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Dr Jo Coldron explains how to recognise and control asthma.
Asthma is one of those medical topics that we all know something about. All of us would at the very least know someone with it, many of you reading this will be a member of a whole family of asthmatics. However, it’s a condition, perhaps because of its familiarity, that is historically undertreated and therefore causes far more morbidity, and claims far more lives, than it should.
Asthma can present at ANY age, although it’s often thought of as developing only in childhood. If presenting in early childhood it can then sometimes disappear or regress for many years, but if diagnosed in adulthood, the condition tends to remain. Asthma typically presents with shortness of breath, wheezing, coughing and a feeling of a tight chest or restriction to breathing. The symptoms of asthma are caused by inflammation in airways, which can be made worse by inhaled allergens and infections. However, the diagnosis can sometimes be challenging because there is an overlap in symptoms with other conditions such as viral induced wheeze in children, and acid reflux, bronchitis, emphysema, and lung cancer in older adults.
The diagnosis of asthma is confirmed together by the GP and practice nurse and can include the following steps:
- History: What are the symptoms? Does anything trigger them? Is there a family history? Does the patient have eczema or hay fever?
- Tests: A peak flow diary and spirometry are commonly used tools in general practice. Tests to rule out other things may be considered, for example a chest x-ray.
- Trial of treatment: Sometimes a trial of inhalers can confirm the diagnosis – especially in the very young who can’t complete any of the other tests.
There's currently no cure for asthma, but treatment can help control the symptoms so patients are able to live a normal, active life – treatment includes:
- Reliever inhalers: Most asthmatics will have one of these but although very important they are not the mainstay of symptom management most of time, except in the very mildest asthma. If you are using your blue inhaler more than 3 times per week on a regular basis you should be seeing the asthma nurse to discuss whether it’s possible to improve your prevention treatment.
- Preventer inhalers: These are used every day to decrease inflammation in the airways and reduce sensitivity and reactivity of the lungs. They are either just a steroid medicine or a combination of a steroid and a long-lasting version of the reliever inhaler.
- Tablets: Some tablets are taken every day as a preventer. Some, such as steroids and antibiotics, tend to be used as ‘rescue medicines’ for exacerbations.
Daily symptoms of cough, shortness of breath and tiredness are impactful and we certainly want to reduce them, but the main threat of asthma is the abrupt and rapid deterioration of an asthma attack which in its worst form can be life threatening. The frequency of asthma attacks, and therefore the danger of asthma, can be reduced by having the right level of treatment prescribed and using it regularly, as well as having an asthma plan. An asthma plan helps the asthma patient identify a significant deterioration in symptoms and (most importantly) know what to do about it – whether that’s increasing inhalers, starting a ‘recue pack’ of steroids or contacting the medical services. Patients who are adept at monitoring and assessing their symptoms can more quickly and appropriately respond to them, reducing the chance of deterioration into an out-of-control and life-threatening situation. For younger asthma patients an asthma plan is a good way of communicating information to any of those involved in their care – family members, teachers, friends etc.
It’s important that if you have asthma and don’t have a personal action plan, you make an appointment with your practice asthma nurse to discuss one. If you do have one, and even if your symptoms are well controlled, you should have an annual review with the asthma nurse to discuss your symptoms, current treatment and review your plan. There is a huge amount of research in the field of asthma and you should always be up-to-date with the best treatment.
More information on the presentation, diagnosis and treatment of asthma is available at www.asthma.org.uk and www.nhs.uk/conditions/asthma