GAD can cause a change in your behaviour and the way you think and feel about things. It can also cause physical changes. This results in symptoms like:
restlessness
a sense of dread
feeling constantly “on edge”
difficulty concentrating
irritability
dizziness
tiredness
a noticeably strong, fast or irregular heartbeat (palpitations)
muscle aches and tension
trembling or shaking
dry mouth
excessive sweating
shortness of breath
stomach ache
feeling sick
headache
pins and needles
difficulty falling or staying asleep (insomnia)
Your symptoms may cause you to withdraw from social contact to avoid feelings of worry and dread.
You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.
The exact cause of GAD is not fully understood. It’s likely that a combination of several factors plays a role, like:
overactivity in areas of the brain involved in emotions and behaviour
an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
the genes you inherit from your parents – you’re estimated to be 5 times more likely to develop GAD if a close relative has it
having a history of stressful or traumatic experiences, like domestic violence, child abuse or bullying
having a painful long-term health condition, like arthritis
having a history of drug or alcohol misuse
However, many people develop GAD for no apparent reason.
GAD can have a significant effect on your daily life. There are several different treatments are available that can help. These include:
talking therapies – like cognitive behavioural therapy (CBT)
medication – like a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)
There are also many things you can do yourself to help reduce your anxiety, like:
trying a self-help course
exercising regularly
stopping smoking
cutting down on alcohol
drinking less caffeine
With treatment, many people are able to control their levels of anxiety. However, some treatments may need to be continued for a long time. There may be periods where your symptoms worsen.
Self help for anxiety
Our mental health self-help guides are based on Cognitive Behavioural Therapy (CBT). They’ve proven highly successful in helping people with anxiety and other mental health issues.
Try the anxiety self help guide
Daylight
Daylight is a digital programme to improve anxiety based on Cognitive Behavioural Therapy (CBT). It’s clinically proven to help people improve their anxiety symptoms by using it for just a few minutes each day.
You can use Daylight via the app for iOS and Android devices.
To access this course, you need to provide the first half of your postcode and your email address.
Sign up for Daylight
Contact support groups
Support groups can give you useful advice about how to effectively manage your anxiety. They’re also a good way to meet other people with similar experiences.
Examples of support groups you may find useful include:
Anxiety UK
Mind
Rethink Mental Illness
Support groups can often arrange face-to-face meetings, where you can talk about your feelings with other people. Many support groups also provide support and guidance over the phone or in writing.
Ask your GP about local support groups for anxiety in your area. Or search our support service directory for mental health information and support services near you.
Some children are simply born more nervous and anxious and less able to cope with stress than other children.
Sometimes traumatic life events like an illness, or an accident, can cause anxiety. This can happen even if your child was previously confident by nature before.
A child’s anxious personality may be partly determined by the genes they’ve inherited from their parents. Parents of anxious children may recognise the signs and remember feeling and behaving the same when they were younger.
Life events
Some children can also develop anxiety after a series of difficult life events. They may be able to cope with one of these events, but several difficult events together, or a traumatic single event, may be too much for them to cope with. Examples are:
frequently moving house and school – it can be hard to settle when you’re always expecting change
divorce or separation of parents
death of a close relative or friend
becoming seriously ill or injured in an accident
having someone in the family who is ill or disabled
school-related issues like homework or exams, or bullying or friendship problems
becoming involved in crime
being abused or neglected
Medical conditions
Children with certain conditions such as attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders may experience anxiety as part of the symptoms of their condition. This is because of differences in the way their brain functions.
You should seek help for your child’s anxiety if:
you feel it’s not getting better or is getting worse, and efforts to tackle it yourself have not worked
you think it’s slowing down their development or having a significant effect on their schooling or relationships
it happens very frequently or they feel anxious all the time
it’s making them feel physically unwell a lot of the time like feeling sick or having constant headaches
your child becomes very withdrawn and is anxious about doing things they used to enjoy
The type of treatment offered will depend on what is causing your child’s anxiety.
It can be helpful for your child to talk in confidence about what’s worrying them to a trained person, especially as it’s someone they don’t know.
