A written action plan
What to take daily, what to take when symptoms worsen, when to start rescue treatment, and the point at which you should go to hospital rather than wait.
Asthma & Lung Disorders
Airways are meant to be responsive. Asthma is when they overreact.
Breathlessness, cough and wheeze get treated for years on impression alone. Here they get measured — because the treatment for asthma, COPD, bronchiectasis and a post-infective airway are not the same, and the inhaler that suits one will not fix another.
In plain terms
The short version
- Breathlessness, cough and wheeze are symptoms, not diagnoses. Several different conditions produce all three.
- Asthma, COPD, bronchiectasis and a lingering post-infection airway need different treatment — so they are measured, not guessed at.
- If your asthma is not controlled, the answer is more often inhaler technique, adherence or the diagnosis than a stronger inhaler.
- Bring your inhalers to the appointment. Technique is checked on the real device.
Conditions
What we treat
- Asthma — including allergic, occupational, exercise-induced and difficult-to-control asthma
- COPD — diagnosis, staging, inhaler optimisation and flare-up planning
- Bronchiectasis — including airway clearance technique and infection management
- Chronic cough — a cough lasting more than eight weeks, where the cause is frequently not the lungs at all
- Breathlessness of unclear cause — assessed rather than assumed
- Post-tuberculosis lung disease — the obstructive and structural damage left behind after treated TB, common here and routinely mislabelled as asthma
- Occupational and pollution-related lung disease — construction and stone dust, industrial exposure, biomass and cooking smoke
- Sleep-disordered breathing — snoring, witnessed pauses in breathing, daytime sleepiness
- Recurrent chest infections — where the question is why they keep happening
- Pneumonia and bronchitis — acute chest infection treated, and then followed up. The film that matters is the one taken weeks later, confirming the lung has cleared, not the one taken on the first day
- Interstitial lung disease — the scarring disorders behind a dry cough and breathlessness on stairs, worked up with lung function testing and high-resolution imaging rather than a trial of inhalers
- Pulmonary hypertension and pulmonary embolism — breathlessness out of proportion to the airways, where the circulation is the thing to look at
- Lung cancer screening — for long-term smokers, and the tests that settle what a shadow on a scan actually is
Diagnosis
Spirometry, and what it tells us
Spirometry measures how much air you can blow out, and how fast. It is the single most useful test in respiratory medicine and the one most often skipped.
What happens
You sit next to the machine and wear a soft clip on your nose. You take a deep breath to fill your lungs completely, close your lips tightly around the mouthpiece, and blow out as fast and as hard as you can, for as long as you can — and then keep going to get the last of the air out.
It takes real effort, and it is repeated a few times to get a reliable result. If the airways look narrowed, you will be given a reliever inhaler through a spacer and the test repeated after fifteen to twenty minutes to see how much of the narrowing reverses. That reversibility is often what separates asthma from COPD.
Results fall into four patterns: normal; obstructive, where air cannot leave the lungs as fast as it should; restrictive, where the lungs cannot fully expand; and mixed.
A normal spirometry does not rule out asthma. Asthma is a variable condition — it can be entirely normal on a good day.Why the history still matters
Control
Is your asthma actually controlled?
Many people describe their asthma as fine while meeting every criterion for poor control. It is worth being honest with yourself about the following. In the last month, have you:
- Used your reliever inhaler more than twice a week
- Woken at night, or woken early, because of cough, wheeze or chest tightness
- Avoided or cut short exercise because of your chest
- Needed a course of steroid tablets — more than two courses a year is a red flag
- Missed work or school, or visited a casualty department, because of your breathing
Any of these means the treatment needs reviewing — and very often the answer is not a stronger inhaler but a correction of technique, of adherence, or of the diagnosis itself.
Inhaler technique
The commonest reason treatment fails
A large share of people using inhalers are not getting the drug into their lungs. The device is fired at the wrong moment, or into the mouth rather than the airway, or without a spacer where one is needed. No adjustment of dose fixes a technique problem.
Bring every device you use to your appointment — the actual inhalers, not a list. Technique is checked and corrected in the room, and rechecked at follow-up, because it drifts.
Severe asthma
When inhalers are not enough
For a small group with severe asthma that stays uncontrolled despite correct use of maximal inhaled treatment, biologic therapy is now available — targeted injections given every few weeks that act on the specific immune pathway driving the inflammation. Eligibility depends on the pattern of your asthma, blood eosinophil counts and IgE levels, so the assessment is careful and the tests come first.
Two things worth knowing: it can take around four months to judge whether a biologic is helping, and you continue your inhalers throughout. Biologics are added to treatment, never a replacement for it.
Living with it
What you leave with
Technique, demonstrated
Your own device, checked in the room, with a spacer where one is needed and a demonstration you repeat back.
A letter to your doctor
With your permission, a summary goes to your family physician or referring specialist, so your care is joined up rather than parallel.