Asthma

A description of this chronic condition that affects over 3 million people in the UK

Asthma, is a chronic condition, characterised by the restriction of the airways, making breathing difficult, resulting in wheezing or coughing with general tightness and discomfort in the chest. The airways become red, inflamed and sensitive. When inflamed, the airways become narrower, as the surrounding muscle contracts, and produces, mucus/phlegm. Attacks may be mild or severe, with symptoms lasting from a few hours to a few days. Diagnosis and assessment of control, is made by monitoring the peak flow of your airways.

The first signs usually show in childhood or adolescence with fewer cases starting in later life. A family history of Asthma or conditions such as eczema and/or hay fever are fairly well known links. Although a common problem, affecting over three million people, as yet, there is no definitive cure for Asthma. There are however many ways of relieving the symptoms and bringing the condition under control.

What are the precipitating factors of Asthma.

Some form of allergy, upper respiratory tract infection or exercise usually triggers an attack. These are some of the most common causes;

Keep a detailed record of when and how the attacks occur this will help you and your Doctor to have a better understanding of your condition.

In all cases, the earlier you can recognise the condition and seek professional help, the better the chances of effective control.

Most of us will be familiar with the sight of inhalers. They are two main types, the ones that bring relief and those that help prevent attacks. The benefit of this form of treatment, is that the drug is delivered to the site of action, rather than being absorbed into the rest of the body. This thus reduces the incidence of side effects.

The relievers, used regularly during an acute attack, are, the Beta-agonists, the most well known, being Ventolin (Salbutamol)- the blue inhaler. They work by relaxing the muscles around the airways, thus opening them up and relieving the symptoms. Sometimes Atrovent ( Ipratropium ) a different type, is also used in children and the elderly.

The preventers, as the name suggests, are used continuously, even when well. They offer a build up of protection and are mainly steroids or corticosteroids. The most common being Becotide (Beclomethasone)- the brown one which prevents inflammation of the airways.Regular users may develop a sore throat or hoarse voice but gargling and rinsing of the mouth, after each use, should help prevent this. Other preventers, occasionally used in children, are the non-steroid types. The most common being Intal (Sodium Cromoglycate) Their use however is diminishing, since it has been found that inhaled steroids are more effective.

Severe attacks that do not readily respond to both types of inhaler, are next treated with a short course of steroid tablets. Normally, this treatment lasts for five to ten days, to reduce the incidence of side effects. Occasionally, if the Asthma is difficult to control, xanthine tablets (Slo-Phyllin) are used as a longer-term alternative. Recently introduced, the leukotriene antagonists are a preventative form of treatment, used in mild to moderate asthma, not controlled by both types of inhalers.

Most often used in an emergency or severe attack. It is a machine that produces a high dose of medicine in the form of a mist, breathed through a mask. As an alternative to normal nebuliser use, i.e., non-emergency, a spacer device may prove useful.

This is a very large and complex subject. I hope however, that this brief explanation, together with a description of some treatments available, will be of interest. In all cases, if you are feeling unwell, or have any of the symptoms mentioned above, please consult your Doctor. Most surgeries hold asthma clinics where a review is undertaken on a six monthly or yearly basis. Look at your environment, see if changes can be made, refer to the list of common causes and remember the importance of keeping a detailed record of events.

Dr Malin Thorpe