Chronic Disease Management
As well as dealing with acute illnesses we provide yearly checks ups and education to patients in managing their condition. Our fully trained doctors provide this service. If you suffer from any of the conditions listed below you are encouraged to attend regular reviews in order to optimise control and minimise any symptoms.
Asthma is a common long-term condition that cause coughing, wheezing, chest tightness and breathlessness. The severity of these symptoms varies from person to person. Asthma can be controlled well in most people, although some people may have more persistent problems.
Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an "asthma attack" although doctors sometimes use the term "exacerbation". Severe attacks may require hospital treatment and can be life threatening, although this is unusual. Speak to your GP or asthma nurse if you think you or your child may have asthma. You should also contact your practice if you are finding it difficult to control your symptoms.
What causes asthma?
Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal.
When you come into contact with something that irritates your lungs – known as a trigger – your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).
- Common asthma triggers include:
- house dust mites
- animal fur
- cigarette smoke
- viral infections
Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday. The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition. Asthma can develop at any age, including in young children and elderly people.
Read more about the causes of asthma.
Who is affected?
In the UK, around 5.4 million people are currently receiving treatment for asthma. That's the equivalent of 1 in every 12 adults and 1 in every 11 children. Asthma in adults is more common in women than men.
How asthma is treated
While there is no cure for asthma, there are a number of treatments that can help control the condition.
Treatment is based on two important goals, which are:
- relieving symptoms
- preventing future symptoms and attacks
For most people, this will involve the occasional – or, more commonly, daily – use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important.
For many people, asthma is a long-term condition –particularly if it first develops in adulthood.
Asthma symptoms are usually controllable and reversible with treatment, although some people with long-lasting asthma may develop permanent narrowing of their airways and more persistent problems.
For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on.
NHS Choices - Asthma's symptoms, causes, diagnosis, treatment and living with the condition
Asthma UK - an independent UK charity dedicated to conquering asthma.
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Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction. Typical symptoms of COPD include:
- increasing breathlessness when active
- a persistent cough with phlegm
- frequent chest infections
Why does COPD happen?
The main cause of COPD is smoking. The likelihood of developing COPD increases the more you smoke and the longer you've been smoking. This is because smoking irritates and inflames the lungs, which results in scarring.
Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more mucus is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed. These changes cause the symptoms of breathlessness, cough and phlegm associated with COPD. Some cases of COPD are caused by fumes, dust, air pollution and genetic disorders, but these are rarer.
Who is affected?
COPD is one of the most common respiratory diseases in the UK. It usually affects people over the age of 35, although most people are not diagnosed until they are in their fifties. It is thought there are over 3 million people living with the disease in the UK, of which only about 900,000 have been diagnosed. This is because many people who develop symptoms of COPD do not get medical help because they often dismiss their symptoms as a ‘smoker’s cough’. COPD affects more men than women, although rates in women are increasing.
It is important that COPD is diagnosed as early as possible so treatment can be used to try to slow down the deterioration of your lungs. You should see your GP if you have any of the symptoms mentioned above. COPD is usually diagnosed after a consultation with your doctor, which may be followed by breathing tests.
Although the damage that has already occurred to your lungs cannot be reversed, you can slow down the progression of the disease. Stopping smoking is particularly effective at doing this.
Treatments for COPD usually involve relieving the symptoms with medication, for example by using an inhaler to make breathing easier. Surgery is only an option for a small number of people with COPD.
Living with COPD
COPD can affect your life in many ways, but help is available to reduce its impact.
Simple steps such as keeping healthy, being as active as possible, learning breathing techniques, and taking your medication can help you to reduce the symptoms of COPD. Financial support and advice about relationships and end of life care is also available for people with COPD.
Want to know more?
British Lung Foundation: COPD
Can COPD be prevented?
Although COPD causes about 25,000 deaths a year in the UK, severe COPD can usually be prevented by making changes to your lifestyle. If you smoke, stopping is the single most effective way to reduce your risk of getting the condition. Research has shown you are up to four times more likely to succeed in giving up smoking if you use NHS support along with stop-smoking medicines such as patches or gum. Ask your doctor about this, call the NHS Smoking Helpline on 0300 123 1044 or go to the NHS Smokefree website.
Quit smoking - Quit.org
COPD explained - NHS Choices
Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. There are two main types of diabetes – type 1 diabetes and type 2 diabetes. In 2010, there were approximately 3.1 million people aged 16 or over with diabetes (both diagnosed and undiagnosed) in England. By 2030, this figure is expected to rise to 4.6 million, with 90% of those affected having type 2 diabetes.
