Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. If you have asthma your airways are almost always sensitive and inflamed. When you come in to contact with something that you are allergic to, or something that irritates your airways (a trigger), your airways react by constricting due to the muscles around the walls of your airways tightening and thereby becoming narrower, making it harder to breathe. The lining of the airways becomes inflamed due to an auto-immune allergic reaction. The outcome is swelling and often the production of sticky mucus or phlegm. This combination leads to the experience of asthma symptoms. Asthma tops the list of chronic respiratory diseases found in children in Western societies today. Over 5.1 million people in the UK have asthma – that's around 1 in 13 adults.

A 1997 study published in Science reported that “the prevalence of asthma in westernized societies has risen steadily this century, doubling in the last 20 years. Asthma now affects one child in seven in Great Britain, and in the United States it causes one-third of paediatric emergency room visits.” Another study found that between 1964 and 1980, asthma in children aged six to 11 years increased 50 per cent. In 1995, the CDC reported that, between 1982 and 1992, asthma increased 52 per cent for persons between the ages of five and 34 years old, and deaths from asthma increased 42 per cent. The 1978 Canada Health Survey found that only 2.3 per cent of Canadians 15 years and over reported having asthma. By 1991, its prevalence was at 6 per cent. Now more than 1.5 million Canadians of all ages suffer from asthma. Asthma’s economic burden is formidable. Asthma costs UK £2 billion every year. In the U.S., the total cost of illness related to asthma in 1990 was estimated at $6.2 billion. According to Canada’s 1994 National Population Health Survey, the long-term disability costs associated with asthma, emphysema, and chronic bronchitis in 1993 totalled $1.8 billion, without counting costs associated with treating asthma in children under 11 years old. Although public health officials attribute the recorded increases in asthma to better case diagnoses, more air pollution indoors and outdoors, and smoking, some scientists find evidence that vaccination and lack of contagious infectious diseases in early childhood may later encourage the development of asthma and other allergic conditions.

In 1996, the British medical journal, The Lancet, published Danish and British findings concerning child health, lung function, and allergy. Noting that the incidence of early childhood diseases in Britain had fallen this century while those of allergic diseases such as asthma, hay fever, and eczema rose sharply, the researchers hypothesized that certain childhood infections, specifically measles, may protect against allergy. A European Commission survey has reported that 13% of people over 15 in the UK have had asthma at some point in their lives. National Asthma Campaign experts say this matches their own statistic, which puts the number of Britons diagnosed with the condition at eight million. The UK figure was the highest in the survey of 16 European Union member states, with runners-up Finland (11%) and Ireland (10.5%) not far behind. Lowest in the table were Germany, with less than 4% of the population saying they had asthma, and Spain, with a total of 4.4%. The survey was carried out in January and February 2003, with an average of 1,000 participants over the age of 15 in each country answering questionnaires about a range of health issues. Eight million people in the UK have been diagnosed with asthma at some point in their lives. More than five million people in the UK are receiving treatment for asthma, and it is the UK's most common long-term childhood illness: one in eight children are currently being treated for asthma symptoms.

The UK has the highest rate of severe wheeze in the world for children aged 13 to 14. Asthma has become more common over the last 30 years, but we still do not know why this is. Scientists believe there may be many contributory factors, which are a result of our changing lifestyles. For example, we are more likely to have centrally heated homes with fitted carpets and little ventilation; ideal conditions for the house-dust mite, a very common asthma trigger that lives in soft furnishings. Our diets now include fewer fresh foods, while some evidence suggests that eating plenty of fruit and vegetables can help to reduce asthma symptoms. It has also been suggested that our increasingly clean environment is to blame for the rise in asthma. The so-called 'hygiene hypothesis' is based on evidence that shows exposure to bacteria at an early age can help to build immunity against developing allergies and asthma later in life.

It is difficult to say for sure what causes asthma, but so far we know that:

• asthma can be inherited (like the related allergic conditions eczema and hay fever).

• many aspects of modern lifestyles – such as changes in housing and diet and a more hygienic environment
   – may have contributed to the rise in asthma over the last few decades.

