Author Archives: Jackie Aim

Definitions – occupational and work aggravated asthma

There are 2 categories:

1) Occupational asthma

Defined as variable asthma with symptoms linked to an irritant found in the work environment but not to causes out side the workplace or at home.
This also falls into 2 types:

  1. Where there can be a delayed reaction, of a few days to years, before symptoms appear, depending on the body’s immune system response to first contact to allergen and the development of symptoms.
  2. Where reaction is immediate and non-allergic caused by irritant, this is Reactive Airways Dysfunction Syndrome (RADS).

2) Work aggravated asthma

Defined as pre-existing asthma worsened by normally harmless irritants or physical effort in the work place.
This however does not mean occupational asthma can not develop due to work place exposure.

This therefore distinguishes occupational asthma from work aggravated asthma. However this distinction also depends on an accurate medical history of present illness, any previous complaints as well as physical examination and selected tests.

 

Healthcare team

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Primary care team

GP

  • Medical history.
  • Listen to your lungs.
  • Refer for X-ray.
  • Refer for Simple breathing tests with the Practice Nurse or Healthcare assistant or Clinical Physiology GP Spirometry service if available.
  • Prescribe medication – inhalers as appropriate.
  • Communicate with Respiratory Consultant in the hospital.

Practice nurse

  • General observations.
  • Perform simple peak flow and/or Spirometry test. (link to previous Spirometry Test section)
  • Reversibility study, if appropriate. (link back to previous sections)
  • Inhaler technique if appropriate. (link to inhaler film clips)
  • Prescribe some medications

Hospital respiratory care team

Respiratory consultant

  • Medical history.
  • Listen to your lungs.
  • Review of X-ray, possible repeat.
  • Refer for further CT, MRI as appropriate.
  • Review Spirometry, possible repeat.
  • Refer of full breathing tests.
  • Refer for Specialised breathing test.(link to exercise induced asthma/challenge test)

Respiratory specialist nurse

  • General Observations.
  • Perform simple peak flow and/or Spirometry test. (link to previous Spirometry Test section)
  • Reversibility study, if appropriate. (link back to previous sections)
  • Review medication and prescribe some medications.
  • Inhaler technique if appropriate.
  • Refer for full breathing tests.
  • Educate you about asthma
  • Issue you with a peak flow meter and diary and give an asthma action plan
  • They may also take history and listen to lungs if they are trained to do so

Specialist pharmacist

  • Advice and review current medication.
  • Advice and dispense medication.
  • Advice about inhaler technique.
  • Explain what your medication is for and any side effects.

Clinical physiologist

  • Assess full lung function.
  • Assess effectiveness of inhaled treatment.
  • Assess hypersensitivity using challenge tests. (link to Challenge test section)
  • Report findings to Respiratory Consultant.

Respiratory physiotherapist

  • Advice on asthma and exercise.
  • Specialist advice and treatment for dysfunctional breathing such as hyperventilation. How to relax and retrain your breathing.
  • Advice to manage your cough and sputum.

How is breathlessness measured by your GP?

Your GP will use the following scale to measure your breathlessness, this is called the Medical Research Council breathlessness scale or MRC scale.

Medical Research Council breathlessness scale
1 2 3 4 5
Person with hiking boots and rucksack climbing hill Lady walking up steep hill with shopping bag getting breathless Man out of breath walk on flat road, road sign with 1 mile Person out of breath, leaning on a wall, 60 metres Person housebound, in their armchair
You are not troubled by breathlessness except on strenuous exercise You are short of breath when hurrying on the level or walking up a slight hill You walk slower than most people on the level, stop after a mile or so, or stop after 15 minutes walking at own pace You stop for breath after walking about 100 yards (60 metres) or after a few minutes on level ground You are too breathless to leave the house, or breathless when dressing or undressing

Where do you fit into this chart today? If you notice that you have gone from a 2 to a 3 or from a 3 to a 4 this would be the time to make an appointment with your GP or healthcare professional for advice and review. If your GP measures you as 3 or above you should be referred to pulmonary rehabilitation.

For more information please see our section on Pulmonary Rehab.

Your lungs and breathlessness

  • When you have COPD your airways may be narrowed and you will have to work harder to maintain the oxygen and carbon dioxide balance as you breathe in and out.
  • If you have emphysema the alveoli (air sacs) in the lung are damaged and oxygen and carbon dioxide may become trapped in the lungs. This will also make you breathless even when resting and worse when you are active. For more information please see: Smoking and emphysema section on this website.
  • When you have an infection or exacerbation, your body uses up more oxygen.
  • Breathlessness can be affected or made worse by something in your environment such as very cold weather or emotional stress.
  • Even though you may be breathless when active it is very important that you stay active to maintain or improve your lungs function. This needs to be done within your own limitations. If you are not sure about how much activity or exercise is the right level for you, ask your GP or healthcare professional. If you have not been to a pulmonary rehabilitation course this may be available in your area and healthcare professionals can make a referral for you.

