Non-alcoholic fatty liver disease (NAFLD)
of stomach liver and gastrointestinal tract

A healthy liver should contain little or no fat. It’s estimated that up to 1 in every 3 people in the UK has early stages of NAFLD where there are small amounts of fat in their liver.

Early-stage NAFLD doesn’t usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes, heart attacks and strokes.

If detected and managed at an early stage, it’s possible to stop NAFLD getting worse and reduce the amount of fat in your liver.


Early-stage NAFLD doesn’t usually cause any harm, but it can lead to serious liver damage, including cirrhosis, if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes, heart attacks and strokes.

If detected and managed at an early stage, it’s possible to stop NAFLD getting worse and reduce the amount of fat in your liver.


If detected and managed at an early stage, it’s possible to stop NAFLD getting worse and reduce the amount of fat in your liver.

Symptoms

There aren’t usually any symptoms of NAFLD in the early stages. You probably won’t know you have it unless it’s diagnosed during tests carried out for another reason.

Occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience:

a dull or aching pain in the top right of the tummy (over the lower right side of the ribs) fatigue (extreme tiredness) unexplained weight loss weakness

If cirrhosis (the most advanced stage) develops, you can get more severe symptoms such as yellowing of the skin and the whites of the eyes (jaundice), itchy skin, and swelling in the legs, ankles, feet or tummy.

Read more about the symptoms of cirrhosis.

Diagnoses

NAFLD is often diagnosed after a blood test called a liver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. However, blood tests don’t always pick up NAFLD.

The condition may also be spotted during an ultrasound scan of your tummy. This is a type of scan where sound waves are used to create an image of the inside of your body.

If you’re diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). Some people may also need a small sample of liver tissue (biopsy) taken using a needle to have it analysed in a laboratory.

Treatments

Most people with NAFLD won’t develop any serious problems, but if you’re diagnosed with the condition it’s a good idea to take steps to stop it getting any worse.

There’s currently no specific medication for NAFLD, but making healthy lifestyle choices can help and treatment may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications.

You may be advised to have regular appointments with your doctor to check your liver function and look for signs of any new problems.

Healthy diet and lifestyle

Adopting a healthy lifestyle is the main way of managing NAFLD. The following can all help. 

Lose weight – you should aim for a BMI of 18.5-24.9. Losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it.

Eat a healthy diet – try to have a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt. Eating smaller portions of food can help too.

Exercise regularly – aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week. All types of exercise can help improve NAFLD, even if you don’t lose weight.

Stop smoking – if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes.

NAFLD isn’t caused by alcohol, but drinking may make the condition worse. It’s therefore advisable to cut down or stop drinking alcohol. Read some tips on cutting down on alcohol.

Medication

There isn’t currently any medication that can treat NAFLD, but various medicines can be useful in managing the problems associated with the condition.

For example, your doctor may recommend medication to treat high blood pressure, treat high cholesterol, treat type 2 diabetes and/or treat obesity.

Liver transplant

If you develop severe cirrhosis and your liver stops working properly, you may need to be put on the waiting list for a liver transplant.

For adults, the average waiting time for a liver transplant is 145 days for transplants from recently deceased donors.

Alternatively, it may be possible to have a transplant using a section of liver removed from a living donor. As the liver can regenerate itself, both the transplanted section and the remaining section of the donor’s liver are able to regrow to a normal size.

Read more about liver transplants. 

Non-Hodgkin lymphoma
of cancer, cancer types in adults

Non-Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body.

The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes.

In non-Hodgkin lymphoma, the affected lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection.

The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.

Read more about the symptoms of non-Hodgkin lymphoma. 

Symptoms

The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.

Lymph nodes, also known as lymph glands, are pea-sized lumps of tissue found throughout the body. They contain white blood cells that help to fight against infection.

The swelling is caused by a certain type of white blood cell, known as lymphocytes, collecting in the lymph node.

However, it’s highly unlikely you have non-Hodgkin lymphoma if you have swollen lymph nodes, as these glands often swell as a response to infection.


Some people with non-Hodgkin lymphoma also have other more general symptoms. These can include:

night sweats unintentional weight loss  a high temperature (fever) a persistent cough or feeling of breathlessness persistent itching of the skin all over the body

Other symptoms depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion.

A few people with lymphoma have abnormal cells in their bone marrow when they’re diagnosed. This may lead to:

persistent tiredness or fatigue an increased risk of infections excessive bleeding – such as nosebleeds, heavy periods and spots of blood under the skin

Causes

The exact cause of non-Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if you:

have a medical condition that weakens your immune system take immunosuppressant medication have previously been exposed to a common virus called the Epstein-Barr virus – which causes glandular fever

You also have a slightly increased risk of developing non-Hodgkin lymphoma if a first-degree relative (such as a parent or sibling) has had the condition.

Read more about the causes of non-Hodgkin lymphoma.


Non-Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called lymphocytes. The exact reason why this happens isn’t known.

DNA gives cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions, so the cells keep growing. This causes them to multiply uncontrollably.

The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, it’s possible for the abnormal lymphocytes to spread into other parts of your body, such as your:

bone marrow spleen liver skin lungs

However, in some cases, non-Hodgkin lymphoma first develops in an organ or somewhere else outside the lymphatic system (the network of lymph vessels and glands found throughout the body).