• smoking during pregnancy increases the chance of a child developing asthma.

• environmental pollution can make asthma symptoms worse but has not been proven to actually cause asthma.

• late-onset asthma may develop after a viral infection.

• irritants found in the workplace may lead to a person developing asthma.

Asthma triggers?

An asthma trigger is anything that irritates your airways.
Everyone's asthma is different and you will probably find that you have several asthma triggers.

Common asthma triggers include:

• viral infections (colds or 'flu)

• allergies (eg to pollen, animals, house-dust mites)

• irritants (eg cold air, tobacco smoke, chemical fumes)

• exercise

Although it is unlikely that you will be able to avoid all your asthma triggers all of the time, steering clear of them when you can, will help to keep your symptoms at bay. Keeping a record of the times and situations when your asthma is worse will help you identify what your asthma triggers are. Exercise and asthma? If you are fit you are also less likely to be troubled by your asthma. Some people find that exercise triggers their asthma. However, if you take your preventer treatment regularly and keep your reliever inhaler to hand, there's no reason why you can't take part in exercise as much as everyone else.

Asthma treatments

Conventionally there are two main kinds of asthma treatment that your doctor may prescribe for you. They are called relievers and preventers. Relievers are treatments taken to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways (within 5-10 minutes), making it easier to breathe again. Reliever inhalers are usually blue. If you need to use your reliever inhaler more than once in any day, or more than 3-4 times a week, you will usually be prescribed a preventer treatment by your doctor to keep your asthma symptoms under control. This is because relievers do not reduce the inflammation and swelling in the airways. Preventers help to control swelling and inflammation in the airways. They also stop the airways from being so sensitive to asthma triggers. Preventer inhalers are usually brown, red or orange. Preventer treatments are designed to be taken regularly (as prescribed by your doctor).

Side effects

Sometimes, high doses of reliever treatment can slightly increase your heart beat or give you mild muscle shakes. These effects are harmless and generally wear off after a short period of time. It is not possible to overdose on reliever treatment. Preventer treatments usually contain corticosteroids. Using a preventer inhaler brings a small risk of a mouth infection called thrush and hoarseness of the voice. You can avoid this by using your inhaler before brushing your teeth and by rinsing out your mouth afterwards. Using a spacer or volumiser device will also reduce your chances of these side effects.

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See also: Wikipedia on Asthma / Asthma UK (Charity)

Hay fever

Dr Eccles discusses – What is Hay fever?

Hay fever is medically known as ‘seasonal allergic rhinitis’; it causes an inflammation and irritation in the delicate linings of the nasal passage, throat and eyes. Hay fever commonly appears around the age 11-12, the symptoms usually peak in the 20's and early 30's then gradually disappear. However, more and more people are beginning to experience hay fever for the first time in their 30's. Although we still use the term ‘hay fever’, in fact a fever is not a symptom of the disease, nor is it due to hay. There are two types of allergic rhinitis, seasonal allergic rhinitis and perennial allergic rhinitis. Seasonal rhinitis is when you only experience symptoms during the spring and summer pollen season.

When the majority of people say they have hay fever, it usually means seasonal allergic rhinitis. Perennial rhinitis is when you experience symptoms all year around. Perennial rhinitis is usually caused by indoor allergens, such as house dust mites, moulds and animal fur. The symptoms are similar to those of hay fever though you may feel like you have a permanent cold and suffer with a blocked nose and sore throat.

Hay Fever affects 15 - 20% of the population in the United Kingdom and is the most common of allergic conditions. Those who suffer from hay fever may also have symptoms of asthma. Hay fever is caused by an allergic reaction to the allergen pollen. Pollens that are light enough to be wind-borne are what cause the problem for most hay-fever sufferers. Heavier pollens that are carried from plant to plant by bees and by other insects can also be allergens, but they cause trouble only when a person comes into direct contact with the plant. Airborne pollens can penetrate anywhere, indoors and out, and are most numerous at the height of the pollinating season for the particular plant.