If your child is being seen at CAMHS, they might see a child and adolescent psychotherapist or a clinical psychologist. If they’re at a youth counselling service, it might be a trained youth counsellor or psychotherapist.
These sessions can help them work out what is making them anxious and how they can work through the situation.
Psychological therapies
Psychological therapies can really help with anxiety. They’re evidence based talking treatments, like cognitive behavioural therapy, that are proven to help.
Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave.
It’s been proven to help with anxiety and is commonly offered to young people who are anxious.
Your child will work with the psychological therapist to find ways to change the way they think. They’ll help your child to find strategies for coping in situations that make them anxious. The psychological therapies matrix describes the most helpful talking therapies for anxiety.
What is psychological therapy?
Medication
If your child’s anxiety problem has not got better, your doctor may talk to you about trying medication.
A type of antidepressant, called a selective serotonin reuptake inhibitor (SSRI), may help your child feel calmer and differently about things.
Antidepressants usually take around 2 to 4 weeks to work properly, so you or your child may not notice the difference immediately.
It’s natural to be concerned about side effects. Your child should be aware of any possible adverse effects and should tell you or their doctor if they happen.
Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.
Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe.
Pressing on this area, coughing, or walking may all make the pain worse.
If you have appendicitis, you may also have other symptoms, including:
feeling sick (nausea)
being sick
loss of appetite
diarrhoea
a high temperature (fever) and a flushed face
It’s not exactly clear what the causes of appendicitis are. Most cases are thought to occur when something blocks the entrance of the appendix.
For example, a blockage may be formed by a small piece of faeces or an upper respiratory tract infection could lead to a swollen lymph node within the wall of the bowel.
This obstruction leads to the development of inflammation and swelling. The pressure caused by the swelling can then lead to the appendix bursting.
As the causes aren’t fully understood, there’s no guaranteed way of preventing appendicitis.
Appendicitis can be tricky to diagnose unless you have the typical symptoms, which are only present in about half of all cases.
Also, some people’s appendixes may be located in a slightly different part of their body, such as:
the pelvis
behind the large intestine
around the small bowel
near the right lower part of the liver
Some people develop pain similar to appendicitis, but it’s caused by something else, such as:
gastroenteritis
severe irritable bowel syndrome (IBS)
constipation
a bladder or urine infection
Your GP will ask about your symptoms, examine your abdomen, and see if the pain gets worse when pressure is applied to the appendix area (your lower right-hand side).
If your symptoms are typical of appendicitis, this is normally enough for your GP to make a confident diagnosis. In this case, you’ll immediately be referred to hospital for treatment.
If your symptoms aren’t typical, further tests may be required in hospital to confirm the diagnosis and rule out other conditions.
Further tests may involve:
a blood test to look for signs of infection
a pregnancy test for women
a urine test to rule out other conditions, such as a bladder infection
an ultrasound scan to see if the appendix is swollen
a computerised tomography (CT) scan
It can sometimes take time to get test results. Your surgeon may recommend a laparoscopy to inspect your appendix and pelvic organs if the diagnosis is still uncertain.
You’ll usually be advised to have your appendix removed if appendicitis is suspected, rather than run the risk of it bursting. This means some people will have their appendix removed even though it’s eventually found to be normal.
In some cases where a diagnosis is not certain, a doctor may recommend waiting up to 24 hours to see if your symptoms improve, stay the same, or get worse.
If your doctor suspects your appendix has burst, you’ll be sent to hospital immediately for treatment.
Read more about treating appendicitis.
If you’re experiencing abdominal pain that’s gradually getting worse, contact your GP or local out-of-hours service immediately. If these options aren’t available, phone NHS 24’s 111 service for advice.
You should phone 999 for an ambulance if you have sudden pain that continues to get worse and spreads across your abdomen.
These are signs your appendix may have burst, which can lead to potentially life-threatening complications.
Read more about:
diagnosing appendicitis
complications of appendicitis
In most cases of appendicitis, the appendix needs to be surgically removed as soon as possible.
