Bronchial Asthma

What can make asthma symptoms worse?

Asthma symptoms may flare up from time to time. There is often no apparent reason why symptoms flare up. However, some people find that symptoms are triggered, or made worse, in certain situations. It may be possible to avoid certain triggers which may help to reduce symptoms. Things that may trigger asthma symptoms include the following:

  • Infections. Particularly colds, coughs, and chest infections.
  • Pollens and molds. Asthma is often worse in the hay fever season.
  • Exercise. However,¬†sport and exercise are good for you if you have asthma. If necessary, you can use an inhaler before exercise to prevent symptoms from developing. But, as a rule, exercise-induced asthma often represents undertreated asthma. If it occurs, it may indicate a need to step up your usual preventer treatment.
  • Certain drugs. For example, about 1 in 50 people with asthma is allergic to aspirin which can trigger symptoms. Other drugs that may cause asthma symptoms include: anti-inflammatory painkillers such as ibuprofen, diclofenac etc, and beta-blockers such as propranolol, atenolol, or timolol. This includes beta-blocker eye drops used to treat glaucoma.
  • Smoking and cigarette fumes. If you smoke and have asthma, you should make every effort to stop. See a practice nurse for help if you find it difficult. Passive smoking can make asthma worse too. Even where adults smoke away from the presence of children, smoke on clothes, hair, etc, may make asthma worse. All children deserve to live in a smoke-free home. In particular, children with asthma.
  • Other fumes and chemicals. For example, fumes from paints, solvents and pollution. The increase in air pollution may be a reason why asthma is becoming more common.
  • Emotion.¬†Asthma is not due to ‘nerves’, but such things as stress, emotional upset, or laughing may trigger symptoms.
  • Allergies to animals. For example, pet cats, dogs, and horses. Animals do not trigger symptoms in most cases, but some people notice that their symptoms become worse when close to certain animals.
  • House dust mite. This is a tiny creature which lives in mattresses and other fabrics around the home. If you are allergic to it, it may make symptoms worse. It is impossible to get rid of house dust mite completely. To greatly reduce their number takes a lot of time and effort and involves: using special mattress covers, removing carpets, removing or treating soft toys, etc. However, if symptoms are difficult to control with treatment, and you are confirmed to be allergic to house dust mite, then it may be worth considering trying to reduce their number.
  • Some foods. This is uncommon. Food is not thought to be a trigger in most cases.

How is asthma diagnosed?

Sometimes symptoms are typical, and the diagnosis is easily made by a doctor. If there is doubt then some simple tests may be arranged. The two commonly used tests are called spirometry and assessment with a peak flow meter.

Spirometry

This test measures how much air you can blow out into a machine called a spirometer. Two results are important: the amount of air you can blow out in one second (called forced expiratory volume in 1 second (FEV1)) and the total amount you can blow out in one breath (called forced vital capacity (FVC)). Your age, height and sex affect your lung volume. So, your results are compared with the average predicted for your age, height and sex. A value is calculated from the amount of air that you can blow out in one second divided by the total amount of air that you blow out in one breath (called FEV1/FVC ratio). A low value indicates that you have narrowed airways which are typical in asthma (but a low value can occur in other conditions too). Therefore, spirometry may be repeated after treatment. An improvement in the value after treatment to open up the airways is typical of asthma. Note: spirometry may be normal in people with asthma who do not have any symptoms when the test is done. Remember, the symptoms of asthma typically come and go. Therefore, a normal result does not rule out asthma. But, if your symptoms suggest that you have asthma, ideally the test should be repeated when your symptoms are present.

Assessment with a peak flow meter

This is an alternative test. A peak flow meter is a small device that you blow into. It measures the speed of air that you can blow out of your lungs. No matter how strong you are, if your airways are narrowed, your peak flow reading will be lower than expected for your age, size, and sex. If you have untreated asthma, then you will normally have low and variable peak flow readings. Also, peak flow readings in the morning are usually lower than the evening if you have asthma. You may be asked to keep a diary over two weeks or so of peak flow readings. Typically, a person with asthma will usually have low and variable peak flow readings over several days. Peak flow readings improve when the narrowed airways are opened up with treatment. Regular peak flow readings can be used to help assess how well treatment is working.

Other tests

If the diagnosis remains in doubt then a specialist may perform further, more complex tests. But these are not needed in most cases.

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