Asthma

Manchester's Premier Respiratory Clinic

What is asthma?

Asthma is a chronic disease that effects the airways of your lungs. The airways are the breathing tubes that carry air in and out of your lungs.

Asthma is an inflammatory process which causes:

Swelling within the airways making it harder for the air to flow within the tubes.
There is increased mucus production leading to an increased risk of airway plugging and lung infection.
The muscles around the airways become increasingly irritable leading to narrowing of the airways (bronchospasm).

During an acute attack all these processes occur with increased severity cause inability to breath, tightness of the chest, cough and wheeze. In between acute attacks the inflammation process persists in the background unless effectively treated leading to progression of the asthma remodeling of the lung with potential for long term limitation in quality of life.

Symptoms

Asthma has many classical symptoms. Often individuals may only complain of a single symptom such as breathlessness or a persistent cough and in others all the symptoms may be present at varying times.

1. Breathlessness: This often related to variation in the day, and triggered by exposure to. Inhaled irritants / allergens/ infections

2. Cough: This is often dry but can be productive. Individuals often describe it as a cause of broken sleep.

3. Wheezing: This occurs on the out breath due to narrowing of the airways.

4. Chest tightness: Is usually localised to the central chest though sometimes felt higher up even at the lower part of the neck.

Causes

Asthma is not one disease but has a variety of causes all leading to the inflammation and narrowing of the airways, which bring on the common symptoms we attribute to asthma.

It is important to acknowledge that asthma can develop at any age including late on in life. It has many precipitators including allergies, exposures to irritants, exercise and infections. Understanding the cause of asthma in an individual usually allows the best treatment outcomes with the lowest medication burden.

Other causes presenting with asthma like symptoms:

Although Asthma has some classical symptoms there are a few illnesses which can mimic asthma. This often leads to a misdiagnosis of asthma in some patient and hence prescribed asthma medication is not as effective.

The most common alternate illnesses diagnosis include:

Inducible Laryngeal Obstruction
Breathing Pattern Disorder
COPD
Causes of recurrent lung infections

It is important to know that wheezing and breathlessness is not purely due to asthma.

Diagnosis

Relies on:

Subjective assessment which occurs during the consultation with your doctor, this allows the identification of the disease causing your symptoms as well as the triggers causing acute ‘flare ups’.
Objective investigations which support understanding the severity of the inflammation and obstruction to airflow within the lungs.

The common investigations include:

Lung function testing (LFTs): LFTs are blowing test which define the type and extent of respiratory limitation an individual may have.
Exhaled Nitric Oxide (FeNO) analysis, again is a simple blowing test taking a few minutes to undertake with near instantaneous results, which demonstrates the severity of inflammation in certain types of asthma.
Challenge testing: These are a variety of lung function tests, where an individual is exposed to irritants in a controlled low dose manner to bring on mild asthma to objectively assess the sensitivity of the lung and hence the inflammatory process causing the asthma. Common tests include Mannitol challenge testing and EVH (Eucapnic Voluntary Hyperventilation) test.
Cardiopulmonary exercise testing (CPET): This is often used when the cause of breathlessness is difficult to diagnose on initially investigations. CPET allows assessment of respiratory, cardiac and muscle during exercise to understand why breathlessness has occurred.
Field exercise testing supports assessment of an individual’s breathlessness symptoms on exposure to activities that bring on symptoms.

As part of our service we have access to the largest environmental chamber in europe where we can replicate environmental temperature, humidity and altitude whilst exercise is undertaken to support diagnosis of the cause of breathing difficulties.

At Respiratory Medical Ltd. We are the only current private respiratory service that has the ability to undertake all these investigation for our patients to support not only a diagnosis but also to support assessing outcome to treatment and optimisation of individual well being.

Treatments

With current treatments available the vast majority of individuals with asthma should have no limitations in their lives due to the illness. Even in the 5% of severe spectrum asthma patients new biological treatments available ensure significant improvement in quality of life and ability to undertake physical activity and reduce lung exacerbation (severe acute attacks).

As long an individual is correctly diagnosed and uses their medication correctly, which includes having good technique with an inhaler and using the correct dose of the medication at the correct time then asthma symptoms should at worse be minimal.

What does good asthma control look like?

Need your reliever (usually blue inhaler) infrequently which means less than 3 times a week but preferably not all.
Have no acute lung flare ups throughout the year.
Be able to exercise and undertake other physical activities without limitation from your asthma.
Sleep without being disturbed by symptoms.
Have the ability to control any deterioration yourself early on in the process without needing to access medical support.

Treatments include:

Improving lifestyle measure as we know active lives lead respiratory wellbeing, which in turn reduces ill health.
Inhaled therapies: Aim to reduce lung inflammation causing acute attacks and symptoms leading to limitation of physical activity.
Oral medication: This is less frequently used as it has a smaller role to play in asthma control than inhalers.
Oral Steroids can be used to control acute attacks and stabilise severe symptoms. Any patient needing steroids more than once in a year should be reviewed by a specialist asthma team.