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How inhalers could make your asthma work and why they may also be serious



 Felicity Payne from Eastbourne, East Sussex, found herself constantly exhausted and thought she had ashma

Felicity Payne from Eastbourne, East Sussex , found herself constantly exhausted and thought she had ashma

As far as Felicity Payne's GP was concerned, the annoying cough she had for months was a sign that she was suffering from asthma.

So the former teacher, who was in her late 50s, was a steroid inhaler to use twice daily and another drug to dilate her when and when she needed it. Felicity's condition had worsened after more than a year of using them as prescribed. She was frequently breathless and struggling to maintain her active lifestyle.

previously the mother of three, a widow from Eastbourne, East Sussex, had been a no-walker who enjoyed running around after her five grandchildren, now she found herself constantly exhausted

She also had numerous chest infections that lay here low for weeks on end.

And there was a reason for that: Felicity, now 62, didn't have asthma at all. In fact, they had chronic obstructive pulmonary disease (COPD) ̵

1; a condition for which inhaled steroids are just ineffective, they can make it worse.

It would take more than two years to ing and fro between them here GP and specialists before anyone would think to run the simple test that gave the correct diagnosis – and new research has found this is not uncommon.

More than a million people in the UK are being treated for COPD, but some experts fear

Indeed, a new study from Imperial College London has found that more than half of COPD patients are mistakenly deemed to have asthma and wait months, COPD is an umbrella term for progressive lung disease such as emphysema and chronic bronchitis. It is quite different from asthma, which is an allergic condition triggered by exposure to allergens.

Those affected by COPD struggle to get into air and out of their lung, due to damage to the air sac and an inflamed, narrowed airway.

 Felicity's condition had worsened after more than a year of using a steroid inhaler as prescribed. She was frequently breathless and struggling to maintain her active lifestyle. And there was a reason: Felicity didn't have asthma, she had chronic obstructive pulmonary disease. But after more than a year of using a steroid inhaler as prescribed, Felicity's condition had worsened. She was frequently breathless and struggling to maintain her active lifestyle. And there was a reason: Felicity didn't have asthma, she had chronic obstructive pulmonary disease. But after more than a year of using a steroid inhaler as prescribed, Felicity's condition had worsened. She was frequently breathless and struggling to maintain her active lifestyle. And there was a reason: Felicity didn't have asthma, she had chronic obstructive pulmonary disease. </p>
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<p class= One of the first signs is a cough, which leads to breathlessness and wheezing. This is because over several years the walls of the airway are thickened and excess mucus is produced, which have been implicated, but smoking is responsible for 90 per cent of cases. And there lies a problem

Experts say there is a common misconception among family doctors that COPD affects only smokers, or those who have quit within the past couple of years. In fact, a significant proportion – such as Felicity , who quit cigarettes in the Eighties – stopped smoking 20 or 30 years before symptoms emerged. And at least one in 20 has never smoked at all.

'This is a big problem,' says Peter Barnes, a professor of medicine at the National Heart and Lung Institute. GPs are very good at diagnosing asthma, but not so good at diagnosing COPD.

'One of the problems is that even ex-smokers can get short of breath, which is a symptom. But when they tell their GP that they don't smoke, the GP is, much less inclined to consider COPD and much more likely to diagnose asthma. '

Dr. Jennifer Quint, a respiratory disease specialist at Imperial College London, says many of her patients are smoking decades before they were diagnosed. "COPD is just not a doctor's radar," she says. 'Yet this illness can literally blow huge holes in your lung.'

It can be diagnosed with a test that is readily available to all GPs, called spirometry. This is a hand-held mouthpiece to measure how much air and patient breathes out and how fast they blow it out. [Asthmaisgettingpatientstotakeapuffonanasthmainhalertodilatetheairwaybeforerepeatingthetest

In asthma, the drug should reverse the inflammation – so the air flows freely. In COPD, the damage is irreversible, so there will always be greater obstruction. Professor Barnes, who is also a consultant in respiratory medicine at the Royal Brompton Hospital in London, says both current and form smokers – even those who quit decades ago – should be tested for chronic obstructive pulmonary disease if they have a persistent cough or breathlessness. 'Smoking seems to set off this slow inflammatory process that keeps progressing even when you've quit,' he says.

