What is Asthma?
Asthma is an often chronic (i.e.-long term and persistent) medical condition, that causes difficulty in breathing. It develops as a result of inflammation and muscular contraction within the (small) air passages inside the lungs. This restriction, combined with excessive mucus production, causes the symptoms associated with asthma. Asthma can be genetically inherited or triggered by environmental factors. Trigger factors (factors that can cause asthma) include amongst other things: Infections (chest/colds), other medicines (aspirin/Ibuprofen), pollen spores, exercise, cigarette smoke, house dust mites, cold weather and also pet hair/saliva/skin. Asthma ‘attacks’ (displaying the signs of asthma) typically last for a few minutes or hours maximum when treated, but without treatment this can extend to days or even weeks.
What are the signs and symptoms of Asthma?
Asthma symptoms can occur quickly and vary in severity, depending on the individual. The most common symptoms can include a wheeze (a high-pitched sound when breathing), a persistent cough, a feeling of chest tightness or being short of breath.
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Symptoms often appear in childhood, with 368,000 people, of whom 20% are children, receive treatment for asthma in Scotland (2018). Children can sometimes grow out of asthma but for most individuals its often a chronic(i.e.-persistent and life long) condition, that is controllable but not curable. Asthma symptoms can vary from: mild(symptoms that appear from time to time, normally caused by a trigger factor), moderate(symptoms present on most days or at certain times of the day) or severe(can occur at any time, involving a severe shortness of breath and bad wheeze).
How is the condition assessed?
Asthma assessment involves looking for the presence of typical asthmatic symptoms, as they are presented to a health care professional, such as a general practitioner (GP). Checking a patients medical and family history, as well as performing tests to confirm a diagnosis of asthma, are often carried out.
The two main asthma diagnosis tests consist of a spirometry test and a peak flow test. With spirometry, the test is carried out ideally when asthma symptoms are present, in order to provide a more accurate diagnosis.
The patient blows multiple times into a spirometer machine. This tests measures the maximum volume of air expelled in one second(called FEV1) and the maximum total volume of air expelled in one complete breath(called FVC). The ratio of FEV1 to FVC is then calculated, with a low value being typical of someone who is asthmatic. Medication to relieve asthmatic symptoms are then administered. If subsequently an increase in this ratio occurs, then a diagnosis of asthma is often given.
With peak flow, the test involves blowing as fast/hard as you can into a small device, called a peak flow meter. Your output value is then compared to the ‘normal’ value for your size, age and sex, with lower than average values indicating the possibility of having asthma. A further benefit with the peak flow is that it can be performed 24 hours a day, outside the clinical (GP surgery or hospital) environment. More rarely, a nitric oxide test (FeNO) can also be performed (often by a GP), where the greater presence of Nitric Oxide in the patients measured breath output, can indicate lung inflammation and the presence of asthma.
Asthma assessment also often involves trying to reject conditions or diseases which present with similar symptoms, for example COPD.
What treatment and care is given for asthma?
The main treatment for an asthmatic (someone with asthma), is through the use of inhalers. These are small, handheld devices that deliver a measured dose of medicine into the lungs by breathing it in (inhalation). The two main types of inhaler are: Reliever; which relax the muscles in the airways and aim to relieve asthma symptoms immediately. Preventer; which is taken daily and use steroids to prevent symptoms (inflammation) occurring. More rarely steroid tablets or liquid medication (i.e. for children) can be used. So consulting with the health care provider is essential to discuss treatment options available.
Asthma care often involves either a doctor or (asthma) nurse, providing the patient with an asthma action plan. This normally consists of the patient being prescribed reliever and/or preventer inhalers, to take in certain doses, at certain times. The patient is also given a chart to plot their breathing output, using a peak flow meter, over a period of time, so long-term breathing patterns can be monitored. Low peak flow, that varies over a time period (i.e.-a week) is typical for an unmedicated asthmatic person. Regular consultation with either a doctor or (asthma) nurse enables the medicines to be fine ‘tuned’ to suit the individual. Annual reviews are used to check for patient progress, proper inhaler usage and check that the most effective medicines are being used to prevent asthma symptoms. In all instances the main aim is to make sure the asthma is stable and well controlled.
In severe cases of asthma, more members of the multi-disciplinary team(professionals with different specialities who work together) can become involved in patients treatment and care, sometimes in a hospital environment. These include, as well as GP’s, asthma nurses and pharmacists (providing medication), also respiratory specialists, physiotherapists, dieticians and stop smoking service providers. Consideration should also be given to the fact that untreated or ‘first time’ asthma can be a life-threatening condition (1,400 dead in 2018)**. So proper treatment, by a suitable health care provider such as a GP is essential. Any severe breathlessness or not being able to breath should be treated as a medical emergency and 999 called immediately, as severe asthma can be life threatening and onsets quickly in certain cases.
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