What causes asthma and is there a cure?

                  We do not fully understand all the causes of asthma however, it can sometimes run in
                  families, especially if there is a history of eczema and hayfever. 

                  At present there is no cure for asthma, but there are many effective treatments to help
                  control the condition.

                  What makes the airways narrow?

                  The airways become narrow when the lining of the airways becomes inflamed. The
                  inflammation can cause:

                       The lining of the airways to swell 
                       Lots of sticky mucus (phlegm) may be produced (the phlegm can block the
                       airways). There may also be spasm (tightening) of the muscles in the walls of the
                       airways. 
                       Spasm (tightening) of the muscles in the walls of the airways. 

                  In an asthma attack all of these happen together to different degrees. Taking the right
                  medicines will help keep the width of the airways normal, and will help make narrowed
                  airways go back to normal.

                  What starts an asthma attack?

                  Although the exact cause of asthma is not clear, the following can set off an asthma attack:

                       Infections - which are usually caused by a virus (e.g. colds or flu) 
                       Allergies - which are usually triggered by house dust, house dust mites, pets or
                       pollen 
                       Exercise - especially in cold weather 
                       Excitement, fear or anger 
                       Irritants - such as tobacco smoke or air pollution 
                       Smoking - Asthma Patients and parents of asthmatic children should avoid smoking 
                       Changes in the weather - e.g. a cold spell. 
                       Some food additives - for example, tartrazine (an artificial food colouring). In
                       general, people with asthma do not need a special diet 
                       Certain medicines - some people may be allergic to some drugs, for example aspirin

                  Who develops asthma?

                  Asthma is common, and can start at any age. In the UK it affects about 3 million people: 1
                  in 10 children, and 1 in 20 adults. Asthma runs in families, and is more common in families
                  where someone already has the condition, but this is not always the case. People with
                  asthma often also have either eczema or hay fever.

                  At what age does asthma start?

                  Asthma can start at any age, although about half of all people with asthma have had their
                  first symptoms by the age of 10. Many children with asthma have had their first asthma
                  attack before the age of 5. Adults may develop asthma after an infection, or their asthma
                  may be linked to the type of job they do, but often, a cause cannot be identified.

                  Is asthma a life-long disease?

                  Asthma is a chronic disease. For some children however symptoms may only appear
                  intermittently. Also for some children the symptoms of asthma may seem to disappear as
                  they mature to adult life

                  How is asthma treated?

                  Asthma can be treated in two main ways:

                       By using "reliever" medicines, which help to open up the airways and enable the
                       person with asthma to breathe more easily. Reliever medicines are used when the
                       symptoms of asthma appear or sometimes before exercise. 
                       By using "preventer" medicines, which reduce inflammation in the airways, making
                       them less likely to respond to asthma "triggers" 

                  Some people with asthma need additional medication to control their symptoms. These
                  "controller/protector" medicines are taken regularly to help provide long-lasting relief of
                  symptoms and to help to prevent attacks. Some medicines act as both preventers and
                  controllers.

                  There are different types of preventer, reliever and controller medicines.

            Asthma

            Australasia leads the world in incidence and varieties of asthma.
            In 1996, 730 Australians died from asthma, and many of these
            deaths may have been preventable. Asthma is a respiratory
            condition in which the casualty suffers the onset of constricted
            passages in the lower airway and it becomes progressively more
            difficult to breathe. Trigger factors for asthma may include: 

                 Viral respiratory infections 
                 Exposure to known allergens, eg: dust
                 mites, pollens, animal dander, moulds 
                 Exposure to chemicals or other
                 occupational sensitisers 
                 Exposure to irritants, eg: cigarette smoke,
                 perfume 
                 Reflux 
                 Drugs, eg: aspirin and beta-blockers 
                 Foods, eg: nuts, seafood 
                 Food additives - colourings, metabisulphite,
                 monosodium glutamate (msg) 
                 Changes in weather, exposure to cool air 
                 Exercise 
                 Emotion 

            Asthma can be a life-threatening condition that
            may develop suddenly, or over several days. 
            Asthma is usually considered in three
            classifications of severity:

                   SYMPTOMS
                                   MILD
                                            MODERATE
                                                              SEVERE AND
                                                           LIFE-THREATENING
                 Physical
                 exhaustion
                                     No
                                                No
                                                        Yes, may have paradoxical chest
                                                               wall movement
                 Talks in
                                  Sentences
                                               Phrases
                                                                  Words
                 Pulse rate
                                  <100/min
                                             100-120/min
                                                                 >120/min
                 Central cyanosis
                                   Absent
                                               May be
                                               present
                                                             Likely to be present
                 Wheeze intensity
                                   Variable
                                            Moderate-loud
                                                                Often quiet

                 As a first aid provider you should Be
                 aware that both mild and moderate
                 asthmatics are subject to unexpected
                 severe attacks, and that minor
                 respiratory infections such as colds
                 and flu, as well as seasonal changes,
                 may cause an asthmatic condition to
                 worsen. Treat the condition with
                 care, as the effects are sudden and
                 serious.

                 OTHER SIGNS AND
                 SYMPTOMS

                      pale, cool, clammy skin 
                      coughing, especially at night 
                      pale, cool, clammy skin 
                      shortness of breath - using all
                      the chest and diaphragm
                      muscles to breathe 
                      wheezing - a high pitched
                      raspy sound on breathing 
                      anxiety 
                      exhaustion 
                      rapid, weak pulse 
                      cyanosis 
                      severe asthma attack: collapse
                      - leading to eventual
                      respiratory arrest 

                 CARE AND TREATMENT

                 Conscious casualty:

                      sit the person comfortably
                      upright.  Be calm and
                      reassuring 
                      give 4 puffs of a blue
                      reliever inhaler (puffer) -
                      Ventolin, Respolin,
                      Bricanyl, Respax or
                      Asmol.  Use the person's
                      own inhaler if possible.  If
                      not, use the First Aid kit
                      inhaler or borrow one from
                      someone else. 
                      Relievers are best given
                      through a spacer, if
                      available. 

                      With spacer:

                           shake inhaler
                           and insert
                           mouthpiece into
                           spacer 
                           place spacer
                           mouthpiece in
                           person's mouth
                           and fire 1 puff
                           into the spacer 
                           ask the person
                           to breath in and
                           out normally
                           for about 4
                           breaths 
                           wait 4 minutes. 
                           If there is little
                           or no
                           improvement,
                           repeat the
                           above
                           sequence. 
                           repeat until 4
                           puffs have been
                           given 

                      Without spacer:

                           shake inhaler 
                           place
                           mouthpiece in
                           person's
                           mouth.  Fire 1
                           puff as the
                           person inhales
                           slowly and
                           steadily 
                           ask the person
                           to hold that
                           breath for 4
                           seconds, then
                           take 4 normal
                           breaths 
                           repeat until 4
                           puffs have been
                           given 

                 Collapsed casualty:

                      call 000 for an ambulance 
                      if possible, assist with 6-8
                      puffs of a reliever 
                      if little or no immediate
                      improvement - repeat
                      reliever medication every 4
                      minutes 
                      reassurance 
                      if in respiratory arrest —
                      expired air resuscitation
                      (EAR)