Asthma is becoming more common, but fortunately its treatment has improved. The death rate from acute asthma 45 years ago was very high, mainly because of the innate medical conservatism of doctors who were reluctant to use adequate medication. The situation improved 20 years ago once universal guidelines on asthma, medication and its management were introduced. Patients were instructed about the danger signs and were given access to specialist units when these became too severe. The breakthrough came with the introduction of inhalers that delivered an effective combination of steroids and B2 agonists, with peak-flow meters suitable for home use.

Someone’s respiratory efficiency could then be measured at home and compared with the predicted or best expected lung function agreed with specialists. If it fell below this level, patients could report for the care of experts at their local unit.

Patients could measure their dose against the severity of the symptoms, increasing it when necessary before reverting to lower levels once control was reestablished.

Asthma is associated with other allergic conditions such as allergic rhinitis (hay fever) in all its manifestations and atopic eczema, a sometimes devastating itchy rash that makes a baby’s life hell. Asthma and other allergic conditions run in families. Asthma is triggered by a variety of irritants including house mites, pollens, animal spit and the dust from their hair. All allergenic reactions are likely to be worse if the person, child or adult is anxious or tense.

In young children the first attacks of asthma usually start before the age of 5. These are often initially misdiagnosed as a persistent cough (which is worse at nights) that has followed a cold.

Asthma is characterised by wheezing, shortness of breath and tightness of chest. The shortness of breath may be so severe that breathing is laboured, the patient develops blue lips, tongue and skin and finds it difficult to talk as well as to breathe. A doctor’s opinion is always needed once breathing is laboured. Most children outgrow asthma before 14, but if there is no improvement by then, it is likely to persist into adult life.