As a GP if somebody comes to you presenting symptoms of asthma what is your course of action, what would you do?

Right. I mean first of all one has to make a proper diagnosis if someone has some symptoms of asthma. So the symptoms may be of feeling tight-chested. There may be shortness of breath. They may be coughing a lot at night time. So theres quite a lot of questions to ask at this point, you know, about what exactly the symptoms are they have been experiencing and particularly about any triggers they may have noticed. Does it come on when they go out in the cold? Is it exercise related? Are there particular things that seem to spark it off? You might also want to find out about whether there is any family history of asthma because it does rather run in families.

Having taken those details and probably had a listen also to the chest to see if there is anything else obvious going on. You’d probably want to do what’s called a peak flow measurement and that’s when you get the patient to blow into a tube as hard and fast as they can and that tells you how much air you can move from the lungs at the time. And if the airways are narrowed your peak flow is reduced.

Now the key feature of asthma is that it’s variable. Sometimes though the airways are narrowed and sometimes they are back to normal and that’s really what you are trying to find out when you are making a diagnosis. Is there this variability? So you would often ask the patient to take away a Peak Flow Meter with them and do some measurements at home at different times of the day. And also before and after using some treatment because if you do think it is asthma it’s a good idea to actually start some treatment there and then which will probably be a Ventolin inhaler, this is salbutamol and it’s a medicine that relaxes the muscles around the airways and helps them to open up. And what we classically see if someone has filled in what’s called a Peak Flow Diary is that sometimes they are achieving much higher peak flows than at others and that the Ventolin will help the airflow.

The first line medicine for asthma is inhaled salbutamol. So salbutamol is a chemical that helps to open up the airways, to relax the muscles that can make the airways be narrow. So this is breathed in into the lungs and it helps you, helps relax the airways. Some people only need to have this. It’s called salbutamol. It’s also known as Ventolin or the blue inhaler. And people take this when they are wheezy and it has an effect within about 15 or 20 minutes. And some people also take it if they are about to do something they know will make them wheezy so before they exercise for example.

Now if you only very, very occasionally get wheezy so less than two times a week in the day time or less than once a week at night then you probably only need a blue inhaler but if you’ve had more severe asthma in the last couple of years or if you are finding you need your blue inhaler frequently then it is suggested you should also have a preventer. So this is inhaled corticosteroids, the brown inhaler. The most common one until recently was something called, Becotide. The most common one in the UK now is Clenil (Clenil Modulite) but the names change quite frequently. This inhaler is not used as and when, it is used regularly every day in the morning and in the evening and it stabilises the airways. It stops them being reactive. It stops them tightening up when you meet a trigger for your asthma. And for most people they will have this pattern of having their preventer morning and night and their treatment inhaler when they need it.

There are other sorts of inhalers as well. There are long-acting treatment ones that get taken twice a day and there are also combination inhalers which are usually combination of the steroids and the long-acting treatment and that’s quite useful because it means you only have to have one inhaler a day. When people have much more severe asthma, when they have an exacerbation sometimes they have to have added in treatments particularly tablets and steroid tablets usually in the form of prednisolone are used when people have a severe attack.