Asthma

Asthma is a long-term condition in which the airways are inflamed and oversensitive. They narrow in response to triggers, causing wheeze, cough, chest tightness and breathlessness that vary from day to day and are often worse at night. The narrowing is reversible, which separates asthma from COPD.

It cannot be cured, but with a regular inhaled steroid most people have no symptoms and live without restrictions. Poor control nearly always traces back to not taking the preventer, poor inhaler technique, ongoing exposure to a trigger, or smoking. A small group have severe asthma that needs specialist treatment.

Symptoms

• Wheezing, a whistling sound when breathing out
• Cough, particularly at night, in the early morning or after exercise
• Chest tightness
• Shortness of breath that comes and goes
• Symptoms set off by colds, pollen, dust, pets, cold air, smoke or exercise
• Needing a reliever inhaler more than twice a week, a sign of poor control

Causes and risk factors

Asthma results from inherited tendency meeting environmental exposure. It commonly occurs with eczema, hay fever and food allergy, and runs in families. Triggers include viral infections, house dust mite, pollens, moulds, animal dander, tobacco smoke, air pollution, cold air, exercise, strong emotions, and medicines such as aspirin, anti-inflammatory painkillers and beta blockers. Occupational asthma arises from workplace substances such as flour, isocyanate paints, wood dust and latex. Obesity, acid reflux and chronic sinus disease make control harder. Adult-onset asthma is often non-allergic and driven by eosinophils.

How it is diagnosed

• Spirometry with reversibility: Measures airflow before and after a bronchodilator. An improvement of 12 percent and 200 ml or more supports asthma.
• FeNO test: Measures nitric oxide in the breath, a marker of allergic airway inflammation.
• Peak flow diary: Twice-daily readings over 2 to 4 weeks show the variability typical of asthma.
• Bronchial challenge test: Used when spirometry is normal but suspicion remains.
• Allergy tests and blood eosinophils: Skin prick or specific IgE tests identify triggers; eosinophil count guides biologic therapy in severe disease.
• Chest X-ray: To exclude other causes when the picture is atypical.

Treatment options

• Inhaled corticosteroid: The foundation of treatment. It may be taken daily, or as a combined steroid and formoterol inhaler used both regularly and for relief.
• Reliever inhaler: Salbutamol for quick relief. Relying on it alone is no longer recommended.
• Add-on treatments: Long-acting bronchodilators, montelukast, or tiotropium when a steroid inhaler is not enough.
• Inhaler technique and spacer: Checking technique fixes a large share of apparently difficult asthma.
• Written action plan: Tells you how to step up treatment and when to seek help as symptoms or peak flow worsen.
• Biologic injections: Omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab for severe asthma with frequent attacks, given every 2 to 8 weeks long term.
• Trigger control and vaccination: Stopping smoking, weight loss, treating rhinitis and reflux, and yearly influenza vaccination.

When it is urgent

Call local emergency services if your reliever is not helping or wears off within 4 hours, you are too breathless to speak in sentences, your lips look blue, your peak flow is below half your best, or you feel exhausted or drowsy. Take one puff of reliever through a spacer every 30 to 60 seconds up to 10 puffs while waiting. An asthma attack is never something to travel for.

Travelling to Türkiye for treatment

Asthma is managed through regular reviews and repeat prescriptions, so it belongs with your home doctor. A visit can add value if your diagnosis is uncertain or control is poor despite treatment: full lung function, FeNO, allergy testing, a CT of the sinuses or chest if needed and a respiratory specialist's written plan can be completed in 2 or 3 days. Biologic treatment has to be started and continued where you live. If you fly with asthma, carry inhalers in hand luggage along with your action plan.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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