Asthma

Allergies

Asthma

Asthma is a chronic condition that causes inflammation and narrowing of the airways. Asthma affects people of all ages and often develops in childhood, but can also develop for the first time in adults. People with asthma have inflamed airways (tubes that carry air into and out of the lungs) that react strongly to ‘triggers’ such as: allergens (pollen, dust, animal fur), exercise or irritants (tobacco smoke, pollution). When a person with asthma inhales triggering substances their airways narrow, causing less air to flow into the lungs. The airways can also swell, reducing the flow of air further. Cells in the airways might make more mucus than usual in reaction to the irritant, which can narrow the airways even more. The reactions in the airways make it difficult to breathe and cause asthma symptoms, which can be seen below. There is currently no cure for asthma, but there are simple treatments that can help keep symptoms under control.

Symptons

The main symptoms of asthma are:

Shortness of breath

Wheezing

Tight Chest

Coughing

There are many different things that could cause the symptoms of asthma. You are more likely to have asthma if the symptoms you experience are:

  • Worse in the early morning or at night
  • A response to ‘triggers’ (pollen, exercise, tobacco etc.)
  • Reoccurring symptoms that happen often and keep coming back

Asthma Attacks

The normal symptoms of asthma can become more severe for a short time; this is known as an asthma attack. It can happen suddenly, or be a gradual increase in the severity of symptoms over a few days. An asthma attack can be potentially life-threatening. If you are having the correct treatment, your risk of having an attack is greatly reduced. Symptoms of a severe asthma attack can include:

  1. Coughing, wheezing and a tight chest that becomes severe and constant.
  2. Rapid breathing.
  3. Faster than normal heartbeat.
  4. Being too breathless to sleep, speak or eat.
  5. Drowsiness, exhaustion, confusion or dizziness.
  6. Blue lips, fingers, skin or tongue (central cyanosis – sign that there is not enough oxygen in the blood).
  7. Fainting (reduced blood flow to the brain).
  8. Your reliever inhaler (typically blue) isn’t helping
  9. Your peak flow (see main tests one of our experts at Ahmeys may use to diagnose asthma) is lower than normal.
  10. Children may also complain of a tummy ache.

What to do when having an asthma attack:

  1. Sit upright (do not lie down) and take slow breaths.
  2. Try to remain calm (panicking will make symptoms worse)
  3. Take one puff of your reliever inhaler every 30 – 60 seconds, up to a maximum of ten puffs
  4. If you do not have your inhaler with you, feel worse despite using your inhaler or don’t feel better after taking ten puffs, call 999 for an ambulance.
  5. If the ambulance has not arrived within 15 minutes, repeat taking one puff of your inhaler every 30 – 60 seconds up to ten puffs.
  6. If possible, try to bring the details of your medication and your asthma plan with you to the hospital

What to do after an asthma attack:

  1. If your symptoms improve and you haven’t called an ambulance, call Ahmeys to make an urgent appointment to see one of our experts. If you have required hospitalisation, call Ahmeys and make an appointment within 48 hours of leaving the hospital
  2. It is quite common for people who have required hospital treatment for an asthma attack to need hospital care again within 2 weeks of the first visit, so it is important to discuss with an expert at Ahmeys how you can reduce your risk of further attacks
  3. Talk to one of our experts at Ahmeys about any changes that may need to be put in place to manage your condition safely. One of our experts may need to adjust your dose of medication or to remind you how to use your inhaler correctly

How to reduce your risk of having an asthma attack:

  1. Take your medications as prescribed and follow your asthma plan
  2. Make sure that you have your reliever inhaler on you at all times
  3. Have regular asthma reviews. Make sure to book an appointment with Ahmeys at least once a year to review your asthma treatment
  4. Check with your Ahmeys expert that you are using your inhaler correctly
  5. Try to avoid ‘triggers’ and irritants whenever possible
  6. Do not ignore your symptoms if they are more severe than usual
  7. Make an urgent appointment with Ahmeys if you experience your symptoms becoming worse and not getting better
  8. Make your family and friends aware of what might happen during an asthma attack, so that they know how to help in an emergency
  9. Make copies of your asthma plan so that you can carry one with you in case of emergency and share it with anyone who might need a copy. You can use your phone to take a photograph if you do not have access to a photocopier

