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I’ve just been diagnosed with adult onset asthma: what next?

February 21st, 2017 by Stephanie Hall

Roughly 1 in every 12 UK adults is treated for asthma, according to Asthma UK.

At first glance, a statistic like this seems harmless. In truth, it does little to instil us with any sense of urgency or any sense of needing to educate ourselves about adult onset asthma.

But how about the following statistic from Asthma UK:

“1,468 people died from asthma attacks in the UK in 2015.”

I’m guessing that kind of statistic is more successful in getting us to re-evaluate whether or not we can afford to dismiss asthma so freely; whether or not we can afford to assume that asthma is a largely innocuous condition that can easily be managed using modern medicine.

In light of figures from the Office for National Statistics telling us that asthma deaths have been increasing, with an increase of 21% occurring from 2014 to 2015, I’d say it’s high-time that we educate ourselves about what adult onset asthma really is and what dangers it can pose to our health.

If you have recently been diagnosed with adult onset asthma, or you simply want to learn more about the condition in light of the information given above, Echo has compiled the following guide on what to expect next after being diagnosed with adult onset asthma.

What is adult onset asthma?

Adult onset asthma is a condition that causes adults (usually aged 16 years or older) to experience asthma symptoms for the first time in adulthood.

Symptoms

As with most other types of asthma (including childhood asthma, occupational asthma and seasonal asthma), the symptoms of adult onset asthma include wheezing, coughing, breathlessness, and a tight chest, according to NHS criteria.

While symptoms tend to be more severe for people diagnosed with adult onset asthma compared to those diagnosed with childhood asthma, the condition operates in the same way as that experienced in childhood.

As a chronic, long-term condition, ‘asthma’ can be understood in most general terms as an airway disease that causes inflammation and irritation on the surface of the smooth muscles lining your airways (i.e. the tubes carrying oxygenated air into your lungs and carbon dioxide out of your lungs).

While airway inflammation reduces a person’s ability to breath in as much air as needed to supply the body’s vital organs and muscles with enough oxygen, airway irritation causes discomfort when breathing, further adding to a person’s inability to breathe in deep, full breaths.

What sets adult onset asthma apart from other types of asthma is the severity of its symptoms, which tend to be worse in adults.

Echo-NHS-Healthcare-Young-Man-Coughing

Causes

The exact cause of adult onset asthma remains unknown, and it may well turn out that scientists find there is no exact cause. Nonetheless, researchers are continuing to investigate the condition.

One trend that research has uncovered is that adult onset asthma tends to affect more women than it does men, according to data provided by the European Respiratory Review.

Recent research has suggested that women’s contraception, menopause and hormone replacement therapy could all contribute to an increased chance of developing adult onset asthma. But this research is only in its early stages and will need further verification to be considered conclusive.

A study published in the International Journal of Chronic Obstructive Pulmonary Disease has suggested that:

“Early life exposures such as childhood infections, smoke, obesity, and allergy influence adult-onset asthma.”

Many people with adult onset asthma also experience airway hyper-responsiveness (AHR). AHR is essentially an allergic reaction to minor irritants like dust, animal fur and cold air, which cause the muscles lining the airways to constrict, thereby making breathing more difficult.

Echo-NHS-Healthcare-Young-Woman-Coughing

Is there a cure for adult onset asthma?

As with all other forms of asthma, there is no confirmed cure for adult onset asthma.

It is more appropriate to think of asthma treatment in terms of symptom management than it is to think of possible cures, and there are many different types of inhalers available to help you manage your asthma symptoms.

Your doctor or GP will talk you through the different types of asthma inhalers and whether or not you may need to start using an inhaler in the near future, but the differences between two of the most commonly prescribed inhalers are listed below:

  1. Reliever inhaler - often blue, reliever inhalers alleviate the symptoms of asthma within a matter of minutes.

  2. Preventer inhaler - often brown, purple, or orange in colour, preventer inhalers help prevent asthma attacks by building up your resistance to asthma symptoms over a longer period of time.

Echo’s clinical director, Alistair Murray, reminds us that:

“It is vital to make sure your inhaler technique is correct when using asthma inhalers. Many asthmatics use their inhalers incorrectly without even realising it, and certain mouth infections can serve as indications that your inhaler technique isn’t quite right. It’s always best to check how you should be using your inhaler with your GP, nurse or pharmacist.”

