Asthma & Wheezing
Asthma can strike at any age, but it usually begins in childhood, with 50% of these children outgrowing it by the time they reach adolescence. With childhood-onset asthma, there is a tendency for it to be genetic, with early respiratory tract infections and atopy often present. In the case of adult onset, lifestyle factors such as obesity, smoking and depression are more likely to be involved. Allergic asthma is the most common type of asthma, and attacks are often triggered by environmental allergens such as fur, dust, pollen and mold spores.
When the condition is managed properly, those affected can live normal lives, and participate in activities such as sport.
- Allergies to dust mites; tree and grass pollen; domestic animals including pets and birds; some foods; and mould spores can bring on attacks.
- A bout of flu or even a cold can exacerbate asthma for up to six weeks.
- Pollutants including some chemicals, cigarette smoke and car exhaust fumes can cause an attack.
- Exercise, especially in cold temperatures, can induce an attack. However, this doesn’t mean asthmatics should not exercise. In the long term, exercise is beneficial as it increases lung fitness.
- Emotions including anxiety, anger and laughter can lead to an attack.
- Drinks that use sulfur dioxide as a preservative (for example, lime and fruit squash) can trigger attacks.
- Medicines such as aspirin, certain anti-inflammatory tablets, eye drops and beta blocker blood pressure pills may aggravate asthma in adults.
Asthma Treatment and Immunotherapy
Fortunately for most sufferers, if they manage their asthma, they can lead entirely normal lives. The first step is to determine if any environmental allergens are triggering your condition so that you can avoid them, or undergo Immunotherapy. Our allergists will give you skin-prick or intradermal tests to find specific antibodies (IgE) to dogs, cats, types of pollen, dust mites, mold spores and cockroaches. If you cannot avoid your triggers, a course of Immunotherapy could be ideal. In this case, over a period of time, you will be injected with whichever allergen has been identified so as to build up a resistance to that allergen.
Medication and Monitoring
Aside from Immunotherapy, there are two types of medicine you could be prescribed. As their names imply, Preventer medicines are used daily to prevent attacks, while Reliever medicines are used on the spot to stop an attack.
Preventer medicines prevent the mucous membrane that lines the airway of your lungs from becoming inflamed or swollen. Their effect is built up over a period of time and they must be used every day. Low-dose inhaled cortico-steroids, normally given atomised in an inhaler, are the backbone of asthma prevention, and the medicines derived from them are very safe when used correctly.
Newer oral medicines called Leukotriene Antagonists are also available. For severe allergic asthma that is difficult to control, monoclonal anti-IgE antibodies in the form of Omalizumab (Xolair) is effective, but costly, and involves shots every four weeks.
Unlike Preventers, Relievers are used during an actual attack. They work by relaxing the muscles surrounding the bronchial tubes, providing immediate relief. If you find you are using Preventers more frequently than our allergists recommended, you should tell them as it could be a sign that your Preventer dosage needs to be increased.
Longer-acting bronchodilator relievers (LABAs) such as Salmeterol plus Formoterol are used twice daily, but are usually recommended as add-on treatment to inhaled steroids. LABAs should be used in conjunction with inhaled steroids that reduce airway inflammation (this is known as ‘combination therapy’).
Since treatments have improved, older oral drugs such as the Aminophylline and Theophyllines are rarely prescribed now.
You might need additional treatment if you find that your asthma worsens at night or in the early hours of the morning. Seek urgent medical assistance if you have taken several inhalations of your Reliever medicine, but still have a tight chest or wheezing, particularly if you also experience difficulty talking.
Our doctors will work with you to create a plan to manage your asthma. This could include a short course of oral steroid tablets to take in an emergency.