Causes

The exact cause of asthma is still unknown. The symptoms of asthma make a diagnosis possible; inflamed airways that are sensitive to ‘triggers’ in the air and become narrow and clogged with mucus cause wheezing, coughing and a tight chest. It has been suggested that pollution, genetics and modern hygiene standards could all be causes of asthma, but there is not currently enough evidence to confirm that any one of these factors is responsible.

Several things can increase your chances of getting asthma:

  1. Already having an allergy-related condition (atopic condition) such as: a food allergy, hay fever or eczema
  2. Having a history of atopic conditions or asthma in your family
  3. Being a smoker
  4. Exposure to secondhand smoke
  5. Your mother smoking during pregnancy
  6. Having had bronchiolitis (a common childhood lung infection)
  7. Being born prematurely (before 37 weeks) or with a low birthweight
  8. A work environment that exposes you to asthma-causing agents (animal or insect proteins, plant proteins or chemicals), for example: veterinarians, poultry farmers, carpenters, spray painters or factory workers in plastics manufacturing)

Work related asthma:

  1. If you appear to have occupational asthma (asthma caused or linked to your job), you may be referred to a specialist to confirm the diagnosis
  2. Your employer has a responsibility to protect you from the causes of occupational asthma

Common asthma triggers:

Asthma symptoms are often triggered by something. There are typically three categories of asthma trigger: exercise-induced (which may be worse when the air is cold and dry), occupational (triggered by workplace irritants as mentioned above) and allergy-induced (triggered by airborne substances such as spores, pollen and pet dander). Common triggers include:

  1. Viral and bacterial infections such as the common cold and flu
  2. Allergies (to pollen, dust, animal dander or feathers)
  3. Tobacco
  4. Fumes and pollution
  5. Emotions (stress, anxiety and even laughter)
  6. Medicines (particularly anti-inflammatory painkillers such as aspirin and ibuprofen)
  7. Weather (sudden changes in temperature, especially cold and dry air)
  8. Mould or damp
  9. Exercise
  10. Job-related asthma causing agents: isocyanates (chemicals found in spray paint), colophony (a substance found in solder fumes), latex, animals, flour and grain dust, wood dust etc.

Diagnosis

One of our experts will usually be able to diagnose your asthma from your symptoms and some simple tests. If you feel as though you or a member of your family has the symptoms of asthma, call and make an appointment with Ahmeys to see an expert. Tests can’t always be easily done on young children, so your child may be given an asthma inhaler to see if it helps to relieve their symptoms until they are old enough to have the test.

Your expert at Ahmeys may ask

  1. What symptoms you have
  2. How often they happen
  3. When they happen
  4. If anything seems to cause or ‘trigger’ them
  5. If you or any blood relative have a pre-existing condition such as allergies or eczema

The main tests one of our experts at Ahmeys may use to diagnose asthma are:

  1. Peak Flow Meter – a calibrated handheld device that measures your lung capacity (how quickly you can blow air out of your lungs). Regular peak flow tests can give an indication whether your condition is getting worse or improving
  2. Spirometry – a small machine connected to a mouthpiece that measures how much air you can breathe out in one forced breath
  3. FeNO test – a machine that measures the levels of nitric oxide in your breath (which is a sign of inflammation in the lungs)

Treatment

Although there is currently no cure for asthma, routine treatment can control symptoms and help you to live a normal, active life. Below are the different types of treatment you could be prescribed by your expert at Ahmeys:.

