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Multipharmacy.com :: Health Info :: Chest
Asthma is a very common long-term condition that affects the airways and breathing. Approximately one child in 8 and about one adult in 13 are currently being treated for asthma in the UK[1]. It can be so mild that it is hardly noticeable, or it can be sudden and severe causing the affected person to panic. Most cases are somewhere in between.
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, and this suggests that these three conditions can be inherited (they can run in families).
Asthma affects the airways, the small tubes that carry air in and out of the lungs. In someone with asthma, the 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. It makes it harder for the person to get enough breath, and causes wheezing, coughing and a strong feeling that the air can't get in or out of the lungs.
Asthma does not usually cause trouble all the time. Attacks (when symptoms show themselves) may sometimes occur quite often, but in many cases the person with asthma is free from the trouble for quite long periods.
More than many disorders, asthma is a 'self-help' condition in which the affected person can do much to prevent attacks. When attacks do happen they can usually be stopped fairly quickly. However, it is not a trivial condition – around 1400 people die from it each year in the UK, and many of those deaths are avoidable if people know how to recognise the danger signs.
Asthma does not have a single known cause but there are several factors that may contribute to the development of this condition. These include atopy, genetic predisposition (having something in your genes that makes you likely to develop asthmas), diet and the environment.
Atopy is a general genetic condition that makes people more likely to develop allergic reactions to various substances (called allergens). It increases the likelihood of a person having asthma, eczema or hay fever. All three are related to genes that a person will have inherited from their parents – so there is often a family history of these conditions.
Exposure to industrial or atmospheric pollution may also cause asthma symptoms. More than 200 industrial substances are known to bring on asthma.
People with atopy are more likely to develop asthma in response to industrial and other pollutants than are people who do not have atopy, and to do so more quickly.
When a person has asthma, an attack can be started by a number of different things. These include:
Breathing in (inhaling) certain allergens, such as pollens or fungal spores, animal allergens or house dust mites
Viral and bacterial chest infections
Seasonal changes
Exercise, especially when it is cold
Some medicines, especially beta-blockers and aspirin
Strong smells and perfumes
Smoke, pollution or vehicle exhaust fumes
Worry and stress
Alcohol
Foods such as nuts and shellfish, or food additives such as tartrazine.
In a small number of people with asthma, an attack can be triggered by aspirin or other NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen. Paracetamol is generally a safer painkiller for those with asthma.
A recent study has found that fumes given off by cleaning products and solvents in the home including floor cleaners, room fresheners and polish may cause asthma in young children (2).
The most common features of asthma are:
Coughing (this is more common in children than adults)
Feeling out of breath
Tightness in your chest
Wheezing (a whistling sound that happens when you breathe)
How long the attack lasts and how severe it is can vary greatly. Some people with asthma never have a severe attack, only a little wheezing or the occasional bout of coughing. These mild attacks may affect children from time to time for a few years, then stop, because many children may improve to the point where they no longer require medication.
In most cases, however, asthma is rather more severe. Attacks are regular, and the person experiences definite wheezing and a feeling of breathlessness. People affected in this way are often able to work out what brings them on and can help to control their attacks with self treatment.
Severe asthma can be alarming, especially when an attack comes on suddenly. In a severe attack, symptoms can include:
Finding it hard to talk because of lack of breath
Nostrils open very wide when you breathe
Using extra muscles (accessory muscles) in the neck and chest to help you breathe (this appears as a pulling-in of skin around these areas)
Heart beats faster than normal
Finding it hard to walk
Lips or fingernails turn blue or grey (very serious because it means the person is not getting enough oxygen to keep the blood a healthy red colour)
This is a dangerous situation and needs urgent hospital attention.
There is no single test for asthma. Diagnosis is based on examination and treatment of the person affected. For example, the doctor may listen to the patient’s chest with a stethoscope, to determine how well the airways are working. Sometimes, when coughing is the main effect, it can be harder to know that a person has asthma, but there are tests that can be done to prove it for example using a spirometer (a tube attached to a computer) or a skin prick test (to check for allergies). Nearly all cases involve some breathing difficulty.
A GP or other healthcare professional, or the person themselves, can use a tube called a peak (expiratory) flow meter, to measure whether patient is having difficulty in getting air through their lungs. The patient blows as hard as possible into this tube, and by looking at the scale, it is possible to work out if the condition is getting worse or whether treatment is working. People with asthma should have one these tubes to monitor their condition. They are suitable for adults and children over the age of 6 and are available on prescription.
In people who are unable to use a peak expiratory flow meter, such as very young children, the diagnosis of asthma may be made if their symptoms disappear in response to specific asthma treatment.
In children the diagnosis must often be based entirely on symptoms. This can be difficult because symptoms may be very variable, with only occasional coughing or breathing difficulties, and no discernable patterns. If there is a family history of asthma, hay fever or eczema then this may help the GP to diagnose the condition.
