Asthma symptoms include coughing, wheezing, a tight feeling in the chest and trouble breathing. Asthma occurs when the main breathing tubes of your lungs are over-sensitive and react to a variety of triggers called allergens (eg house dust) or irritants (fumes, cold air). As a result they may become swollen and narrow. These changes should be controlled with inhalers as prescribed by your doctor. If your asthma is not getting better with standard treatment (preventor and reliever inhalers) or if you are having more asthma attacks than you or your doctor are comfortable with, or if the attacks are severe, you may be referred to a specialist. In most cases you’ll be asked to give a complete medical history and will also be examined by the doctor. Other conditions can mimic asthma or make asthma worse, so you may be asked to have some tests to help in the assessment. Tests looking for severity and complicating features of asthma include: chest X-ray, lung function tests and CT scans of the chest and sometimes the sinuses. For more details see below. You may, however, not need any of these tests. Treatment This may include taking medicines as well as making some adjustments to your living patterns. A peak flow meter can be used to keep a watch on your asthma and to help with plans to prevent attacks. Stopping smoking is very important as is learning to recognise what brings an asthma attack on. Asthma is treated with inhaled medicines. There are two types: 1. an inhaled steroid medicine which is usually taken every day. It soothes the irritated breathing tubes and prevents worsening of asthma, “asthma attacks”. 2. a reliever helps reduce asthma symptoms. There are 2 types (long acting and short acting). They relax the tightened muscles around the breathing tubes. For more information on asthma see www.asthmanz.co.nz

This is similar to a blood test but instead of a needle going into a vein it is inserted briefly into a small artery in your wrist. A small amount of blood is taken and sent to the laboratory to test for the amount of oxygen your blood is carrying. This gives a very good indirect measure of how your lungs are working. Many conditions can cause a blood gas imbalance and while the blood gas tests do not identify the exact cause of the imbalance they will point to either a chest or metabolic problem.

During this test a thin fibreoptic tube is inserted into your breathing tubes, through the mouth or nose, to view the tubes. Usually salty water is flushed down the scope and suctioned away and a biopsy may be taken. These tests are then sent to the laboratory for examination under a microscope. It is undertaken with use of sprays of local anesthetic to the back of the throat and breathing tubes. You will be given medicine into a needle inserted into your vein to make you sleepy and relaxed. A specialist doctor does this procedure in an operating theatre environment.

A chest X-ray is normally undertaken to check the chest wall, lungs and heart. A chest X-ray is often the first test used to determine the reason for shortness of breath, persistent cough, chest pain or injury. Although you may think of an X-ray as a picture of bones, a trained observer can also see air spaces, like the lungs (which look black) and fluid (which looks white). Women should always advise their doctor if they are or think they may be pregnant before an X-ray is undertaken. When having a chest X-ray you are exposed to a very small amount of radiation. What to expect? You will have all metal objects removed from your body. You will be asked to remain still in a specific position and hold your breath on command. There are staff present, but they will not necessarily remain in the room, but will speak with you via an intercom system and will be viewing the procedure constantly through a windowed control room.

This term is used to describe lung disease where the breathing tubes become scarred and the surrounding tissue and air sacs inside the lungs become damaged. COPD includes conditions such as emphysema and chronic bronchitis and may very occasionally complicate chronic asthma. COPD is a long term and sometimes fatal disease that can be halted. Smoking is the main cause of emphysema and chronic bronchitis and stopping smoking is by far the most effective treatment. Chronic bronchitis is an inflammation of the main breathing tubes (bronchi) in the lungs, which results in the production of excess mucous (phlegm) and a reduction in the amount of airflow in and out of the lungs. In the early stages of chronic bronchitis, a cough usually develops (so called smokers cough). As the disease progresses, associated shortness of breath and an increased rate of chest infections may occur. Emphysema is the gradual destruction of the air sacs (alveoli) in the lungs. The main symptom is usually breathlessness. Emphysema cannot be cured, but can be managed through medication, rehabilitation programmes and stopping smoking. People with COPD have often lost half their lung function before the condition is diagnosed. The best way of picking up the condition early is to ask your doctor for a test of lung function (spirometry). Investigations You may have some of the following tests before or after your clinic appointment: chest X-ray, lung function tests (including spirometry), CT chest. The specialist will decide if you need any of these tests, depending on your symptoms and examination findings. Treatment There are ways to manage COPD. The first and most important is to stop smoking if this applies to you. There are exercises and dietary changes that can help maintain and improve fitness. Medications, including inhalers, are often useful. If you have COPD it is a good idea to have the flu vaccination every year as this reduces episodes of bronchitis by up to 50%. For more information on COPD see www.asthmanz.co.nz MAGIC COPD Support Group (PDF, 31.9 KB)

