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How inhalers could make your asthma BAD and why they may obscure an equally serious condition

  Felicity Payne from Eastbourne, East Sussex, was constantly exhausted and thought she had Ashtma.

Felicity Payne from Eastbourne, East Sussex was constantly exhausted and believed she suffered from Ashtma

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

So the Former Teacher In her late 50s, she was prescribed a steroid inhaler that was to be used twice a day, and another medication to expand the airway when and whenever he needed it.

However, more than a year after being prescribed, Felicity's condition had deteriorated. She was often breathless and struggling to maintain her active lifestyle.

While the mother of three children, a widow from Eastbourne, East Sussex, was an avid walker who loved to chase after her five grandchildren, she was now exhausted all the time

She also had numerous breast infections that hit rock bottom for weeks.

And there was a reason: Felicity, now 62, had no asthma at all. In fact, she has had chronic obstructive pulmonary disease (COPD) ̵

1; a condition in which inhaled steroids are not only ineffective, but may even aggravate them.

It would take more than two years for your family doctor and their specialists to do the simple test with the correct diagnosis – and new research has shown that this is not uncommon.

In the UK, more than one million people are being treated for COPD, but some experts fear that thousands of those affected may be affected who have been falsely told that they have another complaint, such as asthma.

In fact, a recent study by Imperial College London found that more than half of COPD patients were mistakenly told to have asthma and wait months. years to get a correct diagnosis.

COPD is a generic term for progressive lung diseases such as emphysema and chronic bronchitis. It is quite different from asthma, an allergic disease caused by allergen exposure.

Those affected by COPD have difficulty in getting air into their lungs and taking them out of their lungs because the air sacs and an inflamed, narrowed airway are damaged.

  But after more than a year using a steroid inhaler as prescribed, Felicity's condition had deteriorated. She was often breathless and struggling to maintain her active lifestyle. And there was a reason: Felicity had no asthma, she had chronic obstructive pulmonary disease

But after over a year of using a steroid inhaler as prescribed, Felicity's condition had worsened. She was often breathless and struggling to maintain her active lifestyle. And there was a reason: Felicity had no asthma, she had a chronic obstructive pulmonary disease

One of the first signs is a cough that causes shortness of breath and shortness of breath. This is because the walls of the airways thicken over several years and produce excessive mucus, which worsens the symptoms and increases the risk of infection.

Air pollution and genetics are involved, but smoking accounts for 90 percent of all cases. And that's a problem.

Experts say there is a common misconception among GPs that COPD only affects smokers or those who have quit in the last few years.

In fact, a significant portion – such as Felicity, who stopped smoking in the 1980s – stopped smoking 20 or 30 years before the onset of symptoms. At least one in 20 years has never smoked.

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

"One of the problems is that even ex-smokers can get respiratory distress, which is a symptom. But if you tell your family doctor that you do not smoke, the family doctor is much less likely to consider COPD and much more likely to diagnose asthma. "

Dr. Jennifer Quint, respiratory specialist at Imperial College London, says many of her patients stopped smoking decades ago.

"COPD just is not on the doctors radar," she says. "But this disease can literally punch huge holes in your lungs."

It can be diagnosed with a test that is readily available to all general practitioners, spirometry. It is measured with a mouthpiece, how much air exhales a patient and how fast he blows it out.

The secret, to distinguish it from asthma, is to make patients inhale with an asthma inhaler to widen the airways. Repeat the test.

In asthma, the drug should lift the inflammation – so the air can flow freely. In the COPD, the damage is irreversible, so there will be more and more obstacles.

Professor Barnes, who also works as a consultant for respiratory medicine at the Royal Brompton Hospital in London, says that both current and former smokers – even those who have been stopping for decades – should be tested for chronic obstructive pulmonary disease if they have persistent cough or shortness of breath. "Smoking seems to trigger this slow inflammatory process, which continues after quitting," he says.

Added value: Should our foods be fortified with vitamins and minerals?

