My first thought, on regaining consciousness, was “I really must do something about that cough”. I was lying on my back. A stream of vomit was congealing on my clothes. Stars were spinning in front of my eyes.

Never in my life before that moment had I blacked out with the suddenness of a switch being thrown. I struggled mentally to recall what had been happening before the lights went out. Faintly and distantly, I remembered a coughing fit.

I had been getting ready to go to bed in the spare room of my aged mother’s flat, having sat with her watching television. Many times throughout the evening, bouts of wracking, gasping coughing had left me pathetically whimpering for breath. “My God,” my mother would occasionally say, “that cough sounds like death.” But, most times, she kept her eyes on the screen and took no notice of these onslaughts. She had been hearing them for years.

I seemed to remember that I had been standing beside the bed, unfastening my belt, when I started coughing and blacked out. That would explain why I had landed safely on my back on the mattress. I couldn’t be completely sure what had happened, but I knew what I must do. I must see a doctor as soon as I got home. This condition had to be dealt with. What if I were to black out while I was driving? Or while I was looking after one of our young children?

Unfortunately, I had no reason to feel confidence in my doctors. Many times (six? nine?) over the previous five years, I had visited the surgery of our NHS practice in the centre of my nearest town. One of the six doctors on the list (never the same one on consecutive visits) would ask if I smoked (I had stopped), listen to my chest, look into my throat and declare that everything was “normal”. One diagnosed rhinitis and prescribed a nasal spray. Another recommended steam inhalations and told me to use a face mask over a bowl of boiling water with a few drops of eucalyptus. Most times, they would shrug and say: “There’s a lot of it about.”

On and off, this appalling cough had been frightening the horses for years.

Every time I caught a cold, or started a bout of hay fever, a heaving, convulsive hawking would start up that made people turn around in the street or on a plane to see who it was who was evidently gasping his last. Having smoked 20 to 30 cigarettes a day – together with cigars and pipes – for 35 years since my teens, I supposed that I was simply suffering my due desserts. My father, who smoked all his life, had developed the same cough in his late middle age. Apart from the fact that I often sounded like a miner with emphysema, however, my health was robust.

Luckily, when I went to the surgery after the blackout, I saw a doctor who had never previously dismissed this cough – an old family doctor who was soon to retire. He asked a lot of careful questions about our house: did we have pets? Carpets? Open fires? Old mattresses? We then talked about the hens that I was keeping at the time and the possibility that mites in their straw bedding might be bugging me. Then he said: “My guess is that you are suffering from late-onset asthma.”

I was flabbergasted. The idea had never occurred to me. “It’s easy enough to test,” the doctor said. “I’ll prescribe an asthma inhaler. If it works, it’s a pretty good sign that you’ve got asthma. If not, we’d better think again.”

The coughing eased a little as soon as I started using a metered-dose inhaler of albuterol, a brochodilator that relaxes the muscles of the windpipe; so the doctor was happy that his diagnosis was confirmed – so happy, in fact, that he promptly retired and left me to it. The practice did nothing further to help me to understand and control the condition so it was only slightly ameliorated by my occasional use of albuterol whenever I started coughing.

After another year of spluttering and hawking, my wife said in exasperation: “Surely they must have an asthma nurse or clinic that could give you guidance?”

When I called the practice, the manager confirmed that they did, indeed, have an asthma nurse to whom I should have been automatically referred “but somehow you must have dropped through the system”.

The nurse gave me a peak-flow meter and chart on which to record my lung efficiency with twice daily readings. When I took the chart back to the surgery after a week, she gasped: “That’s horrible! That’s a classic picture of advanced asthma!” She prescribed a Pulmicort inhaler, a steroid that reduces the inflammation of my tubes, to keep the attacks at bay (from which I must take two puffs twice a day, apparently for the rest of my life); and a Bricanyl turbohaler, a bronchodilator for immediate relief if an attack gets under way (see box, above).

The combination seems to work. My life is entirely normal now. My lung efficiency is as good as anybody’s of my age (early sixties). I can’t remember the last time I was short of breath from a coughing fit and I have never felt close to blacking out since the diagnosis of “late-onset asthma”. But why did it take so long before any of my doctors thought of it?

What is late-onset asthma? People can develop asthma (a tendency for the airways leading to the lungs to narrow) at any time in their lives. When it starts as an adult, it is often called “late-onset asthma”.

What causes it? In most cases of late-onset asthma the symptoms are triggered by catching a cold, exercise or irritants such as cigarette smoke. Asthma can be more difficult to diagnose in older people as some of the symptoms (cough, wheeze, shortness of breath) are shared with bronchitis and emphysema.

What are the treatments? Although there is no cure for asthma, there are some effective treatments. Reliever inhalers are fast-acting and used during an asthma attack to open up the airways. Preventor inhalers are slower-acting and used over a long period to lessen the chances of a full-blown attack. Some people are also prescribed tablets to prevent inflammation in their airways.

For more information Asthma UK, www.asthma.org.uk; 08457 010203

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