Diagnoses

The only way to confirm a diagnosis of non-Hodgkin lymphoma is by carrying out a biopsy.

This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory.

Read more about diagnosing non-Hodgkin lymphoma.


If you see your GP because you’re concerned about symptoms of non-Hodgkin lymphoma, they’ll ask about your health and carry out a simple physical examination.

If necessary, your GP will refer you to hospital for further tests.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of non-Hodgkin lymphoma and refer people for the right tests faster.

To find out if you should be referred for further tests for suspected non-Hodgkin lymphoma, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

If you’re referred to hospital, a biopsy will usually be carried out, as this is the only way to confirm a diagnosis of non-Hodgkin lymphoma.


If a biopsy confirms a diagnosis of non-Hodgkin lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma.

Further tests may include:

blood tests – samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidney are working bone marrow sample – another biopsy may be carried out to see if the lymphoma has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic chest X-ray – this can check whether the cancer has spread to your chest or lungs computerised tomography (CT) scan – this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread of the cancer  magnetic resonance imaging (MRI) scan – this scan uses strong magnetic fields to build up a detailed picture of areas of your body to check the spread of the cancer positron emission tomography (PET) scan – this scan measures the activity of cells in different parts of the body and can check the spread of the cancer and the impact of treatment; it’s usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working lumbar puncture – using a thin needle, a sample of spinal fluid is taken and examined to see if it contains any lymphoma cells

Treatments

There are many subtypes of non-Hodgkin lymphoma, but they can generally be put into one of 2 broad categories:

high-grade or aggressive non-Hodgkin lymphoma – where the cancer develops quickly and aggressively low-grade or indolent non-Hodgkin lymphoma – where the cancer develops slowly, and you may not experience any symptoms for many years

The outlook for non-Hodgkin lymphoma varies greatly, depending on the exact type, grade and extent of the lymphoma, and the person’s age.

Low-grade tumours don’t necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated straight away, but tend to respond much better to treatment and can often be cured. 

The main treatments used for non-Hodgkin lymphoma are:

chemotherapy radiotherapy  a type of targeted treatment called monoclonal antibody therapy

Overall, most cases of non-Hodgkin lymphoma are considered very treatable. You can read more detailed information about the outlook for non-Hodgkin lymphoma on the Cancer Research UK website.

However, there’s a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future.

Read more about: 

treating non-Hodgkin lymphoma  complications of non-Hodgkin lymphoma


Speak to your GP if you have any of these symptoms, particularly if you have persistently swollen glands with no other signs of infection.

While the symptoms are unlikely to be caused by non-Hodgkin lymphoma, it’s best to get them checked out.


Non-Hodgkin lymphoma is usually treated with cancer-killing medication or radiotherapy, although some people may not need treatment straight away.

In a few cases, if the initial cancer is very small and can be removed during a biopsy, no further treatment may be needed.


The recommended treatment plan will depend on your general health and age, as many of the treatments can put a tremendous strain on the body.

Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT).

Your MDT will recommend the best treatment options for you. However, you shouldn’t be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner.

You’ll be invited back to see your care team for a full discussion about the risks and benefits of any treatments planned before treatment begins.

You can ask your care team if a clinical trial is available to take part in.

Complications

Some people treated for non-Hodgkin lymphoma experience long-term problems, even if they’ve been cured.

Non-Hodgkin lymphoma: Children
of cancer, cancer types in children

More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past.

It’s devastating to hear that your child has cancer. At times it can feel overwhelming and there are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information. If you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

The lymphatic system is part of the immune system, the body’s natural defence against infection and disease. This is a complex system made up of the bone marrow, thymus, spleen, and lymph nodes throughout the body. The lymph nodes are connected by a network of tiny lymphatic vessels.

Lymph nodes are also known as lymph glands, and the ones that you’re most likely to notice are those in the neck, armpit and groin.

The number of lymph nodes varies from one part of the body to another. In some parts there are very few, whereas under your arm there may be 20 to 50 nodes.

Cancers that start in the lymphatic system are called lymphomas. There are 2 main types of lymphoma:

Hodgkin lymphoma  non-Hodgkin lymphoma (NHL)

Although they’re both types of lymphoma, there are differences between them, which means they need different treatment.

There are 2 main types of NHL. B-cell NHL usually involves the lymph nodes in the abdomen and intestines, but may involve nodes in the head and neck. T-cell NHL usually affects lymph nodes in the chest.

Occasionally, NHL can develop in unusual places outside the lymph nodes. This is called extranodal lymphoma.


It’s devastating to hear that your child has cancer. At times it can feel overwhelming and there are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information. If you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

The lymphatic system is part of the immune system, the body’s natural defence against infection and disease. This is a complex system made up of the bone marrow, thymus, spleen, and lymph nodes throughout the body. The lymph nodes are connected by a network of tiny lymphatic vessels.

Lymph nodes are also known as lymph glands, and the ones that you’re most likely to notice are those in the neck, armpit and groin.

The number of lymph nodes varies from one part of the body to another. In some parts there are very few, whereas under your arm there may be 20 to 50 nodes.

Cancers that start in the lymphatic system are called lymphomas. There are 2 main types of lymphoma:

Hodgkin lymphoma  non-Hodgkin lymphoma (NHL)

Although they’re both types of lymphoma, there are differences between them, which means they need different treatment.