The charity Diabetes UK estimates that around 850,000 people in England have diabetes but haven't been diagnosed. Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes. This is sometimes known as pre-diabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased.
It's very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.
You should therefore visit your GP as soon as possible if you have symptoms, such as feeling thirsty, passing urine more often than usual and feeling tired all the time.
Symptoms of diabetes
The main symptoms of diabetes are:
- feeling very thirsty
- urinating more frequently than usual, particularly at night
- feeling very tired
- weight loss and loss of muscle bulk
- itching around the penis or vagina, or frequent episodes of thrush
- cuts or wounds that heal slowly
- blurred vision (caused by the lens of the eye becoming dry)
Type 1 diabetes can develop quickly over weeks or even days. Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.
What causes diabetes?
The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it's broken down to produce energy. However, if you have diabetes, your body is unable to break down glucose into energy. This is because there's either not enough insulin to move the glucose, or the insulin produced doesn't work properly.
Type 1 diabetes
In type 1 diabetes, the body's immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body's organs.
Type 1 diabetes is often known as insulin-dependent diabetes. It's also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years.
Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes. If you're diagnosed with type 1 diabetes, you'll need insulin injections for the rest of your life. You'll also need to pay close attention to certain aspects of your lifestyle and health to ensure your blood glucose levels stay balanced. For example, you'll need to eat healthily, take regular exercise and carry out regular blood tests.
Type 2 diabetes
Type 2 diabetes is where the body doesn't produce enough insulin or the body's cells don't react to insulin. This is known as insulin resistance. Type 2 diabetes is far more common than type 1 diabetes. In the UK, around 90% of all adults with diabetes have type 2 diabetes. If you're diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly and monitoring your blood glucose levels. However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets.
Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it's more common in older people. You can use the BMI healthy weight calculator to check whether you're a healthy weight.
Gestational diabetes (in pregnancy)
During pregnancy, some women have such high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. This is known as gestational diabetes and affects up to 18 in 100 women during pregnancy.
Pregnancy can also make existing type 1 diabetes worse. Gestational diabetes can increase the risk of health problems developing in an unborn baby, so it's important to keep your blood glucose levels under control. In most cases, gestational diabetes develops during the second trimester of pregnancy (weeks 14 to 26) and disappears after the baby is born. However, women who have gestational diabetes are at an increased risk (30%) of developing type 2 diabetes later in life (compared with a 10% risk for the general population).
Coronary Heart Disease
Coronary heart disease (CHD) is the leading cause of death both in the UK and worldwide. It's responsible for around 74,000 deaths in the UK each year. About 1 in 5 men and 1 in 8 women die from CHD. In the UK, there are an estimated 2.7m people living with the condition and 2m people affected by angina (the most common symptom of coronary heart disease).
CHD generally affects more men than women, but from the age of 50 the chances of developing CHD are similar for men and women. As well as angina (chest pain), the main symptoms of CHD are heart attacks and heart failure. However, not everyone has the same symptoms and some people may not have any before CHD is diagnosed. CHD is sometimes called ischaemic heart disease.
About the heart
The heart is a muscle about the size of your fist. It pumps blood around your body and beats approximately 70 times a minute. After the blood leaves the right side of the heart, it goes to your lungs, where it picks up oxygen. The oxygen-rich blood returns to your heart and is then pumped to the organs of your body through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation. The heart gets its own supply of blood from a network of blood vessels on the surface of your heart, called coronary arteries.
Why does coronary heart disease happen?
Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma.
Atherosclerosis can be caused by lifestyle habits and other conditions, such as:
Diagnosing coronary heart disease
If your doctor feels you are at risk of CHD, they may carry out a risk assessment. This involves asking about your medical and family history, your lifestyle and taking a blood test.
Further tests may be needed to confirm a diagnosis of CHD, including:
Treating coronary heart disease
Although coronary heart disease cannot be cured, treatment can help manage the symptoms and reduce the chances of problems such as heart attacks. Treatment can include lifestyle changes, such as doing regular exercise and stopping smoking, as well as medication and surgery.
If you have problems such as a heart attack, or have any heart surgery, it is possible to eventually resume your normal life. Advice and support is available to help you deal with aspects of your life that may have been affected by CHD.