This Week: White Flour

Since the Second World War, white flour in the UK has had to use calcium, iron, niacin (vitamin B3, which helps repair our DNA) and thiamine (vitamin B1, which our body uses to make it) Glucose metabolism needed) are enriched.

  White flour has been fortified in the UK with vitamins.

White flour has been fortified in the UK with vitamins.

The idea was to increase the nutritional value of flour at a time when many people were on short rations.

The government has recently decided to make this fortress compulsory. "It turned out that there are still advantages, especially for disadvantaged groups such as older people," says dietician Ursula Arens.

The limits are set in such a way that it would be difficult to overdose by eating baked goods.

THE DOWNSIDE: "Cumulatively, you could surpass the recommended levels, especially if you were high-dose too," says nutritionist Frankie Phillips. For example, those who consume more than 20 mg of iron per day and consume plenty of white flour products may experience nausea and vomiting.

Professor Barnes is worried that undiagnosed patients will miss intervention if, if started early enough, can help manage the condition. An asthma misdiagnosis can also lead to the wrong treatment and increase the risk of life-threatening infections.

Asthma patients routinely receive inhaled steroids, which are inefficient for most COPD patients. In the worst case, they can be dangerous because the drugs suppress the body's immune system to reduce the swelling in the airways, which makes it easier for bacteria to enter the lungs. Patients who have been falsely identified as asthmatics are therefore prone to frequent breast infections.

The disease is resistant to steroids because inflammation is caused by a variety of cell types, explains Professor Barnes.

In asthma, this is mainly due to eosinophils being white blood cells that produces the immune system as part of an allergic reaction.

In COPD, lungs in the lung are due to neutrophils, another type of white blood cells that fight infection. Inhaled steroids can calm inflammations caused by eosinophils, but are largely ineffective against neutrophils. Although incurable, COPD can be treated well with pulmonary rehabilitation. Regular exercise (such as walking, jogging, jumping, rowing, and swimming) slows lung damage.

"The sooner it starts, the greater the benefit," adds Dr. Quint, who was involved in recent research. 19659005] By Dr. med. Quint are patients who have been identified early, started lung rehabilitation, and are able to "cycle for 20 minutes" despite advanced lung disease.

Other patients who received a late diagnosis are tied to the house and rely on portable oxygen cylinders. [19659005] Felicity is grateful that she was diagnosed before she reached this stage, but she wondered why it took so long.

Her doctor diagnosed asthma when she was almost 58 years old and complained of the sudden loss of her husband David to cancer. However, asthma almost always develops during childhood or adulthood. COPD, on the other hand, rarely occurs in people under the age of 35 years.

There were other important signs that she had no asthma.

People with chronic obstructive pulmonary disease suffer from a chronic cough around the clock, which produces a lot of mucus – as Felicity did. Asthma causes more nocturnal wheezing, which disturbs sleep. And the inhaled steroid beclomethasone and an inhaler of the drug salbutamol – which was given to dilate the airways – could not help her.

A spirometry test could have been the last piece in the jigsaw In response to the steroids, Felicity's family doctor instructed her for a chest x-ray that revealed a suspicious shadow that, as she was warned, might be lung cancer.

"I was scared," says Felicity.

September 2015 She saw a specialist at the Eastbourne General Hospital who was eliminating cancer.

"It was a tremendous relief," says Felicity. Nevertheless, she coughed and was breathless. She was referred to a throat, nose and throat specialist to see if her cough was due to a dripping nose drop – where excessive mucus runs from the nose to the throat causing irritation. But the doctors found nothing.

It was only after her fourth breast infection in a year and no improvement in her asthma symptoms that she was eventually referred back to a respiratory specialist who performed a spirometry test.

Felicity has given up taking inhaled steroids and has had no breast infection for more than two years; she copes with her condition with a bronchodilator inhaler when she becomes breathless.

"I try not to let my illness stop me from doing what I do," she says. "I started yoga three times a week and swam. I intend to enjoy life as much as possible. "

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