There are 2 main types of NHL. B-cell NHL usually involves the lymph nodes in the abdomen and intestines, but may involve nodes in the head and neck. T-cell NHL usually affects lymph nodes in the chest.

Occasionally, NHL can develop in unusual places outside the lymph nodes. This is called extranodal lymphoma.


Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your child’s specialist will give you more detailed information. If you have any questions it’s important to ask the specialist doctor or nurse who knows your child’s individual situation.

The lymphatic system is part of the immune system, the body’s natural defence against infection and disease. This is a complex system made up of the bone marrow, thymus, spleen, and lymph nodes throughout the body. The lymph nodes are connected by a network of tiny lymphatic vessels.

Lymph nodes are also known as lymph glands, and the ones that you’re most likely to notice are those in the neck, armpit and groin.

The number of lymph nodes varies from one part of the body to another. In some parts there are very few, whereas under your arm there may be 20 to 50 nodes.

Cancers that start in the lymphatic system are called lymphomas. There are 2 main types of lymphoma:

Hodgkin lymphoma  non-Hodgkin lymphoma (NHL)

Although they’re both types of lymphoma, there are differences between them, which means they need different treatment.

There are 2 main types of NHL. B-cell NHL usually involves the lymph nodes in the abdomen and intestines, but may involve nodes in the head and neck. T-cell NHL usually affects lymph nodes in the chest.

Occasionally, NHL can develop in unusual places outside the lymph nodes. This is called extranodal lymphoma.

Symptoms

The first sign of NHL is usually a lump somewhere in the body, which is caused by swollen lymph nodes. This can cause different symptoms, depending on where the swollen lymph nodes are. If glands in the abdomen are affected, this may cause a feeling of being full after meals and some stomach pain. Other symptoms of NHL include a high temperature (fever), tiredness, weight loss, and loss of appetite. In a few children, lymphoma cells may be found in the bone marrow or in the fluid around the spinal cord (cerebrospinal fluid).

Causes

We don’t know what causes NHL but there is research going on all the time to try to find out. It’s important to remember that nothing you have done has caused the cancer.

Diagnoses

A variety of tests and investigations may be needed to diagnose NHL. Part, or all, of a swollen lymph gland, may be removed so that the cells can be examined in the laboratory (biopsy). This involves a small operation that is usually done under a general anaesthetic. Tests such as X-rays, ultrasound scans, MRI scans, CT scans, blood tests and bone marrow samples may be carried out to find out the extent of the disease. This is known as staging.

Any tests and investigations that your child needs will be explained to you. The Children’s Cancer and Leukaemia Group (CCLG) has more information about what the tests and scans involve.

Staging

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. The type of treatment your child receives depends on the stage of the disease. 

Stage 1

One group of lymph nodes is affected, or there’s a single extranodal tumour.

Stage 2

Two or more groups of nodes are affected, or there is a single extranodal tumour that has spread to nearby lymph nodes, or there are two single extranodal tumours, but only on one side of the diaphragm (the sheet of muscle under the lungs, which plays a large part in our breathing).

Stage 3

There’s lymphoma on both sides of the diaphragm (either in two or more groups of nodes) or there are two single extranodal tumours or the lymphoma is affecting the chest.

Stage 4

The lymphoma has spread beyond the lymph nodes to other organs of the body such as the bone marrow or nervous system.

Treatments

Treatment for NHL has a very good success rate and many people are cured. Chemotherapy is the most important treatment for children with NHL. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

It’s common for a combination of drugs to be used and treatment may last a number of months or years. The treatment will be planned according to your child’s particular type of NHL and the stage of the disease. B-cell NHL is treated with 4 to 8 courses of intensive chemotherapy. T-cell NHL is treated for about 2 years. Your child’s doctor will discuss the treatment options with you.

NHL can sometimes affect the brain and spinal cord. To stop this, chemotherapy may be injected directly into the fluid around the spinal cord. This is called intrathecal chemotherapy.

Very rarely, radiotherapy is also necessary. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

High-dose chemotherapy with a bone marrow transplant is sometimes used (again very rarely) if the NHL comes back (recurs) after initial treatment.

Side effects of treatment

Treatment for NHL can cause different side effects, and your child’s doctor will discuss these with you before the treatment starts. Any possible side effects will depend on the part of the body that’s being treated and what treatment is being used. Some children have just a few side effects, while others experience more.

Side effects can include:

feeling sick (nausea) and vomiting a sore mouth temporary hair loss a low blood count leading to an increased risk of infection, bruising and bleeding (sometimes blood and/or platelet transfusions are needed) tiredness diarrhoea

Late side effects

Months or years later some children will develop late side effects from the treatment they have had. These include a possible reduction in bone growth, a change in the way the heart, lungs and kidneys work, and a small increase in the risk of developing another cancer in later life.

After treatment with chemotherapy, some children – particularly boys – may become infertile. Older boys, and their parents, should be aware of the option of sperm banking. In this situation, sperm can be stored for possible use in later years.

Your child’s doctor or nurse will talk to you about any possible late side effects and will keep a close eye on possible long-term side effects in follow-up clinics.