With CT you can see much more detail than with a normal X-ray. Using an X-ray beam, which is sent through the body from different angles, creates a CT image and by using a complicated mathematical process a computer is able to produce an image. This allows cross-sectional images of the body without cutting it open. The CT is used to view all body structures but especially soft tissue such as body organs (heart, lungs, liver etc.). What to expect? You will have all metal objects removed from your body. You will lie down on a narrow padded moveable table that will be slid into the scanner, through a circular opening. You will feel nothing while the scan is in progress, but some people can feel slightly claustrophobic or closed in, whilst inside the scanner. You will be asked to remain still and hold your breath on command. There are staff present, but they will not necessarily remain in the room, but will speak with you via an intercom system and will be viewing the procedure constantly through a windowed control room, from where they will run the scanner. Some procedures will require Contrast medium. Contrast medium is a substance that makes the image of the CT clearer. Contrast medium can be given by mouth, or by injection into the bloodstream. The scan time will vary depending on the type of examination required, but as a rule it will take around 30 minutes.

Depending on what is seen on the CT scan an additional test can be done where a fine needle is inserted into your chest into the cancer and some cells sucked up into the needle. This is done while taking pictures with the CT scanner to guide the doctor as to where to place the needle. Local anesthetic is put into your skin and muscles so that the test is not overly painful. A specialist doctor does this.

Why do we need oxygen? Oxygen is essential for life. When a person has normal lungs oxygen moves from the lungs to the blood, meaning that every part of the body is supplied with oxygen. Even when the lungs are damaged there is usually still enough oxygen moving from the lungs into the blood and then to the body tissues and a person is able to continue normal activities. For a small number of people with damaged lungs, the oxygen level is low even when the person is well. If the oxygen level is persistently low, our body tissues are unable to function efficiently and this may cause health problems. In this situation using Home Oxygen Therapy can be useful. The person would have their oxygen level checked twice, 3 weeks apart and if the oxygen level was low on both occasions Home Oxygen Therapy would be offered. The aim of this therapy is to make sure the heart muscle, brain and other body tissues get a good supply of oxygen to keep them healthy and functioning well. How is oxygen used? For this therapy to be useful, the oxygen must be used for at least 16 hours per day. This means starting the oxygen at approximately 4pm, continuing use through the evening and overnight until 8am. This leaves the day free to carry out usual activities. The reason oxygen is used overnight is that during sleep the oxygen level is lower than during the day. Using the oxygen at night may improve sleep quality, which can improve energy levels during the day time. The oxygen is provided by an electrically powered machine which draws air from the room and, by a filter mechanism, holds onto the oxygen and removes the other gases. As long as the machine is plugged in and turned on, a constant supply of oxygen is provided. The oxygen is delivered to the nose through a soft tube which is joined to the machine. Most patients who are started on oxygen therapy will require oxygen permanently, but some patients will only need oxygen for short periods, and then the equipment can be retrieved. Is oxygen used to treat breathlessness? Oxygen treatment is not helpful when the oxygen level in the blood is in the normal range. It is important to remember that breathlessness has many causes. For many people with damaged lungs breathlessness will be something which happens on a daily basis and is expected to happen. Even when oxygen levels are normal, breathlessness can be a major problem, and it is important to speak to your doctor or nurse to find out about breathing management which includes: using medication effectively, using breathing management strategies, and keeping up a regular level of exercise.

