HEALTH Bringing asthma under control

COMMON COMPLAINT?Although asthma usually presents first in childhood, it can also develop in adulthood.

Bringing asthma under control


Doctor's insight
Dr Ronan Clancy

Approximately half a million Irish people suffer from asthma at some level. Although usually presenting in childhood, symptoms can also develop in adulthood, often following chest infection. It is closely related to allergic conditions such as eczema and hay fever. It commonly runs in families, and in some families it even gallops!
Asthma is a condition that affects the lower airways. These airways are comprised of a system of tubes of decreasing size from the trachea all the way down to the tiny airways of the lungs where oxygen and carbon dioxide are exchanged with the blood. All of these tubes have the ability to constrict or become narrower using tiny muscles and also produce a mucus that traps atmospheric dust and debris.
In an asthmatic, the airways become over sensitive. With certain triggers they constrict (become narrower) and the membranes become swollen and produce more mucus. Airway narrowing and increased mucus in the smaller airways makes breathing more difficult and produces the characteristic wheeze or dry cough of asthma. At the severe end of the spectrum, it can severely comprimise breathing.

Causes and symptoms
Although it is not fully understood why the airways become so sensitive, a trigger is anything that irritates the airways provoking asthma. Common triggers include allergens, such as a viral infection, house dust mite, pollutants, cigarette smoke, occupational chemicals, certain drugs and pollen, as well as exercise, stress, emotion and certain foods. Most sufferers will have more than one trigger.
Often with a time lapse between exposure and onset of asthmatic symptoms, triggers can be difficult to identify. Efforts should be made to identify triggers and avoid them as far as is practically possible.
The symptoms of asthma are broad in range and severity. They include shortness of breath at rest or after exercise, wheeze, chronic cough and tightness in the chest. They characteristically vary over time and in intensity with intervening good and bad periods.
Asthma attacks can be quite sudden with severe limitation of breathing but usually follow a deterioration in breathing over a few days. It is important to have a clear plan with your GP on the steps to follow should your asthma become severe.
Aside from severe episodes, the more common negative impact of asthma is on quality of life. Often exercise, sports, and other interactions such as going out or on holiday can be affected by poor asthma control.

Treatment
The goal of treatment is to gain control of the condition and prevent further episodes in the long term. This is done using medications called preventers. These inhaled medications contain corticosteroid drugs that reduce and stop the oversensitivity of the airways, forcing them to behave like normal non-asthmatic airways.
Salbutamol (ventolin) is a fast acting reliever medication that rapidly relaxes the muscles of the airways when they clamp down or constrict. Relievers are a quick and necessary fix, but  the overriding aim is to stop the condition at its source with a preventer.
Other medications may need to be prescribed by your GP if these medications don’t quite gain control of things or during periods when asthma is more severe.
Sufferers should also be vaccinated with the pneumococcal vaccine and receive the annual influenza vaccine.
Most complimentary therapies for asthma currently lack any significant or robust evidence. There is some evidence to support the fact that breathing exercises may improve the effectiveness of inhaled medications and reduce the need for rescue medication. If trying a complimentary therapy, you should not stop or reduce your usual medications under any circumstance.

Controlling asthma
Having control of the asthma means no daytime or night time symptoms; not needing a reliever (ventolin) more than twice a week; no school or work absenteeism due to asthma; and good lung function.
Loss of control means waking at night with coughing, wheezing, shortness of breath or a tight chest; increased shortness of breath on waking up in the morning; needing more and more reliever treatment or the reliever not working very well; and/or being unable to continue your usual level of activity or exercise.
Overall, understanding of your asthma and your medications, avoiding triggers where possible, adhering to your personalised plan, good inhaler technique and a close working partnership with your GP is key to getting satisfactory control of your asthma.

Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.