Asthma

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Asthma is a common and long term lung condition that requires ongoing management. In asthmatics the airways are sensitive and become inflamed and narrow on exposure to certain triggers, leading to difficulty in breathing. Asthma commonly starts in childhood but it is possible to develop asthma at any age. The causes of asthma are not fully understood, but what we do know is that both the environment and genetics have a role to play in who develops asthma. Asthma cannot be cured, but with a good management plan it can be well controlled.

Allergy and Asthma:

There is a link between asthma and other allergic conditions including eczema, hay fever and food allergy. Individuals with hay fever (allergic rhinitis) or a family history of allergy have an increased likelihood of developing asthma (see Allergy UK’s factsheet on Allergic Rhinitis). It is important if you have both hay fever and allergic asthma that your hay fever is well controlled. Poorly controlled hay fever can lead to the development of asthma or make asthma symptoms worse in existing asthma.

Could it be asthma?


Asthma symptoms:
are individual to each person and can come and go, it is possible to have one or more of the symptoms below. However these symptoms can also be caused by other conditions, so if you suspect you may have asthma you should see your GP.

  • Feeling short of breath
  • Cough (day or night)
  • Wheezing
  • Chest tightness

Diagnosing asthma is a complex process. Your GP will ask a series of questions about your symptoms, duration, timings and possible triggers. They will listen to your chest and may arrange for you to have a breathing test called spirometry (which involves blowing through a tube to see how well your lungs are working). If allergy triggers are suspected you may also be referred to an allergy doctor for further tests. 

Asthma and non-Steroidal anti-inflammatory drugs may be problematic for some people with asthma, as they may have a sensitivity to aspirin or a group of painkillers called non-steroidal anti-inflammatory drugs. If you take these medicines and suspect they trigger your asthma you may have a sensitivity Seek advice from your GP as there are alternative medicines that you may be able to take.. Always check the information provided with your medications to make sure they are suitable for people with asthma and are not contra indicated. Asthma Triggers can cause the already sensitive airways of an asthmatic to become narrow and inflamed. Once this occurs the individual will have difficulty breathing. Triggers are individual to the person and it is not uncommon for people to have more than one trigger. It is not always possible to avoid triggers such as grass pollen or exposure to pollution. Indeed some triggers should not be avoided, for example exercise but reducing exposure to them may help make your asthma symptoms easier to control.

Key Message: Identifying your individual trigger(s) enables you to avoid or reduce exposure and will help to improve your symptoms.

Occupational asthma occurs where people are exposed to substances through the environment in which they work. These substances act as a trigger to existing asthma or may result in the development of adult asthma. All adults with new onset asthma should be assessed for occupational causes of asthma. Dust and chemicals are common triggers in professions such as hairdressing or manufacturing. Mould is another common problem, e.g. from compost and soils. 

Asthma Triggers:

Environmental:

  • Weather changes
  • Pollution or irritants
  • Indoor air quality
  • Secondhand smoke

Allergic:

  • House dust mite
  • Animals and pets
  • Pollen
  • Mould and Fungi
  • Food

Individual:              

  • Emotions (laughing etc)              
  • Smoking
  • Hormones      
  • Sexual activity
  • Alcohol
  • Exercise          
  • Recreational drugs
  • Occupation                  
  • Stress and anxiety

Key message: Having a cold, flu or other viral infection may trigger asthma symptoms. Keeping fit and healthy, avoiding contact with those who are unwell and getting a flu vaccine every year is recommended.

Medication: Most people with asthma use an inhaler of which there are many types containing measured doses of different medications. The two main types of inhalers are called preventers and relievers. There are also combination inhalers which contain both a long-acting reliever and a steroid preventer. It is important you are shown how to correctly use the type of inhaler that is prescribed for you.

Preventer inhalers: contain a steroid which works by reducing swelling and inflammation in the airways. They help prevent asthma symptoms and should be taken as prescribed daily to build up a protective effect.

Reliever inhalers: are used as and when asthma symptoms are experienced. Everyone with asthma needs to have a reliever inhaler prescribed. If you are using this type of inhaler regularly, it means your asthma is not controlled and you need to seek advice from your asthma nurse of GP.

Spacers: Using a spacer (a holding chamber that fits on the end of an inhaler) is an effective way of ensuring your asthma medication reaches the right place with the correct dose. These are useful if co-ordinating the press and breathe action is difficult. Infants and children should always use a spacer as part of their asthma management as they will not be able to use their inhaler effectively without it.

Annual asthma reviews are an important part of your asthma management: If you haven’t already arranged an annual asthma review with your GP or Asthma Nurse it would be advisable to do so. This provides the ideal opportunity for asthma medication to be reviewed, inhaler technique to be observed and to ensure your personal asthma action plan is up to date. In addition to inhalers, oral or nebulised medication may be required. If you are required to take a combination of therapies an asthma management plan is a useful guide to what to take and when. 

Personalised Asthma Action Plans (PAAPS): Asthma treatment consists of 5 steps that relate to how severe your symptoms are from mild (Step 1) to severe (Step 5). Treatment is stepped up or stepped down as needed. Having a written asthma action plan helps you to recognise when symptoms become worse and what to do if you have an asthma attack. An asthma action plan can be viewed and printed from the following link: https://www.asthma.org.uk/advice/manage-your-asthma/action-plan/

Key Message: Asthma medication is only effective if taken properly. When you see your GP, Asthma Nurse or Pharmacist ask for a review of your inhaler technique (even if you have been using your inhaler for a long time it may not be effective). If you require more information on inhaler technique including videos showing correct techniques for different types of inhalers visit Asthma UK website for further information https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers/

Good Control: starts with taking your asthma medication correctly, following your personal asthma action plan to identify when your asthma is not well managed and the avoidance of triggers. If you feel your asthma is not well managed it is important to see your GP or Asthma Nurse without delay. They may advise you on a change of medication or increased dose. It is important to be aware that, if symptoms are not well managed, they can increase quickly and result in a visit to A&E or a hospital admission.

How to recognise if your asthma is getting worse:
  • Coughing or wheezing more than normal
  • Finding it difficult to breath, talk or sleep
  • Reduced peak flow measurements
  • If your reliever is not helping and/or you need to use more than normal
  • You are becoming exhausted by the effort of breathing
What happens in an asthma attack?

In an asthma attack the muscles around your airways can become swollen and inflamed with increased mucus production resulting in one or more of the following symptoms: difficulty breathing, difficulty speaking, experiencing a wheeze, blue colour to the lips and feeling distressed.

Managing an Asthma Attack:

  1. Immediately take 1 puff of your reliever inhaler, repeating 1 puff, if required, every 30-60 seconds, up to a maximum of 10 puffs
  2. Try to remain calm and sit upright ( this allows you to breathe easier )
  3. If you feel worse, or do not feel any better after 10 puffs call an ambulance (this ensures medical help is on its way)
  4. If the ambulance takes longer than 15 minutes to arrive then repeat step 1

Key Message: If your symptoms improve after using your inhaler and you don't need to call an ambulance, it is important to make an appointment that day with your GP or Asthma Nurse who will be able to provide advice on your asthma control.    

 

Last updated: September 2016                   Next review date: September 2019
Version 3

 

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