Lung disease victims misdiagnosed with asthma

Lung disease victims misdiagnosed with asthma James Thomlinson was diagnosed with asthma when he was ten. He was told by his GP the breathlessness he would occasionally suffer was the result of seasonal asthma brought on by rapeseed that grew near his home.
So for the next ten years James carried a steroid-based inhaler and took antihistamines when the plant flowered in summer.
The fact that he also suffered from chest infections every few months was seen as ‘just one of those things’.
Yet his inhaler didn’t really improve his breathlessness.
‘It just made me feel a little buzzy,’ he says.
When he was 19, James suffered bouts of pneumonia in quick succession and was referred to a chest specialist who found why the inhaler had so little effect: he wasn’t asthmatic.
James had chronic obstructive pulmonary disease (COPD). This covers conditions such as emphysema and chronic bronchitis — where permanent damage has been done to the small airways.
This results in breathlessness, a cough and — because it tends to cause excess production of mucus — often leads to chest infections. The condition is linked to smoking, exposure to cigarette smoke and jobs such as mining or those involved in the chemical industry.
Other causes include low birth weight or serious chest infections, particularly as an infant (James, 27, had croup as a baby and whooping cough aged four, followed by serious chest infections every six months).
There are a million people registered with COPD in this country, yet the British Lung Foundation believes there may be two million who don’t know they have it.
It not only increases the risk of respiratory failure and cardiovascular disease, but quadruples the risk of lung cancer.
Though it is a progressive disease, the sooner it is diagnosed and treated the slower it will progress.
‘COPD is the second most common cause of acute hospital admissions in this country,’ says Professor Ian Pavord, a consultant physician in respiratory medicine at Glenfield Hospital, Leicester.
‘The disease normally comes on progressively over years and so initially some may get used to the symptoms.’
Dr Keith Prowse of the British Lung Foundation said it was common for some sufferers to be mistakenly told they had asthma because the symptoms can be confusingly similar.
‘Life for someone with COPD usually involves periods of breathlessness rather than wheezing as you have with asthma,’ he says. ‘But the differences can be subtle.’
With both, the airways become narrowed. But with COPD it’s the smaller airways that narrow — they become scarred and are progressively ‘lost’ through inflammation.
Asthma doesn’t destroy the airways — it’s caused by ‘airflow obstruction’, which is improved when a steroid inhaler is used.
But as Professor Pavord says, a significant number of people have features of both conditions.
However, while inhalers will not make the COPD patient any worse — they may help some — they will not slow the progression of the disease.
‘If a GP has someone on steroids and sees even a small improvement, that person will be labelled as asthmatic,’ says Dr Prowse.
‘They may improve as the steroid can help reduce inflammation in the airway. However, they also need antibiotics when an infection occurs (to stop further damage to airways), medication to help thin phlegm around the lungs, physiotherapy to help dislodge phlegm and an inhaler to open small airways.’
They also need to stay active to help lung function and the heart.
Most people are diagnosed in their 40s or 50s, but Dr Prowse says there is a big push to get it spotted earlier.
Tests for the condition have not always been reliable — lung function tests (blowing out through a tube) may help detect reduced lung capacity, but do not help identify the cause.
X-rays and scans may help spot damage to the lungs not present in asthma, but these are costly.
One reliable option yet to be rolled out across the country is a breath test to measure nitric oxide levels, says Professor Pavord.
These reflect the amount of inflammation in airways — high levels can suggest COPD. The current treatment is inhaled steroids with longer-acting medication that dilates bronchioles (small airways in the lungs).
‘In my opinion this investigation is simple and useful and should be available in all GPs’ surgeries,’ says Professor Pavord.
As well as saving money (people with low levels don’t respond to steroid inhalers and wouldn’t be given the drugs unnecessarily) it would make a huge difference to someone like James.
‘Even after I was diagnosed I didn’t think I was asthmatic as I didn’t need the inhalers every day, and though I would get tired playing sport, I wouldn’t get wheezy,’ says James, from Bromley, South London, who works in digital marketing.
‘But I was prone to chest infections and as a teenager I had pneumonia a couple more times.
‘In my first year at university, I got pneumonia again and was bedridden. It took a month or so to recover, so my GP there referred me to a hospital.
‘A scan found my lungs had heavy scarring and that one part was effectively dead. It was then that I was told I had COPD,’ says James.
‘I was really upset, then shortly after  my diagnosis, a lung surgeon told me: “You are probably going to die of this at some point.” That was scary, though I have since found out this is not true.’
His inhaler was replaced by one with Spiriva, a drug that helps dilate the small airways. He also has antibiotics to take at the first sign of an infection.
‘Now I avoid people who have a cold as that could trigger a chest infection,’ he says.
‘I have daily physiotherapy exercises and continue to play football.’
He has been told it would be better to remove the dead parts of his lungs surgically to stop phlegm pooling.
‘It is a massive operation and I want to put it off until I can no longer do so,’ he says.
‘I feel better knowing what’s wrong and that everything is being done to stop my condition getting worse.
‘OK, my lungs are damaged, but as a doctor said to me: “At least we can reduce the damage done in the future.” And for that, at least, I am grateful.’