Asthma
Asthma is a condition affecting about 1 in 25 adults over the age of 16, and 1 in 7 children aged 2-15. Asthma symptoms can appear and disappear rapidly. It spans all age groups and ranges from the patient with occasional mild symptoms, to those who are too breathless to walk up the stairs or to the end of the street.
Asthma is a common and chronic inflammatory condition of the airways whose cause is not completely understood. As a result of inflammation the airways are hyperresponsive and they narrow easily in response to a wide range of stimuli. Narrowing of the airway is usually reversible, but in some patients with chronic asthma the inflammation may lead to irreversible obstruction of airflow.
There is no permanent cure for asthma but current medications can effectively abolish symptoms for most people with asthma, with minimal side-effects. Unfortunately many cases of asthma go undetected and untreated.
Our trained asthma nurses are available in nurse-led clinics to review patients and for consultations if symptoms worsen. If you are concerned about your asthma please make an appointment in the clinic to discuss your breathing.
Symptoms of asthma
Wheeze
Shortness of breath
Tight chest
Asthma is a common and chronic inflammatory condition of the airways whose cause is not completely understood. As a result of inflammation the airways are hyperresponsive and they narrow easily in response to a wide range of stimuli. Narrowing of the airway is usually reversible, but in some patients with chronic asthma the inflammation may lead to irreversible obstruction of airflow.
There is no permanent cure for asthma but current medications can effectively abolish symptoms for most people with asthma, with minimal side-effects. Unfortunately many cases of asthma go undetected and untreated.
Our trained asthma nurses are available in nurse-led clinics to review patients and for consultations if symptoms worsen. If you are concerned about your asthma please make an appointment in the clinic to discuss your breathing.
Symptoms of asthma
Wheeze
Shortness of breath
Tight chest
Cough (frequently in young children)
It is important to remember that not all people with asthma will have all of these symptoms. These symptoms are not exclusive to asthma. Clues that they may be due to asthma are:
.symptoms are variable
.symptoms are intermittent
.symptoms are worse at night
.symptoms are made worse by specific trigger factors including exertion
Diagnosis
It is important to remember that not all people with asthma will have all of these symptoms. These symptoms are not exclusive to asthma. Clues that they may be due to asthma are:
.symptoms are variable
.symptoms are intermittent
.symptoms are worse at night
.symptoms are made worse by specific trigger factors including exertion
Diagnosis
To obtain a definite diagnosis of asthma we need to measure lung function objectively. Asthma is variable airflow obstruction, so to prove that asthma is present we have to measure airflow and prove that it is variable.
Peak expiratory flow (PEF)
This is the simplest, quickest and cheapest test of lung function, and is the one most commonly used in primary care. It measures the maximum rate of air (expressed in litres per minute) which the patient can forcibly exhale in ten milleseconds, starting from full inspiration. When the airways narrow peak expiratory rate falls.
Peak expiratory flow (PEF)
This is the simplest, quickest and cheapest test of lung function, and is the one most commonly used in primary care. It measures the maximum rate of air (expressed in litres per minute) which the patient can forcibly exhale in ten milleseconds, starting from full inspiration. When the airways narrow peak expiratory rate falls.
Variability in lung function can be assessed over time using a peak flow diary, or in response to bronchodilators, exercise or oral steroids. Asthma is indicated by a change from baseline of 20% in peak expiratory flow. A spirometer which measures lung function may sometimes be used to measure variability.
In children the diagnosis may be more difficult as it is often not possible to measure lung function. In children less than six years of age clinical symptoms and history are of greater importance. Some of the signs and symptoms of asthma are shared with other diseases and it is important to consider possible alternative diagnosis. If asthma treatment is prescribed and there is no improvement, the diagnosis must be reconsidered.
Routine management of asthma
Avoiding triggers that make your asthma worse can reduce unnecessary symptoms but this is not always possible. Triggers include pets, pollen, colds & viral infections, mould and air pollutants.
Smoking cessation
Smoking is dangerous for everyone, but particularly for people with asthma. It can irritate the lungs and bring on asthma symptoms. If you would like help to stop smoking please speak to your nurse or doctor.
For More Information:
QUIT: An independent charity offering help with stopping smoking http://www.quit.org.uk
NHS Stop Smoking Helpline: http://www.givingupsmoking.co.uk
Medications
The aim of asthma management is to achieve maximum control of symptoms with minimum medication.
