People with asthma tend to notice breathlessness as the main issue, which is often associated with chest tightness and wheeziness. Sometimes it can also be associated with a cough as well. I tend to diagnose asthma for the first time in younger patients – it’s rare for me to be diagnosing asthma for the first time in people in their 60s or 70s.
Usually there’s some history of asthma in childhood which people initially appear to grow out of. Often there’s a history of other allergic illnesses like hayfever and eczema as well. It might be that asthma’s been triggered on this occasion because of a change in job or a change in home circumstances, such as getting a new pet, which has led to an allergic-type reaction.
Asthma is usually well managed by GPs, so patients who come to me are often already on treatment. I’m often asked to confirm the diagnosis and optimise the treatment in more difficult cases. Occasionally, people come without a diagnosis and we make the diagnosis of asthma based on history and breathing tests such as peak flow and spirometry tests. Then it’s a case of optimising the treatment, which tends to be inhalers.
When you arrive, I’ll talk to you about your medical history and gather all the information I can. Childhood and family history can be very relevant as it can make a difference as to whether the diagnosis is likely to be asthma or not.
We’ll go through what brought you to me. Is there a new diagnosis of asthma or have you been treated for it for two or three years but don’t feel in control of it? Then, we’ll discuss any other medical problems to make sure nothing else is going on that might be contributing to your symptoms or whether there might be an alternative diagnosis.
The next steps depend on what tests have been done before you came to Circle. If you’ve had a very secure diagnosis, I might not do that many tests. You may not necessarily need a chest x-ray, a CT scan or a breathing test, for example. In that case it might be a question of simply altering your treatment and bringing you back a few weeks later to check that it’s worked.
If it’s not a secure diagnosis or it’s a new one, I may send you for breathing tests. The key test we do is spirometry where you breathe into a tube to help measure your lung capacity. We might also do allergy testing to see if anything specific is triggering your symptoms.
Another test I perform is a FeNO test, which measures exhaled nitric oxide in your breath. If nitric oxide levels are elevated it suggests that any asthma present is not well controlled. I’ll often do a FeNO test to get a feel for whether I need to increase treatment or to decide I’m happy to leave things unchanged.
The tests are all done at a separate appointment at the RUH. Usually, I’ll alter your treatment while you’re awaiting tests and bring you back in six weeks to go through all the results with you.
The main treatments are inhaler-based, although occasionally I might also prescribe a short course of oral steroids to reduce inflammation in the airways.
There are a variety of inhalers available with varying drugs and strengths – up to three different class of drugs are available through many different devices.
If your symptoms fail to settle with inhalers alone I may also try tablets. Very occasionally I come across patients who have very serious asthma and are in and out of hospital. If you’re one of them, I may need to do some tests and then consider sending you to a specialist centre to access newer treatments that have come out recently. There are now more ways of getting on top of asthma than there were even five or ten years ago.
Occasionally, there are some patients whose asthma is not severe but, because of a few bad experiences, have impacted significantly on quality of life. In these cases, a more non-medicinal approach, involving a physiotherapist can be helpful.