Removal of the appendix, known as an appendectomy or appendicectomy, is one of the most common operations in the UK and its success rate is excellent.
The operation is most commonly performed as keyhole surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted.
Open surgery, where a larger, single cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult.
Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to 6 weeks after open surgery.
Read more about treating appendicitis.
If you’re experiencing abdominal pain that’s gradually getting worse, contact your GP or local out-of-hours service immediately. If these options aren’t available, phone NHS 24 111 Service for advice.
Appendicitis can easily be confused with something else, such as:
gastroenteritis
severe irritable bowel syndrome (IBS)
constipation
bladder or urine infections
Crohn’s disease
pelvic infection
In young women, these symptoms can sometimes have a gynaecological cause, such as an ectopic pregnancy or menstrual pain.
However, any condition that causes constant stomach pain requires urgent medical attention.
You should phone 999 for an ambulance if you get a pain that suddenly becomes worse and spreads across your abdomen. These are signs your appendix may have burst.
If the appendix bursts, it can cause peritonitis, a potentially serious infection of the inner lining of the abdomen.
Read more about the complications of appendicitis.
If you have appendicitis, your appendix usually needs to be removed as soon as possible. This operation is known as an appendectomy or appendicectomy.
Surgery is usually also recommended if there’s a chance you have appendicitis but it’s not been possible to make a clear diagnosis.
This is because it’s considered safer to remove the appendix than run the risk of the appendix bursting.
In humans, the appendix doesn’t perform any important function and having it removed doesn’t cause any long-term problems.
If appendicitis isn’t treated, the appendix can burst and cause potentially life-threatening infections.
Phone 999 for an ambulance if you have abdominal (tummy) pain that suddenly gets much worse and spreads across your abdomen. These are signs your appendix may have burst.
The symptoms of arthritis you experience will vary depending on the type you have.
This is why it’s important to have an accurate diagnosis if you have:
joint pain, tenderness and stiffness
inflammation in and around the joints
restricted movement of the joints
warm, red skin over the affected joint
weakness and muscle wasting
There’s no cure for arthritis, but there are many treatments that can help slow down the condition.
For osteoarthritis, medications are often prescribed, including:
painkillers
non-steroidal anti-inflammatory drugs (NSAIDs)
corticosteroids
In severe cases, the following surgical procedures may be recommended:
arthroplasty (joint replacement)
arthodesis (joint fusion)
osteotomy (where a bone is cut and re-aligned)
Treatment for rheumatoid arthritis aims to slow down the condition’s progress and minimise joint inflammation or swelling. This is to try and prevent damage to the joints. Recommended treatments include:
analgesics (painkillers)
disease modifying anti-rheumatic drugs (DMARDs) – a combination of treatments is often recommended
physiotherapy
regular exercise
Read more about how rheumatoid arthritis is treated.
Breathing in asbestos fibres may eventually scar the lungs of some people, which can lead to a number of symptoms, including:
shortness of breath – this may only occur after physical activity at first, but it can eventually become a more constant problem
a persistent cough
wheezing
fatigue (extreme tiredness)
chest pain
in more advanced cases, clubbed (swollen) fingertips
Nowadays, most people who are diagnosed with asbestosis were exposed many years ago, before there were effective controls on exposure to asbestos fibres in the workplace.
See your GP if you have the above symptoms and you think you may have been exposed to asbestos in the past.
Read more about diagnosing asbestosis.
Asbestosis is caused by breathing in asbestos fibres. People working in certain trades are more likely to have been exposed to asbestos in the past.
When diagnosing asbestosis, your GP will first ask about your symptoms and listen to your lungs with a stethoscope (a medical instrument used to listen to the heart and lungs).
If your lungs have been affected by asbestos, they will usually make a crackling noise when you breathe in.
Your GP will also ask about your work history, particularly about periods when you may have been exposed to asbestos, how long you may have been exposed, and whether you were issued with any safety equipment, such as a face mask, when you were working.
There is no cure for asbestosis once it has developed, because it is not possible to reverse the damage to the lungs.