Relievers
Everyone with asthma should have a reliever inhaler (usually blue). Relievers quickly relax the muscles surrounding the narrowed airways and are essential in asthma attacks. They should be carried at all times and taken to relieve asthma symptoms.
Preventers
Preventers (usually brown) control the swelling and inflammation in the airways, reducing the risk of severe attacks. They need to be taken every day as the protective effects build up over a period of time. Preventer inhalers usually contain steroid. There is a small risk of sore throat, hoarseness of voice and oral thrush. Using a spacer and rinsing the mouth after will help avoid this.
Long acting relievers
If asthma is not controlled by using a preventer inhaler regularly, a long-acting reliever may be added to asthma medications. They are usually taken twice a day.
Steroid tablets
If symptoms become severe it may be necessary for the doctor to prescribe a short course of steroid tablets. Short courses of tablets will not give long term side effects. A small minority of people with severe asthma symptoms may need to take steroid tablets for a longer period. They are more at risk of experiencing side effects.
Signs that asthma is getting worse
. Waking at night with coughing, wheezing, shortness of breath or a tight chest
. Having to take time off work because of your asthma
. Needing more and more reliever treatment
. Reliever does not seem to be working
. Needing reliever more often than 4 hours
. Feeling that you cannot keep up with your usual level of activity or exercise
What to do in an asthma attack
Sometimes, despite using your asthma medications regularly and avoiding triggers, an asthma attack may occur. Most people find that asthma attacks are the result of gradual worsening of symptoms over a few days. Do not ignore the warnings. Often, using the reliever will be all that is needed. At other times, symptoms are more severe and more urgent action is needed.
For More Information:
QUIT: An independent charity offering help with stopping smoking http://www.quit.org.uk
NHS Stop Smoking Helpline: http://www.givingupsmoking.co.uk
Medications
The aim of asthma management is to achieve maximum control of symptoms with minimum medication.
Relievers
Everyone with asthma should have a reliever inhaler (usually blue). Relievers quickly relax the muscles surrounding the narrowed airways and are essential in asthma attacks. They should be carried at all times and taken to relieve asthma symptoms.
Preventers
Preventers (usually brown) control the swelling and inflammation in the airways, reducing the risk of severe attacks. They need to be taken every day as the protective effects build up over a period of time. Preventer inhalers usually contain steroid. There is a small risk of sore throat, hoarseness of voice and oral thrush. Using a spacer and rinsing the mouth after will help avoid this.
Long acting relievers
If asthma is not controlled by using a preventer inhaler regularly, a long-acting reliever may be added to asthma medications. They are usually taken twice a day.
Steroid tablets
If symptoms become severe it may be necessary for the doctor to prescribe a short course of steroid tablets. Short courses of tablets will not give long term side effects. A small minority of people with severe asthma symptoms may need to take steroid tablets for a longer period. They are more at risk of experiencing side effects.
Signs that asthma is getting worse
. Waking at night with coughing, wheezing, shortness of breath or a tight chest
. Having to take time off work because of your asthma
. Needing more and more reliever treatment
. Reliever does not seem to be working
. Needing reliever more often than 4 hours
. Feeling that you cannot keep up with your usual level of activity or exercise
What to do in an asthma attack
Sometimes, despite using your asthma medications regularly and avoiding triggers, an asthma attack may occur. Most people find that asthma attacks are the result of gradual worsening of symptoms over a few days. Do not ignore the warnings. Often, using the reliever will be all that is needed. At other times, symptoms are more severe and more urgent action is needed.
. Take your reliever (blue) inhaler, immediately.
. Sit down and ensure that any clothing is loosened. Do not lie down.
. If no immediate improvement during an attack, continue to take one puff of your reliever inhaler every minute for 5 minutes or until symptoms improve.
. If your symptoms do not improve in 5 minutes - or if in any doubt - call 999 or a doctor urgently.
. Continue to take one puff of your reliever inhaler every minute until help arrives.
. After an emergency asthma attack see your doctor or asthma nurse for a review within 48 hours. You will also need to see them a few weeks later to make sure symptoms are better controlled.
Further information:
Asthma.org.uk
The British Thoracic Society www.brit-thoracic.org.uk