Asthma - by Dr David Delvin

No one seems to know why Asthma has become astoundingly common in Britain.

The obvious ‘culprit’ is the awful air pollution that exists today. But in fact, asthma has also increased in parts of the UK where there is practically NO pollution! This is very odd indeed, and at the moment scientists can’t explain it.

But some researchers think that the increase in asthma – in both older people and in children – may be due to one of the following factors:

  • Increased use of air conditioning – which of course doesn’t allow fresh air to circulate;
  • Increased use of fitted carpets – which cut down on currents of fresh air and also encourage dust mites in the home;
  • Possibly pet ownership, since some folk are allergic to cats and dogs without realising it;
  • The increased use of food additives;

People who were brought up in very clean environments are more likely to suffer from asthma as they get older. If this turns out to be true, it seems to suggest that a certain amount of exposure to germs when you are young is not a bad thing!

What is Asthma?

Basically, it’s a closing down of your air tubes. The passages that carry air down into your lungs are little pipes. And unfortunately, it’s all too easy for those pipes to suddenly ‘clamp down’ and get narrower. When that happens, it becomes very difficult for the air to get in.

Result: you can’t breath properly. That’s an asthma attack and very frightening it can be, too. One 64 year old recently had an attack for the first time ever told me “It was the most scary thing that’s ever happened in my life’.

But why do these attacks occur? Why do the air tubes suddenly get narrower? There are several main factors involved:

  • ALLERGY – unfortunately many people have bodies, which are ‘programmed’ so that if the air tubes come into contact with an allergy-provoking agent, they respond by suddenly getting narrower for a while.

  • INFECTION – if an asthmatic person suddenly develops a chest infection, that can tip them over into an asthma attack and regrettably, chest infections are really common particularly in the over-55s.

  • PSYCHOLOGICAL FACTORS – in the past doctors are always ‘going on’ about how emotional factors – such as stress- could bring on asthma attacks. Frankly, it sometimes seemed to me as if this was an unfair way of blaming the patient for his/her asthma! Nevertheless, it is true that getting upset can sometimes make a person drift into an asthmatic attack. So keeping calm is a good idea!

  • PHYSICAL FACTORS – external physical factors like suddenly having to breathe cold air can sometimes trigger an attack. So can certain drugs. And exercise can sometimes bring on an attack, though sensible amounts of exercise are generally good for people who have asthma. Finally smoke (like tobacco smoke!) will usually make things worse.

Symptoms 

So what are the symptoms of asthma? From what we’ve just said, you’ll appreciate that a primary symptom is difficulty in getting your breath. Other common features include:

  • Wheeze
  • Cough
  • If things are getting really bad, going blue.

Happily most asthmatic people don’t have these symptoms all the time. For much of their lives, they are perfectly fine. They may go weeks or months without an attack and in some folk, the asthma eventually decides to go away altogether – which is always very good!

Treatment

What about treatment? Treating asthma is never easy and the best therapy must be worked out by the partnership of you and your doctor. In most cases, your doctor means your GP, though some asthmatic people will see specialist chest physicians.

However there are now so many asthmatic people that they can’t all be managed by specialists at hospitals. You might like to note that lots of general practitioners have set up special ‘asthma clinics’ at their own surgeries, usually run by nurses who have had extra training in this subject.

But what does the treatment consist of? It falls into various categories:

1. Avoiding the cause of the problem:  if you know what brings on your attacks (the allergen), you need to avoid it like the plague. So if it’s clear that a particular type of pollen starts of your asthma, or if dog hairs bring it on, then commonsense dictates that you must steer clear of these things. You should also steer clear of asthma-provoking drugs, such as aspirin and beta-blockers. Also if you are cigarette, cigar or pipe smoker, it is lunacy to continue.

2. Avoiding chest infections:  avoiding infections certainly isn’t easy in Britain – especially in the autumn or winter. But if you have asthma, it makes sense to keep away from crowded places, such as packed buses and train carriages. The worse possible place to be is a doctor’s waiting room with people coughing germs all over you! Also, if one of your grandchildren has just developed a cold or cough, it’s better to keep your distance from them until they are better.

3. Medications: sadly I find that in the UK many people do not really understand the nature of the anti-asthma medications which they use. Some folk tend to talk rather vaguely about ‘the brown one’ and ‘the blue one’ without being clear about what they are on.

So here is a brief guide to the main categories of drugs:

  • Bronchodilators – this word means ‘drugs which open up the air tubes’ that includes agents like salbutamol and terbutaline given in inhalers.
  • Inhaled anti-inflammatory agents – these are drugs, which are meant to damp down inflammation in the air tubes. They include sodium cromoglycate and also inhaled steroids like beclomethasone.
  • Oral steroids – these are cortisone like tablets, given by mouth and usually only to cover a short period (since side effects can be serious). They include prednisolone pills.

Other measures

In some countries, doctors try to ‘desensitise’ people to asthma allergens. This is rarely done now in Britain because it is felt to be risky and ineffective.

Hypnosis, homeopathy, herbal remedies and yoga seem to help some people. But in general, you won’t be able to get them through the NHS and will have to make your own arrangements.

What you can get through the health services is a device called a ‘peak flow meter’. This clever little invention is very useful for showing what sort of state your air tubes are in. You blow into it and it gives you an instant reading of how fast the air is moving. All asthmatics should get one of these excellent ‘PF meters’. Use the device regularly, keep a record of your results and show it to your doctor when you go and see her. The record can be of much help in seeing how you are doing and in forecasting whether you are heading into any trouble.

Good luck and breathe safely !

© 2002 Dr David Delvin / Retirement Matters Ltd