One of the most important things someone with the condition can do is to stop smoking, if they smoke. This is because the symptoms are more likely to get worse in people who smoke, and smoking also increases the risk of lung cancer in people with asbestosis.
If necessary, treatments such as oxygen therapy can improve the quality of life of someone with asbestosis.
Read more about treating asbestosis.
There is no cure for asbestosis, as the damage to the lungs is irreversible. However, you can take steps to reduce your symptoms and improve your quality of life.
There are three main types of asbestos that were used in construction. Two of these – called crocidolite and amosite – were banned in 1985 (although voluntary bans came into force earlier than this) and the use of the third type (chrysotile) was widely banned in 1999.
However, despite these strict regulations having been in place for a number of years, large amounts of asbestos are still found in many older buildings.
It’s therefore important to take precautions to reduce your risk of inhaling asbestos fibres if you live or work in a building that may contain asbestos.
If you are concerned that your house may contain asbestos, you can seek advice from an environmental health officer at your local authority or council. Do not attempt to remove any materials that you think may contain asbestos yourself.
If your job means you could potentially be exposed to asbestos fibres, make sure you are fully aware of what you can do to reduce your risk. Do not attempt to remove any asbestos you come across, unless you have been trained in how to do this safely.
Read about preventing asbestosis.
Although asbestos is no longer widely used in the UK, it’s still important to take precautions to reduce your risk of exposure, because it’s still found in many old buildings.
Strict regulations were introduced in 1970 to regulate the use of asbestos in the workplace.
However, the import, supply and use of brown (amosite) and blue (crocidolite) asbestos was not banned in the UK until 1985. White asbestos (chrysotile) was banned in 1999, except for a small number of specialist uses of the material.
This means that buildings that were built or refurbished before the year 2000 could still contain asbestos.
The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time.
The main symptoms of asthma are:
wheezing (a whistling sound when you breathe)
shortness of breath
a tight chest – which may feel like a band is tightening around it
coughing
These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen.
Read our page on the causes of asthma for more information about potential triggers.
Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms.
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
pollen
cigarette smoke
exercise
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
It’s not clear exactly what causes asthma, although it is likely to be a combination of factors.
Some of these may be genetic. However, a number of environmental factors are thought to play a role in the development of asthma. These include air pollution, chlorine in swimming pools and modern hygiene standards (known as the ‘hygiene hypothesis’).
There is currently not enough evidence to be certain whether any of these can cause asthma, although a variety of environmental irritants, such as dust, cold air and smoke, may make it worse.
If you have typical asthma symptoms, your GP will often be able to make a diagnosis.
They will want to know when the symptoms happen and how often, and if you have noticed anything that might trigger them.
Your GP may also ask whether you have any allergic (atopic) conditions such as eczema and hay fever, which often occur alongside asthma.
A number of tests can be carried out to confirm the diagnosis. These are described below.
In children, asthma can be difficult to diagnose because many other conditions can cause similar symptoms in infants. The tests outlined below are also not always suitable for children.
Your GP therefore may sometimes suggest that your child uses an asthma inhaler as a trial treatment. If this helps improve your child’s symptoms, it is likely they have asthma.
A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test.
This test requires a bit of practise to get it right, so your GP or nurse will show you how to do it and may suggest you take the best of two or three readings.
You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day.
Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take.
To help diagnose asthma that may be related to your work (occupational asthma), your GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work. Your GP may then refer you to a specialist to confirm the diagnosis.
Some people may also need a number of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment.
Airways responsiveness
This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger.
You will be asked to breathe in a medication that deliberately irritates or constricts your airways slightly if you have asthma, causing a small decrease in your FEV1 measured using spirometry and possibly triggering mild asthma symptoms. If you do not have asthma, your airways will not respond to this stimulus.
The test often involves inhaling progressively increasing amounts of the medication at intervals, with spirometry measurement of FEV1 in between to see if it falls below a certain threshold. In some cases, however, exercise may be used as a trigger.
