Asthma

Asthma specialists in Melbourne

Sleep and Lung Care’s respiratory physicians diagnose and manage asthma in adults at five clinics across Melbourne and Victoria. They see people whose asthma is newly suspected, hard to control or severe, and people whose asthma started in adulthood or may be related to their work.

What is asthma?

Asthma is a long-term condition that affects your airways – the tubes that carry air in and out of your lungs. You could say that someone with asthma has ‘sensitive’ airways that are inflamed and ready to react when they come into contact with something that ‘triggers’ the airway. Asthma tends to run in families, especially when there’s also a history of allergies.

When a person with asthma comes into contact with something that irritates their sensitive airways even more (asthma trigger), it causes their body to react in three ways:

1. The muscles around the walls of the airways tighten so that the airways become narrower
2. The lining of the airways becomes inflamed and starts to swell
3. Mucus sometimes builds up, which can narrow the airways even more.

These reactions cause the airways to become narrower and irritated – making it difficult to breathe and leading to asthma symptoms such as chest tightness, wheezing, or coughing.

Asthma can appear at any age. Symptoms usually start during childhood, but it’s not uncommon for adults to get it. Some adults develop it after a viral infection. If you get asthma in adulthood, it’s known as ‘adult-onset’ or ‘late-onset’ asthma. Certain things found in the workplace, such as chemicals or dust from flour or wood, can also lead to asthma symptoms. This is known as occupational asthma.

Research shows you’re more likely to develop asthma if:

• you have a family history of asthma, eczema or any allergies – for example, evidence shows that if one or both of your parents have asthma, you are more likely to have it
• you have eczema or an allergy, such as hay fever (an allergy to pollen)
• you had bronchiolitis (a common childhood lung infection) as a child
• your mother smoked while she was pregnant with you – research has shown that smoking during pregnancy significantly increases the risk of a child developing asthma
• you have been exposed to certain substances at work – this is known as occupational asthma
• you’re an adult female – hormones can affect asthma symptoms, and some women first develop asthma before and after the menopause

Symptoms

When your asthma flares up, the usual symptoms are wheezing, coughing (especially at night), shortness of breath, tightness in the chest etc. The symptoms of asthma can range from mild to more serious. Not everyone will get all of the symptoms. Unfortunately, a small number of people with the condition have what is known as severe asthma, and they require special care and support to manage symptoms. Some people have persistent asthma symptoms because they’re not taking their medicines, or not taking their medicines correctly.

If you’re not taking your medicines as prescribed, your symptoms can get worse. This can affect your day-to-day quality of life. For instance, if you’re coughing at night, you may sleep badly so you end up feeling tired, grumpy with those around you and less able to concentrate at school or work. Or if you’re often breathless, you may miss out on some of the fun things in life, such as playing with your children, having trips out with your friends or enjoying romantic nights in with your partner. And most seriously of all, if your symptoms get worse, this can lead to a potentially life-threatening asthma attack.

Long-term prognosis

Currently, there is no cure for asthma. The good news, though, is that there are lots of safe and effective treatments available to manage the symptoms. Asthma attacks can be serious, but many can be prevented. The reassuring fact is that most people with asthma who get the right treatment – and take it correctly – can manage their symptoms and get on with what they want to do in life.

When to see an asthma specialist

Most people with asthma are looked after by their GP. Your GP may refer you to a respiratory physician if:

• the diagnosis is not clear, or your symptoms could have another cause
• you still have flare-ups even though you use your preventer inhaler as prescribed
• you have needed courses of steroid tablets, or emergency or hospital care, for asthma
• symptoms wake you at night or limit your everyday activities
• your asthma may be caused or made worse by your work
• you are being considered for biologic therapy for severe asthma

If you have chest pain, severe breathlessness or another emergency, call 000.

How asthma is confirmed

Asthma is diagnosed from your symptoms together with breathing tests. The lung function tests used to confirm asthma include:

• spirometry before and after a reliever (bronchodilator) medicine, to see whether narrowed airways open up
• exhaled nitric oxide (FeNO), which measures a type of airway inflammation
• bronchial provocation testing with mannitol, when spirometry is normal but asthma is still suspected

Lung function tests are bulk billed with a valid referral and are available at every clinic. Some inhalers need to be stopped for a set time before testing. Read how to prepare for lung function tests.

Your asthma action plan and inhaler technique

A written asthma action plan tells you which medicines to take every day, how to recognise when your asthma is getting worse and what to do in an emergency. If you don’t have an up-to-date plan, your respiratory physician or GP can prepare one with you.

Using an inhaler correctly makes a big difference to how well the medicine works. Bring your inhalers to your appointment so your technique can be checked. Watch our inhaler technique videos.

Asthma that is hard to control or severe

When asthma stays uncontrolled despite treatment, your respiratory physician reviews the diagnosis, your inhaler technique, how regularly the preventer is used, triggers at home and at work, and other conditions that can mimic or worsen asthma, such as reflux, nose and sinus problems or breathing pattern problems.

Some people have severe asthma that needs more than standard inhaled treatment. Our physicians assess whether biologic therapy, a group of injected medicines for particular types of severe asthma, is suitable for you, and arrange the tests needed to decide.

Preparing for your asthma appointment

Bring your current inhalers, a medicine list and any asthma action plan you already have. Note when symptoms occur and what seems to trigger them. Read what to bring to your first specialist visit.

Frequently asked questions

Do I need to see a specialist for asthma?

Not always. Most people with asthma are looked after by their GP. A referral to a respiratory physician helps when the diagnosis is uncertain, when asthma stays hard to control, or when treatment for severe asthma is being considered.

Which tests confirm asthma?

Spirometry before and after a reliever medicine is the main test. Exhaled nitric oxide (FeNO) and bronchial provocation testing with mannitol help when the diagnosis is still unclear. Lung function tests are bulk billed with a valid referral and are available at every clinic.

Do I need to stop my inhalers before lung function tests?

Some inhalers and medicines need to be stopped for a set time before testing, unless your doctor or our team has told you otherwise. Follow the instructions on your booking, and do not stop a medicine you need to stay safe.

What is biologic therapy for asthma?

Biologic therapies are injected medicines for particular types of severe asthma. Your respiratory physician checks whether you are suitable and arranges the tests needed to decide.

Can asthma start in adulthood?

Yes. Asthma can begin at any age, including in adulthood, sometimes after a viral infection or because of exposures at work.

Do you see children with asthma?

Our physicians see adults. For a child with asthma, please ask your GP about a paediatric service.