~ Weekly Health Advice from PMGH – Asthma ~

Welcome to another health update from the Port Moresby General Hospital, this week we are focusing on Asthma, what are the symptoms of asthma and when is it a medical emergency?

For more information, please contact info@portmoresbygeneralhospital.com

What is Asthma?
Asthma is a chronic condition that causes inflammation and narrowing of the bronchial tubes, the passageways that allow air to enter and leave the lungs. According to Asthma Australia, the causes of asthma are not fully understood, although people with asthma often have a family history of asthma, eczema, and hay fever. Research has shown that exposure to tobacco smoke (especially as a baby or young child), obesity and some workplace chemicals can increase the risk of developing asthma. Although there is currently no cure for asthma, with the right knowledge and good management, most people with asthma can lead full and active lives. According to the National Asthma Council of Australia, many people think they have asthma only when they have asthma symptoms. In fact, the airways are sensitive all the time, and most people with asthma have permanently irritated (inflamed) airways when not taking regular preventer treatment. From time to time, the airways tighten or become constricted, so there is less space to breathe through, leading to asthma symptoms. Asthma causes three main changes to the airways inside the lungs, and all these can happen together:
- the thin layer of muscle within the wall of an airway can contract to make it tighter and narrower – reliever medicines work by relaxing these muscles in the airways
- the inside walls of the airways can become swollen, leaving less space inside, preventer medicines work by reducing the inflammation that causes the swelling
- mucus can block the inside of the airways; preventer medicines also reduce mucus.

Asthma symptoms can be triggered by different things for different people however, common triggers include colds and flu, allergies, and cigarette smoke. An asthma flare-up is when asthma symptoms start up or get worse compared to usual. These flare-ups can happen quite quickly (e.g. if you are exposed to smoke) but they can also come on gradually over hours or days (e.g. if you get a cold). An asthma flare-up can become serious if not treated properly, even in someone whose asthma is usually mild or well controlled. A severe flare-up needs urgent treatment by a doctor or hospital emergency department. 

Asthma Triggers
Triggers can cause the airways to become narrow and inflamed, leading to asthma symptoms. Avoiding triggers, if possible, can help to control asthma. Anything that causes a reaction can set off your asthma symptoms, these triggers differ between individuals. It is not always possible to avoid your triggers, however, reducing exposure to your asthma or allergy triggers may make your symptoms easier to manage. Work with your doctor to work out what your triggers are and get some helpful advice on how to avoid these.
Common Asthma Triggers:
Colds and flu: Colds and flu are the most common trigger for asthma flare-ups, while you can’t always avoid them you can reduce your risk by washing your hands regularly and talking to your doctor about a flu shot.
Cigarette smoke: People with asthma have even more reason to avoid smoking than those without asthma. Your lungs are extra sensitive when you have asthma and they are especially vulnerable to the damaging effects of cigarette smoke. In the short term, smoking and asthma makes you more likely to have asthma attacks or flare-ups. In the long term, you’re at higher risk of developing smoking-related diseases like emphysema. If you smoke, please talk to your doctor about quitting.
Allergies: Allergy occurs when a person’s immune system (the body process that protects against disease) reacts to substances in the environment that are usually harmless to most people. These substances are known as allergens. Examples of allergens include house dust mites, pollen, mould, and pet dander. If you have asthma that is triggered by allergens, you may have asthma symptoms when you vacuum or dust (as this causes house dust mite allergens to become airborne), visit a house where a pet lives, are outdoors in late spring and early summer, and when there are high levels of pollen in the air or are exposed to mould.
Exercise: is a common asthma trigger however exercise is great for your health. If exercise triggers your asthma symptoms, talk with your doctor so you can find the treatment that works best for you.
Other triggers: There are a number of other triggers that may affect individuals at various times such as weather e.g. cold air, change in temperature, thunderstorms, work-related triggers e.g. wood dust, chemicals, metal salts, irritating substances breathed in the air such as burning wood or grass, certain medicines, e.g. aspirin, some blood pressure drugs, stress and high emotions, such as crying. 

Symptoms of Asthma
Common symptoms of asthma include: 
- Coughing (especially at night, during exercise or when laughing)
- Chest tightness
- Shortness of breath
- Wheezing (a whistling or squeaky sound in your chest when breathing, especially when exhaling)

Tip: If you’re experiencing any of the symptoms above talk to your doctor. If diagnosed with asthma develop an asthma management plan with your doctor. Any asthma symptom is serious and can become deadly if left untreated.

Asthma Emergency
Asthma Australia: Any person with asthma can have a flare-up or worsening of asthma symptoms at any time. A sudden or severe flare-up is often called an asthma attack. An asthma flare-up or attack may develop very rapidly over a few minutes, or it may take a few hours or even days to happen. Having good control of your asthma means this is less likely, but it can still happen. Reduce your risk of an asthma flare-up by taking your asthma medicine as advised, being aware of your symptoms and responding quickly when they get worse, following a written asthma action plan, having regular reviews with your doctor and asking them to check you’re using your inhaler well.
You may be having an asthma flare-up or attack if:
 - You have asthma symptoms that are getting worse
 - Your reliever puffer isn’t helping or is lasting less than four hours
 - Your symptoms are making it difficult to eat, speak or sleep
 - You feel like you can’t get your breath in properly
 - Children may complain of a sore tummy or chest, or be more restless
(Start asthma first aid as soon as possible)

Asthma First Aid:
Step 1: sit the person upright
- be calm and reassuring
- do not leave them alone
Step 2: give 4 separate puffs of reliever puffer
- shake puffer
- put 1 puff into spacer
- take 4 breaths from spacer
- repeat until 4 puffs have been taken
Remember: shake, 1 puff, 4 breaths
Step 3: Wait 4 minutes
if there is no improvement give 4 more puffs as above
Step 4: If there is no improvement seek emergency assistance.
Keep giving 4 separate puffs every 4 minutes until emergency assistance is sought.
Please note: If your symptoms improve you still need to make an appointment to see your doctor, preferably the same day.