This is when cells divide and grow in an uncontrolled fashion in the lung tissue. The effect of this is to destroy normal lung tissue and block off the breathing tubes. There are 2 main types of lung cancer. The most common cause is cigarette smoke; however exposure to asbestos, marijuana smoke and a number of other chemicals can also increase your risk of developing cancer. Common signs and symptoms A troublesome cough Coughing up blood Chest pain Loss of appetite and weight Tiredness Recurrent bronchitis or pneumonia Diagnosis To diagnose lung cancer your doctor will look at your medical and smoking history. You will also have a physical examination. The best screening test is a chest X-ray which your doctor should order if concerned. If abnormal shadowing is present other tests will be performed to find out what is the cause of the shadowing and which usually involve obtaining some cells to look at under the microscope. Tests you are likely to have include: CT scans with or without fine needle aspirate (see below) Bronchoscopy (see below). Treatment Once lung cancer is diagnosed, a process known as staging determines the extent of the disease. Knowing the type and stage of cancer means the doctor can plan your treatment. Different treatment options include: Surgery. The type of surgery depends on the size and type of cancer Radiotherapy is a form of high energy radiation (X-ray) that kills cancer cells Chemotherapy is the use of drugs aimed at killing cancer cells. The aim of treatment is to cure if possible. If this is not possible then the aim is to both control symptoms and where possible prolong life. If you have a lung cancer there will be ongoing follow up with specialists and nurses throughout treatment and afterwards. For more information about lung cancer see www.cancernz.org.nz

You may be advised to take lung function tests to find out how much air moves in and out as you breathe. The two most common tools used to measure lung function are spirometers and peak flow meters. Lung function tests are sometimes done before and after taking a medication known as a bronchodilator (asthma reliever medication) to open your airways. Other more detailed lung function tests may be required in a special lung function laboratory. These may include exercise testing.

What is Obstructive Sleep Apnoea (OSA)? If the muscles at the back of the throat relax too much the airway becomes completely blocked and breathing stops. This is called an “apnoea” which means “no air flow to the lungs”. Each time your airway blocks off your body may not get enough oxygen. The apnoea (no air flow to the lungs) can last 10 seconds or more and can happen hundreds of times a night. During the apnoea, the brain soon recognises there is a problem and wakes the person up a little. The muscles then firm up which means the airway opens and breathing begins again. As the person relaxes and becomes deeply asleep, further apnoeas will happen. This can significantly affect sleep quality. Who gets OSA? Anyone. More males than females. Those who have nose or throat problems, i.e nasal polyps, large tonsils. Those with a small throat. Being overweight does not cause OSA, but will make the problem worse. What is the treatment for OSA? Continuous Positive Airway Pressure (CPAP) machine is the usual treatment for OSA. A CPAP machine is a pump which delivers air to the lungs. The air travels from the machine through a tube to a mask on the nose. The air pressure supports the muscles at the back of the throat to keep them open during sleep. The CPAP machine is only used during sleep. The machine will stop you snoring and having apnoeas and improve your sleep quality. Daytime sleepiness should disappear. Note CPAP is a treatment only. There is no cure for OSA. To be effective, CPAP must be used each time you sleep. If you believe that you may have Obstructive Sleep Apnoea, ask your GP to refer you to a Sleep Clinic for assessment. You will have to complete a Sleep Questionnaire which will be sent to the Clinic. Sleep Team Contact information: For replacement parts, broken machines, help with your CPAP/APAP devices, please contact our Sleep Team to make an appointment: Phone 0800 731 277 and leave a brief message. Calls will be returned within 48 hours on working days Or Email: . Obstructive Sleep Apnoea Booklet (PDF, 176 KB) Epworth Sleepiness Score (PDF, 21.5 KB) Epworth Sleepiness Score - to assess sleepiness/tiredness during the day.

This is a small hand-held tube that can measure the flow of air coming from your breathing tubes. You can have one at home and measure your peak flow by blowing into it as hard and fast as possible. You will be shown how to use it. It can be useful in managing asthma. If you perform a test when you are very well the recording serves as a useful reference to compare future recordings with if you are developing worsening asthma symptoms. In this way your doctor may help you develop a management plan that helps guide you as what to do if you start to develop an asthma attack.

Spirometry is a test which measures the speed at which your lungs can be filled and emptied of air. It can be used to diagnose problems of breathing and monitor the usefulness of treatment. In order to do spirometry, you take a deep breath in and blow out as hard as you can into a hollow tube attached to a spirometer machine for 6 seconds. You will be asked to do the test 3 times. The whole process takes 5-15 minutes depending on whether you are given some inhaled medicine and asked to do it again to monitor if there is an improvement.

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