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