By making some simple lifestyle changes, you can reduce your risk of getting CHD. These include:
- eating a healthy, balanced diet
- being physically active
- giving up smoking
- controlling blood cholesterol and sugar levels
Keeping your heart healthy will also have other health benefits, and help reduce your risk of stroke and dementia.
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A stroke is a serious medical condition that occurs when the blood supply to part of the brain is cut off. Strokes are a medical emergency and prompt treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.
If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.
The main symptoms of stroke can be remembered with the word FAST: Face-Arms-Speech-Time.
- Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have dropped
- Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
- Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
- Time – it is time to dial 999 immediately if you see any of these signs or symptoms
Why do strokes happen?
Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain damage and possibly death.
Types of stroke
There are two main causes of strokes:
- ischaemic (accounting for over 80% of all cases) – the blood supply is stopped due to a blood clot
- haemorrhagic – a weakened blood vessel supplying the brain bursts and causes brain damage
There is also a related condition known as a transient ischaemic attack (TIA), where the supply of blood to the brain is temporarily interrupted, causing a 'mini-stroke'. TIAs should be treated seriously as they are often a warning sign that a stroke is coming.
Who is at risk from stroke?
In England, strokes are a major health problem. Every year over 150,000 people have a stroke and it is the third largest cause of death, after heart disease and cancer. The brain damage caused by strokes means that they are the largest cause of adult disability in the UK. People over 65 years of age are most at risk from having strokes, although 25% of strokes occur in people who are under 65. It is also possible for children to have strokes. If you are south Asian, African or Caribbean, your risk of stroke is higher. This is partly because of a predisposition (a natural tendency) to developing diabetes and heart disease, which are two conditions that can cause strokes.
Smoking, being overweight, lack of exercise and a poor diet are also risk factors for stroke. Also, conditions that affect the circulation of the blood, such as high blood pressure, high cholesterol , atrial fibrillation (an irregular heartbeat) and diabetes, increase your risk of having a stroke.
Treating a stroke
Treatment depends on the type of stroke you have, including which part of the brain was affected and what caused it. Most often, strokes are treated with medicines. This generally includes drugs to prevent and remove blood clots, reduce blood pressure and reduce cholesterol levels.
In some cases, surgery may be required. This is to clear fatty deposits in your arteries or to repair the damage caused by a haemorrhagic stroke.
Life after a stroke
The damage caused by a stroke can be widespread and long-lasting. Some people need to have a long period of rehabilitation before they can recover their former independence, while many will never fully recover.
The process of rehabilitation will be specific to you, and will depend on your symptoms and how severe they are. A team of specialists are available to help, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors. The damage that a stroke causes to your brain can impact on many aspects of your life and wellbeing, and depending on your individual circumstances, you may require a number of different treatment and rehabilitation methods.
Can strokes be prevented?
Strokes can usually be prevented through a healthy lifestyle. Eating a healthy diet, taking regular exercise, drinking alcohol in moderation and not smoking will dramatically reduce your risk of having a stroke. Lowering high blood pressure and cholesterol levels with medication also lowers the risk of stroke substantially.
Hypertension (High Blood Pressure)
Known as the "silent killer", high blood pressure (hypertension) rarely has obvious symptoms. Around 30% of people in England have high blood pressure but many don't know it. If left untreated, high blood pressure increases your risk of a heart attack or stroke. The only way of knowing there is a problem is to have your blood pressure measured.
All adults should have their blood pressure checked at least every five years. If you haven’t had yours measured, or you don’t know what your blood pressure reading is, ask your GP to check it for you.
What is high blood pressure?
Blood pressure is measured in millimetres of mercury (mmHg) and is recorded as two figures:
- systolic pressure – the pressure of the blood when your heart beats to pump blood out
- diastolic pressure – the pressure of the blood when your heart rests in between beats, which reflects how strongly your arteries are resisting blood flow
For example, if your GP says your blood pressure is "140 over 90", or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg. You are said to have high blood pressure (medically known as hypertension) if readings on separate occasions consistently show your blood pressure to be 140/90mmHg or higher. A blood pressure reading below 130/80mmHg is considered to be normal.
Who is most at risk?
Your chances of having high blood pressure increase as you get older. There is often no clear cause of high blood pressure but you are at increased risk if you:
- are overweight
- have a relative with high blood pressure
- are of African or Caribbean descent
- eat too much salt
- don't eat enough fruit and vegetables
- don't do enough exercise
- drink too much coffee (or other caffeine-based drinks)
- drink too much alcohol
- are aged over 65
If you fall into any of the groups listed above, consider making changes to your lifestyle to lower your risk of high blood pressure. Also consider having your blood pressure checked more often, ideally about once a year.
