What GPs will ask when diagnosing asthma
When a second opinion is required
Medical treatment
Managing asthma
Complementary therapies
Dealing with asthma during pregnancy
What GPs should do
Medicine during pregnancy, labour and breastfeeding
Questions to ask your GP or asthma nurse
What GPs will ask when diagnosing asthma
When you go to your doctor's surgery he or she will ask questions about symptoms - for example whether you constantly suffer from wheezing, shortness of breath, a tight feeling in the chest or coughing.
They will also ask whether you have a personal or family history of asthma or hay fever, or a history of worsening symptoms following the use of aspirin, beta blockers or glaucoma drops. Other areas that will be covered include any allergies you may have, your exercise regime - exercise can trigger Asthma - and if there is any particular pattern of illness and under what circumstances it appears.
In addition to asking questions, the GP will also want you to have tests to see if you have asthma or not. These may include:
- Taking a measurement of breathing using a peak flow meter. This is a simple, non-electronic machine and you will be asked to keep a record of the results. The time you will need to keep this record will vary. But it is important to learn how to use the machine properly as otherwise the treatment you get may be wrong.
- Measurements depend on age, height, gender and ethnic group. Variations are interesting to your GP so note them and the circumstances that led to any change.
- Measuring your breath using a spirometer in the surgery
- A trial on various different medications
- A chest X-ray
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When a second opinion is required
Many people with the symptoms outlined at the start of this section will have asthma. However, others will not, so your GP may well send you to a specialist for further investigation or an opinion if:
- the diagnosis is not clear
- something unexpected is found
- your tests indicate you may not have asthma
- you might have occupational (work-related) asthma
- you are always short of breath
- you have a wheeze all the time
- you are suffering from chest pain a lot
- you have lost weight without trying to
- you cannot get rid of your cough
- you have had pneumonia and it is hanging around
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Medical treatment
If you are diagnosed with asthma, you will usually be treated with one or more of three or four types of drugs. Treatment with these drugs aims to control symptoms, prevent deteriorations or attacks, and achieve your best possible lung function whilst minimising any potential side effects the drugs may have. Most drugs are given by inhalers. The best inhaler for you is the one you use best after a full explanation and demonstration by your doctor, practice nurse or pharmacist. If you cannot use a device you should ask your GP or practice nurse for an alternative.
Almost all people require an inhaler containing a short-acting beta-2 agonist. Although this might sound complicated these drugs act rapidly to open up narrowed bronchial tubes or airways in asthma, but their effect lasts only four to six hours.
Most people, probably four out of five, also require treatment with inhaled steroids. These are called preventers because they not only treat the inflammation, which narrows the airways in asthma, but also prevent that inflammation occurring in the first place. This is the reason why preventers must be continued, even when you are feeling well. The dose will need adjusting depending upon your asthma control.
Some people need regular inhaled long-acting beta-2 agonists in addition to regular inhaled steroids (and these can be combined in a single inhaler for convenience) and, as necessary, use of short-acting beta-2 agonist. A few people need high dose inhaled steroids, additional therapies beyond the scope of this page or steroid tablets.
Many people worry that, if they take steroids, there will be side effects. Inhaled steroids have few side effects because the amount absorbed into the body is very low indeed. Even so, to minimise this, the British Guideline recommends increasing the amount of steroids only if control remains poor. It also sets out the maximum amount required. Do talk this through with your GP or asthma nurse and get them to explain in detail how things work.
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Managing asthma
For most people with asthma, the guidelines recommend self-management of asthma within an individual written action plan. This should be linked in with what guidelines say and reviewed regularly.
The British Guideline advises doctors to provide simple verbal and written instructions and information on treatment for people with asthma and their carers. It is important that you stick to the action plan you agree with your doctor, otherwise there is a real danger that your asthma will get worse.
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Complementary therapies
Whilst there is little conclusive research to prove that complementary therapies can cause or improve asthma, many people with the condition have found a variety of treatments beneficial.
These include traditional Chinese herbal medicine, where studies found that, in nine out of 17 trials, some improvements in lung function were seen. Another complementary therapy is acupuncture. Although some studies showed some benefit, though less than taking inhaled bronchodilators or cromones, overall there was no evidence of a clinically-valuable benefit from acupuncture.
At home, many people with asthma use air ionisers. Although there is no evidence to suggest they relieve the condition, they do reduce house dust mite allergen levels. One study raised concerns about a link between air ionisers and increased coughing at night. Indeed, the British Guideline discourages the use of ionisers. It also recommends that large studies on homeopathic remedies and hypnosis need to be done before their worth can be assessed. Massage, yoga, Buteyko and other breathing exercises have not had enough research carried out to assess possible benefits. Physical exercise can help as part of a general regimen to improve lifestyle, but people must be cautious of exercise-induced asthma. Finally, counselling did have some success working alongside medication in children.
