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Good evening! I’m Andy Whittamore. I have been a GP for 18 years. Soon after joining the practice I was asked to take responsibility for our respiratory clinics and soon realised there were some important improvements in what we should do. I soon got involved across my area and then nationally helping with guidelines, research, teaching and other things.
In 2016 I joined Asthma UK for a 1 year trial as their Clinical Lead…. It has now been 6 years helping support different parts of the organisation – website, helpline, media team, webinars and blogs, and policy team.
Bear with my slow typing tonight… though it should be easier to read than my doctor’s writing!!
Asthma is a condition that comes and goes. It depends on the inflammation in your airways and what triggers are around. That is why people with asthma have good days/weeks/months and bad days/weeks/months.
Normal asthma tests when you do not have asthma symptoms may still mean that you have asthma but it is ‘quiet’. It is really important to take into account your story as well as the tests. Your story is what symptoms you get and what sets them off/makes them better, and any risk factors for having asthma. We might also ask questions that help us rule in, or rule out other conditions that cause the same symptoms as asthma.
If we think that you have asthma but spirometry is normal then you may need other tests or having the spirometry repeated when you have symptoms.
Other tests include FeNO (measures inflammation in your airways) and peak flow (a less accurate measure of any narrowing in your airways but over at least a couple of weeks). For more information about diagnosing asthma have a look at asthma.org.uk/advice/diagno...
Dr Andy, we've had quite a few questions come in asking about neutrophilic asthma. Can you tell us a bit more about it? How its diagnosed and what treatments are available?
Everybody's asthma is different. It behaves differently and sometimes needs to be treated differently. For most people starting treatment with the usual inhalers (containing low-medium doses of steroid) will work but when they don't then we need to look in to why that is the case. For some people they need help to take their inhalers regularly and with the correct technique. Others have other conditions that make it worse (acid from the stomach, inflammation in the nose, anxiety, breathing pattern problems). If these are all sorted then as a GP i would refer them to a severe asthma clinic.
There are different types of severe asthma. There are some brilliant newish treatments called biologics for severe asthma caused by a blood cell called eosinophils. Other types of severe asthma are awaiting new research to move things forward!
Thanks Dr Andy, lacking eosinophils isn't as great as it's sometimes made out to be when you have severe asthma, I've found! Isn't there a new biologic coming soon that isn't just for eosinophilic/allergic asthma?
We are aware of one biologic that is hopefully going to go through NICE soon that may be useful for non-eosinophilic severe asthma. For those that don't know, NICE are the organisation that give the okay for new drugs to be used in the NHS.
Thanks Dr Andy. Apologies if I'm hogging the questions here but how do you find out if asthma is neutrophilic? Are blood tests helpful for working out if neutrophils are the main issue (like with eosinophils), or is a different method better?
Testing the sputum is important here. This needs to be carried out in the hospital clinic because they need to check the sputum in a special way and quite quickly.
Neutrophilic asthma happens when asthma is being set off by too many blood cells called neutrophils. If you are in a severe asthma clinic your team will try to find out what type of asthma you have. We are hopeful of some new treatments just around the corner but in the meantime your specialist will have a few options that might help. Have a look at our severe asthma page for more asthma.org.uk/advice/severe...
That's a really important question.... our helpline team get a LOT of calls about this.
Asthma is caused by inflammation and narrowing of the airways. These cause coughing, shortness of breath and wheezing. Looking for a wheeze is an important part of diagnosing asthma (along with your story, risk factors, tests and sometimes how your respond to treatments). However, not everyone does wheeze and it is important to highlight this to your doctor/nurse.... peak flow, FeNO can help to prove what is going on in your lungs.
In the end it comes back to the story.... is there a pattern of chest symptoms coming and going, worse with certain triggers and better with certain treatments!!
Mandevilla My asthma is very much weather-related, and I find that I can go from not needing my blue inhaler at all for weeks to suddenly needing it multiple times a day, just because the weather has decided to go from frosty to foggy or dry to misty rain overnight. My GP doubled my maintenance inhaler last winter to try to even things out, but it doesn't really help. Because on the good days, I don't need that much and on the bad days, it's not enough.
A lot of people find that their asthma changes according to the weather, or season. It may be the damp, cold or things in the air (pollens, moulds) that are setting you off. We are increasingly finding that people need different doses of treatment at different times because of these changes.
I would go back to basics first:
make sure you are taking your preventer every single day, even when you are well
Make sure you have had a full asthma review and got an updated asthma action plan.
If these are all done then speak to your GP about different treatments - you may need a higher dose inhaler well before your bad symptoms - the inflammation builds over time and can take weeks to get under control. Other treatments might help too - eg montelukast asthma.org.uk/advice/inhale...
A newer way of managing asthma is with a variable dose of preventer.... with only one inhaler as preventer and a reliever. This means you automatically increase your preventer when you get symptoms... for more see asthma.org.uk/advice/inhale...
Montelukast is a really important option for some people. It seems to be really good for people who have allergic symptoms (especially involving the nose) and exercise symptoms. Children seem to respond really well too. As it is a tablet it is easier to take than inhalers (and there is no issue with incorrect technique).
There are reports of it affecting people's mental health. Some people find it interferes with sleep and/or mood but this is unusual and goes back to normal when stopped. I always warn people who have a history of mental illness just so they are prepared. I also always tell parents of children starting montelukast so they can look out for behaviour changes.... which again are unlikely but important to know about.
Lenathesinger asks: whether it can cause any harm to my lungs by continuing with Ventolin and not using a combined inhaler, as my asthma nurse urges me to do? I appreciate that it might work with many people but I have a bad reaction to the steroids they contain. Many thanks.
Hi Lena. Some people do have concerns about steroids, which have got a bad press over the years with bodybuilders and stuff.... however, the dose of steroid in inhalers is very very low and if taken correctly will work in your lungs and not cause side effects. Depending on the side effects i will work with my patients to make sure they are taking the inhaler correctly (with a spacer if a metered-dose / gas inhaler). More info on steroids here asthma.org.uk/advice/inhale...
There are some steroid inhalers which may be even better in your case. Speak to your GP or asthma nurse about ciclesonide which i have found has helped a patient of mine who was getting voice issues despite excellent inhaler technique.
You can use your blue inhaler regularly BUT needing it is a signal that there is untreated inflammation in your airways. This increases your chances of having a flare up (needing steroid tablets!!) or asthma attack. We also know that regularly overusing your blue inhaler can make the blue inhaler less effective.... if you are needing the blue inhaler 3 or more times per week you should have better preventer medication to help you out
Anon asks: When should I take my blue inhaler? Is it just for emergencies or do I take it when I have symptoms? What happens if I take it more than 4 times a day?
Your blue inhaler is there for whenever you have asthma symptoms. You can use it as often as you need to but it should last 4hours. If it doesn't, and you still have symptoms then you should seek help.
If you are using your blue inhaler 3 or more times per week it suggests that you have untreated inflammation in your airways and need to start, or have better preventer medication to help dampen down that inflammation.
Using your blue inhaler 4 times per day will not cause you problems but does suggest that you need an asthma review and a check of your medicines.
Having an asthma action plan can help you to know what to do if your symptoms increase...
This "Ask Me Anything" with Dr Andy is now closed. We have locked the thread, so that no more questions can be posted in the thread. However, we will keep the post on the community so that you can see all of the questions and answers. Any questions that Dr Andy didn't get to respond to in this live hour we will try to post over the next week or so....
Thank you Dr Andy for your time and energy answering these questions! And thank you to all those who submitted questions!
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