Clinical trials

Many children have their treatment as part of a clinical research trial. Cancer research trials are carried out

to try to find new and better treatments for cancer. Clinical trials mean there are now better results for curing children’s cancers compared with just a few years ago. Your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things.

Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child.

Treatment guidelines

Sometimes, clinical trials are not available for your child’s tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.

Follow-up care

Once treatment has finished, the doctors will monitor your child closely with regular appointments in the hospital outpatient department.

If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail.

Norovirus
of infections and poisoning

Norovirus can be very unpleasant but usually clears up by itself in a few days.

You can normally look after yourself or your child at home.

Avoid going to your GP, as norovirus can spread to others very easily. Phone your GP practice or NHS 24 on 111 if you’re concerned or need advice.

Phone 999 or go to A&E if you or your child: vomit blood or have vomit that looks like ground coffee have green vomit (adults) have yellow-green or green vomit (children) might have swallowed something poisonous have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache Find your nearest A&E

Phone 111 now if: you’re worried about a baby under 12 months your child stops breast or bottle feeding while they’re ill a child under 5 years has signs of dehydration – such as fewer wet nappies you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets you or your child keep being sick and cannot keep fluid down you or your child have bloody diarrhoea or bleeding from the bottom you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days


You can normally look after yourself or your child at home.

Avoid going to your GP, as norovirus can spread to others very easily. Phone your GP practice or NHS 24 on 111 if you’re concerned or need advice.

Phone 999 or go to A&E if you or your child: vomit blood or have vomit that looks like ground coffee have green vomit (adults) have yellow-green or green vomit (children) might have swallowed something poisonous have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache Find your nearest A&E

Phone 111 now if: you’re worried about a baby under 12 months your child stops breast or bottle feeding while they’re ill a child under 5 years has signs of dehydration – such as fewer wet nappies you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets you or your child keep being sick and cannot keep fluid down you or your child have bloody diarrhoea or bleeding from the bottom you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days


Avoid going to your GP, as norovirus can spread to others very easily. Phone your GP practice or NHS 24 on 111 if you’re concerned or need advice.

Phone 999 or go to A&E if you or your child: vomit blood or have vomit that looks like ground coffee have green vomit (adults) have yellow-green or green vomit (children) might have swallowed something poisonous have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache Find your nearest A&E

Phone 111 now if: you’re worried about a baby under 12 months your child stops breast or bottle feeding while they’re ill a child under 5 years has signs of dehydration – such as fewer wet nappies you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets you or your child keep being sick and cannot keep fluid down you or your child have bloody diarrhoea or bleeding from the bottom you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days

Symptoms

You’re likely to have norovirus if you experience:

suddenly feeling sick projectile vomiting watery diarrhoea

Some people also have a slight fever, headaches, painful stomach cramps and aching limbs.

The symptoms appear 1 to 2 days after you become infected and typically last for up to 2 or 3 days.

Preventions

It’s not always possible to avoid getting norovirus, but following the advice can help stop the virus spreading. You should:

stay off work or school until at least 48 hours after the norovirus symptoms have stopped avoid visiting anyone in hospital during this time wash your hands frequently and thoroughly with soap and water particularly after using the toilet and before preparing or handling food be aware alcohol-based hand gels don’t kill the virus

Maintain basic hygiene and cleaning to help stop the spread of norovirus by:

disinfecting any surfaces or objects that could be contaminated, using a bleach-based household cleaner. washing any items of clothing or bedding that could have become contaminated separately on a hot wash (60°C) to ensure the virus is killed. not sharing towels and flannels flushing any poo or vomit in the toilet and cleaning the surrounding area with a bleach-based household cleaner avoiding eating raw, unwashed food only eating oysters from a reliable source as they can carry norovirus

Nosebleed
of ears nose and throat

The medical name for a nosebleed is epistaxis.

During a nosebleed, blood flows from one or both nostrils. It can be heavy or light. It can last from a few seconds to 15 minutes or more.


During a nosebleed, blood flows from one or both nostrils. It can be heavy or light. It can last from a few seconds to 15 minutes or more.

Causes

The inside of your nose is full of tiny, delicate blood vessels that can become damaged and bleed relatively easily.

Common causes of nosebleeds include:

picking your nose blowing your nose very hard a minor injury to your nose changes in humidity or temperature causing the inside of the nose to become dry and cracked

Occasionally, bleeding can come from the blood vessels deeper within the nose. This can be caused by a blow to the head, recent nasal surgery and hardened arteries (atherosclerosis).

Treatments

Go to your nearest accident and emergency (A&E) or phone 999 if: the bleeding continues for longer than 20 minutes the bleeding is heavy and you’ve lost a lot of blood you’re having difficulty breathing you swallow a large amount of blood that makes you vomit the nosebleed developed after a serious injury, such as a car crash

Contact your GP practice if: you’re taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn’t stop you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion a child under 2 years of age has a nosebleed you have nosebleeds that come and go regularly If your GP practice is closed, phone 111.


If you see your GP or go to hospital with a nosebleed, you’ll be assessed to find out how serious your condition is and what’s likely to have caused it. This may involve:

looking inside your nose measuring your pulse and blood pressure carrying out blood tests asking about any other symptoms you have additional treatments such as ointments for your nose, cautery to seal blood vessels in your nose, or nasal packing may be required – but will be discussed with you by the doctor

Preventions

There are things you can do to prevent nosebleeds.

