Asthma
Asthma is one of the commonest of all medical conditions. There are several different patterns of asthma which may represent a number of closely related diseases which cause similar symptoms. Many doctors believe that asthma is more likely to occur in people who have particular combinations of genes which may be "switched on" by events in the environment at any stage of a patient's life. There is a lot of research going on in this area.
Asthma most commonly starts in childhood when allergies, especially to pollens, house dust and domestic animals often trigger attacks. However, it is important to understand that in the majority of patients allergy aggravates asthma rather than being the fundamental cause of it. When asthma starts in adult life, allergic factors are less likely to be found and attacks are more likely to be provoked by other triggers, for example the common cold, aspirin, or beta blocking drugs (medicines sometimes used to treat angina or high blood pressure). Some patients with asthma will deteriorate without any obvious provoking cause. Many occupations (for example working with isocyanates- chemicals used in some painting and plastics industries) can cause asthma for the first time or aggravate existing asthma. When an adult develops asthma for the first time it is important for their doctor to consider whether their occupation might be involved.
The commonest asthma symptom is wheezy breathlessness which is often worst or most frequently occurs at night or in the early morning. However other patients are more troubled by a cough and may also produce sticky sputum which can even look yellow or green, mimicking a chest infection. A child with a recurrent cough often turns out to have asthma and sometimes it can be difficult for the doctor to make a diagnosis of asthma straight away. Measuring the Peak Flow Rate (a simple breathing test) with a simple meter at home is often very useful in making the diagnosis and monitoring treatment.
What causes asthma?
What is happening in patients with asthma is that there is chronic inflammation in the bronchi (air passages). This makes their walls swell up so that they become narrower and muscles around the air passages become irritated so that they contract, causing sudden worsening of symptoms. The inflammation can also make mucus glands produce excessive sputum which further blocks up air passages which are already narrowed. If the inflammation is not controlled with treatment, as well as causing acute attacks, it can lead to permanent narrowing and scarring of the air passages so that eventually asthma drugs won't relieve the symptoms any more. This process is known asairway remodelling.
Can it be cured?
There is no cure for asthma at present but modern drugs can control the inflammation to stop it causing symptoms and leading to disability in the future from airway remodelling. The best medicine available at present to control inflammation (and the most important treatment for the vast majority of patients), is a steroid inhaler. Many patients are frightened of these medicines but they are very safe and have been in use now for over 20 years. Steroid tablets are also safe when used for short periods of a few days or weeks to control acute attacks and can be life saving. A few patients with severe asthma may have to be treated with steroid tablets long term but even in these patients skilful management by specialist/GP can avoid any serious side effects. It is very important to understand that these medicines need to be used regularly because they arepreventers i.e. medicines which protect patients from asthma.Reliever inhalers (e.g. salbutamol) only temporarily relieve the spasm in the airway muscles. This helps to relieve symptoms but does not control the underlying inflammation. Many patients are tempted to rely on their reliever medicine alone. If you have been prescribed a preventer medicine it is very important to use it regularly even when you feel well.
Most asthma patients are diagnosed and treated by their GP. Most GPs have asthma clinics where the practice nurse will look after patients with asthma. Most asthma patients can expect to live normal lives and have a normal life expectancy. However, deaths and disability can still occur in patients with asthma and this is usually due to a failure to take preventer treatments properly and regularly.
Asthma Web Links
Please note that the Society does not endorse the content of any of these web links, but hopes that by providing the links below it is providing a useful service.
Asthma UK
http://www.asthma.org.uk/
There is also a Helpline - 0800 121 62 44
British Lung Foundation
The British Lung Foundation exists to provide a complete package of support for people living with lung disease and the people who look after them, in hospital and at home.
http://www.lunguk.org/
Global Initiative for Asthma
Resources for management of asthma, leaflets in several languages.
http://www.ginasthma.com/