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Asthma
Reviewed by Dr Gavin Petrie, consultant respiratory physician and Dr Paul Klenerman, consultant physician
How does the doctor make the diagnosis?
The diagnosis is made on the basis of the patient's history of symptoms and on simple tests of the lungs' function but it is not always easy to come to a diagnosis of asthma if the symptoms are mild and intermittent.
For those people whose asthma is associated with eczema and hay fever it can be helpful to take blood samples and skin tests to look for hypersensitivity towards specific substances.
What should I do?
Be active. If you get attacks during intense activity it may be a good idea to take 'reliever' medicine before you begin to exercise. These medicines, properly known as bronchodilators, have a relaxing effect on the muscle surrounding the bronchioles. Swimming is probably the best form of exercise for asthma patients but the most important thing is to stay active.
What are the prospects for asthma suffers?
Medicine
Medicines for asthma are generally thought of in two main groups.
Longer-acting beta-2 agonists include salmeterol and formoterol (eg Foradil, Oxis). Their action lasts over 12 hours, making them suitable for twice daily dosage to keep the airways open throughout the day.
Anticholinergics
Theophyllines
Preventers
Although steroids are powerful medicines with many potential side effects, their safety in asthma has been well established. It is also important to balance the problems that arise from poorly treated asthma against the improvement in health which occurs when the condition is well treated.
Cromones
Leukotriene receptor antagonists
By blocking this effect with these antagonist medicines the constriction is reversed. There are two such medicines currently available: montelukast and zafirlukast, both of which are taken as tablets.
One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles. The nerve impulses cause the muscles to contract, thus narrowing the airway. Anticholinergic medicines block this effect, allowing the airways to open. The size of this effect is fairly small, so it is most noticeable if the airways have already been narrowed by other conditions, such as chronic bronchitis. An example of an anticholinergic is ipratropium bromide. It has a maximum effect 30 to 60 minutes after inhalation, which lasts for three to six hours.
Theophylline and aminophylline
are given by mouth and are less commonly used in Britain because they are more likely to produce side effects than inhaled treatment. They are still in very wide use throughout the world. All three types of reliever can be combined if necessary.
There are three main groups of these.
There are two medicines in the cromone group: sodium cromoglicate and nedocromil sodium. They also act to reduce inflammation of the airways. They tend to be best for mild asthma and are more effective in children than adults. The medicines are given by inhalation and are usually very well tolerated.
Leukotriene receptor antagonists are compounds released by inflammatory cells within the lungs and which have a powerful constricting effect upon the airways.
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