exercise induced Asthma often represents undertreated Asthma; if it occurs, it may indicate a need to step up your usual preventative treatment.

Certain Drugs; for example, about 1 in 50 people with Asthma is allergic to aspirin which can trigger symptoms; other drugs that can cause Asthma sympoms are anti-inflammatory painkillers such as iIbuprofen (eg NurofenŽ), Diclofenac, etc, and betablockers such as Propranolol, Atenolol, Timolol and the betablocker eye drops used to treat glaucoma.

Smoking and Cigarette Fumes; smoking is not good for anyone, at any time, but if you smoke and have Asthma, you should make every effort to stop; seek help from your doctor if you find it difficult; passive smoking can also make Asthma worse, even where adults smoke away from the presence of children; the smoke on clothes, hair, etc, may make the Asthma worse and all children deserve to live in a smoke free home, in particular, children with Asthma.

Other Fumes and Chemicals, for example, fumes from paints, solvents and pollution; the increase in air pollution may be a reason why Asthma is becoming more prevalent.

Emotion; Asthma is not due to nerves, but such things as stress, emotional upset, or laughing may trigger symptoms.

Allergies to Animals; for example, pet cats, dogs, and horses; animals do not trigger symptoms in most cases, but some people notice that their symptoms become worse when close to certain animals.

House Dust Mites; this is a tiny creature which lives in mattresses and other fabrics around the home; if you are allergic to it, it may make symptoms worse; it is impossible to get rid of house dust mites completely; to greatly reduce their number takes a lot of time and effort and involves using special mattress covers, removing carpets, removing or treating soft toys, etc; however, if symptoms are difficult to control with treatment and you are confirmed to be allergic to house dust mites, then it may be worth considering trying to reduce their number.

Some Foods; most people with Asthma do not have to follow a special diet and it is uncommon for food to trigger Asthma symptoms; however, there are the unlucky few where certain foods such as cow’s milk, eggs, fish, shellfish, yeast products, nuts and some food colourings and preservatives, can make symptoms worse.

Some people only develop symptoms when exposed to a certain trigger; for example, exercise, as I have already mentioned, can make Asthma symptoms worse, but, some people only develop symptoms when they exercise and are fine for the rest of the time; another example is that some people only develop symptoms when exposed to specific chemicals.

How is Asthma Diagnosed?

Sometimes symptoms are typical and the diagnosis is easily made by a doctor, but if there is any doubt then some simple tests may be arranged; the two most commonly used tests are called Spirometry and Assessment with a peak flow meter.

The Spirometry Test:

This test measures how much air you can blow out into a machine called a spirometer; two results are important the amount of air you can blow out in one second, called the Forced Expiratory Volume in 1 second (FEV1) and the total amount you can blow out in one breath, called the Forced Vital Capacity (FVC); your age, height and sex affect your lung volume, so your results are compared with the average predicted for your age, height and sex.

A value is calculated from the amount of air that you can blow out in one second divided by the total amount of air that you blow out in one breath, called the FEV1/FVC ratio; a low value indicates that you have narrowed airways which are typical in Asthma, but a low value can occur in other conditions too; therefore, the Spirometry Test may be repeated after treatment; an improvement in the value after treatment to open up the airways is typical of Asthma.

NB. Spirometry may be normal in people with Asthma who do not have any symptoms when the test is done; remember, the symptoms of Asthma typically come and go; therefore, a normal result does not rule out Asthma, but, if your symptoms suggest that you have Asthma, ideally the test should be repeated when your symptoms are present.

The Assessment Test with a Peak Flow Meter:

This is an alternative test and a Peak Flow Meter is a small device that you blow into; a doctor or nurse will show you how; it measures the speed of air that you can blow out of your lungs; no matter how strong you are, if your airways are narrowed, your peak flow reading will be lower than expected for your age, size and sex; if you have untreated Asthma, then you will normally have low and variable peak flow readings; also, peak flow readings in the morning are usually lower than the evening if you have Asthma.

You may be asked to keep a diary over two weeks or so of peak flow readings; typically, a person with Asthma will usually have low and variable peak flow readings over several days; peak flow readings improve when the narrowed airways are opened up with treatment; regular peak flow readings can be used to help assess how well the treatment is working.

If after performing the above tests, the diagnosis remains in doubt then a specialist may perform further, more complex tests, but these are not needed in most cases.

What are the Treatments for Asthma?

For most people with Asthma, the symptoms can be prevented most of the time with treatment, so that you are able to get on with normal life, school, work, sport, etc.

Inhalers:

Most people with Asthma are treated with inhalers; these deliver a small dose of drug directly to the airways, which is enough to treat the problem and the amount of drug that gets into the rest of your body is so small that side effects are unlikely, or at least minor; there are various inhaler devices made by different companies; different ones suit different people; a doctor or nurse will advise on the different types; drugs delivered by inhalers can be grouped into Relievers, Preventers and Long Acting Bronchodilators.

Reliever Inhalers:

A reliever inhaler is taken as required to ease symptoms, which relaxes the muscle in the airways, making the airways open wider and the symptoms usually ease; these drugs are also called Bronchodilators as they dilate (widen) the bronchi and bronchioles (airways); there are several different reliever drugs, for example, Salbutamol and Terbutaline and these come in various brands made by different companies; if you only have symptoms every now and then, then the occasional use of a reliever inhaler may be all that you need; however, if you need a reliever inhaler three times a week or more to ease symptoms, a preventer inhaler is usually advised.

