The hidden danger of adult asthma (part 2)
"As far as we know, there's no single gene that makes you more likely to develop asthma," says Professor Martyn Partridge, consultant chest physician at Charing Cross Hospital and chief medical adviser to Asthma UK. "Far more likely is that having a certain combination of genes makes you more susceptible."
Prof Partridge points out that while these genes obviously run in families, it's not unusual for just one family member to develop asthma while others remain symptom-free.
"Genetic linkage is only one part of the equation," he says. "There is a whole host of factors that contribute."
He adds that many adults experiencing first attacks may have had symptoms without realising. "Many patients with so-called late-onset asthma were 'chesty' children," he says. "They suffered bouts of what was probably identified at the time as bronchitis, but was likely to have been undiagnosed asthma."
While having certain genes can make you more susceptible, the triggers that bring about the condition vary widely. In women, hormones can play a part. "Cases of late-onset asthma in women peak around the menopause," says Prof Partridge. "Some women find their symptoms are worse during pregnancy, and a sizeable minority of female asthmatics find they are worse just before a period."
Many cases of late-onset asthma are triggered by viral infections - for Celeste Abrahams, it was a bout of pleurisy - but environmental factors such as pollution and allergens can also cause the inflammation that leads to an attack. People who suffer allergic conditions, such as hay fever and eczema, are particularly susceptible (again, there could be a genetic link), while foods that often cause allergic reactions, such as nuts, shellfish and dairy products, are other common triggers. There is also anecdotal evidence that being overweight can exacerbate the symptoms.
"The jury is still out on whether obesity causes asthma," says Prof Partridge. "It could simply be that people with existing but very mild symptoms of breathlessness find they become more acute with obesity." However, many overweight asthmatics find that their symptoms improve dramatically with weight loss.
Your working environment can make you more likely to develop asthma, too. Roughly 10 to 15 per cent of cases of late- onset asthma are work-related; people dealing with chemicals, animals or flour are particularly at risk.
This type of asthma can be cured by the sufferer changing jobs. But for the large majority of late-onset cases, the issue is management rather than cure.
After her first attack, Abrahams was sent home with a 10-day course of oral steroids. "Doctors said it was a one-off triggered by the pleurisy and that it would never happen again," she says. "But I was still worried."
She wasn't wrong. Over the next three years, she had acute attacks every few months.
"I found myself in the resuscitation suite of my local hospital on 10 occasions, and took myself to casualty at least 40 times in those first few years," she says. "I was so sick of being sick, I wanted to die."
Doctors eventually diagnosed a particularly severe form of the disease, sometimes known as brittle asthma. "It means you can be totally symptom-free for months and then - wham! - it hits you again," she says. "I was lucky my employers were so understanding. I work as a sales manager for a wine company, so I travel all over Europe, but in those first few years, I had to cancel so many trips."
Abrahams, now 43, has learnt to manage her condition in the 11 years since her first attack. "I used to carry a nebuliser - a machine that delivers high doses of medication to the lungs through an oxygen-type mask. Now, I just use my preventative inhaler plus a steroid inhaler when I'm feeling a bit iffy. But compared with the amount of steroids I was taking before, it's nothing," she says.
"I've also worked out what my triggers are - milk, fish oils, nuts and shellfish - but sometimes I go without an attack for so long, I get a bit cocky and I'll have something I shouldn't. Then, I suffer for days. But it's been years since I've had a severe attack.
"I know I'll never be 'cured' and that I could have a serious attack again, but I'm ready for it now."
By Trish Lesslie
http://www.telegraph.co.uk
