Treatment of allergic airway disease targets an allergic reaction in the lower airways that causes chronic inflammation of the airway wall and reversible narrowing, producing episodes of wheeze, breathlessness, chest tightness and a cough that worsens at night or with cold air, laughter or exertion. This is the pattern clinicians usually call allergic asthma, and its familiar triggers in Jordan are dust mites, pollens, mould, animal dander, cigarette and waterpipe smoke, viral colds, cold dry air, weather changes, occupational dust and strong odours. Diagnosis is not made by listening to the chest alone. Reversible obstruction is demonstrated with spirometry repeated after a bronchodilator, and home peak flow monitoring may be used to capture variability. A chest X-ray may be requested to exclude other causes, and allergy testing to identify the trigger. In young children who cannot perform the test reliably, diagnosis rests on a repeated clinical pattern and a documented response to a structured trial of treatment. **Not every cough or wheeze is allergy: reflux, post-nasal drip, recurrent infection, vocal cord dysfunction and, in a child, an inhaled foreign body all mimic it and must be distinguished.** Treatment rests on two pillars, not one: a daily inhaled preventer that reduces inflammation and prevents attacks, and a fast-acting reliever used only when symptoms occur. Alongside these come reduction of allergen exposure, complete avoidance of cigarette and waterpipe smoke in the home, treatment of coexisting nasal allergy because neglecting it keeps the airways irritated, seasonal vaccination as advised, and immunotherapy for those who meet the criteria. **Relying on the reliever inhaler while neglecting the preventer is a marker of poor control and of the risk of a severe attack, not a sign of success.** The limits matter. Treatment controls the disease rather than curing it, antihistamines alone are not enough for the lower airways, and antibiotics do not treat an allergic flare without bacterial infection. Several myths cause real harm: that inhalers are addictive, that they weaken the heart, that they should be saved until things get bad, or that an inhaled steroid is the same as oral steroid tablets. In reality the inhaled dose is local and small and its risks are far smaller than those of uncontrolled attacks, while follow-up in children includes measuring height and weight and rinsing the mouth after use. Which medicine and which dose suit you, and when to step down or up, is decided by clinical assessment and lung function testing, not by reading.
Procedure steps
- 1
History and trigger identification
You are asked about the pattern and night-time timing of symptoms and their link to exertion, cold, dust and animals, about the number of emergency visits and courses of oral steroid in the past year, about nasal allergy and eczema, and about smoking, waterpipe use at home and your work environment.
- 2
Lung function testing
Spirometry is performed before and after a bronchodilator to demonstrate reversible obstruction, home peak flow may be recorded morning and evening for two weeks, further tests are added as needed, and a chest X-ray is requested if another cause must be excluded.
- 3
Allergy testing where indicated
When a specific trigger is suspected, skin prick testing or specific IgE is performed for allergens selected from your history and interpreted together with symptoms; the aim is to identify what genuinely needs avoiding, not to collect a long list.
- 4
A written control plan and inhaler training
A written plan sets out the daily preventer and the reliever when needed, what to do if symptoms deteriorate and when to seek emergency care, and inhaler technique is taught with a spacer or mask for children and practised in front of the clinician rather than merely described.
- 5
Follow-up and dose adjustment
Symptoms, reliever use, adherence, technique and the home environment are reviewed every few months; the dose is stepped down to the lowest that maintains control after a stable period, or stepped up when control is poor, and a child's height and weight are measured at every visit.
Before the procedure
Before your visit, record how many times a week you use the reliever inhaler, how many nights cough or wheeze has woken you, how many days of work or school you have missed, and how many emergency visits or courses of oral steroid you had in the past year. Bring all your inhalers and medicines in their original devices — not just their names — so the clinician can check your technique and how much is left, and bring any previous lung function test or chest X-ray. Mention heart disease, blood pressure, thyroid problems and reflux, list all your medicines including beta blockers and eye drops, and report any drug allergy, particularly to non-steroidal anti-inflammatory painkillers. For lung function testing, ask about temporarily withholding bronchodilators beforehand, avoid a heavy meal, caffeine and smoking for some hours before, and wear loose clothing. Postpone testing if you are in an acute attack or have an active chest infection, and tell the clinician if you are pregnant.
After the procedure
Take the preventer every day at the same time, even on good days, because it is what prevents attacks; use the reliever only for symptoms and record how often you need it. Rinse your mouth with water after each preventer dose, use a spacer if one was prescribed, and check the device is not empty. Reduce dust sources in the bedroom, keep pets out of it, keep the home completely free of cigarette and waterpipe smoke, and avoid going out at peak pollen or dust or wear a mask. **Go to emergency immediately if breathlessness stops you completing a sentence, for severe wheeze or a silent chest, use of neck muscles to breathe or in-drawing between the ribs in a child, blue lips, if the reliever does not help or symptoms return before the next dose is due, or with a racing pulse, drowsiness, confusion or inability to lie flat.** **Also go to emergency for a severe allergic reaction: swelling of the lip or tongue, dizziness, or a widespread rash with breathlessness.** Arrange an early review if you need the reliever more than a few times a week, wake at night repeatedly, or your peak flow falls below your usual reading.
Expected duration
An assessment visit usually takes 30 to 45 minutes and spirometry 20 to 30 minutes including the post-bronchodilator repeat; the effect of preventer treatment is normally judged after four to eight weeks, with review every three to six months once stable.
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