Services › Asthma Management
Most people think of asthma as an allergy in the lungs, and in many cases, it is. However, asthma is better described as a hypersensitivity of the lungs, whereby the lungs over-react to certain stimuli which can be different from person to person.
WHAT HAPPENS IN ASTHMA?
Asthma is in fact an inflammation in the airways. This inflammation is caused when airways get exposed to something one is allergic to or when a situation triggers a chain of events that lead to three things happening:
The muscles around the airway tighten (bronchospasm)
The airway lining itself becomes thickened and swollen
There is increased mucus production
These all contribute to a significant narrowing of the main airway, the cardinal sign in asthma.
WHAT ARE THE SYMPTOMS?
The classic symptoms of asthma are:
Difficulty in breathing
Shortness of breath
Depending on the severity of the attack there may also be rapid breathing, chest tightness or pressure, difficulty talking, shortness of breath on minimal exercise or even at rest, disturbed nights, and feeling of anxiety or panic. In worse cases there can be signs of lack of oxygen including blue lips or fingernails.
Mild asthma attacks are generally more common, with the symptoms within a few minutes to hours after administering reliever therapy. Severe attacks are less common and require immediate medical help usually involving oxygen, nebulised treatment, and steroid injections.
TRIGGERS OF ASTHMA
Allergies – by far the most recognised cause of asthma. The most common would be allergies to dust, pollen, and mould spores.
Food and food additives – the most common foods that cause allergy include eggs, cow’s milk, peanuts, wheat, soy, fish, shellfish, and part of the reaction they cause includes asthma.
Exercise – heavy exertion can trigger an attack in 80% of asthmatics even without the presence of, say, pollen or dust. The symptoms usually start in the first 15 minutes of an aerobic workout, especially when there has not been a proper warm up.
Acid Reflux – especially when lying down. If the acid reaches the throat, the irritation can spark off an inflammation and an asthma attack
Smoking – this can obviously make asthma worse, with the hundreds of chemicals and irritants that are being inhaled together with the fumes.
Sinusitis and respiratory infections – be they viral or bacterial, can cause asthma, probably as a direct result of the irritation and increased mucus in the airway. They are a quite common cause of asthma attacks in the under 10s.
Medications – often overlooked, but some of the most commonly used drugs, such as aspirin, non-steroidal anti-inflammatory drugs, and beta-blockers can cause asthma.
Weather – cold air, sudden changes in temperature and humidity are known to precipitate attacks of asthma.
Inhaled irritants – including tobacco smoke, smoke from woodfires, perfumes, cleaning agents, workplace dust and chemicals can also cause asthma in those susceptible.
Stress – and strong emotions, including anxiety, shouting, anger and laughing hard are known to bring on an attack in some people.
There are some people who are more at risk than others of developing asthma. Risk factors include:
Gender – childhood asthma is more common in boys. But the ratios do change in different age groups.
Family history – a family history of asthma makes you more likely to develop it yourself.
Atopy and allergies – those people with hay fever and eczema are more likely to develop asthma.
Pollution – exposure to smoke or pollution, including first- and second-hand smoke, can also predispose a person to asthma, making them susceptible to other triggers.
Maternal smoking – smoking during pregnancy has been associated with an increased risk of asthma in the child.
Premature birth – this has also been linked with increased risk of asthma in the child.
Weight – Obesity has been shown to increase risks in some studies.
Do keep in mind however, that whereas you cannot change many of the above risk factors, especially the genetic ones, you can change your lifestyle by avoiding smoking, polluted areas, allergens and by taking care of your general health.
WHERE CAN WE HELP?
At St. Andrews, all our GPs are well versed in asthma, its diagnosis and treatment.
The four main services are:
Physical examination. This will be carried out after a proper history-taking to discuss the symptoms and assess the risk factors for developing asthma. The examination will look for signs of allergies, other risk factors, and the classic sign: expiratory wheezes.
Lung function tests. They include Spirometry and PEFR. Spirometry measures how much air you blow out and how fast. It is important in the diagnosis of asthma and differentiating it from other chronic obstructive airway diseases. The PEFR measures how fast you push out the air. It is less accurate than spirometry but is much easier to use, making it a quicker test to carry out and more readily available, both in the clinic and at home. It has a particular role not only in diagnosis of asthma, but more importantly monitoring the control of asthma, both in a steady state situation as well as after taking treatment.
Asthma control test. Our doctors can also walk you through the asthma control test (ACT). This comprises a series of questions rating how you feel with your symptoms and your perception of its control or lack thereof. It takes into consideration the frequency and severity of the symptoms and is thus centred around the patient’s own experience. The results of this test can guide us whether to start or resume treatment or change or increase existing treatments. A link to an online version of the ACT can be found here. Feel free to check it out, but please communicate your result or any other questions, to your doctor.
Referral is also possible to our resident Specialist in Respiratory Medicine and Allergist. He will be able to consult those difficult-to-treat cases or offer more specialised investigations and advice. As an allergist, he is also the one who runs our own St. Andrews Allergy Clinic. The services here overlap and complement much of what has been said above. This includes Skin Prick Tests, tests able to identify the cause of inhaled allergies and in this case allergic asthma. CLICK HERE to read more about the Allergy Clinic.