Added value: Should this be fortified with vitamins and minerals?

This week: White flour

Since World War II, white flour in the UK has been fortified with calcium, iron, niacin (vitamin B3, which helps repair our DNA) and thiamine (vitamin B1, which our bodies need to metabolize glucose).

 White flour has been fortified in the UK with vitamins

White flour has been fortified in the UK with vitamins

The idea was to boost flour's nutritional value at a time when many people were on short rations.

The government recently decided to keep this fortification mandatory. 'It saw that there were still benefits to be had, particularly among vulnerable groups such as older people, says dietitian Ursula Arens.

The limits are set so that it would be difficult to overdose by eating baked goods.

THE DOWNSIDE: 'Cumulatively, you could exceed recommended amounts, especially if you take high-dose supplements, too, says dietitian Frankie Phillips. So those taking supplements of more than 20mg a day of iron, for example, who have eaten lots of white flour-based products may experience nausea and vomiting.

Professor Barnes is concerned that undiagnosed patients are missing out on interventions that, if Started early enough, can help manage the condition. Also, asthma misdiagnosis may lead to the wrong treatment, including the risk of life-threatening infections. Asthma patients are routinely given inhaled steroids, which are usually ineffective for most COPD sufferers. At worst they can be dangerous, as the drugs suppress the body's immune system – to help reduce swelling in the airway – which makes it easier for bacteria to penetrate the lung.

The condition is resistant to steroids because the inflammation is caused by different types of cells, explains Professor Barnes.

An asthma, it is mainly due to eosinophils, white blood cells produced by the immune system as part of an allergic response [16659005] In COPD, swelling in the lung is due to neutrophils, a different type of white blood cell that fights infection. Inhaled steroids are good at calming inflammation caused by eosinophils but largely ineffective against neutrophils. Although incurable, COPD may be well managed with pulmonary rehabilitation; Regular exercise (such as walking, jogging, skipping, rowing and swimming) slow the damage to the lungs.

'The earlier the beginning, the greater the benefits,' adds Dr Quint, who was involved in the recent research. 19659005] Dr Quint has patients who were identified early, started pulmonary rehabilitation and, despite suffering from advanced lung disease, can cycle for 20 minutes.

Others who received a late diagnosis are housebound and rely on portable oxygen cylinders. ] Felicity is thankful she was diagnosed before reaching that stage, but it took so long

Her GP diagnosed asthma when she was almost 58 and grieving the sudden loss of her husband, David, to cancer. Yet asthma almost always develops in childhood or young adulthood. COPD, on the other hand, rarely occurs in those under 35.

There are other key signs that she did not have asthma.

People with chronic obstructive pulmonary disease suffer from round-the-clock with a chronic cough that produces a lot of phlegm – as Felicity did. Asthma is more likely to be dragging to cause night-time wheeziness that disturbs. And the inhaled steroid beclomethasone, plus an inhaler of the drug salbutamol – given to dilate the airway – failed to help her.

A spirometry test could have been the final piece in the jigsaw. Respond to the steroids, Felicity's GP referred to a chest X-ray that revealed a suspicious shadow which, she was warned, could lung cancer.

'I was terrified,' says Felicity.

In September 2015, She saw a specialist at Eastbourne General Hospital who ruled out cancer. "It was an enormous relief," says Felicity. Yet she was still coughing and breathless. She was referred to an ear, nose and throat specialist to see if her cough was due to post-nasal drip – where excessive mucus runs from the nose into the throat, causing irritation. But doctors found nothing.

It was only after her fourth chest infection in a year and no improvement in her asthma symptoms that she was finally referred to as a respiratory specialist who carried out a spirometry test.

Felicity has now stopped taking inhaled steroids and has had a chest infection for more than two years, managing her condition with exercise and a bronchodilator inhaler if she gets breathless.

'I try not to let my illness stop me from doing the things I like, 'she says. 'I have taken yoga and swim three times a week. I plan to enjoy life as much as I can. '


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