HOW TO COPE WITH ASTHMA

Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness.
The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems.
Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an "asthma attack", although doctors sometimes use the term "exacerbation".
Severe attacks may require hospital treatment and can be life threatening, although this is unusual.
Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control your symptoms.

What causes asthma?

Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal.
When you come into contact with something that irritates your lungs – known as a trigger – your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).
Common asthma triggers include:

• house dust mites
• animal fur
• pollen
• cigarette smoke
• exercise
• viral infections

Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday.
The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition.
Asthma can develop at any age, including in young children and elderly people.

Symptoms of asthma 

The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time.
The main symptoms of asthma are:

• wheezing (a whistling sound when you breathe)
• shortness of breath
• a tight chest – which may feel like a band is tightening around it 
• coughing

These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen.
Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms.

Asthma attacks

When asthma symptoms get significantly worse, it is known as an asthma attack or "acute asthma exacerbation".
Asthma attacks often develop slowly, sometimes taking a couple of days or more to become serious, although some people with asthma are prone to sudden, unexpected severe attacks. It is important to recognise attacks early and take appropriate action.
During an asthma attack, the symptoms described above may get worse and – if you're already on treatment – your inhaler medication may not work as well as it normally does.
You might be monitoring your asthma using a device called a peak flow meter, and there may be a drop in your peak expiratory flow. 
If you think you or your child are having an asthma attack, don't ignore it. Contact your GP or asthma clinic as soon as possible, or consult and use your asthma action plan if you have one.
Signs of a particularly severe asthma attack can include:

• your reliever inhaler (which is usually blue) is not helping symptoms as much as usual, or at all
• wheezing, coughing and chest tightness becoming severe and constant
• being too breathless to eat, speak or sleep
• breathing faster
• a rapid heartbeat
• feeling drowsy, exhausted or dizzy
• your lips or fingers turning blue (cyanosis)                                                                                    Seek immediate help if you or someone else has symptoms of a severe asthma attack

  Who is affected?

The equivalent of 1 in every 12 adults and 1 in every 11 children. Asthma in adults is more common in women than men.

Diagnosing asthma 

If you have typical asthma symptoms, your GP will often be able to make a diagnosis.
They will want to know when the symptoms happen and how often, and if you have noticed anything that might trigger them.

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A number of tests can be carried out to confirm the diagnosis. These are described below.
In children, asthma can be difficult to diagnose because many other conditions can cause similar symptoms in infants. The tests outlined below are also not always suitable for children.
Your GP therefore may sometimes suggest that your child uses an asthma inhaler as a trial treatment. If this helps improve your child's symptoms, it is likely they have asthma.

Spirometry

A breathing test called spirometry will often be carried out to assess how well your lungs work. This involves taking a deep breath and exhaling as fast as you can through a mouthpiece attached to a machine called a spirometer.
The spirometer takes two measurements – the volume of air you can breathe out in the first second of exhalation (the forced expiratory volume in one second, or FEV1) and the total amount of air you breathe out (the forced vital capacity or FVC).
You may be asked to breathe into the spirometer a few times to get an accurate reading.
The readings are then compared with average measurements for people your age, sex and height, which can show if your airways are obstructed.
Sometimes an initial set of measurements is taken, and you are then given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing when another reading is taken.
This is known as reversibility testing, and it can be useful in distinguishing asthma from other lung conditions, such as chronic obstructive pulmonary disease (COPD).

Peak expiratory flow test

A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test.
This test requires a bit of practise to get it right, so your GP or nurse will show you how to do it and may suggest you take the best of two or three readings.
You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day.
Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take.
To help diagnose asthma that may be related to your work (occupational asthma), your GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work. Your GP may then refer you to a specialist to confirm the diagnosis.

Other tests

Some people may also need a number of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment.

Airways responsiveness

This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger.
You will be asked to breathe in a medication that deliberately irritates or constricts your airways slightly if you have asthma, causing a small decrease in your FEV1 measured using spirometry and possibly triggering mild asthma symptoms. If you do not have asthma, your airways will not respond to this stimulus.
The test often involves inhaling progressively increasing amounts of the medication at intervals, with spirometry measurement of FEV1 in between to see if it falls below a certain threshold. In some cases, however, exercise may be used as a trigger.

Testing airway inflammation

It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways:

• a mucus sample – the doctor may take a sample of mucus (phlegm) so it can be tested for signs of inflammation in the airways
• nitric oxide concentration – as you breathe out, the level of nitric oxide in your breath is measured using a special machine; a high level of nitric oxide can be a sign of airway inflammation

Allergy tests

Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies, such as dust mites, pollen or foods.
Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma.

  How asthma is treated
While there is no cure for asthma, there are a number of treatments that can help control the condition.
Treatment is based on two important goals, which are:

• relieving symptoms 
• preventing future symptoms and attacks

For most people, this will involve the occasional – or, more commonly, daily – use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important.
You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so.

Treating asthma 

Anyone with asthma should be able to lead a full and unrestricted life. The treatments are effective in most people and should enable you to keep the condition under control.

Taking asthma medicines

Inhalers

Asthma medicines are usually given by inhalers – devices that deliver medication directly into the lungs as you breathe in.
This is an effective way of taking an asthma medicine as most goes straight to the lungs, with very little ending up elsewhere in the body.
Each inhaler works in a slightly different way. You should have training from your GP or nurse in how to use your device or how to help your child use theirs. This should be checked at least once a year.
Some inhalers are pressurised canisters – similar to a spray deodorant or an air freshener. You press the inhaler while breathing in, so the vapour containing the medication can pass into your lungs.
Some inhalers are not pressurised canisters but contain the medication in dry powder form, usually in a capsule that is punctured when the inhaler is "primed".
It is not possible to use a spacer with these inhalers and, unlike pressurised canisters, the powder must be inhaled quickly and forcefully if the medication is to reach the lungs.

Spacers

Pressurised canister inhalers can work better if given through a spacer – a hollow plastic or metal container with a mouthpiece at one end and a hole for the inhaler at the other.
Children under the age of three may have a spacer attached to a face mask rather than a mouthpiece, as this can make it easier for them to breathe in the medicine.
When using a spacer, the vapour from the inhaler is released into the container, where it is held while you breathe in slowly and progressively until your lungs are full. You should then hold in your breath before relaxing so the vapour has time to settle in your lungs.
This can make the medication more effective because much more of it reaches your lungs and much less stays in your mouth or is swallowed, where it has no effect on your lungs but is more likely to cause possible unwanted effects.
Spacers are also good for reducing the risk of thrush in the mouth or throat, which can be a side effect of some inhaled asthma preventer medicines.
Spacers can also be very helpful for people who find using inhalers difficult, such as young children. As spacers also improve the distribution of medication into the lungs, their regular use is preferred in many cases – particularly for preventer medications – even in people who use inhalers well.

 

Outlook

For many people, asthma is a long-term condition – particularly if it first develops in adulthood.
Asthma symptoms are usually controllable and reversible with treatment, although some people with long-lasting asthma may develop permanent narrowing of their airways and more persistent problems.
For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on.