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Kent Respiratory Care Limited

Dr Syed Arshad Husain

Respiratory Consultant Services, Kent

Bronchial Asthma for patients

Is a common long term (chronic) inflammatory condition causing narrowing of the airways

Asthma is thought to have both genetic and environmental causative factors

Prevalence of Asthma in 2004 was 300 million worldwide with prediction of increasing to 400 million around 2025 according to World Health Organisation estimates. Prevalence of Asthma in UK is greater than 15 %

We are currently coming across high pollen counts in our summer seasons where hay fever or allergic asthma symptoms gets worse, figure seems worse specifically in the South East of England

It can affect children who can grow out of the illness as they grow but could also occur in late age as late onset Asthma

What happens in Asthma is that the airway walls get thickened (Hyperplasia) airways lining (Epithelium) starts shedding, basement membrane starts thickening; mucous secretions occurs and so they block the airways

Asthma can run in families and these are usually atopic families or individuals with having other allergic conditions also seen like Hay fever, Eczema or Allergic Rhinitis.

Other patients who get Asthma are children with Bronchiolitis and common childhood infections, low birth weight and prematurely born babies

Children of mothers who smoke during pregnancy could also get Asthma

Environmental pollution seems to be also an important factor

Hygiene theory with less childhood infections the immune system does not work well is thought of as a simple explanation especially prevalence seems to increase with urbanisation or cities getting westernised

Asthma could also be occupational especially individuals working in the bakery or people doing soldering work and individuals exposed to chemicals

Important things are worsening of symptoms with change of temperatures i.e going from a cold room to a hot room and vice versa, worsening of symptoms with use of perfumes, deodorants or strong odours

Various common allergens which could precipitate or trigger this condition i.e dusty environments, pets i.e cats, exercise, environments with dampness, medications like beta blockers, Non steroid anti inflammatory tablets, rarely thunder lightening’s

Common symptoms of Asthma include either a cough with or without whitish sputum, shortness of breath, wheezing i.e musical sounds coming from the chest, chest tightness or a combination of these could be present in an individual

Cough variant Asthma is another condition if the present only with cough as a symptom

Important point to remember is that night-time coughing or symptoms are very suggestive of poor control in Asthma and hence you should seek help with your doctor. Asthma could be categorised as mild, moderate or severe

Asthma is a very difficult diagnosis and useful tools include-Peak Flow recordings or Spirometry tests with reversibility assessments, Eosinophil count and Exhaled Nitric Oxide measurements (FeNO) and challenge testings

In Asthma the mainstay of treatment is usually an inhaled corticosteroids which are also called the preventer treatment and should be used regularly while the Salbutamol (Ventolin) is a short acting bronchodilator i.e the reliever treatment and should accompany the patients all the time on a regular basis just like a spare wheel kept in your car and you only use it in a crisis situations i.e in Asthma you would use it for immediate relief of symptoms as its only a short acting reliever medication

In Asthma the main stay of treatment is an inhaled corticosteroid (puffers) depending on the control could include Inhaled corticosteroids with long acting Beta agonists puffers or inhalers

Add on treatment like tablet Montelukast an anti-leukotrine agent given at night time, sometimes we also use Aminophylline group of tablets to control symptoms or add on long acting anticholinergic agent called Tiotropium or Respimat Inhalers

With the inhalers the common problems seen are sore throat or hoarseness of voice could be prevented by regular rinsing the mouth after using the inhalers (puffers), if you are using inhaled corticosteroids with long acting beta agonists then leg cramping could be a worrying side effect but usually settles as you continue with the treatment.

Aminophylline group of add on medications could cause nausea, vomiting and palpitations and if these side effects occur stopping this treatment should be considered

Steroid tablets (Prednisolone) tablets for one to two weeks are sometimes useful to settle symptoms down from an exacerbation and a weeks worth antibiotics is also helping in the settings of an infection.

Some patients do require longer use of Prednisolone and when used for a longer than 6 weeks period we worry about thinning of the bones (Osteoporosis) so bone protection tablets are needed once a week normally and also stomach protection tablets are also needed, other effects would be thinning of the skin, and high sugars or diabetes could be caused apart from weight gain

In Asthma patients there could be psychological overlay with stress and anxiety and these could make Asthma symptoms worse in susceptible individuals

Severe Asthma is seen only around 10% of cases but takes up big chunk of the health care resource funding. For

Severe Asthma newer drug likes Omalizumab or Mepolizumab are dispensed through designated hospital centres occasionally a new treatment called Thermoplasty (Radiofrequency waves given to the airways via a Bronchoscope) could be offered with prevention of exacerbations and improvement in symptom control in selected group of Asthma patients

Non-compliance in asthma is a big problem for both children and adults could be as high as 50% so it is important for patient to strictly adhere to their doctor s advice about the regular use of preventer inhalers or puffers

It is a condition where symptoms could be well controlled with appropriate treatment so a benign chronic condition but if uncontrolled or not treated well could lead to deaths in young patients

Asthma deaths 430 thousand deaths reported in 2015 to estimates of 610 thousand deaths in 2030 according to WHO statistics and these deaths are in very young individuals and most of these deaths are preventable if appropriate help is taken on time.

Review of these deaths have shown that most of these patients whose asthma is uncontrolled were found repeatedly using the short acting relievers instead of using preventer medications or seeking urgent medical help. 

By Dr Syed Arshad Husain FRCP(Glas), FCCP(USA)