Adult asthma explained
According to Asthma Australia, 1 in 9 Australians are affected by asthma, or 2.7 million people. In 2017-2018 there were 38,792 hospitalisations in which asthma was the main diagnosis.
Respiratory and sleep physician, Dr Barton Jennings runs a private practice called Lung and Sleep based at Bentleigh Specialist Centre and consults at Bayside Specialist Suites. He works with adult asthma sufferers. Here, he explains what asthma is, symptoms to look out for, how it’s diagnosed and the treatment options.
What is asthma?
Asthma is inflammation of the small airways in the lung. That inflammation causes two main problems. One is that the airway becomes narrowed and that tends to cause shortness of breath, tightness in the chest and wheeze. The other is mucous secretion into the airway which can cause cough and sputum production.
Asthma tends to be exacerbated by certain things, such as viral infections, allergens in the air (e.g. pollens) or smoke. These triggers can flare up the asthma and cause it to get worse, potentially resulting in an asthma attack.
There are genetic links – if your parents have asthma you’re more likely to have it yourself. There’s also environmental links. In Victoria, for example, some people who arrive here from other areas get asthma for the first time due to the weather and pollens.
Do many people develop adult asthma?
Yes, more so than was previously recognised. Sometimes kids may have asthma and they grow out of it, but during adulthood it comes back again. It might be that they’re exposed to a virus or pollen and that flares up their asthma.
Sometimes symptoms in childhood can be very subtle and they may have not been diagnosed with asthma. For others, they may just suddenly develop adult asthma.
Symptoms and when to see a doctor
If you have unexplained respiratory symptoms such as a cough, episodes of breathlessness, wheeze or tightness in the chest, you should see your GP. If the symptoms don’t get better with common treatments, that’s when you should consider seeing a specialist.
A specialist can confirm the diagnosis and what types of treatments may help control symptoms. A specialist can also determine whether there is something else that is contributing to your symptoms. Examples include problems with the upper airway, dysfunctional breathing, vocal cord dysfunction, sleep apnoea and sinus disease.
How is adult asthma diagnosed?
Asthma is diagnosed by taking history from patients, but the most important test to do is lung function testing (spirometry) in a respiratory lab.
Spirometry essentially involves the patient breathing forcefully into a machine to measure the force by which they can expel air from the lung. This gives us an idea as to whether the airways are narrowed, causing slowing down of expiratory airflow.
We then do the same manoeuvre after giving the patient Ventolin or bronchodilator. In patients with asthma, we would expect their airflows to improve because these treatments open up their inflamed airways.
What are the treatment options for adults with asthma?
The main treatment is inhaled corticosteroid taken through a puffer. That can sometimes be combined with a long-acting bronchodilator.
For patients with severe asthma or asthma which is inadequately controlled with inhaler therapy, there are some very good new treatments for asthma. They tend to come under the heading of biologic therapies.
Biologic therapies can only be prescribed by a specialist for people with severe asthma. By definition severe asthma is asthma which is not able to be optimally controlled despite a high dose of inhaled corticosteroid with long-acting beta agonist.
For patients who are on maximal inhaler therapy and are actually using it (non-compliance is a common problem), and who don’t have any other contributing factors as to why their asthma can’t be controlled, they often qualify for one of these biologic therapies.
In the past, patients in that cohort would end up on prednisone, an oral steroid, which has lots of side effects such as weight gain, increasing risk of diabetes and osteoporosis, among others. However, now with these new biologic treatments patients get such significant benefit and often no longer need the prednisone.
What’s the long-term outlook for sufferers?
It’s usually very good. Our goal for people with asthma is to return their lung function to normal and to control their symptoms so that they’re able to participate in activities of daily life, including work, exercise, sport, and get through the night without symptoms of cough, shortness of breath or wheeze.
We also want want to prevent patients from having exacerbations. If they have well-controlled asthma, meaning their lung function is normal and they’re not getting symptoms, that would suggest their airway inflammation is well-controlled. If they’re then exposed to a virus such as the common cold or to pollen then their airways should not fire up and cause an exacerbation or asthma attacks.
What’s an asthma action plan?
This outlines what the patient should take on a day-to-day basis when they’re feeling well. It also explains what to do if they experience the symptoms of asthma, such as increasing their medication or taking Ventolin, a short-acting bronchodilator.
Lastly, the asthma action plan outlines what to do if things are not improving and they’re likely to have an exacerbation.
Like to make an appointment?
For a referral to Dr Jennings, please book in with your GP at Bayside Family Medical. Call (03) 9583 1630 or book online.
Alternatively, to make an appointment directly at Bayside Specialist Suites, call (03) 9599 8220.
About Dr Barton Jennings