Inhalers

Inhalers can be attached to a spacer. A spacer is a large plastic or metal container with a mouthpiece and a space for the aerosol inhaler. They help you to get the best dose from your inhaler, especially if you use a metered dose inhaler. Spacers help children to use their inhalers and spacers with facemasks can be used on babies and young children who find it hard to use an ordinary inhaler or spacer.

Reliever Inhalers

  1. Most people with mild asthma will be prescribed a reliever inhaler, which is typically blue and a short-acting reliever that makes it easier for you to breathe
  2. The reliever inhaler relaxes the muscles around your airways
  3. You will usually be instructed by your expert at Ahmeys to use your reliever inhaler as soon as you notice asthma symptoms
  4. Using your reliever inhaler as soon as possible after noticing your symptoms can get your asthma back in control and prevent an asthma attack
      There are several different types of reliever inhaler:

    • MDIs (Metered dose inhalers) give medicine in a spray form (aerosol) e.g. Ventolin, Salamol and Airomir
    • DPIs (Dry powder inhalers) give a medicine in a powder form rather than aerosol e.g. Accuhaler
    • BAIs (Breath actuated inhalers) automatically release a spray of medicine when you inhale e.g. Easi-breathe, Airmac and Autohaler
  5. Call and make an appointment with Ahmeys to make an asthma plan and practice good inhaler technique
  6. Your expert at Ahmeys may suggest using your reliever inhaler 20 minutes before exercise if your symptoms are triggered by exercise. However, if exercise frequently triggers your symptoms you should contact Ahmeys to have an asthma review. Symptoms being triggered by any kind of exercise could indicate that your asthma needs to be managed better
  7. Equally, if you notice that you need to use your reliever inhaler three or more times a week, this could similarly indicate that your asthma isn’t being well controlled. Call Ahmeys to talk to an expert and review your asthma treatments
  8. Possible side effects of Reliever Inhalers
    1. Shaking
    2. Rapid pulse for a few minutes after use

Preventer Inhalers / Corticosteroid inhalers

  • If you need to use a reliever inhaler frequently, you may also need a preventer inhaler
  • Preventer inhalers are for every-day use and help to reduce the inflammation and sensitivity of your airways
  • Preventer inhalers contain steroid medicine such as beclometasone or fluticasone
  • It is important to use your preventer inhaler regularly (as instructed by your Ahmeys expert) even if you do not have any symptoms
  • Preventer inhalers do not usually have side effects, but you can reduce your risk of experiencing any side effects by using a spacer and rinsing your mouth after using your inhaler
Possible side effects of Preventer Inhalers
  • A fungal infection of the mouth or throat (oral thrush)
  • A sore throat
  • A hoarse voice
  • Rapid pulse for a few minutes after use

Combination Inhalers

  • If using a preventer and reliever inhaler doesn’t control your asthma successfully, you may be prescribed an inhaler that combines both
  • Combination inhalers are for daily use to help stop symptoms occurring and provide relief if they do occur
  • It is important to use your combination inhaler regularly (as instructed by your Ahmeys expert), even if you do not have any symptoms
  • Potential side effects of combination inhalers are similar to those of preventer and reliever inhalers

How to use your inhaler

The instructions below will show you how to use a standard reliever ‘puffer’ inhaler.

    • Remove cap (some caps will require squeezing at the sides to release)
    • Hold inhaler upright and shake well
    • Breathe out gently (not into the inhaler)
    • Put mouthpiece between teeth and close lips without biting to form a seal
    • Begin breathing in slowly through your mouth while pressing down firmly on the canister
    • Continue to breathe in deeply and slowly
    • Hold your breath without breathing out for around five seconds or as long as comfortable
    • Remove the inhaler from your mouth while holding your breath
    • Breathe out gently (not into the inhaler)
    • Replace cap

If more than one dose is needed, repeat all steps. If you are experiencing the symptoms of an asthma attack, take one puff of your reliever inhaler every 30 – 60 seconds, up to a maximum of ten puffs

Tablets

If use of inhalers isn’t controlling your symptoms well enough. You may be prescribed tablets to take in addition to inhaler use.

