Late onset or non-allergic asthma

Others develop asthma later in life often in their 30s or 40s without any clear external or allergic triggers. This type of asthma is commoner in women and may be related to sensitivity to aspirin and related drugs.

Occupational asthma

Exposure to dusts, chemicals or other agents can cause asthma in the workplace.

Investigation of Asthma

If you have asthma this should be assessed by your doctor or an asthma nurse. Investigation will include a history of your symptoms, whether asthma wakes you at night, what provokes them, your work, family history, any history of asthma attacks or admissions to the emergency room or hospital. If you have a history of allergens (cats, dogs, dust, pollens etc) as triggers for asthma symptoms it may be appropriate to have an allergy opinion and skin prick tests. Blowing tests including peak flow (how fast you can blow air out of the lungs) and spirometry (how much air you can blow out in a fixed time and in total) are helpful in assessing asthma and you may be asked to record these in a diary at home.

Management of Asthma

There are national and international guidelines for the diagnosis and management of asthma setting out investigations and treatment including aims and specific medications - British Thoracic Society. In addition there are excellent asthma charities that act as a patient resource with websites and asthma helplines such as (Asthma UK).

Important aims of asthma management are:
• Freedom from daytime symptoms
• Freedom from night time symptoms

• Freedom from limitation of exercise, work or leisure activities by asthma
• Freedom from asthma attacks
• Normal lung function (blowing tests within 80% of the average for age, gender and height for non-asthmatics)
• Minimal treatment and minimal treatment side effects

It is not always possible to achieve all of these and often there is a balance to be struck between level of treatment and symptoms.

An important principle of asthma management is that asthmatics understand their disease and assume an active part in and responsibility for day to day management and treatment of attacks. This implies understanding medication, triggers and when and how to seek help.

To achieve these goals asthma guidelines recommend that each asthmatic has a tailored written asthma management plan specially designed for them.

Asthma Diagnosis

A diagnosis of asthma is usually made on the basis of history (variable symptoms of cough, wheeze and breathlessness) and confirmation of airway narrowing that is variable or can be reversed (usually by peak flow tests over time or before and after a reliever inhaler). Depending on age it may be important to rule out other lung diseases such as infections or inhaled objects in children or COPD (smoking related fixed airway narrowing) in older adults. A chest X ray is usually not required to diagnose asthma but may be helpful in excluding other causes of symptoms.  Asthma is often seen together with rhinitis or nasal inflammation and detection and treatment of this may help.

Skin prick tests may be helpful to confirm allergic sensitisation.

 

Non - Medical Treatment

 

General health promotion will help asthmatics feel better. Thus healthy diet and avoiding obesity are important. Not smoking is important: smokers with asthma do not respond to treatment as well as non smokers and lung function deteriorates more rapidly over time than for smokers without asthma or asthmatics who do not smoke.

Although allergen avoidance measures such as mattress covers for dust mites seem intuitively likely to help, recent large trials showed no benefit for either treatment or prevention of asthma. Further studies are needed in targeted patient groups. Specific breathing exercises may be helpful but further research is required.

 

TREATMENT FOR ASTHMA

Inhalers

Inhalers for asthma can be divided intro relievers and controllers. Reliever inhalers relax the airways if they are narrowed and act to give rapid relief of symptoms. These include salbutamol (albuterol in USA). Generally these are blue inhalers and should be used to relieve symptom when they occur or occasionally to avoid symptoms, for example before exercise.

Relievers do not reduce inflammation of the airways so do not reduce the underlying irritability that causes excess narrowing in responses to smoke, cold or allergens (airway hyperresponsiveness). If relievers are required more than twice a week or at night this suggests the need for a controller inhaler.

 

Controller inhalers

These act to reduce airway inflammation so lessen the likelihood of symptoms developing. Most effective are inhaled steroids such as beclomethasone, fluticasone, budesonide, mometasone or ciclesonide (and flunisolone and triamcinolone in the USA). These should be taken regularly even in the absence of symptoms as their job is to control the disease. Which drug is used, at what dose, in which device and how often (once or twice a day) will depend on each individual case in accordance with the guidelines. Make sure you are happy with, informed about, and involved in the choice for your asthma.

 
In addition many asthmatics take long acting bronchodilators such as eformoterol or salmeterol: often in combination with the inhaled steroid as a combination inhaler (such as seretide or symbicort). Trial data suggests this approach my improve control and reduce the dose of inhaled steroid required. A combination inhaler may be appropriate if asthma symptoms continue despite use of an inhaled steroid alone. These drugs are usually used on a regular once or twice a day basis but additional use to reduce symptom may be feasible at least for symbicort.