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Asthma is common. The typical symptoms are wheeze, cough, chest tightness, and shortness of breath. Symptoms can range from mild to severe. Asthma cannot be 'cured', but treatment is usually effective. Many people with asthma use an inhaler each day to keep symptoms away.
What is asthma and who does it affect?
Asthma is a condition that affects the airways (bronchi) of the lungs. From time to time the airways constrict (become narrow) in people who have asthma. This causes the typical symptoms. The extent of the narrowing, and how long it lasts, can vary greatly.
Asthma can start at any age, but it most commonly starts in childhood. At least 1 in 10 children, and 1 in 20 adults, have asthma. Asthma runs in some families, but many people with asthma have no other family members affected.
What are the symptoms of untreated asthma?
The common symptoms are cough and wheeze. You may also become breathless, and develop a feeling of chest tightness. Symptoms can range from mild to severe between different people, and at different times in the same person. A bout of symptoms may last just an hour or so, or persist for days or weeks unless treated.
Typical symptoms if you have mild asthma
You tend to develop mild symptoms from time to time. For example, you may develop a mild wheeze and a cough if you have: a cold, a chest infection, in the hay fever season, or when you exercise. For most of the time you have no symptoms. A child with mild asthma may have an irritating cough each night, but is often fine during the day.
Typical symptoms if you have moderate (untreated) asthma
Without treatment: you typically have bouts of wheezing and coughing from time to time. Sometimes you become breathless. You may have spells, sometimes long spells, without symptoms. However, you tend to be wheezy for some of the time on most days. Symptoms are typically worse at night, or first thing in the morning. You may wake up some nights coughing or with a tight chest. Young children may not have typical symptoms. It may be difficult to tell the difference between asthma and recurring viral chest infections in young children.
Typical symptoms of a severe attack of asthma
You become very wheezy, have a 'tight' chest, and have difficulty in breathing. You may find it difficult to talk because you are so breathless. Severe symptoms may develop from time to time if you normally have moderate symptoms. Occasionally, severe symptoms develop 'out of the blue' in some people who normally have just mild symptoms.
What causes asthma?
Asthma is caused by inflammation in the airways. It is not known why the inflammation occurs. The inflammation irritates the muscles around the airways, and causes them to squeeze (constrict). This causes narrowing of the airways. It is then more difficult for air to get in and out of the lungs. This leads to wheezing and breathlessness. The inflammation also causes the lining of the airways to make extra mucus which causes cough and further obstruction to airflow.
What can make asthma symptoms worse?
Asthma symptoms may flare up from time to time. There is often no apparent reason why symptoms flare up. However, some people find that symptoms are triggered, or made worse in certain situations. It may be possible to avoid certain triggers which may help to reduce symptoms. Things that may trigger asthma symptoms include the following:
Some people only develop symptoms when exposed to a certain 'trigger'. Two examples are:
How is asthma diagnosed?
Sometimes symptoms are typical, and the diagnosis is easily made by a doctor. If there is doubt then some simple tests may be arranged. A peak flow meter is commonly used to help confirm that symptoms are due to asthma (see below). Sometimes a test called spirometry may be done to confirm the diagnosis. This involves breathing into a machine that measures the rate and volume of airflow in and out of your lungs.
What is the the peak flow meter?
This is a small device that you blow into. A doctor or nurse will show you how. It measures the speed of air that you can blow out of your lungs. No matter how strong you are, if your airways are narrowed, your peak flow reading will be lower than expected for your age, size, and sex. If you have untreated asthma, then you will normally have low and variable peak flow readings. Also, peak flow readings in the morning are usually lower than the evening if you have asthma.
You may be asked to keep a diary over 2 weeks or so of peak flow readings. Asthma is usually confirmed if you have low and variable peak flow readings over several days. Peak flow readings improve when the narrowed airways are opened up with treatment. Regular peak flow readings can be used to help assess how well treatment is working.
What are the treatments for asthma?
For most people with asthma, most of the symptoms can be prevented with treatment. So, you are able to get on with normal life, school, work, sport, etc.
Most people with asthma are treated with inhalers. Inhalers deliver a small dose of medicine directly to the airways. The dose is enough to treat the airways. But, the amount of medicine that gets into the rest of your body is small so side-effects are unlikely, or minor. There are various inhaler devices made by different companies. Different ones suit different people. A doctor or nurse will advise on the different types.
Inhalers can be grouped into 'relievers', 'preventers' and 'long acting bronchodilators'
A reliever inhaler is taken 'as required' to ease symptoms. The medicine in reliever inhalers relaxes the muscle in the airways. This makes the airways open wider, and symptoms quickly ease. These medicines are also called 'bronchodilators' as they dilate (widen) the bronchi (airways). There are several different reliever medicines. For example, salbutamol and terbutaline. These come in various brands made by different companies. If you only have symptoms every 'now and then', then the occasional use of a reliever inhaler may be all that you need. But, if you need a reliever inhaler once a day or more, a preventer inhaler is usually advised.
A preventer inhaler is taken every day to prevent symptoms from developing. The medicine commonly used in preventer inhalers is a steroid. There are various brands. Steroids work by reducing the inflammation in the airways. When the inflammation has gone, the airways are much less likely to become narrow and cause symptoms. It takes 7-14 days for the steroid in a preventer inhaler to build up it's effect. So, it will not give any immediate relief of symptoms. But, after a week or so of treatment, the symptoms have often gone, or are much reduced. It can take up to 6 weeks for maximum benefit. You should then not need to use a reliever inhaler very often, (if at all).