Are there any triggers for my condition?

The long list of asthma triggers can be divided into two strands:

  1. Atopic

  2. Non-atopic

Atopic triggers cause asthma symptoms to emerge in the wake of an allergic reaction. Many asthmatics suffer with airway hyper-responsiveness (AHR), which means that the walls of their airways become inflamed in response to allergic triggers. The NHS lists the following atopic asthma triggers on their website:

  1. Infections - e.g. common cold and flu

  2. Allergens - e.g. pollen, dust, animal fur, feathers

  3. Medicines - e.g. aspirin, ibuprofen, beta-blockers

  4. Food additives - e.g. sulphites (found in pickled foods, wine and beer)

  5. Weather conditions - e.g. cold air, humidity, sudden changes in temperature

  6. Poor housing conditions - e.g. mould or damp 

  7. Irritants - e.g. cigarette smoke, fumes, air pollution

Echo-NHS-Healthcare-Cigarettes

By contrast, non-atopic asthma triggers, or triggers that cause asthma symptoms to emerge in the absence of an allergic reaction, include anxiety, stress, exercise and laughter.

In both atopic and non-atopic cases of asthma, the walls of the airways swell and the muscles surrounding the airway walls contract. This swelling and contraction causes the passages through which any inhaled or exhaled air can travel to narrow significantly, thereby reducing the amount of air that can move in and out of the lungs.

The secretion of mucus in response to asthma triggers can cause the passages of the airways to become even narrower, causing unpleasant symptoms like wheezing, breathlessness and the feeling of a tight chest.

If you can identify your asthma triggers, you will be far better equipped to treat your asthma symptoms and manage your condition in a sustainable way.

How many check-ups will I need to manage my adult onset asthma?

NICE (the National Institute for Health and Care Excellence) states that people who have been diagnosed with asthma should be called in for a check-up at least once a year.

In addition to this, Echo’s clinical director, Alistair Murray, tells us that:

“It is likely your asthma will be monitored more regularly for a short time following your initial diagnosis. Once you, your doctor, your nurse, your GP, and your pharmacist are confident in your ability to control your symptoms without the need for professional medical intervention, the amount of check-ups you will need will reduce.”

NICE also notes that:

“Closer monitoring of people with poor lung function and/or a history of an asthma attack within the last year should be considered.”

Asthma check-ups will often be structured around a set of diagnostic and health management questions, as devised by The Royal College of Physicians. These questions are aimed at monitoring your symptom control and often include the following:

  1. Have you had difficulty sleeping because of your asthma symptoms?

  2. Have you experienced your usual asthma symptoms during the day?

  3. Has your asthma interfered with your usual activities?

If you are managing your asthma using the medication(s) you have been prescribed, and you are following the necessary steps for taking your medication correctly, then you should have good symptom control.

If you find that you are struggling to control your symptoms, you should contact your GP immediately.

Echo-NHS-Healthcare-Portable-Asthma-Spirometer

Do I need to tell anyone about my adult onset asthma?

Your doctor knows that you have adult onset asthma, and he or she will note it on your records for other clinical practitioners to see as and where necessary.

If your diagnosis for adult onset asthma was made in a hospital rather than a GP surgery, you may want to tell your GP about your diagnosis the next time you visit your practice too.

It can also be helpful to tell your pharmacist about your condition, so that he or she can guide you away from any over-the-counter medicines that could interact with your asthma medication.

Echo’s clinical director and lead pharmacist, Alistair Murray, says:

“There are certain common painkillers like ibuprofen (Nurofen) and aspirin (Anadin) that can make asthma symptoms worse for some people. You should only use these medicines if you have confirmed with your GP that it is safe to do so.”

Ultimately, whomever you choose to tell about your condition is a matter of personal choice. But it’s worth noting that making your friends, family members, and even your co-workers aware of your condition means that you’ll be giving yourself the best chance of building up a strong support network.

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What are the top treatments for adult onset asthma?

Asthma is most commonly treated through self-management. This means that you will be expected to manage the symptoms of your condition on a day-to-day basis, by avoiding asthma triggers and using asthma inhalers.

In addition to self-management, your doctor will likely monitor your treatment using a step-up and step-down approach, meaning that your medication will be increased or decreased over time according to the increase or decrease in your asthma symptoms.

