Hard to diagnose and so difficult to treat – just don’t ignore asthma

It can appear at any time from childhood to older age and patients often do not think they are ill since they adjust their daily exertion, and their expectations, to their disease. Often it is only by asking, “Can you keep up with people of your own age?” that the answers will emerge.

Asthma is still a cause of fatalities with nearly 200 deaths in 2012-2013. In more than half of these deaths – 58 per cent – the sufferers were thought to have mild or moderate disease. In other words, neither the patient nor their doctor classed their disease as serious.

However, four out of ten of those who died had not attended their GP surgery in the previous year so their medication or their inhaler use wasn’t reviewed.

There was a tendency for these patients to continue to use their blue (relieving) inhalers excessively when in fact their treatment needed to be increased. In this study, blue (relieving) inhalers were overused and preventive inhalers weren’t used enough

The diagnosis must be made on clinical symptoms and sometimes tests like spirometry, though helpful in raising suspicions, do not confirm the diagnosis.

Sometimes the only way is to “Treat and See”. If the symptoms improve then the diagnosis of asthma becomes more probable.

In adult asthma, four out of every ten patients with symptoms will have Occupational Asthma, that is the symptoms are provoked by their working conditions.

Bakers, waiters, dentists, hairdressers may report wheezing at work though often they don’t realise it is related to their workplace until they go on holiday and feel much better.

So questions about whether they feel better at weekends or when they are away will provide clues that their wheeziness may well be Occupational Asthma. This needs referral to respiratory physicians to confirm this diagnosis since it will have an impact on one’s working life.

Blood tests and tests for inflammation are also helpful and where the asthma is related to allergic reactions, then skin prick testing may isolate an allergen.

Antihistamines, though they may dampen an allergic response, have yet to be proved effective in treatment but avoidance of known triggers helps.

Animal hair or fur (dander) can be a trigger, as can thunderstorms when increased levels of ozone are generated. The aim is good control with no wheezing or breathlessness in the day or the night, or on exercise or with normal activity.

Inhaler technique is important since it is imperative that the inhaled medication actually gets down into the lungs. This is one of the things checked at an asthma review. Stepping up the medication until the patient is symptom-free is the standard treatment though it may be necessary to over treat initially to get rid of symptoms and then step down medication if appropriate.

Personalised Action Plans improve the quality of life and allow a tailored approach to the individual patient’s life style.Wheezing should not be ignored and asthma need to be managed carefully. The incidence of asthma and allergies is increasing. It is not a disease to be ignored.