Asthma 

Introduction

Asthma is a very common long-term condition that affects your airways and breathing. Approximately one adult in 13 is currently being treated for asthma in the UK.

Asthma affects the airways, the small tubes that carry air in and out of your lungs. If you have asthma, your airways are sensitive and easily become swollen. When they are irritated they narrow, the muscles around them tighten, and there may be an increase in production of sticky mucus or phlegm. This makes it harder to get enough breath, and causes wheezing, coughing and your chest may feel tight.

Asthma may be very mild, or it can be very severe. Most cases are somewhere in between. Even if your asthma is mild, you should visit the GP regularly to have it monitored. Your GP can then prescribe the treatment most likely to help your symptoms and prevent your asthma from getting worse. An asthma attack can become very serious, if you can't control the symptoms with your treatment regime - you should see your GP or a hospital doctor immediately if this happens.

The cause of asthma is not fully understood. It is partly an allergic condition. There is also a genetic connection between asthma, hay fever and eczema. This suggests that these three conditions can be inherited (they can run in families).

Sometimes certain triggers can bring on symptoms. It's sensible to try to avoid these triggers as much as possible, as they will make your asthma worse. Common triggers include house dust mite, animal fur, pollen, tobacco smoke, cold air, viral and bacterial chest infections.

Symptoms

Symptoms include:

• Feeling breathless (you may gasp for breath).
• Your chest may feel tight (like a band tightening around your chest).
• Wheezing,
• Coughing, especially at night (this is less common in adults than children).

§         Your symptoms are likely to vary from day to day and are often worse during the night and with exercise.

Symptoms of a severe attack include:

• Your symptoms will get worse quickly.
• It will be difficult to breathe and to talk.
• Your pulse may race.
• Your lips and/or your finger nails may turn blue.
• Your skin may tighten around your chest and neck.
• Your nostrils may flair as you try and breathe.

§         You should immediately seek medical help if you have symptoms of a severe asthma attack.

Causes

Asthma does not have a single known cause but there are several factors that may contribute to you having the condition.

These include a genetic predisposition, diet and the environment.

Genes are passed from parents to children and although there is no specific gene that causes asthma, a combination of genes passed from parents to children increases the likelihood of having asthma (also eczema and hay fever).

Attacks can be triggered by

Breathing in (inhaling) certain allergens (something that causes an allergy), such as pollen or fungal spores, animal fur or house- dust mite droppings. 

Viral and bacterial chest infections.

Exercise, especially when it is cold.

Changes in the weather. 

Fumes given off by cleaning products and solvents in the home including floor cleaners, room fresheners and polish.

Tobacco smoke, pollution or vehicle exhaust fumes.

Worry and stress.

Foods such as nuts and shellfish, or food additives such as tartrazine.

If you have an asthma attack your immune system overreacts to a trigger causing the airways to become swollen and inflamed. The muscles in the airways also tighten causing your air passages to get narrower.

Sometimes you may have another asthma attack 6 to 10 hours after breathing in an allergen. This is known as a late reaction

Diagnosis

Many adults were first diagnosed with asthma as children.

However a few adults first get asthma as adults, sometimes for the first time in their 50’s or 60’s. Adults may also get asthma again later in life after having ‘grown out’ of it as children or teenagers.

If you think you have developed asthma as an adult you should visit your GP, who will ask about your symptoms, examine your chest and listen to your breathing.

The GP will want to rule out other conditions that cause breathing difficulties, such as COPD (chronic obstructive pulmonary disease) or bronchiectasis.

The GP may ask you to use a peak flow meter before and after you inhale (breathe in) a bronchodilator (a medicine that helps to open up your airways). The peak flow meter measures how quickly you can breathe out. If you can breath better after inhaling the asthma medicine, it usually means that you are diagnosed as having asthma.

A spirometry test is another way of measuring how well your lungs are working, This is linked to a computer and measures how much you breathe out very accurately. This test may be done in your local hospital.