The general path for treating asthma runs as follows (in accordance with information listed on patient.info web pages):

  1. Mild, intermittent asthma - prescribe a short-term reliever inhaler containing a short-acting beta2 agonist, such as salbutamol.

  2. Asthma symptoms three times a week or more - prescribe inhaled corticosteroids (ICS) to be taken using a preventer inhaler.

  3. Persistent symptoms with a preventer inhaler - prescribe ‘add-on’ therapy in the form of a long-acting reliever inhaler containing a long-acting beta2 agonist (LABA) such as salmeterol or formoterol (used in addition to a preventer inhaler).

  4. Poor symptom control with preventer inhaler and long-acting reliever inhaler - cease prescribing the LABA and/or increase the dose of ICS; add a leukotriene receptor antagonist (LTRA).

  5. Continuously poor symptom control on high-dose therapies - prescribe daily steroid tablets at the lowest dose possible to provide adequate symptom control.

Echo-NHS-Healthcare-Asthma-Medications

There are three principal types of asthma inhaler that your doctor can prescribe you, in addition to alternative treatments for severe asthma. A comprehensive breakdown of each of the different types of asthma medication your doctor might prescribe you is given below:

1) Reliever Inhaler

The most common type of inhaler prescribed to asthmatics, the reliever inhaler is intended to deliver fast-acting, short-term relief from asthma symptoms.

Reliever inhalers are often, but not always, blue in colour.

Reliever inhalers usually contain a short-acting beta2-agonist, such as salbutamol, and this medicine is designed to open up your airways. It does this by relaxing the smooth muscle in your airways, making it easier for air to get in and out of your lungs.

Asthma UK recommend that you use your reliever inhaler:

“... as soon as you notice asthma symptoms, such as coughing, wheezing, shortness of breath and tightness in the chest. You should feel a difference to your breathing within a few minutes.”

2) Preventer Inhaler

Preventer inhalers usually come in orange, brown, purple, or red casings, and are used to prevent asthma symptoms.

Unlike reliever inhalers, preventer inhalers contain corticosteroids that reduce any swelling or inflammation in your airways over time, with the aim of averting a flare-up in your symptoms.

The NHS recommends that you use your preventer inhaler:

“... twice or occasionally once a day to stop asthma symptoms occurring.”

3) Long-acting reliever inhaler

Long-acting reliever inhalers are used in the same way as reliever inhalers, and most commonly have green casings.

The difference between a long-acting reliever inhaler and a standard reliever inhaler is that the former contains a long-acting beta2-agonist, as opposed to the short-acting beta2-agonist contained within short-term reliever inhalers.

The relief provided by long-acting reliever inhalers can last as long as 12 hours, but the NHS warns that:

“It's important never to take a long-acting reliever on its own without a preventer. This may temporarily relieve your symptoms, while allowing the inflammation in the breathing tubes to build up, which could result in a sudden severe asthma attack.”

Echo’s clinical director, Alistair Murray, notes that:

“Many asthmatics will use combination inhalers that contain both a preventer steroid and a long-acting reliever ingredient. If this is the case, you won’t need to use an additional preventer inhaler unless you have been advised to do so by your doctor. Branded combination inhalers include Symbicort, Seretide, DuoResp, and Fostair.”

4) Other possible treatments

Aside from inhalers, asthma can be managed with tablets containing anti-inflammatories, steroids or bronchodilators (the latter of which are used to open up air passages).

Omalizumab, also known by the brand name Xolair, may be prescribed to prevent severe, recurrent asthma attacks that are induced by allergic reactions. This treatment is given in the form of an injection every month or fortnight, but is not commonly prescribed as it is not suitable for all asthmatics.

Top tips for effective asthma management

For novices and seasoned asthmatics alike, the following tips offer simple but effective ways of managing your asthma medication:

  1. Give your inhaler a good shake each time before you use it.

  2. If you have not used your inhaler for 14 days or longer and your prescription is still valid, squirt two puffs in the air before inhaling.

  3. Wash the plastic casing of your inhaler by removing the canister filled with medicine, and then use water to wash the frame.

That’s the end of Echo’s ‘What Next?’ guide to adult onset asthma, but you can read our ‘What’s Next?’ guide to high blood pressure and other conditions on our blog.

If you have any further questions about your condition, you should consult your doctor, GP or pharmacist.

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