A long acting bronchodilator may be advised in addition to a steroid inhaler. One may be needed if symptoms are not fully controlled by the steroid inhaler alone. The medicines in these inhalers work in a similar way to 'relievers', but work for up to 12 hours after taking each dose. They include salmeterol and formoterol. (Some brands of inhaler contain a steroid plus a long acting bronchodilator for convenience).
Tablets or liquid medicines to open up the airways
Most people do not need these as inhalers usually work well. However, in some cases a tablet or liquid medicine is prescribed in addition to inhalers if symptoms are not fully eased by inhalers alone. Some young children use liquid medicines instead of inhalers.
A short course of steroid tablets (such as prednisolone) is sometimes needed to ease a severe or prolonged attack of asthma. Steroid tablets are good at reducing the inflammation in the airways. For example, a severe attack may occur if you have a cold or chest infection. Some people worry about taking steroid tablets. However, a short course of steroid tablets (for a week or so) usually works very well, and is unlikely to cause side-effects. Most of the side-effects caused by steroids occur if you take them for a long time (more than several months), or if you take frequent short courses of high doses.
What are the dosages of treatment?
Everyone is different. The correct dose of a preventer inhaler is the lowest dose that prevents symptoms. A doctor may prescribe a high dose of a preventer inhaler at first, to quickly "get on top of symptoms". When symptoms have gone, the dose may then be reduced by a little every few weeks. The aim is to find the lowest regular dose that keeps symptoms away.
Some people with asthma put up with symptoms. They may think that it is normal to still have some symptoms even when they are on treatment. A common example is a night time cough which can cause disturbed sleep. Tell your doctor or nurse if your symptoms are not fully controlled. Symptoms can often be prevented. For example, by adjusting the dose of your preventer inhaler, or by adding in a long acting bronchodilator.
A 'typical' treatment plan
A common treatment plan for a 'typical' person with moderate asthma is:
Does asthma go away?
There is no once-and-for-all cure. However, about half of the children who develop asthma 'grow out of it' by the time they are adults. For many adults, asthma is variable with some good spells and some spells that are not so good. Some people are worse in the winter months, and some worse in the hay fever season. Although not curable, asthma is treatable. Stepping up the treatment for bad spells will often keep symptoms away.
Some other general points about asthma
— a night time cough or wheeze is troublesome
— sport is being affected by symptoms
— your peak flow readings are lower than normal
— you need a reliever inhaler more often than usual
An adjustment in inhaler timings or doses may control these symptoms
LOW BLOOD SUGAR
Hypoglycaemia is when your blood sugar gets too low (below 4 mmols/l). Always keep dextrose tablets or hypo food with you, following this you will require a long acting carbohydrate.
Hypos can be caused by
Missed or late meals, not enough food, too much insulin or tablets, more activity than normal, alcohol, hot weather.
Help yourself to prevent hypos
Increase carbohydrates or reduce insulin before exercise. Monitor blood glucose more often. Watch for trends in blood glucose and discuss patterns if worried. Remember the effects of exercise on blood sugar can last several hours. Keep to a steady treatment pattern by taking your medication at the correct times. Eat regular meals and snacks. Drink alcohol in moderation.
The symptoms of a hypo will differ between individuals. Similarly, each hypo that you have might not feel exactly like the last one. You may feel:
· weak and wobbly
· a tingling in your mouth
· you may have a headache (a headache on waking may mean you have had a hypo during the night, and nightmares can be a symptom of night hypo)
· have a fast or pounding heartbeat
· or have blurred vision
Other people around you might notice that you are pale, slurring your words, acting strangely, unusually aggressive, or lacking concentration.
Treating a hypo
As soon as you feel as if you maybe going into a hypo, you should stop what you are doing and if at all possible check your blood glucose level. Take some sugar (quick acting carbohydrates) such as: 50ml of Lucozade, a large spoonful of undiluted Ribena, 3-4 teaspoons of sugar, honey, or jam, 5 to 7 glucose/dextrose tablets.
If you are away from home you should always carry with you: glucose/dextrose tablets, or Glucogel (a thick sugary gel). If you start to feel better after 5 minutes or so have some long acting carbohydrate, such as a piece of toast, fruit, biscuits, a scone or a cereal bar. This will make sure that your blood sugar doesn’t go down again.
If you don’t feel better after 5 minutes, take more sugar/quick acting carbohydrate. It is recommended that you do not drive a vehicle for up to 45 minutes after you start feeling better after a hypo, be aware that the risk of further hypo is increased for the next 24 hours.
If you miss the signs
Sometimes it can be hard to catch a hypo at the early stages, and you may need someone to help you to treat it. Tell people that you work with, your family and friends that you have diabetes and may need their help in the future. Let them know where you keep your hypo food too, in case they need to help you. Always carry your ID card or wear an identity bracelet or necklace so that strangers will know what is wrong and what to do.
If you are unable to treat yourself but you are conscious
Jam, honey, treacle or Glucogel can be put into the side of your mouth and your cheek rubbed from the outside. If there is any doubt about your ability to swallow, do not put anything in your mouth. Once you are feeling better,you should take a snack. Your Diabetes Specialist nurse can teach a friend or relative how to deal with the situation. If there is any doubt or you do not respond an ambulance must be called: 999. Ensure friends understand you do not need insulin in this situation.
Your blood glucose control
Very poor control, take immediate action to lower
Poor control, take action to lower
Marginal control, take action to lower
Good control target
Very good control