Do avoid picking your nose and keep your fingernails shortblow your nose as little as possible and only very gentlykeep your home humidifiedwear a head guard during activities in which your nose or head could get injuredalways follow the instructions that come with nasal decongestants – overusing these can cause nosebleeds

Talk to your GP if you experience nosebleeds frequently and aren’t able to prevent them.

Obesity
of nutritional

The term ‘obese’ describes a person who’s very overweight, with a lot of body fat.

It’s a common problem in the UK that’s estimated to affect around one in every four adults and around one in every five children aged 10 to 11.

Causes

Obesity is generally caused by consuming more calories – particularly those in fatty and sugary foods – than you burn off through physical activity. The excess energy is stored by the body as fat.

Obesity is an increasingly common problem because for many people modern living involves eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting down, at desks, on sofas or in cars.

There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism), although these type of conditions don’t usually cause weight problems if they’re effectively controlled with medication.

Read more about the causes of obesity


Obesity is generally caused by eating too much and moving too little.

If you consume high amounts of energy, particularly fat and sugars, but don’t burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat.

Diagnoses

Body mass index (BMI) is widely used as a simple and reliable way of finding out whether a person is a healthy weight for their height.

For most adults, having a BMI of 18.5 to 24.9 means you’re considered to be a healthy weight. A person with a BMI of 25 to 29.9 is considered to be overweight, and someone with a BMI over 30 is considered to be obese.

While BMI is a useful measurement for most people, it’s not accurate for everyone.

For example, the normal BMI scores may not be accurate if you’re very muscular because muscle can add extra pounds, resulting in a high BMI when you’re not an unhealthy weight. In such cases, your waist circumference may be a better guide (see below).

What’s considered a healthy BMI is also influenced by your ethnic background. The scores mentioned above generally apply to people with a white Caucasian background. If you have an ethnic minority background, the threshold for being considered overweight or obese may be lower.

BMI shouldn’t be used to work out whether a child is a healthy weight, because their bodies are still developing. Speak to your GP if you want to find out whether your child is overweight.

Treatments

The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly. To do this you should:

eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian) join a local weight loss group take up activities such as fast walking, jogging, swimming or tennis for 150 to 300 minutes (two-and-a-half to five hours) a week eat slowly and avoid situations where you know you could be tempted to overeat

You may also benefit from receiving psychological support from a trained healthcare professional to help change the way you think about food and eating.

If lifestyle changes alone don’t help you lose weight, a medication called orlistat may be recommended. If taken correctly, this medication works by reducing the amount of fat you absorb during digestion. Your GP will know whether orlistat is suitable for you.

In rare cases, weight loss surgery may be recommended.

Read more about how obesity is treated


If you’re obese, speak to your GP for advice about losing weight safely.

Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity.

They can also let you know about other useful services, such as:

local weight loss groups – these could be provided by your local authority, the NHS, or commercial services you may have to pay for exercise on prescription – where you’re referred to a local active health team for a number of sessions under the supervision of a qualified trainer

If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS), high blood pressure, diabetes or obstructive sleep apnoea, your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist.

Read more about how your GP can help you lose weight

Obsessive compulsive disorder (OCD)
of mental health

This can be distressing and can have a big impact on your life. Treatment can help you keep it under control.



This pattern has 4 main steps:

Obsession – where an intrusive, distressing thought, image or urge repeatedly enters your mind. Anxiety – the obsession provokes a feeling of intense anxiety or distress. Compulsion – repetitive behaviours or mental acts that you feel you have to do as a result of the anxiety and distress caused by the obsession. Temporary relief – the compulsive behaviour brings temporary relief, but the obsession and anxiety return, causing the cycle to begin again.

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point in their life. This might be a concern that you’ve forgotten to lock the door of the house or that you might get a disease from touching other people. It could be sudden unwelcome violent or offensive mental images.

Most people are able to put these types of thoughts and concerns into context. They can then carry on with their day-to-day life. They do not repeatedly think about worries they know have little substance.

If you have persistent and unwanted thoughts that dominates your thinking, you may have developed an obsession.

Some common obsessions that affect people with OCD include:

fear of deliberately harming yourself or others – for example, fear you may attack someone else, even though this type of behaviour disgusts you fear of harming yourself or others by mistake or accident – for example, fear you may set the house on fire by accidentally leaving the cooker on fear of contamination by disease, infection or an unpleasant substance a need for symmetry or orderliness – for example, you may feel the need to ensure all the tins in your cupboard face the same way

Compulsive behaviour

Compulsions happen as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not connected at all.

For example, a person who fears becoming contaminated with dirt and germs may wash their hands repeatedly. Or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to ‘neutralise’ the thought of harm. This type of compulsive behaviour is particularly common in children with OCD.

Most people with OCD realise that such compulsive behaviour is irrational. They might know it makes no logical sense, but they cannot stop acting on their compulsion.

Not all compulsive behaviours will be obvious to other people.

Symptoms

OCD affects people differently. It usually causes a particular pattern of thought and behaviour.