When pollen particles are breathed in the body's immune system overreacts, as it believes it to be a harmful substance. The body then produces an antibody, immunoglobulin E (IgE) to fight it off. The IgE antibody stimulates the release of certain chemicals, in particular histamine, to flush the pollen out of the airways. It is this process, which causes the many symptoms associated with hay fever. If you tend to suffer your hay fever symptoms in early spring then it is most likely an allergy to tree pollens, if you suffer more in the summer then it is more likely to be a grass pollen allergy.

Hay fever is the commonest form of allergy in the UK affecting up to 20% of the population of the UK, which would be up to 10 million sufferers. It is an allergy to pollen. Whilst grass pollen is the most common culprit for producing hay fever symptoms, tree pollen, flower pollen, and fungal spores (the fungus equivalent of pollen) can also produce the same symptoms in sensitive people. An estimated 26.1 million Americans have hay fever symptoms annually resulting in 10 million lost days of school or work each year. 14.6 million Americans have asthma, which can often accompany hay fever.

Symptoms of Hay Fever?

Sneezing that is repeated and prolonged is the most common feature in the hay fever sufferer. A stuffy and watery nose is also a main sign of hay fever. Other symptoms include redness, swelling and itching of the eyes; itching of the nose, throat and mouth and itching of the ears, or other ear problems. Breathing difficulties at night due to obstruction of the nose may interfere with sleep. These symptoms differ in degree according to the individual, ranging from mild to severe. When severe, they are very uncomfortable, make it difficult to carry out daily tasks, and may cause loss of time from work and school. Health complications from repeated hay fever attacks, year after year, may be an even more serious problem.

Chronic sinusitis -- inflammation of the sinus cavities -- is one of these problems. Another is nasal polyps, or growths. In addition, significant percentages of people with hay fever have or develop asthma.

The Seasons

For Hay Fever The "hay fever season" can be a different time of year for different people depending where in the world they live. In part, this is because trees, grasses, and weeds produce pollens during different seasons. In the last few years the weather in the United Kingdom has been much warmer than the long term average so the flowering times for many plants have altered. For example, Birch trees have flowered several weeks earlier in the last few years than they did several decades ago. Hay fever subsides with the onset of cold weather.

Spring - causes the release of tree pollens

Summer - brings grass pollens, and the peak in hay fever

Autumn - releases fungal spores and autumn flower pollens

In the USA:

For example, people in the eastern and Midwestern United States who are sensitive to tree pollen may suffer in the early spring when trees such as elm, maple, birch and poplar are producing pollen. People who are sensitive to pollens produced by grasses may suffer in the late spring, and early summer, the time when most grasses are pollinating. About half of all hay fever sufferers are sensitive to grass pollens. Weeds flourish in most parts of the country from midsummer to late fall. In the late fall, ragweed is the most common problem. In fact, ragweed is the plant that causes the most hay fever.
But an individual may react to one or more pollens in more than one of these groups, so the person's "season" may be from early spring to the first frost. For that matter, people who are sensitive to dust, to dog or cat dander (tiny scales or particles that fall off hair, feathers, or skin) or to some other airborne material that they cannot protect themselves from may suffer all year round. Mould and fungus spores ("seeds"), also airborne during the summer and fall months, cause reactions in many people. Frequently found around hay, straw, and dead leaves, their growth is encouraged by humid weather and by places with poor air circulation--damp basements for instance.
You can be sensitive to just one or two types of pollen, and so your pattern of symptoms may be different to someone else's. The exact timing of symptoms can also vary slightly from year to year, depending on how the weather effects pollen production. Also the warmer conditions in the south produce pollen earlier than in the north, but the general pattern is the same each year. Town and cities have different pollen mixtures to the countryside, depending on what plants grow locally.
Very high pollen counts can produce symptoms in some people who do not normally show hay fever symptoms, and so may only experience discomfort every few years.

