What causes these symptoms?

Trigger factors, which could be anything from house dust mite to cat fur, cause the airways to become inflamed. This results in the production of mucous, which in turn results in the narrowing of the airways which causes bronchospasm.

Who gets asthma?

Anyone, whether child or adult, can get asthma. A family history of asthma may well predispose you. Asthmatics tend to be allergic, and may also have seasonal allergic rhinitis, hayfever and eczema. Asthma can be triggered by exercise, but sometimes that wheezing can just mean that you're unfit! Occupational exposure to dusts or fumes can exacerbate or cause asthma. People with hypertension who have asthma should not be on beta-blocking drugs (eg Tenormin), since these will cause bronchospasm.

Symptoms

The wheezing that is generally associated with asthma doesn't always occur in children. The classic symptoms of asthma in children are a cough at night and coughing on any kind of exertion.

In adults, the classic symptoms of asthma are coughing, wheezing and shortness of breath on exertion.

How is asthma treated?

People generally think of asthma treatment as the use of the various inhalers which cause bronchodilation, or opening up of the airways, so relieving the wheeze.

Treatment is actually aimed towards preventing the three components of asthma occurring. If we stop the inflammation, then the mucous production is halted, so no airways narrowing occurs. Generally, anyone, adult or child, who needs more than an occasional puff of an inhaled bronchodilator (eg Venteze, Ventolin, Berotec), will require some sort of anti-inflammatory drug.

In children the usual anti-inflammatory used is sodium cromoglycate (eg Lomudal). Sometimes, this on its own is sufficient to prevent the symptoms. Ketotifen (Zaditen) is also used in children with asthma as a preventative medication.There are times when an inhaled steroid (eg Becotide, Inflammide, Pulmicort) will be needed rather than either of these. However, some children will need inhaled bronchodilators as well.

In adults, treatment requires regular use of an inhaled steroid, with bronchodilators used when required, for wheezing. Some adults also find great benefit from the newer long acting inhaled bronchodilators, such as salmeterol (Serevent).

In adults and children, it is important to remember that the preventative part of the treatment is at least as important as the medication to relieve the wheeze. If the anti-inflammatory drug is used daily, in whatever doses your GP has recommended, then you shoudn't wheeze. Or your child shouldn't cough.

Are there side effects of these drugs?

Unfortunately, no drugs are without side effects. All the bronchodilators can cause a fast heartbeat, which can sometimes be uncomfortable. They can also cause a feeling of nervousness and a fine tremor.

Sodium cromoglycate is remarkably without side effects, although it can cause a dry throat and some hoarseness.

Ketotifen can cause drowsiness, and sometimes excitement. It also increases appetite.

The anti-inflammatory drugs everyone worries about most, of course, are the inhaled steroids. As long as the daily doses are less than 400 to 800 micrograms in children and less than 1200 to 1600 micrograms in adults, there should not be any of the side effects associated with long term steroid use. In someone with severe asthma, who requires very high doses of inhaled steroids, some of the side effects of steroids may be seen. In these cases, using long acting bronchodilators such as Serevent will often reduce the dose of the steroid needed.

Danger signs in asthma

So far we have been talking about people with stable asthma, which will be well controlled with daily doses of around 800 micrograms of an inhaled steroid, and either occasional use of a bronchodilator or daily use of a long acting bronchodilator. They should generally be free of symptoms and leading a normal life.

Unstable asthma is characterised by the following danger signals:

Daily symptoms:

Why do some people have unstable asthma? Unfortunately, some people have very severe disease, and cannot be controlled on the normal medication outlined in this article. They will require oral steroids regularly, with all the side effects these cause, as well as inhaled bronchodilators and inhaled steroids in very high doses. There is research in progress on new drugs for such sufferers.

The other causes of unstable asthma are inadequate preventative medication, either due to the medication not being taken as prescribed, or being prescribed in inadequate doses.

Constant exposure to trigger factors can also result in unstable asthma.

How can you help yourself or your child with asthma?

Asthma is something which can be controlled completely, allowing the sufferer to lead a normal life and even regularly engage in strenuous sports.

Your GP may well have suggested that you get a peak flow meter (that funny thing you blow into in the surgery), which is a cheap and easy measure of the severity of asthma. You can use this at home. Check your peak flow daily, and seek help if you see that it is going down. Your GP may also have suggested ways in which you can intervene before an attack happens, such as increasing the dose of your inhaled steroid for a few days.

If you get exercise-induced asthma, then take two puffs of your bronchodilator before you start. Ask the teacher to do this for your child at school.

If your child has asthma:

Asthma can be controlled, allowing you to lead a completely normal life.