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 things that don’t affect other people. As a result of this they become swollen and narrow.

If your asthma is not getting better with standard treatment (preventer and reliever inhalers) or if you are having more asthma attacks than you or your doctor are comfortable with, 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. Sometimes other conditions can appear like asthma or complicate asthma, so you may be asked to have some tests to help in the diagnosis.

Tests looking for severity and complicating features of asthma include: chest X-ray, spirometry and CT chest.

Treatment

This includes taking medicines as well as changing some lifestyle factors. A peak flow meter can be used to keep a watch on your asthma and 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. a preventer medicine is taken every day. It soothes the irritated breathing tubes and prevents worsening of asthma, “asthma attacks”.
2. a reliever treats the asthma attacks. It relaxes the tightened muscles around the breathing tubes.

For more information on asthma see Asthma New Zealand website.

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 for information about the oxygenation of your blood and other gases.

Blood gas measurements may also be used if you have known respiratory, metabolic or kidney disease, especially if you have severe difficulty breathing. 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 respiratory or metabolic problem.

A tiny camera attached to a long tube is inserted through your nose or mouth and passed down through the airways into your lungs. This allows the surgeon to make a diagnosis either by seeing directly what is causing the problem or by taking a small tissue (biopsy) or lung secretion sample.

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 blocked and the surrounding tissue and air sacs inside the lungs become damaged. COPD includes conditions such as emphysema, chronic bronchitis and chronic asthma. COPD is a long term and sometimes fatal disease that can be managed and slowed down. Smoking is the main cause of emphysema and chronic bronchitis.

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 occurs in the morning. As the disease progresses, coughing persists throughout the day. There is often associated shortness of breath and an increased rate of chest infections.

Emphysema is the gradual destruction of the air sacs (alveoli) in the lungs. The alveoli are unable to completely relax. As they become larger they are not as good at transporting oxygen to the blood. Emphysema cannot be cured, but can be managed through medication and lifestyle changes.

Investigations

You may have some of the following tests before or after your clinic appointment:

• chest X-ray
• spirometry
• lung function tests
• 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 include inhalers, although they are not used for everyone. If you have COPD it is a good idea to have the flu vaccination every year.

For more information on COPD see www.asthmanz.co.nz

• MAGIC COPD Support Group (PDF, 31.9 KB)

Note: PDF downloads require the free Adobe Reader application to view.

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 anaesthetic 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 abnormal malignant 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 several 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 cough that gets worse with time
• coughing up blood
• chest pain
• loss of appetite and weight
• tiredness
• repeated doses of, or not improving, 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. This is usually followed by a number of tests. The aim of the tests is to confirm the diagnosis and find out what type of cancer it is which usually involves obtaining some cells to look at under the microscope. Test you are likely to have include:

• chest X-ray. This is the first test that may raise the question of a lung cancer. It is usually followed by other tests to confirm the diagnosis
• CT scans with or without fine needle aspirate
• bronchoscopy

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 keep the person as well as possible even if the cancer cannot be cured.

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 Cancer Society NZ - Lung cancer

Spirometry is a tool that measures how effectively your lungs are working. It can show how much air lungs are able to hold (their volume) and how much air can be breathed in and out (inhaled and exhaled) which is called flow. It can be used to diagnose problems of breathing and monitor the usefulness of treatment. The test involves taking a deep breath in and blowing out as hard as you can into a hollow tube attached to a spirometer machine. You will be asked to do the test several times. The whole process takes 15 - 30 minutes depending on whether you are given some inhaled medicine and asked to do it again to monitor if there is an improvement. Read more about Spirometry on the Healthify website

Peak flow meter This is a small hand-held tube that can measure what is happening in 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 measure it and compare it with what you can blow when you are well as part of your asthma management plan if you think you are having an asthma attack. For more information view on the Healthify website

Service types: Obstructive sleep apnoea (OSA).

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. 

• Patients are now required to call or email to arrange collection of the required equipment.  
  • Phone:  0800 731 277 
  • Please leave a voicemail with your name, NHI and what you require. Calls are aimed to be returned within two working days.  
• Email:  sleep.team@middlemore.co.nz 

• Obstructive Sleep Apnoea Booklet (PDF, 176 KB)
• Epworth Sleepiness Score (PDF, 21.5 KB)
  

  Epworth Sleepiness Score - to assess sleepiness/tiredness during the day.

• Management of Snoring (PDF, 163.5 KB)
• Drowsy Driving Tips (PDF, 151.2 KB)
• Sleep Hygiene Information (PDF, 197.3 KB)

Note: PDF downloads require the free Adobe Reader application to view.

Would you like your home insulated for FREE?
If you would like a warmer, drier home for your family, please click here for more information about the Snug Homes or Warm Up Counties Manukau home insulation programmes.