Preventer Inhalers:

A preventer inhaler is taken every day to prevent symptoms from developing; the drug commonly used in preventer inhalers is a steroid and these come in various brands made by different companies; steroids work by reducing the inflammation in the airways; when the inflammation has gone, the airways are much less likely to become narrow and cause symptoms; it takes 7 to 14 days for the steroid in a preventer inhaler to build up its effect; therefore, it will not give any immediate relief of symptoms; however, after a week or so of treatment, the symptoms have often gone, or are at least much reduced; it can take up to six weeks for maximum benefit, which means that you should then continue with the preventer inhaler every day even when your symptoms have gone, in order to prevent the symptoms from coming back.

Long Acting Bronchodilator Inhalers:

A long acting bronchodilator may be advised in addition to a preventer inhaler; one may be needed if symptoms are not fully controlled by the preventer inhaler alone; the drugs in these inhalers work in a similar way to reliever inhalers, but work for up to 12 hours after taking each dose; they include Salmeterol and Formoterol; some brands of inhaler contain a steroid plus a long acting bronchodilator for convenience.

Spacer devices are used with some types of inhaler; these are commonly used by children, but many adults also use them; a spacer is like a small plastic chamber that attaches to the inhaler; it holds the drug like a reservoir when the inhaler is pressed; a valve at the mouth end ensures that the drug is kept within the spacer until you breathe in; when you breathe out, the valve closes, so you don't need to have good co-ordination in order to inhale the drug if you use a spacer device; a face mask can be fitted on to some types of spacers, instead of a mouthpiece, which is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.

Tablets to Open up the Airways:

Most people do not need tablets as inhalers usually work well; however, in some cases a tablet, or in liquid form for children, is prescribed in addition to inhalers if symptoms are not fully eased by inhalers alone; various tablets may be used which aim to open up the airways.

Steroid Tablets:

A short course of steroid tablets, such as prednisolone, is sometimes needed to ease a severe or prolonged attack of Asthma; steroid tablets are good at reducing the inflammation in the airways; for example, a severe attack may occur if you have a cold or chest infection.

Some people worry about taking steroid tablets; however, a short course of steroid tablets, for a week or so usually works very well and is unlikely to cause any side effects; most of the the side effects caused by steroid tablets occur if you take them for a long time, more than several months, or if you take frequent short courses of high doses.

Omalizumab:

Omalizumab is a drug that is only used in a small number of people who have severe persistent allergic Asthma that has not been controlled by other treatments, so it is not a common treatment; it is given by injection and works by interfering with the immune system to reduce inflammation in the airways, which is present in Asthma.

What are the Dosages of Treatment?

Everyone is different; the correct dose of a preventer inhaler is the lowest dose that prevents symptoms; a doctor may prescribe a high dose of a preventer inhaler at first, to get on top of the symptoms quickly, but when the symptoms have gone, the dose may then be reduced by a little every few weeks; the aim is to find the lowest regular dose that keeps the symptoms away.

Some people with Asthma put up with symptoms; they may think that it is normal to still to have some symptoms even when they are on treatment; a common example is a night time cough, which can cause disturbed sleep, but if this occurs and your symptoms are not fully controlled, tell your doctor or nurse; symptoms can often be prevented, for example, by adjusting the dose of your preventer inhaler, or by adding in a long acting bronchodilator.

A Typical Treatment Plan:

A common treatment plan for a typical person with moderate Asthma is a preventer inhaler used each morning and at bedtime; this usually prevents symptoms throughout the day and night; but a reliever inhaler may be needed now and then if breakthrough symptoms occur, for example, if symptoms flare up when you have a cough or cold; if exercise or sport causes any symptoms, then a dose of a reliever inhaler just before the exercise usually prevents the symptoms; the dose of the preventer inhaler may need to be increased for a while if you have a cough or cold, or during the hay fever season; some people may need to add in a long acting bronchodilator, or tablets, if symptoms are not controlled with the above; at first, adjusting the doses of inhalers is usually done on the advice of a doctor or nurse, but in time, you may agree an Asthma action plan with your doctor or nurse.

What is an Asthma Action Plan?

An Asthma action plan is a plan agreed by you with your doctor or nurse; it enables you to make adjustments to the dose of your inhalers, depending on your symptoms and/or peak flow readings and is tailored to your individual circumstances; the plan is written down, usually on a standard form, so that you can refer to it at any time; research studies suggest that people who complete personal Asthma action plans find it easier to manage their Asthma symptoms and that their plan helps them to go about their lives as normal.

Does Asthma Go Away?

There is no once and for all cure; however, about half of the children who develop Asthma grow out of it by the time they are adults; for many adults Asthma is variable with some good spells and some bad spells; some people are worse in the winter months and some are worse in the hay fever season; although not curable, Asthma is treatable; therefore, stepping up the treatment for a while during bad spells will often control the symptoms.

Some other General Points about Asthma:

It is vital that you learn how to use your inhaler(s) correctly; in some people, symptoms persist simply because they do not use their inhaler properly and the drug from the inhaler does not get into the airways properly; seek advice from your practice nurse or doctor if you are not sure if you are using your inhaler properly.

See a doctor or nurse if symptoms are not fully controlled, or if they are getting worse, for example, if a night- time cough or wheeze is troublesome; if Sport is being affected by symptoms; if your peak flow readings are lower than normal; if you need a reliever inhaler more often than usual, an adjustment in inhaler timings or doses may control these symptoms.

See a doctor immediately if you develop severe symptoms that are not eased by a reliever inhaler; in particular, if you have difficulty talking due to shortness of breath; you may need emergency treatment with high dose reliever drugs and other treatments, sometimes in hospital.

Asthma Related Information Leaflets


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