Some people suffer all year round when they are allergic to things that are in the air all year.
There are two common causes of this:

House dust mite is a minute insect living in most of our homes, and feeding on dust (which consists mainly of human skin cells). Its droppings easily get into the air, and we breathe them in. Insects you can not see are easy to ignore!
Pet dust - in actual fact dead skin cells and hair particles from our beloved pets are dropping all around your house all the time.
Other causes of symptoms can be food allergy, either to a food or to a flavouring or colouring, alcohol, smoke, stress, some medicines or many other triggers.

Sensitivity and How It Works

"Sensitivity" is the term used to describe the process by which you develop an allergy. Sensitivity is established when the tissues that form antibodies (lymphoid tissues) are stimulated to make specialized antibodies to otherwise harmless pollens, spores, etc. These antibodies fix to other specialized cells throughout the body that contain powerful defensive substances such as histamine. When the individual next is exposed to the pollen (as in the nose, for instance), the antibodies trigger the cells to secrete their defensive substances. This in turn causes the dilation of blood vessels, increased secretions of fluids, swelling of tissues, itching, sneezing, and other reactions that add up to hay fever.

The inflammation and other symptoms -- while real enough -- actually are not of the same destructive nature as those carried by more serious diseases. Removing the cause of the reaction results in immediate relief.

Control HayFever

Avoiding the substance that causes a reaction is the best way to control hay fever. Moving to a different part of the country is sometimes suggested, but taking this drastic and expensive step may prove useless if the person has or develops sensitivity to a substance common in the new location.

Using air conditioning and air purifying devices may help cut down on suffering during the hay fever season, so that normal sleep and work are possible. Dust masks should be used during outdoor work if the work cannot be avoided.

Antihistamines - drugs that counteract the histamine released by the allergen-antibody reaction usually serve to give relief from some symptoms.

Decongestants may help, as well. However, they don't affect the underlying sensitivity. Each individual has to depend on his or her doctor to find out what drug or combination of drugs works best.

Over-the-counter nose sprays are usually of limited value and their prolonged use may actually cause symptoms or make them worse.

Inhaled steroids are often effective and may be prescribed by a doctor. Specific desensitizing injections can also be used.

What Causes Allergic Rhinitis?

Chemical substances, such as histamine, are normally stored in mast cells in tissues of the body, including the nose and eyes. The allergic person forms antibodies against pollens and other allergens. These antibodies attach themselves to the mast cells, and when combined with the allergen the result is the release of histamine and other chemical substances from the mast cells. These chemical substances cause the allergic responses of itching, sneezing, congestion, and dripping.

Hay Fever Treatment:

Avoidance is the best treatment for any allergy whenever possible. Keeping doors and windows closed in the home and in your car and avoiding vigorous outside activity will help to lessen your exposure during times when the pollen count is high. Removing pets from the home and dust and mould control measures can significantly relieve symptoms due to perennial allergens. Antihistamines may relieve many hay fever symptoms by inhibiting the action of histamine on nasal and eye tissues. When a person first starts to take these medications they often cause drowsiness, but this usually goes away after a day or two of taking antihistamines on a regular basis.

Be careful not to drive or operate dangerous machinery until you know how an antihistamine affects you.

It is generally best to start with a low dose and increase the dose gradually until symptoms are controlled or until the maximum dose is reached. Newer antihistamines tend not to cause drowsiness in most people. Nasal decongestants act to decrease the swelling of the nasal tissue and the resulting feeling of stuffiness. Oral decongestants may cause sleeplessness and jitteriness. Topical nasal decongestants cause "rebound" congestion and irritation of the nasal passages if used more than 2-3 days. This means the stuffiness returns, but the nose spray doesn't help as much. Opticom nose spray works by blocking the allergic reaction on the mast cell. It prevents or reduces the release of histamine and other chemical substances, which cause the allergic symptoms. It does not cause drowsiness and does not cause "rebound" congestion. It is best started before exposure to known allergens, such as before the grass pollen season. Nasal corticosteroids (e.g.Beconase) are effective in treating allergic symptoms and are best used locally to minimize side effects. It often takes several days to become effective. Nose bleeding has been reported with nasal steroid use. Oral corticosteroids (prednisone) are different in that when taken internally the risk of side effects is much greater than when used in small amounts locally, such as in the nose. Similarly, long acting injections of steroids may have an increased incidence of side effects. When possible, it is prefered to treat with topical steroids rather than oral or injectable. If oral steroids are unavoidable then short bursts of oral steroids on alternate days minimizes side effects. Eye drops Antihistamine decongestant eye drops act similarly to oral preparations and can relieve allergic symptoms of red, itchy, watery eyes. Opticrom blocks the release of chemical substances from the mast cells around the eyes, thus preventing or reducing allergic symptoms. Saline (salt water) nose drops are often helpful in relieving nasal symptoms. You can purchase these or make your own by mixing 1 cup of water, 1/2 teaspoon salt, and a pinch of baking soda. Inhale a handful of this solution at a time. Discard the home-made solution after twenty-four hours because it contains no preservative.