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Asthma during pregnancy
Being told you have any lung condition, including asthma, is stressful for anyone. This is especially true when you are pregnant. Pregnancy can affect the course of asthma. It varies in each person but in general studies show that asthma worsens during pregnancy in a third of women and that it may well remain the same in each pregnancy. It is difficult to predict, though, who will get better, who will get worse or who will stay the same.
What GPs should do
- Offer pre-pregnancy counselling to women with asthma on the importance and safety of asthma medication during pregnancy
- Monitor pregnant women with asthma closely so that any change in symptoms can be matched with a change in treatment
- Advise women who smoke about the risks involved for mother and baby and help them stop
- Give you the same drug therapy as normal
- In the rare instance of a very severe attack, ensure you get enough oxygen to keep you and your baby well
- Ensure your obstetrician and respiratory consultant liaise about your health
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Medicine during pregnancy, labour and breastfeeding
The British Guideline states that: 'in general the medicines used to treat asthma are safe in pregnancy. The harm from severe or under-treated asthma outweighs any small risk from the medication you use for your asthma.' (British Guideline on the Management of Asthma: A national clinical guideline; British Thoracic Society/Scottish Intercollegiate Guideline Network. Thorax, February 2003 vol. 58 supplement 1, p50. Reproduced by kind permission of BMJ Publishing Group Ltd).
Acute asthma attacks are very rare in labour. All forms of pain relief known for labour are safe for asthmatics and new mothers should continue their usual medication.
Delivery by Caesarean section may be offered to pregnant women with acute severe asthma. If an anaesthetic is needed it is better to have a local one than a general one.
If you are on steroid tablets at more than 7.5 micrograms per day for over two weeks before delivery then doctors should give 100mg intravenous or intra-muscular hydrocortisone every six to eight hours during labour. Prostaglandin F2a should not be given because of risks of inducing an asthma attack.
Breastfeeding reduces the risk of your child becoming asthmatic. All the medicines used for treating asthma including steroid tablets are safe for nursing mothers. Less than 1% of theophylline goes through to breast milk.
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Questions to ask your GP or asthma nurse
Many people with lung disease feel uneasy about asking their GP even basic questions about their condition. Some feel that the GP is too busy, others feel intimidated. There is no need to be. Do ask as many questions as you need, as often as you can, so that you feel comfortable. Some good questions for the GP include:
- How will my pregnancy affect my asthma?
- Will the effect be different at different stages of pregnancy?
- Will you be monitoring my asthma during my pregnancy?
- What, if any, complications may occur if I don't take my medication?
- What, if any, complications may occur if I take my medication? (Use the name of your own medication and check which type it is, i.e. beta-2 agonist, inhaled steroids, oral and intravenous theophyllines, steroid tablets, leukotriene receptor antagonists, then look at the chart for individual problems)
- How will my baby get enough oxygen if I am always short of breath?
- Will this pregnancy affect my asthma in the same way as last time?
- What kind of labour should I plan to have?
- How will a general anaesthetic affect me?
- Should I have an epidural?
- I am on steroid tablets - how will this affect my labour? Should Itake some extra medicine before my labour?
- I have heard prostaglandin F2a is dangerous. What does it do?
- I want to breast feed my baby. Will my medication affect my baby?
- Will my baby have asthma because I do?
- Will my baby's immune system be affected by my medication?
Every person's condition is different, so there can be no general answer for everyone, but the more informed you are, the more comfortable you will feel.
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Medicine
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Comment
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Use
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Βeta-2 Agonists
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These are safe and so should be used as normal during pregnancy
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Continue use
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Inhaled steroids
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No adverse effects known. Help to decrease risk of acute asthma attack.
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Continue use
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Oral Theophylines
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No adverse effects known. Have levels monitored
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Probably lower usual dose
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Steroid tablets
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Balance of evidence shows steroid tablets do not affect the fetus. Extensive research has been done into possibility of fetus developing cleft palate/lip if steroids taken by tablet during first trimester. No evidence has been found to prove this.
The doctor will have to balance risk to pregnant woman with life threatening asthma attack and any possible association with oral clefts.
There is some evidence of a link between steroid tablets and pregnancy induced hypertension or pre-eclampsia and pre-term labour.
The doctors will use short courses of steroid tablets for severe asthmatic deteriorations during pregnancy.
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Leukotriene Receptor Antagonists
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Insufficient data known
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Do not start during pregnancy.
Continue during pregnancy if no other medication works effectively.
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Page last medically updated: February '05