The GP may use a Methacholine challenge test. This is based on the fact that if you have asthma your breathing will get very difficult when you breathe through the chemical methacholine. This effect can be relieved by using an asthma reliever inhaler.

Sometimes the GP will refer you for allergy testing. This involves putting tiny amounts of possible allergens under your skin using a small needle. You are allergic to the things that make your skin red and swollen.

The GP may also refer you for a chest X ray or a CT scan to rule out other conditions that can cause similar symptoms to asthma.

Treatment

Treatment is based on medicines taken through an inhaler to relieve symptoms whilst you are having an asthma attack (Relievers). Also, if necessary, medicines taken through an inhaler to prevent you from developing symptoms (Preventers). If the asthma is still not fully controlled, other medicines may be added on (Add-ons) to the reliever and preventer medicines.

Relievers

Most adults with asthma use a reliever inhaler (puffer). If you only get symptoms occasionally i.e. less than once a day this is probably the only treatment you will be prescribed.

Salbutamol and terbutaline inhalers are the most common relieving inhalers. They are also known as beta-2 agonists. They deliver a small dose of medicine directly to your lungs, which causes the muscles of  your airways to bronchodilate (relax and open up) but do not reduce the inflammation in the airways. They  work quickly, but the effect only lasts for a few hours. There are several different brands and types of reliever inhaler. The inhaler is blue or grey in colour.

If exercise brings on your asthma symptoms, then your GP or asthma nurse may recommend that you use a reliever inhaler just before exercise.

Preventers

If you get asthma symptoms more than 3 times a week or night-time asthma symptoms more than once a week , you will also be prescribed a preventer inhaler. Preventer inhalers reduce inflammation and are used to prevent asthma symptoms, such as shortness of breath and wheezing. They need to be taken regularly, usually twice a day, even when you do not have symptoms.

Most preventer inhalers contain corticosteroids, which are similar to natural hormones produced in your body. There are several kinds but they all work in the same way. They include beclometasone, budesonide, fluticasone and mometasone. The dose of corticosteroid you need, will depend on how often you get symptoms and how bad they are. Preventer inhalers are usually brown, cream, red or orange.

Add-ons

If your asthma is still not fully controlled, your doctor or asthma nurse may suggest that you try a long-acting beta-2 agonist inhaler e.g. salmeterol or formoterol. This is taken together with your reliever and preventer inhalers.

The longer acting beta-2 agonist inhalers are slow to start working, about 15 to 30 minutes, and so won't treat your symptoms when they happen. However, their effect on the airways last for up to 12 hours. They should help to reduce your asthma symptoms and make you feel and sleep better.

If you do not respond to a longer acting beta-2 agonist inhaler, then your doctor may suggest you take leukotriene antagonist tablets e.g. montelukast or zafirlukast, to help prevent your asthma symptoms. These must again be taken together with your reliever and preventer inhalers.

Or your doctor may suggest you take theophylline tablets. These help keep your airways open, so you can breathe more easily. They work very slowly so you need to continue using your reliever and preventer inhalers.

Steroid tablets

Steroid tablets may be prescribed as a short course of treatment for one or two weeks if you have a severe asthma attack. They reduce inflammation and improve how well your lungs work. They reduce your symptoms quickly and lessen the chance of you needing to be admitted to hospital.

Nebulisers

Nebulisers are sometimes used in a hospital or doctor’s surgery to give high doses of reliever medicine if you are having a severe attack. They are however no more effective than an inhaler for every day use.

Prevention

You should try to avoid the factors that may be triggering your asthma. This includes reducing contact with anything that you are allergic to, such as animal hair or pollen. Always wash your hands after touching things that trigger your asthma, especially when stroking pets.

 It is also sensible to reduce house dust mite residues where possible, by using mattress covers, vacuum cleaners with allergy filters, and damp dusting. You should ensure that you avoid general irritants such as tobacco smoke where possible.

It is important that you take all prescribed preventive medicines as your doctor or asthma nurse advises, even when you have no symptoms. Also, that you are using your inhalers correctly.

Healthcentral 2005

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