LTRAs (Leukotriene Receptor Antagonists)

  • LTRAs are the most common tablets used for the treatment of asthma
  • They can also come in a powder and syrup form
  • LTRAs block the effects of the chemicals (leukotrienes) that cause inflammation in reaction to an irritant or allergy
  • They have been shown to improve lung function, reduce symptoms and reduce the need for reliever medicines. They also cut down how sensitive your airways are when exposed to cold air
  • They are especially useful in treating people with solely exercise-induced asthma

Theophylline

  • Your expert at Ahmeys may suggest Theophylline if other treatments aren’t helping to control your symptoms
  • It is taken daily to stop your symptoms occurring
  • This medicine can help to relieve breathlessness by relaxing muscles in your airways so that they open wider and air can flow more easily through them

Steroid Tablets

  • Like Theophylline, steroid tablets may be recommended when other more common treatments aren’t helping to control your symptoms
  • Steroids can help to calm and prevent inflammation in the airways by blocking the chemicals that cause inflammation
  • They can be taken as an immediate treatment when you are having an asthma attack, but can also be taken daily as a long-term treatment (usually only for very severe asthma that does not respond to other treatments and inhalers)

Possible side effects of Steroid Tablets (long-term use)

  • Increased appetite and therefore weight gain
  • Bruising easily
  • Mood changes
  • High blood pressure
  • Fragile bones (osteoporosis)

Alternative/ Additional Treatments

  • Injections (Xolair, Nucala, Cinqaero for those with severe asthma to help control symptoms)
  • Surgery (bronchial thermoplasty may be offered as a treatment for severe asthma; a thin, flexible tube is passed down your throat and heat is applied to your muscles around your airways to help them stop narrowing)
  • Complementary Therapies (breathing exercises such as the Papworth method and the Buteyko, traditional Chinese herbal medicine, acupuncture, manual therapies, homeopathy, dietary supplements). While there is some evidence to suggest that breathing exercises can help alleviate the symptoms of asthma and reduce the need for relievers, there is little evidence to suggest that any of the other complementary therapies help with asthma.

How to manage your asthma symptoms

  • Use your inhaler correctly (see How to use your inhaler). If you are not sure about using your inhaler, call to make an appointment at Ahmeys and one of our experts will remind you of the correct steps
  • Use your preventer inhaler and or additional tablets every day. This will help you to keep your symptoms under control and reduce your risk of having an asthma attack
  • Check before taking other medications. Some medications are not suitable for people with asthma; check the packet to see if the medicine you are taking is suitable for someone with asthma. If in doubt, call Ahmeys and ask one of our experts
  • Do not smoke. Quitting smoking can significantly reduce the severity and frequency of asthma symptoms
  • Exercise regularly. Once you have an appropriate treatment plan, exercise should not trigger your symptoms. Regularly exercise can improve how well your lungs work so that you have more stamina and get less breathless. It can also boost your immune system and release feel-good chemicals (endorphins) into your brain and help to reduce the symptoms potentially caused by stress
  • Eat healthily with a varied and balanced diet
  • Get an annual flu jab
  • Try to identify and avoid ‘triggers’ that make your asthma symptoms worse
  • Book regular checkups with Ahmeys. Regularly checkups will allow you to discuss your symptoms, medicines and treatment
  • Take precautions when travelling (make sure you have your inhaler, asthma plan and enough medication with you)
  • Speak to an expert at Ahmeys if you are pregnant and think that your symptoms may be getting worse
  • If your child suffers from asthma, it is important to ensure that the school has up-to-date information about your child’s medicines including what they are, dosage and what times they need to take them. You may want to supply the school with a spare reliever inhaler as a precaution as well as making sure the child has an inhaler available with them during the school day
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