It ain't easy being wheezy!
Written by Dr Alexander Ritchie, Sleep and Respiratory Physician
Asthma is very common, affecting approximately 2 million Australians. Asthma can affect anyone at any age. Often the condition presents initially in childhood and can improve with time, however many patients have their first episode of asthma in adulthood. There is no cure for asthma, however it can be controlled very well with medication. The economic cost of asthma to the community is significant, leading to missed school and work. In severe cases, asthma requires hospitalisation. Asthma is a serious medical condition, tragically leading to 441 deaths in Australia in 2017. Fortunately, there are now many fantastic treatment options for people with asthma to minimise the impact of the condition.
What is Asthma?
The symptoms of asthma are due to intermittent obstruction of the bronchial tubes, usually caused my excessive mucous and spasm of the muscles in the airways. People with asthma have sensitive airways that respond with narrowing and mucous secretion when irritated. For most people with asthma there are specific triggers that might cause a flare up of their symptoms. These might include smoke, strong smells, chemicals, pollens and grasses, and dust mite allergy. Allergies are a common feature of asthma and the avoidance of known allergens can help reduce symptoms.
What are the symptoms of Asthma?
The key symptoms of asthma are cough, shortness of breath and wheezing. Wheezing is a whistling noise that is made when the air passes through the narrowed bronchial tubes. Sticky white phlegm is seen in some cases. The cough may be present at any time, but cough at night is a good clue that asthma may be present. Sometimes the shortness of breath and wheezing may be brought on with exercise.
Poor asthma control is suggested by:
waking up at night coughing, wheezing or breathless
shortness of breath with normal activity
use of your reliever puffer more than 2 days a week
How is Asthma diagnosed?
The most important test to diagnose asthma is a lung function test or spirometry test. Spirometry measures how easily you can empty your lungs. People with active asthma have narrowed bronchial tubes and take longer to empty their lungs. With treatment the obstruction, or narrowing is usually reversible. Repeat testing after a dose of a medicine that can relieve the obstruction, called a bronchodilator, will show improvement in lung emptying. Monitoring lung function when well and when you have symptoms can help make the diagnosis and monitor treatment effectiveness.
In some cases more specialised testing might be considered. This could include:
Skin prick allergen testing – to see if there are any avoidable triggers
Complex lung function testing – to exclude other problems of breathing, for example emphysema
Blood tests – to look for patterns of inflammation that might respond better to some newer treatments for asthma
How do you treat Asthma?
After a diagnosis of asthma is made, your doctor will discuss the range of treatments available for you. The key goal is prevention of flare-ups and maintaining good lung health. In simple terms, asthma medicines are divided into Relievers and Preventers.
A reliever is a short acting medicine to relieve the symptoms of wheezing and tightness. These important medicines are great to give short term relief but for most patients they are insufficient to provide optimal management of their asthma.
Preventer medicines help to reduce the inflammation in the bronchial tubes, reducing symptoms and dramatically reduce the likelihood of an asthma attack. As with any medicine your doctor will discuss the best option for you. There are many options for preventer medicines now available to allow an individually tailored dose and device for you. You should check with your doctor that you are using the device correctly. Puffers work best when combined with a spacer device.
What about an Asthma action plan?
An asthma action plan empowers you to manage your asthma yourself with a set of tailored medication instructions that is developed by your GP and or specialist. The plan will discuss what medicines to take when you are well or when your symptoms increase. If your asthma is not well controlled, it is a good idea to review the action plan with your GP.
If you find that you are needing your reliever puffer often, you should make an appointment to see your GP.
Call 000 and ask for an ambulance if you are struggling to breathe or cannot speak in full sentences without taking a breath.
Do I need to see a Respiratory Physician about my Asthma?
The vast majority of asthma is expertly managed by your GP. Sometimes asthma is difficult to control or there may be some uncertainty in the diagnosis. In these cases, a respiratory physician can undertake a detailed assessment and if needed conduct additional specialised testing. Often there may be additional factors that need to be addressed to get your asthma under control, for example sinusitis, gastro oesophageal reflux or sleep apnoea. In a small subset of difficult asthma cases, a respiratory physician may consider prescribing highly specialised injectable medications. These new drugs can dramatically improve very severe asthma.
Where can I get more information?
Asthma Australia provides a comprehensive resource for patients and carers. https://www.asthmaaustralia.org.au/