You should seek emergency assistance if the person:
- is not breathing
- the person's asthma suddenly becomes worse or is not improving
- the person is having an asthma attack, and a reliever is not available
- you are not sure if it's asthma
- the person is known to have Anaphylaxis - follow their Anaphylaxis Action Plan, then give them Asthma First Aid (see above)

How is Asthma Diagnosed?
If you suspect, you may have asthma talk to your doctor. A diagnosis of asthma is more likely if you have eczema or hayfever or have close relatives with allergies and/or asthma, and if your symptoms: keep coming back, or happen at the same time each year, are worse at night or in the early morning, are clearly triggered by exercise, allergies or infections, or improve quickly with reliever medication according to Asthma Australia. The most certain way to diagnose asthma is with a lung function test, a medical history, and a physical exam. However, it's hard to do lung function tests in children younger than 5 years and doctors must rely on children's medical histories, signs and symptoms, and physical exams to make a diagnosis. Doctors also may use a 4–6 week trial of asthma medicines to see how well a child responds.
In diagnosing asthma, your doctor will ask about your medical history as well as: 
Physical examination: During a physical examination your doctor will listen to your breathing and look for signs of asthma or allergies such as wheezing, a runny nose or swollen nasal passages, and allergic skin conditions (such as eczema). Keep in mind that you can still have asthma even if you don't have these signs on the day that your doctor examines you.
Spirometry tests: Spirometry is the most accurate breathing test for asthma. It measures the amount of air you can breathe in and out of your lungs, and how hard and fast you can breathe out. The machine used to do the test is called a spirometer and tests your overall lung function. Doctors use a spirometer to: check whether the airways in your lungs are narrower than they should be, confirm whether you have asthma, work out how severe your asthma is, see if your asthma is getting worse, see if your asthma is getting better with treatment. The test results help you and your doctor to decide whether you need any medicines, or to work out whether the type or dose of your current medicine needs to change. Most adults and children over 7 years of age can do the spirometry test correctly.
Peak flow test: A peak flow test is done with a peak flow meter. It measures the maximum (or peak) speed at which you can blow air out. This gives an idea of how narrow your airways are. It also shows how much your airways are changing. However, a peak flow test cannot be used to confirm whether you have asthma. Your doctor may ask you to use a peak flow meter to check your asthma at home.
Allergy testing: Asthma is strongly linked with allergies, many people will be required to have allergy testing usually through skin prick or blood (RAST) tests. Talk to your doctor.

Treatment and Management of Asthma
Centre’s for Disease Control and Prevention (CDC): You can control your asthma and avoid an attack by taking your medicine exactly as your doctor tells you to do and by avoiding things that can cause an attack. Not everyone with asthma takes the same medicine, some medicines can be inhaled or breathed in, and some can be taken as a pill. Asthma medicines come in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you need to use your quick-relief medicines more and more, you should visit your doctor to see if you need a different medicine. Long-term control medicines help you have fewer and milder attacks, but they don’t help you if you’re having an asthma attack. Asthma medicines can have side effects, but most side effects are mild and soon go away. Ask your doctor or other medical professional about the side effects of your medicines. The important thing to remember is that you can control your asthma. With your doctor’s or other medical professional’s help, make your own asthma action plan (management plan) so that you know what to do based on your own symptoms. It is important to see your doctor for regular check-ups to ensure you are on the right track with your asthma management.

Asthma and Exercise
Exercise is great for health and well-being, and having asthma shouldn't stop you playing sport or taking part in any other activity whether it is for fun or competitively. Don’t let your asthma stop you being physically active, talk to your doctor. The National Asthma Council of Australia states that if you get asthma symptoms when you get active, there are some things you can do:
- Get as fit as possible – the fitter you are, the harder you need to work before symptoms start.
- Exercise in a place that is warm and humid – avoid cold, dry air if possible.
- Avoid exercising where there are high levels of pollens, dust, fumes or pollution.
- Breathe through your nose when you exercise.
 - Do a proper warm-up and cool-down.
- Keep your reliever handy and be prepared if your asthma flares up. If your asthma does flare up, don’t ignore it or hope the symptoms will go away by themselves.
- Take action - Asthma symptoms after exercise are common but treatable. If exercise triggers your asthma symptoms, tell your doctor so you can find the treatment that works best for you.

Preventing Asthma Episodes and Controlling Your Asthma
For people with asthma, having an asthma management plan is the best way to prevent symptoms. An asthma management plan is something developed by you and your doctor to help you control your asthma, instead of your asthma controlling you. An effective plan should allow you to:
- Be active without having asthma symptoms.
- Fully take part in exercise and sports.
- Sleep all night, without asthma symptoms.
- Attend school or work regularly.
- Have the clearest lungs possible.
- Have few or no side effects from asthma medications.
- Have no emergency visits or stays in the hospital.

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