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Asthma is the only chronic disease in the developed world that is becoming increasingly common. It is now the commonest reason for childhood admission to hospital and one of the leading causes for adults. Asthma is a condition that affects the lungs and airways. Sufferers with asthma often find it difficult to breathe and may experience coughing, wheezing and tightness across their chest.

Symptoms of Asthma

- Shortness of breath. Breathing difficulties, tightness in the chest and shortness of breath are the main symptoms of asthma. They can be short-lived symptoms as a feeling of tightness after exercise or increase in severity to cause disabling breathlessness.

- Wheezing. This is a whistling sound heard most often when breathing out. This symptom does not always occur in very severe asthma because insufficient quantities of air are being expelled to cause the high pitched noise.

- Coughing. The characteristic cough of asthma is well known, and is often more common at night. It can be difficult for doctors to make a diagnosis of asthma when the cough is the only symptom. Other lung conditions may have a similar type of cough, such as infection with the respiratory syncytial virus giving rise to bronchiolitis. This makes the lungs swell, and a young child would experience wheezing, breathlessness and fever. Young children are often prescribed several courses of antibiotics before the asthma diagnosis is made. Similarly, with adults it may be difficult to distinguish between bronchitis and asthma, particularly in those that smoke. It should always be stressed that sufferers or parents of sufferers, of asthma should stop smoking.

- Night-time. All the symptoms of asthma worsen at night - this is due to circadian rhythm. Lung function for everybody is worse at around four in the morning and best at four in the afternoon; this is due to circulating levels of the hormone adrenaline. As the symptoms worsen through the night, the patient may have a restless night and feel very tired and low the next day. Adrenaline helps muscles to relax, and keep the airways open. When the body shuts down during deep sleep, nerve impulses slow the heart and intestinal activity, but causing narrowing of the airways at the same time. These effects aren't noticed by those who don't have asthma, but are greatly exaggerated by asthma sufferers.

- Exercise. Inhaling cold dry air when exercising leads to changes in the fluid lining of the lungs, triggering the release of histamine and othe chemicals such as leukotrienes from mast cells. This can lead to an asthma attack lasting 10 -20 minutes, having a devastating effect on a child's joining in of games and sport, disrupting social and physical development. Swimming should be encouraged as the moist air helps keep the airways moist.


What causes Asthma?

No-one knows exactly what causes asthma. It does run in families along with other allergic conditions such as eczema (allergic dermatitis), hayfever (allergic rhinitis) and itchy eyes (allergic conjunctivitis).some asthma sufferers may experience one or more of these related disorders. Smoking during pregnancy increases asthmatic symptoms in babies after birth.


How is Asthma diagnosed?

There is no such thing as an "asthma test", with no simple blood test or x-ray. After listening to symptoms presented either by the patient or the patient's parent, the doctor will review the case history. He will look and see if there is a positive family history or if the patient has been suffering from related conditions. To definitively make a diagnosis of asthma, the doctor needs to ascertain the degree of obstruction to the flow of air through the lungs at different times.

Using a small airflow meter, the maximum rate at which air is blown out of the lungs can be measured at different times of the day. This is to record the PEAK EXPIRATORY FLOW RATE (PEFR). The maximum PEFR depends on the age, sex and height of the patient and varies from approximately 600 litres per minute in a fit young man of average height to 300 litres in an older smaller woman. Recordings in people with asthma show a reduced peak flow measured when they wake up compared to peak flows measured in the early evening. A peak flow variation from morning to evening of 15 per cent or more confirms the diagnosis of asthma.

The PEFR is very useful in monitoring the effects of treatment. Effective treatment will reduce the variation in morning to evening peak flow, as well as improving the peak expiratory flow rate overall. The lower the PEFR, the more severe athma.


Trigger Factors

Most patients can name a few things that make their asthma worse - these are known as trigger factors. It is best to try and identify trigger factors because then:
- they can be avoided as best as possible.
- Extra treatment can be taken before or at the time of contact with the trigger factor.

The most common trigger factors are -


Every asthma sufferer has different trigger factors, and identifying them can prove very beneficial in the management of their asthma. Using a peak flow measurement when the asthma is bad can help find the trigger factors. Making a list of possible triggers and talking to doctor about them will be very helpful.


Treatment of Asthma

Asthma cannot be completely cured but it can be well managed when using the proper medications correctly.

The emphasis of treatment has moved from treating the symptoms if and when they arrive and towards treating the anti-allergic and anti-inflammatory basis of the illness.


Asthma Medicines

1. "Preventer" medication - to prevent or reduce asthmatic attacks requires regular treatment. The preventer medicine has an anti-inflammatory action and soothes the airways, making them less irritable. These inhalers are extremely effective when taken regularly in controlling asthma symptoms and improving lung function. It is vital to remember these medicines have to be used regularly, even when the symptoms of asthma are not present and the patient feels well.

2. "Reliever" medication - to treat a wheeze when it happens. This relaxes the bronchial tube muscles. These medicines are called bronchodilators. The quickest and most convenient way to take it is through an inhaler - a puff or two will help nearly instantly! The tablet or liquid forms of reliever medicines take slower to work.


What if the Asthma gets worse?

If the asthma sufferer finds that their condition is worsening at certain times for example in the presence of a cold or a flu, some extra "help" may be needed to control the problem. It can involve increasing the inhalers (preventative and/or reliever), or taking a course of steroid tablets and possibly an antibiotic to relieve an underlying infection.


Will it go away?

Some children may grow out of asthma by their teens. In adults it tends to remain, but as before it can be well controlled and patients can lead very full lives. In some people, it may become worse but it is not always the usual pattern.


Is it dangerous?

For most people, asthma is more of a nuisance. Some people do however, get severe attacks and unfortunately, a few people do die from asthma. If people follow their doctor's instructions and keep their condition well controlled they will be in a good position to avoid/deal with serious attacks if these occur.

Asthma sufferers or the parents of asthma patients should always see their GP regularly for check-ups and monitoring of their PEFR. Other information can be obtained from the local GP, asthma/practice nurse, pharmacist and also the Asthma Society of Ireland. www.asthmasociety.ie

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