Friday 20 September 2019

Dear Dr Nina: Why has my asthma returned in my 60s?

Photo posed
Photo posed

Nina Byrnes

I’m a 62-year-old man, I’m very fit and active and have never smoked. As a child I suffered from asthma but grew out of it and I have had no problems for years. But this past winter I’ve had a terrible wheeze which gets worse at night. It has improved as the weather has got warmer. My GP says that my asthma has more than likely returned and says that next winter I may need to consider an inhaler, which I’m worried about. Why would my asthma have come back at this stage, or could this be something more serious?

Dr Nina replies: Many of those who have asthma will experience seasonal change or peaks and troughs in their symptoms. For some people with asthma, the winter is particularly problematic. The cold weather or simply being indoors and exposed more to house dust mites can trigger a flare, causing coughing, wheezing and shortness of breath.

Asthma can flare at any stage in a person’s life. Increasing age can play a roll. As we get older, our lungs are less elastic, chest walls more rigid and muscles become weaker. All these things can exacerbate breathing problems. Other conditions such as heart and lung disease, Chronic Obstructive Pulmonary disease (COPD) or heart failure may also cause symptoms that mimic asthma.

The atmosphere you live in plays a roll. Has this changed recently? Common triggers in winter months are house dust mites, moulds, fungal spores, and animal dander. Treatment involves firstly reducing exposure to the triggers. Carpets and blow heaters will harbour and circulate dust and spores and should be avoided.

Colds or viral illness can be a trigger. We become more susceptible to these with age and it may be necessary to temporarily increase asthma treatment during this time. Having an action plan in place can be very helpful at this time. This can be agreed between you and your doctor. Occasionally it may also involve having steroid tablets available to take if inhalers alone are not working.

It is worth having a thorough check-up with your doctor to assess your wheeze. As you had been symptom-free for many years, I would think a reassessment and investigation is appropriate to rule out other conditions and confirm that your symptoms are, in fact due, to asthma. Spirometry, a chest x-ray, ECG, bloods and full exam are warranted. Further cardiac tests such as an echocardiogram and Holter could help rule out rhythm or pumping issues with the heart. You mention you didn’t smoke but if you lived or worked with smoke exposure you are at risk of smoking-related disease. Wheeze and shortness of breath on exertion are symptoms in many conditions. It is important that the diagnosis is not assumed to be asthma just because you had that when younger.

When symptoms increase it may be necessary to have a reliever to hand and even add in a preventive inhaler. These are usually inhaled corticosteroids and are often referred to as the brown inhaler. This inhaler must be taken regularly, usually twice daily, to help control symptoms.

If corticosteroids alone are not enough to control symptoms, then a combined inhaler, which has a long-acting version of the blue inhaler and corticosteroids, may be recommended. For more severe asthma, other medication may be added.

If the diagnosis does turn out to be asthma, don’t take this lightly. Death rates for older adults with asthma are higher than those in younger people and medical complications are more common. Remain vigilant about your symptoms and keep inhalers in date and to hand at all times. An asthma attack can happen at any time. Being prepared can be life-saving.

Q. My teenage daughter is embarrassed by her toes, which point upwards. They've been like  this since she was little. Now it's summer she won't wear sandals. Can anything help?

It is difficult to ascertain exactly what the issue is without having actually seen your daughter's feet. A high arch or "cavus foot" can sometimes lead to the appearance of toes pointing upwards. This isn't an actual problem with the foot, just simply the shape of it. I think a good place to start with your daughter would be a podiatrist who can fully examine the foot and explain any structural issues. Simple stretching exercises and treatment may help loosen any tight ligaments and tendons. Occasionally, insoles can help support the foot, helping with discomfort that may arise.

If there is a question that the shape and structure of the foot are causing problems getting appropriate footwear then an orthopaedic surgeon who specialises in foot and ankle issues can advise you as to whether any intervention may help.

Shoes with a narrow toe push the toes together and over time can damage the structure of the toes. High-heeled shoes push a lot of weight and strain onto the ball of the foot and are a major cause of foot change. Obesity, poor posture or balance can alter the body's centre of gravity leading to pressure through the feet.

High intensity exercise that involves jumping or running also puts a strain on the structures of the foot. It's important to wear appropriate footwear to avoid further problems and protect your daughter's adult feet.

If the shape of your daughter's toes is causing her undue concern, it is also very important to assess the source of this. Many teenage girls can become fixated on a certain part of their body when underlying issues such as poor self-esteem or anxiety are at play. It would be equally important to address any psychological distress.

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