Do not adjust your set....

I may have to apologise to my old friend the controller of Radio Four. Regular readers (bless you all) may recall a running spat I had with Radio Four, and particularly the Today Programme, a few months ago. They appeared to have taken over the collective consciousness of the citizens of Borsetshire so that every little health problem mentioned over the airwaves immediately presented to me in surgery, and without any of thos affected having heard the news reports in question. Well after yesterday it appears it might have been me all along. Apparently I have psychic powers verging on the supernatural. I've thought it through and it's the only explanation that makes any sense...

I'm feeling your skepticism here, but once I have recounted the events that follow, I am sure that even you, gentle reader, will be convinced of my newfound ability.

Oh yes you will!

*teeters precariously on the brink of Panto before pulling us back to relative sanity*

There, glad that's all behind me....

*somewhere off in the distance the screams of hundreds of children all frantically pointing- only to be ignored*

It all begins, as so many of these posts do, with the drive in to work. I like the drive. Leafy lanes, thrashy music, and time for thinking. The kids have been left behind at school, the mobile is either off or inaudible (Jethro Tull's "Aqualung" at eleven on the car stereo), so there are few distractions (sheep and pigeons excepted).

This particular drive in I am pondering asthma. And it strikes me that the past decade or so has seen the presentation of asthma change quite a bit. The condition remains the same, i.e. cough and / or wheeze depending on age. What appears to have changed is the number and frequency of acute exacerbations. In the good old days we used to just have two broad treatments to offer, relievers (like Ventolin) that relieved wheeze quickly only to wear off after about 4 hours, and preventers (steroids like Becotide) that reduced the severity of attacks and helped prevent them in the longer term.

But, preventers need to be used all the time, and the inhalers are not nice to take, often being quite "peppery" on the tongue. Worse still they have sife effects -- sore tongue and hoarse voice, and they are "steroids" which in may people's books make them nasty. Especially when their use, and indeed the use of the relievers, is banned in certain compettetive sports unless you have a "note from the doctor". Add to that the fact that most of our new asthmatics tend to be children, so we are asking mums and dads to give their little darlings something with all the appeal of nerve gas, and it's no wonder preventers meet with a degree of resistance.

In the past this led to significant under treatment and fairly frequent exacerbations. Especially when there were lots of viral coughs about or the air was very cold / hot / polluted. During these episodes, surgeries would be full of wheezy, coughy people all queueing up for a "go" on the nebulizer- a wizzo machine that makes an aerosol of medication that you can breathe, spaceman-like, through a mask. This is a huge hit with the seven to twelve year olds, a source of terrour to the pre-schoolers, and a monumental pain in the wossname to the rest of us. But it does help turn around exacerbations. That and bucketfuls of steroid tablets.

Anyways, in the past few tears other inhalers and pills have become available that bridge the gap between prevention and relief. These (drugs like Salmeterol and Montelukast) have made a big difference to tolerability of treatment and symptom control. This has meant we have seen fewer severe exacerbations and our nebuliser instead of seeing constant use has been relegated to a hidey hole under the sterilizer most of the time.

Back in the car Jethro Tull have moved on to the Dambusters march* as I am musing that we seldom seem to need the nebuliser anymore. So guess what I had to do for three patients yesterday morning....

So there you have it. Convincing proof I think you'll find the power of my immense intellect to forsee the future and influence human behaviour. Now if only I could put it to good use.

So go on. How many of you are now thinking about chocolate digestives then eh?

*name that album for a bonus point.