This pattern has 4 main steps:

Obsession – where an intrusive, distressing thought, image or urge repeatedly enters your mind. Anxiety – the obsession provokes a feeling of intense anxiety or distress. Compulsion – repetitive behaviours or mental acts that you feel you have to do as a result of the anxiety and distress caused by the obsession. Temporary relief – the compulsive behaviour brings temporary relief, but the obsession and anxiety return, causing the cycle to begin again.

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point in their life. This might be a concern that you’ve forgotten to lock the door of the house or that you might get a disease from touching other people. It could be sudden unwelcome violent or offensive mental images.

Most people are able to put these types of thoughts and concerns into context. They can then carry on with their day-to-day life. They do not repeatedly think about worries they know have little substance.

If you have persistent and unwanted thoughts that dominates your thinking, you may have developed an obsession.

Some common obsessions that affect people with OCD include:

fear of deliberately harming yourself or others – for example, fear you may attack someone else, even though this type of behaviour disgusts you fear of harming yourself or others by mistake or accident – for example, fear you may set the house on fire by accidentally leaving the cooker on fear of contamination by disease, infection or an unpleasant substance a need for symmetry or orderliness – for example, you may feel the need to ensure all the tins in your cupboard face the same way

Compulsive behaviour

Compulsions happen as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not connected at all.

For example, a person who fears becoming contaminated with dirt and germs may wash their hands repeatedly. Or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to ‘neutralise’ the thought of harm. This type of compulsive behaviour is particularly common in children with OCD.

Most people with OCD realise that such compulsive behaviour is irrational. They might know it makes no logical sense, but they cannot stop acting on their compulsion.

Not all compulsive behaviours will be obvious to other people.

Causes

The exact cause of OCD is not known. There are some factors that could make a person more likely to have OCD.

These factors might include:

genetics life events personality traits chemical differences in the brain

Diagnoses

Diagnosis and treatment can help to reduce the impact of OCD on your day-to-day life.

Speak to your GP if: you think you might have OCD

Many people do not tell their GP about their symptoms because they feel ashamed or embarrassed. They may also try to disguise their symptoms from family and friends.

If you have OCD, you should not feel ashamed or embarrassed. Like diabetes or asthma, it’s a long-term health condition, and it’s not your fault you have it.

Your GP will probably ask you a series of questions to see if it’s likely you have OCD.

If the results of the initial screening questions suggest you have OCD, the severity of your symptoms will be assessed. Either your GP or a mental health professional will carry out the assessment.

It’s important you’re open and honest. Accurate and truthful responses will ensure you receive the most appropriate treatment.

If you think someone you know may have OCD, it’s a good idea to:

talk to them carefully about your concerns suggest they speak to their GP

Treatments

Treatment for obsessive compulsive disorder (OCD) depends on the how much the condition is affecting your daily life.

The 2 main treatments are:

cognitive behavioural therapy (CBT) medication

If your OCD has a severe impact on your daily life, you’ll usually be referred to a specialist mental health service. Here you’ll likely receive a combination of intensive CBT and a course of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

Children with OCD are usually referred to a healthcare professional with experience of treating OCD in children.

It can take several months before a treatment has a noticeable effect.

Further treatment

You might be offered specialist treatment if you’ve tried other treatments and your OCD is still not under control.

Most people improve after receiving treatment.

Obstructive sleep apnoea
of lungs and airways

Obstructive sleep apnoea (OSA) is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing.

This may lead to regularly interrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions.

Symptoms

The symptoms of OSA are often first spotted by a partner, friend or family member who notices problems while you sleep.

Signs of OSA in someone sleeping can include:

loud snoring noisy and laboured breathing repeated short periods where breathing is interrupted by gasping or snorting

Some people with OSA may also experience night sweats and may wake up frequently during the night to urinate.

During an episode, the lack of oxygen triggers your brain to pull you out of deep sleep – either to a lighter sleep or to wakefulness – so your airway reopens and you can breathe normally.

These repeated sleep interruptions can make you feel very tired during the day. You’ll usually have no memory of your interrupted breathing, so you may be unaware you have a problem.

Causes

It’s normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesn’t cause breathing problems.

In people with OSA the airway has narrowed as the result of a number of factors, including:

being overweight – excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles; excess stomach fat can also lead to breathing difficulties, which can make OSA worse being male – it’s not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution being 40 years of age or more – although OSA can occur at any age, it’s more common in people who are over 40 having a large neck – men with a collar size greater than around 43cm (17 inches) have an increased risk of developing OSA taking medicines with a sedative effect – such as sleeping tablets or tranquillisers having an unusual inner neck structure – such as a narrow airway, large tonsils, adenoids or tongue, or a small lower jaw alcohol – drinking alcohol, particularly before going to sleep, can make snoring and sleep apnoea worse smoking – you’re more likely to develop sleep apnoea if you smoke the menopause (in women) – the changes in hormone levels during the menopause may cause the throat muscles to relax more than usual having a family history of OSA – there may be genes inherited from your parents that can make you more susceptible to OSA nasal congestion – OSA occurs more often in people with nasal congestion, such as a deviated septum, where the tissue in the nose that divides the two nostrils is bent to one side, or nasal polyps, which may be a result of the airways being narrowed

Diagnoses

Obstructive sleep apnoea (OSA) can usually be diagnosed after you’ve been observed sleeping at a sleep clinic, or by using a testing device worn overnight at home.