There are several other conditions, such as chronic obstructive pulmonary disease (COPD) and hyperventilation syndrome, which have similar symptoms. These may need to be ruled out with tests before asthma can be diagnosed.
The type of treatment that is given depends on how often the asthma attacks occur and how bad the symptoms are. Most treatment is by prescribed drugs and these are often taken using an inhaler (a device which enables the drug to be breathed in directly to the affected area, the lungs).
The most common treatments for symptoms when they begin are short-acting beta-2 agonist inhalers such as salbutamol (Ventolin). These act to widen the air passages of the lungs.
Other medicines called ‘preventers’ may then be prescribed to prevent asthma symptoms from occurring. Corticosteroid inhalers such as beclomethasone reduce inflammation in the air tube linings, so reducing breathlessness. Inhaled steroids are taken twice a day, everyday.
If asthma is still not fully controlled, before increasing preventer treatment, other medicines are ‘added on’. These include long-acting beta-2 agonist inhalers such as salmeterol (Serevent), and aminophylline, which relaxes the tight muscles in the air tubes.
More specialist types of drugs may also be prescribed. An example is ipratropium, which dries up the mucus and relax the muscles around the airways, so that they loosen and allow flow of air. This is sometimes prescribed for the very young and the elderly.
In severe asthma, steroid drugs may also be taken by mouth in tablet form for a time. However, inhaled steroids are widely recognised as an important way of preventing worsening symptoms and long-term damage.
It is important to know how to use inhalers properly so that the drugs reach the air tubes and are not just deposited in the mouth or throat. Large-volume spacer devices may help. They are larger in size than other inhalers and may have a mask attached for easy of use. They mix the dose of drugs in a greater quantity of air and reduce the problems of poor inhaler technique.
To get initial control of symptoms, a higher or more frequent dose of inhaled drugs may be required, but once the symptoms and peak flow have improved the dose will be carefully reduced to the minimum that maintains control.
Inhaled steroids are usually used twice a day. If symptoms are not controlled on this dosage, then taking smaller amounts of drug more often may be more effective. The advice of your doctor is essential.
There is limited evidence that acupuncture, homeopathy, hypnotherapy, herbal medicine or yoga may help some people with asthma. In one study it was demonstrated that acupuncture may help people to cope better with their asthma. However, acute attacks should still be treated with effective conventional medicines.
In order to reduce frequency of allergic reactions, it may be useful to minimise house dust mite residues where possible. This can be achieved by using mattress covers, vacuum cleaners with allergy filters, and damp dusting, for example. Immunisation with the influenza vaccine is recommended for asthmatic people.
It is not possible to prevent a person from developing asthma, but individual asthma attacks can often be prevented.
People with asthma should check the state of their air tubes by regularly using a peak expiratory flow meter. The results should be noted and any drop in performance, shown by a reduction in the free flow of air, reported to the doctor.
Asthmatics should try to avoid anything that they know has brought on attacks in the past, such as particular allergens or smoky atmospheres. There is clear evidence that passive smoking makes childhood asthma worse, and that removal from exposure improves the asthma.
A program of self-management, which involves a written action plan, including what to do if you are experiencing worsening symptoms, self-monitoring (either by peak expiratory flow rate or using a symptom diary) and regular medical review, should be offered to all people with asthma. An action plan is available from the National Asthma Campaign.
People with asthma (and those who provide them with care) should know the aims, effects and side effects of medication, how to monitor asthma, and when and how to increase drug dosage.
Occasionally, asthmatics may experience symptoms getting suddenly worse, or steadily worsening over a period of days. Signs that asthma is getting out of control may include:
Waking at night with coughing, wheezing, shortness of breath or a tight chest
Having to take time off work because of your asthma
Finding it difficult to breathe, and breathing short shallow breaths
Needing more and more reliever treatment (treatment that helps symptoms); using it more frequently than every 4 hours
Finding that your reliever does not seem to be working
Feeling unable to keep up with usual levels or activity or exercise
Very rarely, a person with asthma will have a severe attack in which none of the treatments work and the attack continues to get worse. This can be life-threatening.
This condition calls for urgent medical attention at any time of the day or night. The same applies to a steady worsening, when treatment seems to be working less and less.
The risk of death from asthma can be increased by the following factors:
A previous near-fatal episode of asthma
Abrupt development of symptoms that respond poorly to treatment and that rapidly progress
Asthma attack with a rise in the level of carbon dioxide in the blood (detected by blood tests or if the lips had turned blue-grey)
Not being aware how severely the airways have become blocked
Clear daily variations in ease of air flow
Frequent hospital admissions or emergency visits
Recent increased frequency of night-time awakenings or daytime breathing difficulty
Failure to diagnose asthma or to provide adequate treatment, or failure to ensure the patient can cope with self-care measures.
source NHSDirect 151204
Product code:sym-asthma |
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