Prevention and treatment
You can take steps to prevent high blood pressure by:
- losing weight if you need to
- reducing the amount of salt you eat
- exercising regularly
- eating a healthy diet
- cutting back if you drink too much alcohol
- stopping smoking
- cutting down on caffeine
If your blood pressure is found to be high, it will need to be closely monitored until it is brought under control. Your doctor will usually suggest changes to your lifestyle and, sometimes, medication to achieve this.
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Epilepsy is a condition that affects the brain and causes repeated seizures, also known as fits.
Epilepsy affects more than 500,000 people in the UK. This means almost 1 in 100 people has the condition. Epilepsy usually begins during childhood, although it can start at any age.
Seizures are the most common symptom of epilepsy, although many people can have a seizure during their lifetime without developing epilepsy. The cells in the brain, known as neurones, communicate with each other using electrical impulses. During a seizure, the electrical impulses are disrupted, which can cause the brain and body to behave strangely.
The severity of the seizures can differ from person to person. Some people simply experience a ‘trance-like’ state for a few seconds or minutes, while others lose consciousness and have convulsions (uncontrollable shaking of the body).
Why does epilepsy happen?
Epilepsy can happen for many different reasons, although usually it is the result of some kind of brain damage. Epilepsy can be defined as being one of three types, depending on what caused the condition. These are:
- Symptomatic epilepsy – when the symptoms of epilepsy are due to damage or disruption to the brain.
- Cryptogenic epilepsy – when no evidence of damage to the brain can be found, but other symptoms, such as learning difficulties, suggest that damage to the brain has occurred.
- Idiopathic epilepsy – when no obvious cause for epilepsy can be found.
Epilepsy is most often diagnosed after you have had more than one seizure. This is because many people have a one-off epileptic seizure during their lifetime. The most important information needed by a GP or neurologist is a description of your seizures. This is how most cases of epilepsy are diagnosed. Some scans may also be used to help determine which areas of your brain are affected by epilepsy, but these alone cannot be used for a diagnosis.
How is epilepsy treated?
While medication cannot cure epilepsy, it is often used to control seizures. These medicines are known as anti-epileptic drugs (AEDs). In around 70% of cases, seizures are successfully controlled by AEDS.
It can take some time to find the right type and correct dose of AED before your seizures can be controlled. In some cases, surgery may be used to remove the area of the brain affected or to install an electrical device that can help control seizures.
Living with epilepsy
While epilepsy is different for everyone, there are some general rules that can help making living with the condition easier. It is important to stay healthy through regular exercise , a healthy diet, and avoiding excessive drinking. You may have to think about your epilepsy before you undertake things such as driving, using contraception and getting pregnant.
Advice is available from your GP or support groups to help you adjust to life with epilepsy.
Sudden unexpected death in epilepsy (SUDEP), while rare, is one of the main dangers associated with epilepsy. Every year between 500 and 1,000 people die as a result of SUDEP, this is less than 1% of people with epilepsy. Although the cause of SUDEP is unknown, a clear understanding of your epilepsy and good management of your seizures can reduce the risk.
Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints.
The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body. There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints.
When to seek medical advice
You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause. Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.
What causes rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease. This means that your immune system – which usually fights infection – attacks the cells that line your joints by mistake, making them swollen, stiff and painful.
Over time, this can damage the joint itself, the cartilage and nearby bone. It's not clear what triggers this problem with the immune system, although you are at an increased risk if you are a woman, you have a family history of rheumatoid arthritis, or you smoke.
Who is affected?
Rheumatoid arthritis affects around 400,000 people in the UK. It can affect adults at any age, but most commonly starts between the ages of 40 and 50. About three times as many women as men are affected.
How rheumatoid arthritis is treated?
There is no cure for rheumatoid arthritis, but early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares and to be able to lead full lives and continue regular employment.
The main treatment options include:
- medication that is taken in the long-term to relieve symptoms and slow the progress of the condition
- supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities
- surgery to correct any joint problems that develop
Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening. Possible complications include carpal tunnel syndrome, inflammation of other areas of the body (such as the lungs, heart and eyes), and an increased risk of heart attack and strokes. Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of complications such as these.