If you think you have OSA, it’s important to visit your GP in case you need to be referred to a sleep specialist for further tests and treatment.

Before seeing your GP it may be helpful to ask a partner, friend or relative to observe you while you’re asleep, if possible. If you have OSA, they may be able to spot episodes of breathlessness.

It may also help to fill out an Epworth Sleepiness Scale questionnaire. This asks how likely you’ll be to doze off in a number of different situations, such as watching TV or sitting in a meeting. 

The final score will help your doctor determine whether you may have a sleep disorder.

For example, a score of 16-24 means you’re excessively sleepy and should consider seeking medical attention. A score of eight to nine is considered average during the daytime.

An online version of the Epworth Sleepiness Scale can be found on the British Lung Foundation website.

Treatments

See your GP if you think you might have OSA.

They can check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre.

As someone with OSA may not notice they have the condition, it often goes undiagnosed.

Read more about diagnosing OSA.


OSA is a treatable condition, and there are a variety of treatment options that can reduce the symptoms.

Treatment options for OSA include:

lifestyle changes – such as losing excess weight, cutting down on alcohol and sleeping on your side using a continuous positive airway pressure (CPAP) device – these devices prevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask wearing a mandibular advancement device (MAD) – this gum shield-like device fits around your teeth, holding your jaw and tongue forward to increase the space at the back of your throat while you sleep

Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure.

However, for most people surgery isn’t appropriate and may only be considered as a last resort if other treatments haven’t helped.

Read more about treating OSA.


Treatment for obstructive sleep apnoea (OSA) may include making lifestyle changes and using breathing apparatus while you sleep.

OSA is a long-term condition and many cases require lifelong treatment.

Preventions

It’s not always possible to prevent OSA, but making certain lifestyle changes may reduce your risk of developing the condition.

These include:

losing weight if you’re overweight or obese limiting how much alcohol you drink and avoiding alcohol in the evening stopping smoking if you smoke avoiding the use of sleeping tablets and tranquillisers

Complications

The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases.

If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such as poor performance at work and school, and placing a strain on your relationships with others.

Poorly controlled OSA may also increase your risk of:

developing high blood pressure (hypertension) having a stroke or heart attack developing an irregular heartbeat – such as atrial fibrillation developing type 2 diabetes – although it’s unclear if this is the result of an underlying cause, such as obesity

Research has shown someone who has been deprived of sleep because of OSA may be up to 12 times more likely to be involved in a car accident.

If you’re diagnosed with OSA, it may mean your ability to drive is affected. It’s your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability.

Once a diagnosis of OSA has been made, you shouldn’t drive until your symptoms are well controlled.

The GOV.UK website has advice about how to tell the DVLA about a medical condition.

Oesophageal cancer
of cancer, cancer types in adults

Oesophageal cancer is a type of cancer affecting the oesophagus (gullet) – the long tube that carries food from the throat to the stomach.

It mainly affects people in their 60s and 70s and is more common in men than women.

Symptoms

Oesophageal cancer doesn’t usually cause any symptoms in the early stages when the tumour is small. It’s only when it gets bigger that symptoms tend to develop.

Symptoms of oesophageal cancer can include:

difficulty swallowing persistent indigestion or heartburn bringing up food soon after eating loss of appetite and weight loss pain or discomfort in your upper tummy, chest or back

Read more about the symptoms of oesophageal cancer


Oesophageal cancer doesn’t usually have any symptoms at first. But as the cancer grows, it can cause swallowing problems and other symptoms.


Other symptoms of oesophageal cancer can include:

persistent indigestion or heartburn bringing up food soon after eating loss of appetite and weight loss persistent vomiting pain or discomfort in your upper tummy, chest or back a persistent cough hoarseness tiredness, shortness of breath and pale skin vomiting blood or coughing up blood – although this is uncommon

Causes

The exact cause of oesophageal cancer is unknown, but the following things can increase your risk:

persistent gastro-oesophageal reflux disease (GORD) smoking drinking too much alcohol over a long period of time being overweight or obese having an unhealthy diet that’s low in fruit and vegetables

Stopping smoking, cutting down on alcohol, losing weight and having a healthy diet may help reduce your risk of developing oesophageal cancer.

Read more about the causes of oesophageal cancer


The exact cause of oesophageal cancer is unknown, but certain things can increase the risk of it developing.

Diagnoses

Speak to your GP if you experience symptoms of oesophageal cancer. They will carry out an initial assessment and decide whether you need to have any further tests.


The 2 main tests used to diagnose oesophageal cancer are:

an endoscopy – this is the most common test a barium swallow or barium meal


If you have oesophageal cancer, further tests will be recommended to determine how far the cancer has spread – known as called the ‘stage’. 

These tests may include:

a computerised tomography (CT) scan – where a series of X-rays are taken and put together by a computer to create a detailed picture of the inside of your body an endoscopic ultrasound scan – where a small probe that produces sound waves is passed down your throat to create an image of your oesophagus and the surrounding area a positron emission tomography (PET) scan – a scan that can help show how far the cancer has spread a laparoscopy – a type of keyhole surgery performed under general anaesthetic (where you’re asleep), in which a thin tube with a camera at the end is inserted through a cut in your skin to examine the area around your oesophagus

Treatments

Speak to your GP if you experience:

swallowing difficulties heartburn on most days for three weeks or more any other unusual or persistent symptoms

The symptoms can be caused by several conditions and in many cases won’t be caused by cancer – but it’s a good idea to get them checked out.