YAMOA More recently I have discovered Yamoa, a novel plant extract. I believe that one of the ways that this is having its positive effect in both asthma and hayfever is by an immune modulatory action leading to less allergic response and less inflammation in the airways. (See other sections on this website for more details and clinical experience with this product). There may be a genetic link in hayfever. You are more likely to develop it if your parents had hay fever, or if they suffered with other allergic conditions such as eczema or asthma. So if your brother or sister already suffers from hay fever, then you may well have inherited the same sensitivity from your parents. Similarly if you had eczema or asthma as a child this makes you more likely to develop hay fever, and this is often the pattern that shows itself for someone who suffers from allergies. The peak age for hay fever is late teens and twenties. After that it usually gets gradually better, but may always give you some symptoms, especially in years with high pollen counts.  The way we live may have some effect on the development of hay fever. Our modern lifestyle could expose us to many allergy-triggering substances. This allergy overload causes more people to become allergic to something. This could explain the increase in hay fever over recent years.

How do you know if you have hay fever?

Due to the similarities between a common cold and hay fever it can sometimes be very difficult to differentiate between the two, especially when the symptoms are brief and irregular. The symptoms related to hay fever will come and go throughout the summer months and vary in severity. Itchy, watery eyes usually accompany hay fever but are not normally a cold symptom. You will also begin to notice a pattern in the times of year when you have the attacks. The symptoms of hay fever will disappear when the allergen is removed or a suitable treatment is used. Almost half of those who suffer from hay fever say their work is affected, the main causes being irritability and lack of concentration. During the hay fever season sufferers claim to feel unhappy and depressed. 10% of hay fever sufferers have taken time off from work as a result of the related symptoms. Many sufferers said they are self-conscious about the effects hay fever has on their appearance, therefore affecting their social lives.

Is there anything I can do to prevent hay fever?

To lessen symptoms you need to avoid contact with the allergens, which cause your symptoms. Apart from a trial of Yamoa the following may prove useful: Keep doors and windows shut at home and in your car on high pollen count days. Wear sunglasses or glasses when outdoors. Avoid mowing or weeding the lawn in the summer and avoid lying on freshly cut grass. Apply a thin layer of Vaseline™ just inside nostrils to trap pollen. Wash your clothes after going out, as pollen can stick to your garments. Keep your bedding clean. Shower or bathe before going to bed to wash off pollen in your hair and on your skin. Avoid going outdoors in the early evening when the pollen count is usually at its highest.

To prevent perennial allergic rhinitis symptoms try Yamoa but the following may help:

Dust and vacuum your house regularly to minimise the presence of dust and therefore the dust mite.

Use special bed and pillow coverings.

Hot wash all bedding at least once a week.

Avoid having pets but if you do, bathe them regularly, keep them outside and never allow them in the bedroom.

How is Hay fever (allergic rhinitis) diagnosed?

Allergic rhinitis is usually diagnosed from symptoms alone, especially in the case of hay fever. Perennial rhinitis is more difficult to diagnose, your doctor might suggest you keep a record of all your symptoms, when they occur and when they are at their worst. This might help identify what is triggering the symptoms to occur. Your doctor may suggest you have an allergy test to confirm exactly what you are allergic to.