Ask Dr Ellie! This week: Asthma, shingles and an underactive thyroid

Q  How do I know if my son has asthma? My husband and I both have it, so we think it’s very likely. He’s 18 months old and seems to be fine. Is there a test we can do?

Asthma in a young child is a clinical diagnosis, which means that doctors diagnose it on the basis of symptoms, history and likelihood, rather than a specific test: we can’t do a blood test or a specific X-ray to diagnose asthma in a pre-school child, and the breathing tests we can do are for over fives.

At 18 months, your son is too young to be diagnosed with asthma. We tend to diagnose once a child is older than two.

Diagnosing asthma involves firstly looking at the likelihood of him having it, so in his case there is certainly some chance because of his family history.

Other high likelihoods would come from him having other associated diseases, such as eczema and hay fever.

Asthma symptoms are very typical and a doctor will look out for these to consider diagnosing the condition. These would include a cough that has a pattern, so particularly worse in the evening or the morning, or worsened by exercise, laughing or the cold.

A wheeze is the other noticeable feature of asthma and you may hear this, or a doctor would hear it through the stethoscope.

For now, you won’t know if your son has asthma, but keep an eye on symptoms going
forward and go promptly to the doctor if he shows signs.

Q   Do you think my mother should have the shingles vaccine? She is 78 and has been offered one by her GP surgery. She has not had shingles before and is thankfully pretty healthy. 

This is very much a personal decision – more than 20 percent of adults will get struck by shingles in their adult life and it can be debilitating: shingles is much more common in the elderly, as the immune system weakens.

It is worth knowing that shingles is more than just a rash – it can be a
very painful illness that causes long-term issues. The rash of shingles only lasts two weeks or so, but some people go on to develop a pain condition as a result, known as post-herpetic neuralgia. This leads to permanent pain in the area of the rash and it is very difficult to treat.

Neuralgia doesn’t respond to normal painkillers and can lead to the use of very strong medication and a poor quality of life.

The vaccine boosts the level of antibodies in the blood and has been shown to prevent shingles in more than 70 percent of people who have it.

In those who do get it, having had the vaccine, the episode has been shown to be much milder and with a lower chance of developing the long-term neuralgia. The vaccine is thought to last at least four years.

The shingles vaccine has been licensed since 2006 and used here as part of the national programme for vaccination since 2013 to good effect.

Q  How would I know if I have an underactive thyroid? I am always very tired. 

Thyroid disease is a common condition affecting one in 50 women with an underactive thyroid or hypothyroidism. The thyroid is a gland that lies over the windpipe at the front of the neck. Some people have an enlarged thyroid gland, known as a goitre, and this is seen as a swelling at the front of the neck.

The thyroid produces a hormone called thyroxine that controls how fast our bodily functions work. Because thyroxine controls these functions, an underactive thyroid causes a general slowing down of all the bodily functions. So along with tiredness, you will notice weight gain, constipation, low mood, loss of libido and even slowing down mentally. People can become aware of their hair thinning, skin becoming dry and even a deeper voice. It can be a cause of period disturbances and infertility in women, as well as general body aches and pains.

Some combination of these symptoms would usually prompt a visit to the GP and a standard blood test can be used to assess thyroid function: the results are conclusive in most cases.

If it is not your thyroid, it may be you have a vitamin D deficiency, menopausal symptoms, B12 deficiency or a lack of iron. Treatment aims to replace the thyroid hormone, which has not been produced naturally. A replacement known as Levothyroxine is taken in tablet form every day: in most cases treatment is for life.