If your GP thinks you need to have some tests, they can refer you to a hospital specialist.

Read about how oesophageal cancer is diagnosed


If oesophageal cancer is diagnosed at an early stage, it may be possible to cure it with:

surgery to remove the affected section of oesophagus chemotherapy, with or without radiotherapy (chemoradiation), to kill the cancerous cells and shrink the tumour

If oesophageal cancer is diagnosed at a later stage, a cure may not be achievable.

But in these cases, surgery, chemotherapy and radiotherapy can be used to help keep the cancer under control and relieve any symptoms you have.

Read more about how oesophageal cancer is treated and living with oesophageal cancer


Speak to your GP if you experience:

swallowing difficulties heartburn on most days for three weeks or more any other unusual or persistent symptoms

The symptoms can be caused by several conditions and in many cases won’t be caused by cancer – but it’s a good idea to get them checked out.

Read about how oesophageal cancer is diagnosed


The main treatments for oesophageal cancer are surgery, chemotherapy and radiotherapy.


You’ll be cared for by a group of different healthcare professionals and your team will recommend a treatment plan they feel is most suitable for you, although final treatment decisions will be yours.

Your plan will largely depend on how far your cancer has spread – known as the ‘stage’.

stage 1 to 3 oesophageal cancer is usually treated with surgery to remove the affected section of oesophagus (oesophagectomy) – chemotherapy and sometimes radiotherapy may be given before surgery to make it more effective or is sometimes used instead of surgery stage 4 oesophageal cancer has usually spread too far for a cure to be possible, but chemotherapy, radiotherapy and other treatments can slow the spread of the cancer and relieve symptoms

Oral thrush in adults
of infections and poisoning

It’s also called oral candidosis (or candiasis) because it’s caused by a group of yeasts called Candida.

Contact your GP practice if: You develop symptoms of oral thrush, which can include: white patches (plaques) in the mouth that can often be wiped off, leaving behind red areas that may bleed slightly loss of taste or an unpleasant taste in the mouth redness inside the mouth and throat cracks at the corners of the mouth a painful, burning sensation in the mouth

In some cases, the symptoms of oral thrush can make eating and drinking difficult.

If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable.

In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.


Contact your GP practice if: You develop symptoms of oral thrush, which can include: white patches (plaques) in the mouth that can often be wiped off, leaving behind red areas that may bleed slightly loss of taste or an unpleasant taste in the mouth redness inside the mouth and throat cracks at the corners of the mouth a painful, burning sensation in the mouth

In some cases, the symptoms of oral thrush can make eating and drinking difficult.

If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable.

In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.


If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable.

In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.

Symptoms

If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable.

In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.


In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.

Causes

Low numbers of the fungus Candida are naturally found in the mouth and digestive system of most people. They don’t usually cause any problems, but can lead to oral thrush if they multiply.

There are a number of reasons why this may happen, including:

taking a course of antibiotics, particularly over a long period or at a high dose taking inhaled corticosteroid medication for asthma wearing dentures (false teeth), particularly if they don’t fit properly having poor oral hygiene having a dry mouth, either because of a medical condition or a medication you are taking smoking having chemotherapy or radiotherapy to treat cancer

Babies, young children and elderly people are at a particularly high risk of developing oral thrush, as are people with certain underlying conditions, including diabetes, an iron deficiency or vitamin B12 deficiency, an underactive thyroid (hypothyroidism) and HIV.

As most people already have Candida fungi living in their mouth, oral thrush is not contagious. This means it cannot be passed to others.

Treatments

Oral thrush can usually be successfully treated with antifungal medicines. These usually come in the form of gels or liquid that you apply directly inside your mouth (topical medication), although tablets or capsules are sometimes used.

Topical medication will usually need to be used several times a day for around 7 to 14 days. Tablet or capsules are usually taken once daily.

These medications don’t often have side effects, although some can cause nausea (feeling sick), vomiting, bloating, abdominal (tummy) pain and diarrhoea.

If antibiotics or corticosteroids are thought to be causing your oral thrush, the medicine – or the way it is delivered – may need to be changed or the dosage reduced.

Preventions

There are a number of things you can do to reduce your chances of developing oral thrush.

Do rinse your mouth after mealsbrush your teeth twice a day with a toothpaste that contains fluoridefloss regularlyvisit your dentist regularly for check-ups, even if you wear dentures or have no natural teethremove your dentures every night and clean them with paste or soap and water before soaking them in a solution of water and denture-cleaning tabletsbrush your gums, tongue and inside your mouth with a soft brush twice a day if you wear dentures or have no or few natural teethvisit your dentist if your dentures do not fit properlystop smoking if you smokerinse your mouth with water and spit it out after using a corticosteroid inhaler, and use a spacer (a plastic cylinder that attaches to the inhaler) when you take your medicineensure that any underlying condition you have, such as diabetes, is well controlled

If you have a condition or are receiving treatment that could put you at a high risk of developing oral thrush, your doctor may recommend taking a course of antifungal medication to prevent this happening.

Read more about taking care of your oral health