It seems strange that a skin and lung disease can be connected, but this is the case. In fact, there is a third disease—hay fever—that is also connected to eczema and asthma. All three are ‘ atopic’ diseases—that is there is a specific type of reaction by the tissue in the lung, skin and nose, often to outside substances such as temperature changes, dust or pollen, but sometimes to internal triggers such as stress or hormone changes.

Patients with these conditions will know that the disease flares and settles without treatment, and usually for no apparent cause. Others will recognise that before a menstrual period, at times of anxiety, in certain seasons or with a particular type of weather, their condition will worsen.

People with one of these three diseases, also have an above average risk of developing one of the others.

It is possible for allergists to desensitise you to any allergies that may be the cause, but this procedure will not work against the other factors. Fortunately there are creams, sprays and medications that can control these diseases, but there is no cure.

The best treatment is that which completely prevents the disease. It is far better to prevent asthma than to deal with acute attacks. If the asthma only occurs every month or two, intermittent treatment may be appropriate. Most patients are being under-medicated, rather than taking too much. This applies particularly to patients who obtain their medication over the counter from chemists rather than seeing a doctor. This habit could prove expensive to your health!

Prevention involves two classes of drugs:

— Intal or Tilade

— Steroids (eg. Becotide, Becloforte, Flixotide, Pulmicort, Aldecin etc.).

Both groups are designed to be used regularly on a long term basis to prevent asthma attacks.

If an attack does occur, treatment is usually by one of a number of sprays (eg. Ventolin, Respolin, Bricanyl, Serevent). These can also be given by a nebuliser (when they are even more effective) or in a tablet or mixture (when they are less effective than a spray).

Combination inhalers are now available (eg. Seretidc) that have both preventive and treatment medication in the one dose.

Tablets or mixtures of a group of drugs called theophyllines can also be given to treat an attack of asthma. These include medications such as Ausryn and Theo-Dur.

If these medications do not work adequately, there are a number of add-on sprays and tablets that can be used including Atrovent and Prednisone.

I must emphasise how important it is to be under the continued care of a doctor when using any of these medications. Asthma can be well controlled with the cooperation of the patient.

Question: About 6 months ago I was moving a quantity of asbestos sheets without any protection, and that night I coughed a lot and felt irritation on my chest. This has persisted ever since. I would appreciate it if you could advise me what to do.
Asbestos can only cause harm to humans if inhaled. Touching, or even swallowing small amounts of asbestos, is quite harmless. To be inhaled, asbestos must be in a dust or powder form, and it is sometimes used in this way as insulation in ceilings and between walls. The sawing of asbestos sheets also produces asbestos dust that can be inhaled, and particles of asbestos may be widespread in asbestos mines and factories that manufacture asbestos products.
Old asbestos sheets may deteriorate to the point where the surface breaks down and crumbles, and a small amount of asbestos dust may be produced in this way. If small amounts of asbestos dust are inhaled infrequently, the lungs can cope adequately and expel the particles. Only long exposure to considerable amounts of asbestos dust will result in severe lung disease.
The asbestos particles are quite long and thin fibers when viewed under a microscope, which makes them difficult for the lung to remove by coughing up the mucus that accumulates around them. Over a number of years, they can irritate the lung lining to the point where the cells become cancerous. The most common form of lung cancer caused by asbestos is called mesothelioma, and this is virtually untreatable. The casual handling of sheets of asbestos for a short period of time is not going to cause any lasting lung disease, and I suspect your cough is coincidental, x-rays would not show the presence of small quantities of asbestos dust in the lungs. Please be reassured.

Question: I have recently been very ill with double pneumonia. Why is double pneumonia different to ordinary pneumonia?
Pneumonia occurs when a bacterium enters the tiny air bubbles that fill your lung, and starts multiplying to cause an infection. Usually only one part of the lungs, often at the bottom of your chest, is affected at first, but the problem soon spreads to other parts of the lung.
If a sample of the sputum you cough up is sent to a laboratory, the specific bacteria causing your pneumonia can be identified. Once one bacterium is in residence, your resistance to further infection is lowered, and it is much easier for a second type of bacteria to infect the lungs as well. When this happens, both types of bacteria can be identified by the laboratory, and you are said to have double pneumonia. It is possible to have triple, and rarely even quadruple pneumonia if you are particularly unlucky!
The laboratory will also be able to tell which antibiotics will kill the various types of bacteria infecting your lungs. The appropriate combination of antibiotics can then be given by the doctor to cure the condition. Expectorants and chest physiotherapy are the other mainstays of treatment in any type of pneumonia.

Question: I am 78 years old and my doctor tells me I have emphysema. I would be much obliged if you could tell me what is available to ease this condition.
Emphysema is a degenerative disease of the lungs caused by smoking, recurrent lung infections, or the inhalation of toxic gases. Unfortunately, there is no cure for the condition, but there are many medications (most of which require prescriptions) and techniques that can be used to control the cough and shortness of breath that occur. The treatments available include:
• Medication to prevent any spasm of the air tubes (bronchi) in the lungs, and prevent the excess production of mucus. These are in the form of inhalers such as Flixotide, Becotide, Pulmicort and Aldecin.
• Bronchodilators that open up the airways to allow more air into the lungs. Examples include Ventolin, Respolin, Atrovent, Seretide, Oxis and Bricanyl. They can be taken using either an inhaler or a nebuliser.
• Tablets such as Theo-Dur and Nuelin that open up the airways, but often cause the heart to race as a side effect.
• A tablet or mixture called Bisolvon which liquefies the phlegm in the lungs so that it can clear away more easily.
• Antibiotics that are used to treat any infection at the earliest possible stage.
• Steroid tablets or injections which are used as a last resort to treat severe episodes, or prevent a recurrence if no other medication works.
• Physiotherapy, which is very important to assist in the clearance of excess mucus from the lungs.
By using combinations and permutations of the above treatments, most emphysema victims can lead useful and comfortable lives.