Asthma
Asthma is a common lung condition that causes occasional breathing difficulties.
It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults.
There's currently no cure, but there are simple treatments that can help keep the symptoms under control so it does not have a big impact on your life.
Symptoms of Asthma
Most adults with asthma have times when their breathing becomes more difficult. Some people with severe asthma may have breathing problems most of the time.
The most common symptoms of asthma are:
cough
breathlessness
tight chest
persistent wheezing
Many things can cause these symptoms, but they're more likely to be asthma if they if you experience:
happens often & keeps coming back ,
are worse at night & early in the morning,
seem to happen in response to an asthma trigger like exercise or an allergy (such as to pollen or animals) .
If you think you may have asthma, or you have asthma and you are finding it hard to control, contact Virtue to book a consultation with our Consultant Specialists.
Asthma attacks
Asthma can sometimes get worse for a short time – this is known as an asthma attack. It can happen suddenly, or gradually over a few days.
Signs that you may be having an asthma attack include:
you're too breathless to speak, eat or sleep
your breathing is getting faster and it feels like you cannot catch your breath
your symptoms are getting worse (cough, breathlessness, wheezing or tight chest)
your reliever inhaler (usually blue) is not helping
your peak flow score is lower than normal
Many things can cause these symptoms, but they're more likely to be asthma if they:
fast heartbeat
breathlessness
breathing faster
being too breathless to eat, speak or sleep
blue lips or fingers
drowsiness,
confusion, exhaustion or dizziness
fainting
severe and constant
wheezing, coughing
and chest tightness
If you think you are having an asthma attack and you on an Asthma The Home Hospital Care Plan
You should follow the Escalation Pathway provided by your clinical team. If you are unsure about this and your attack occurs between the hours of 08:00 – 20:00 immediately contact the The Home Hospital Member Services Team and select Option 1 (Escalation Line) to speak to our Nursing Hub.
If you think you're having an asthma attack and you are not on a The Home Hospital Care Plan, you should:
Sit up straight – try to keep calm.
Take one puff of your reliever inhaler (usually blue) every 30 to 60 seconds up to 10 puffs.
If you feel worse at any point, or you do not feel better after 10 puffs call 999 for an NHS ambulance.
If the ambulance has not arrived after 10 minutes and your symptoms are not improving, repeat step 2.
If your symptoms are no better after repeating step 2, and the ambulance has still not arrived, contact 999 again immediately.
Never be frightened of calling for help in an emergency.
Try to take the details of your medicines (or your personal asthma action plan) with you to hospital if possible.
If your symptoms improve and you do not need to call 999, contact Virtue to arrange an urgent same-day appointment with a The Home Hospital Consultant to explore how we can help manage your condition and provide urgent support in the event of an attack.
This advice is not for people on SMART or MART treatment. If this applies to you, please arrange a consultation with a Virtue Consultant to understand what to do if you have an asthma attack.
After an asthma attack
You should see a medical practitioner within 48 hours of leaving hospital, or ideally on the same day if you did not need hospital treatment. Contact Virtue to arrange a call with one of our Consultant Specialists.
About 1 in 6 people treated in hospital for an asthma attack need hospital care again within 2 weeks, so it's important to discuss how you can reduce your risk of future attacks.
Our Consultant Specialists will be able to discuss any changes that may need to be made to manage your condition safely via a preventative treatment plan such as our Elective Remote Monitoring service. In the event of another unavoidable exacerbation, we can also prevent hospitalisation by onboarding you to our Acute Virtual Ward where you can receive hospital-level care from the comfort of your home.
Preventing asthma attacks
Prevention is known as the best cure. The Home Hospital offer a range of pioneering Elective Remote Monitoring services that can improve the diagnosis, treatment and management of asthma. These services can also detect early signs of an asthma attack or flare up, enabling early intervention and treatment. In a lot of cases, this early intervention can avoid the onset of an asthma attack, or reduce its severity considerably. If you are signed-up to one of our Elective Remote Monitoring Care Plans and an asthma attack does occur, we may be able to prevent hospitalisation via these services. If the attack is more severe and your Virtue Consultant believes that urgent hospital-level acute care is required, we may also be able to accept you into our Acute Virtual Ward, which can provide such treatment from the comfort of home, avoiding a hospitalisation.
The following steps can help you reduce your risk of having an asthma attack:
Sign-up to a The Home Hospital Elective Remote Monitoring plan
Follow your personal asthma action plan and take all of your medicines as prescribed
Avoid things that trigger your symptoms whenever possible
Have regular asthma reviews with a Consultant Specialist – these should be done at least once a year, but preferably more frequently.
Check with a Consultant Specialist or Advanced Nurse Practitioner that you're using your inhaler correctly
Do not ignore your symptoms if they're getting worse or you need to use your reliever inhaler more often than usual.
Follow your action plan and make an urgent appointment to see a Virtue Consultant if your symptoms continue to get worse.
When to see a The Home Hospital Consultant
See a The Home Hospital Consultant if you think you may have asthma. Several conditions can cause similar symptoms, so it's important to get a proper diagnosis and correct treatment. The Home Hospital Consultant will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests.
Our Elective Remote Monitoring Plans provide a novel method of providing daily monitoring with weekly or monthly appointments with our Advanced Nurse Practitioners – creating a cost efficient method of managing your condition in-between appointments with our Consultant Specialists and improving their insight into and management of your condition.
Treatments for asthma
There's currently no cure for asthma, but treatment can help control the symptoms so you're able to live a normal, active life.
Inhalers, which are devices that let you breathe in medicine, are the main treatment. Tablets and other treatments may also be needed if your asthma is severe.