Please note there is no audio for this animation.

Muscles and organs which demand oxygen

Breathing is an active process and supplies your body with the oxygen it needs and rids it of carbon dioxide so it can stay in balance. The more oxygen your body needs, the harder your lungs work and the more breathless you can become. When you stop being active your breathing should return to normal within a few minutes and the breathlessness should improve.

This balance depends on the how much energy your muscles and internal organs need at any one time. The oxygen you breathe in gets in to your blood through the tiny alveoli in your lungs. Carbon dioxide is a waste product of the body after the energy has been used and this is breathed out. For more information please see: How the lungs work on this website.

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  • Running for the bus, your oxygen needs are diverted to your muscles causing you to feel breathless. Running for the bus, your oxygen needs are diverted to your muscles causing you to feel breathless.
  • Your brain needs a high percentage of oxygen to function if you are doing a lot of concentrated activity.Your brain needs a high percentage of oxygen to function if you are doing a lot of concentrated activity.
  • Eating a large meal causes an increase in blood flow to the stomach, this is achieved by diversion of blood from the muscles and by increasing the volume of blood pumped by the heart. Eating a large meal causes an increase in blood flow to the stomach, this is achieved by diversion of blood from the muscles and by increasing the volume of blood pumped by the heart.
  • Even at rest we need a certain amount of oxygen in the blood. If you are cold or shivery you need more oxygen to generate heat. Even at rest we need a certain amount of oxygen in the blood. If you are cold or shivery you need more oxygen to generate heat.

What happens when you are not so active?

spiral_inactivity

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  1. COPD and moderate exercise or activity
  2. Deconditioning
  3. Doing less exercise or activity
  4. Short of breath with minimal exercise
  5. Inactivity
  6. Disability
  7. Short of breath with daily activities

Exercise to keep control of your COPD.

Deconditioning = a decline in your ability to exercise or be active. At this stage it is still reversible.

Because you are deconditioned you can do less than before.

You start to notice you are more breathless even though you have done very little.

You become even more inactive.

You notice you are unable to do tasks which you used to do and you are becoming dependent on someone else to help.

You are short of breath as soon as you start a task.

This process often happens over a period of time. Think about how much you can do and think about how much you would like to be able to do. Exercise and activity can help to give you the ability and confidence to manage tasks for yourself.

Breathlessness with COPD

An aerobic exercise class for senior mature men and women, led by an instructor.

© Crown Copyright 2009

You may feel breathless getting washed, climbing stairs or going for a walk, but this is normal breathlessness for someone with COPD.

Many people with COPD tend to be more breathless in the morning and you may want to limit tasks that make you breathless to later on in the day, and spread things out around the whole week

It is important to have a plan for exercising and activity even if you do get breathless. The less you do, the less you will be able to do.

It is very easy to get stuck in a rut of not exercising or being less active because you feel breathless. By not exercising you will be making your breathlessness worse over time.

We all need exercise and activity to keep our body healthy. When you are active your muscles, joints and circulation all benefit not just your chest and lungs.

Plan activity and exercise in to your day. How am I going to manage today? Get up, get going and plan to go out if you can. Pacing yourself can also help. (For more information please see our section on Pacing and overcoming fatigue).

Breathlessness and you

  • Think how you felt getting dressed this morning, or climbing the stairs.
  • Did it make you feel breathless?
  • Did it worry you?
  • Your air passages are damaged so air does not flow in and out so easily.
  • Your breathing muscles may not be working so well.
  • Your arm and leg muscles may get tired.

It is normal to be out of breath like this when doing some daily activities. At this point you are not distressed and you quickly recover when you rest.

Fear of the sensation of breathlessness is one of the main reasons people with COPD avoid activity.  You need activity to start the normal breathing stress. You need to recognise you are exercising to the correct extent. People with COPD need to become familiar with the sensation of normal breathlessness so that it doesn’t start feelings of fear and panic. You should be active but in control.

It is important to avoid becoming distressed and breathless during every day activities. By pacing yourself and managing your breathlessness you will reduce the likelihood of symptoms such as gasping for air and feelings of anxiety and panic.

Normal breathlessness and exercise

A group of men and women playing hockey

© Crown Copyright 2009


Think back to the Olympic athletes or other sports people you have seen.

  • Do they look breathless at the end of a race or a football match?
  • Do they look worried about this?

This was normal breathlessness.

This kind of breathlessness does not cause harm.

When we sit still, our breathing is quieter, slower, gentler.

When we are active, our breathing is noisier, faster, harsher.

Normal breathlessness

School children running

© Crown copyright 2014


Think back to when you were at school, think about running around in the playground, playing ‘tag’, skipping or racing your friends.

  • Did you notice that you were breathless?
  • Did you stop because you were feeling breathless?
  • Did you worry about feeling breathless?

This was normal breathlessness.