Contact us to arrange an appointment with a The Home Hospital Consultant to review your personal action plan and treatment, as well as to explore how our services can improve diagnosis, treatment results, ongoing management of your condition and avoidance of hospitalisation.
1. Inhalers
Inhalers can help:
relieve symptoms when they occur (reliever inhalers)
stop symptoms developing (preventer inhalers)
Some people need an inhaler that does both (combination inhalers). Talk to one of our The Home Hospital Consultants to explore which inhaler is right for you.
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Most people with asthma will be given a reliever inhaler. These are usually blue.
You use a reliever inhaler to treat your symptoms when they occur. They should relieve your symptoms within a few minutes.
If you have to use your reliever inhaler 3 or more times a week arrange a call with a Virtue Consultant. They may suggest additional treatment, such as a preventer inhaler.
Reliever inhalers have few side effects, but they can sometimes cause shaking or a fast heartbeat for a few minutes after they're used.
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If you need to use a reliever inhaler often, you may also need a preventer inhaler.
You use a preventer inhaler every day to reduce the inflammation and sensitivity of your airways, which stops your symptoms occurring. It's important to use it even when you do not have symptoms.
Talk to us if you continue to have symptoms while using a preventer inhaler. Preventer inhalers contain steroid medicine. They do not usually have side effects, but can sometimes cause:
a fungal infection of the mouth or throat (oral thrush)
a hoarse voice
a sore throat
You can help prevent these side effects by using a spacer, which is a hollow plastic tube you attach to your inhaler, as well as by rinsing your mouth after using your inhaler.
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If using reliever and preventer inhalers does not control your asthma, you may need an inhaler that combines both.
Combination inhalers are used every day to help stop symptoms occurring and provide long-lasting relief if they do occur.
It's important to use it regularly, even if you do not have symptoms.
Side effects of combination inhalers are similar to those of reliever and preventer inhalers.
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Inhalers should not be thrown away in household waste. Take them to a pharmacy to be disposed of.
2. Tablets
You may also need to take tablets if using an inhaler alone is not helping control your symptoms.
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LTRAs are the main tablets used for asthma. They also come in syrup and powder form. You take them every day to help stop your symptoms occurring.
Possible side effects include tummy aches and headaches.
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Theophylline may also be recommended if other treatments are not helping to control your symptoms. It's taken every day to stop your symptoms occurring. Possible side effects include headaches and feeling sick.
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Steroid tablets may be recommended if other treatments are not helping to control your symptoms.
They can be taken either:
as an immediate treatment when you have an asthma attack
every day as a long-term treatment to prevent symptoms – this is usually only necessary if you have very severe asthma and inhalers do not control your symptoms
Long-term or frequent use of steroid tablets can occasionally cause side effects such as:
increased appetite, leading to weight gain
easy bruising
mood changes
fragile bones (osteoporosis)
high blood pressure
You'll be monitored regularly while taking steroid tablets to check for signs of any problems. Our Elective Remote Monitoring Services provide a cost-effective method of providing heightened oversight and insight into treatment and management of the side-effects – contact us to discuss these services.
3. Other treatments
Other treatments, such as injections or surgery, are rarely needed, but may be recommended if all other treatments are not helping.
Injections – For some people with severe asthma, injections of medicines called biologic therapies are given every few weeks. These can help to control the symptoms. They are not suitable for everyone with asthma and can only be prescribed by one of our Consultant Specialists.
The main side effect is discomfort where the injection is given.
Surgery– A procedure called bronchial thermoplasty may be offered as a treatment for severe asthma. It works well and there are no serious concerns about its safety.
You will be sedated or put to sleep using a general anaesthetic during a bronchial thermoplasty.
It involves passing a thin, flexible tube down your throat and into your lungs. Heat is then used on the muscles around the airways to help stop them narrowing and causing asthma symptoms.
4. Complementary therapies
Several complementary therapies have been suggested as possible treatments for asthma, including:
breathing exercises – such as techniques called the Papworth method and the Buteyko method
traditional Chinese herbal medicine
acupuncture
ionisers – devices that use an electric current to charge molecules of air
manual therapies – such as chiropractic
homeopathy
dietary supplements
Little evidence to support that any of these therapies are effective as preventative treatments.
There's some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some people, but they should not be used instead of your medicine.
Work-related asthma
If you seem to have occupational asthma, where your asthma is linked to your job, you'll be referred to a specialist to confirm the diagnosis. If your employer has an occupational health service, they should also be informed, along with your health and safety officer.
Your employer has a responsibility to protect you from the causes of occupational asthma.
It may sometimes be possible to:
substitute or remove the substance that's triggering your asthma from your workplace
redeploy you to another role within the company
provide you with protective breathing equipment
Causes and Triggers of Asthma
Asthma is caused by swelling (inflammation) of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.
It may happen randomly or after exposure to a trigger. Common asthma triggers include:
allergies
smoke, pollution and cold air
exercise
infections like colds or flu
Identifying and avoiding your asthma triggers can help you keep your symptoms under control.
Complications of asthma
Although asthma can normally be kept under control, it's still a serious condition that can cause a number of problems.
This is why it's important to follow your treatment plan and not ignore your symptoms if they're getting worse.
Badly controlled asthma can cause problems such as:
feeling tired all the time
underperformance at, or absence from, work or school
stress, anxiety or depression
disruption of your work and leisure because of unplanned visits to a GP or hospital
lung infections (pneumonia)
delays in growth or puberty in children
There's also a risk of severe asthma attacks, which can be life threatening.