Testing airway inflammation
It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways:
a mucus sample – the doctor may take a sample of mucus (phlegm) so it can be tested for signs of inflammation in the airways
nitric oxide concentration – as you breathe out, the level of nitric oxide in your breath is measured using a special machine; a high level of nitric oxide can be a sign of airway inflammation
Allergy tests
Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies, such as dust mites, pollen or foods.
Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma.
Read more about diagnosing allergies
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.
You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so.
Read more about treating asthma and living with asthma
Long-acting reliever inhalers
If your asthma does not respond to initial treatment, the dose of preventer inhaler you take may be increased in agreement with your healthcare team.
If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long-acting beta2-agonist, or LABA) to take as well.
These work in the same way as short-acting relievers. Although they take slightly longer to work, their effects can last for up to 12 hours. This means that taking them regularly twice a day provides 24-hour cover.
Regular use of long-acting relievers can also help reduce the dosage of preventer medication needed to control asthma. Examples of long-acting relievers include formoterol and salmeterol, and recently vilanterol, which may last up to 24 hours.
However, like short-acting relievers, long-acting relievers do not reduce the inflammation in the airways. If they are taken without a preventer, this may allow the condition to get worse while masking the symptoms, increasing the chance of a sudden and potentially life-threatening severe asthma attack.
You should therefore always use a long-acting reliever inhaler in combination with a preventer inhaler, and never by itself.
In view of this, most long-acting relievers are prescribed in a ‘combination’ inhaler, which contains both an inhaled steroid (as a preventer) and a long-acting bronchodilator in the one device.
Examples of combination inhalers include Seretide, Symbicort, Fostair, Flutiform and Relvar. These are usually (but not always) purple, red and white, or maroon.
Other preventer medicines
If regular efficient administration of treatment with a preventer and a long-acting reliever still fails to control asthma symptoms, additional medicines may be tried. Two possible alternatives include:
leukotriene receptor antagonists – tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways
theophyllines – tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents
Oral steroids
If your asthma is still not under control, you may be prescribed regular steroid tablets. This treatment is usually monitored by a respiratory specialist (an asthma specialist).
Oral steroids are powerful anti-inflammatory preventers, which are generally used in two ways:
to regain control of asthma when it is temporarily upset – for example, by a lapse in regular medication or an unexpected chest infection; in these cases, they are typically given for one or two weeks, then stopped
when long-term control of asthma remains a problem, despite maximal dosages of inhaled and other medications – in these cases, oral steroids may be given for prolonged periods, or even indefinitely, while maintaining maximum treatment with inhalers as this maximises the chance of being able to stop the oral steroids again in the future
Long-term use of oral steroids has serious possible side effects, so they are only used once other treatment options have been tried, and after discussing the risks and benefits with your healthcare team.
Omalizumab (Xolair)
Omalizumab, also known as Xolair, is the first of a new category of medication that binds to one of the proteins involved in the immune response and reduces its level in the blood. This lowers the chance of an immune reaction happening and causing an asthma attack.
It is licensed for use in adults and children over six years of age with asthma.
The National Institute for Heath and Care Excellence (NICE) recommends that omalizumab can be used in people with allergy-related asthma who need continuous or frequent treatment with oral corticosteroids.
Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped.
Read further information:
Asthma UK: other treatments and ‘add-on’ therapies
Asthma UK: steroid tablets
NICE: omalizumab for severe persistent allergic asthma
Bronchial thermoplasty
Bronchial thermoplasty is a relatively new procedure that can be used in some cases of severe asthma. It works by destroying some of the muscles surrounding the airways in the lungs, which can reduce their ability to narrow the airways.
The procedure is carried out either with sedation or under general anaesthetic. A bronchoscope (a long, flexible tube) containing a probe is inserted into the lungs through the mouth or nose so it touches the airways.
The probe then uses controlled heat to damage the muscles around the airways. Three treatment sessions are usually needed, with at least three weeks between each session.
There is some evidence to show this procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma.
However, the long-term risks and benefits are not yet fully understood. There is a small risk it will trigger an asthma attack, which sometimes requires hospital admission.
You should discuss this procedure fully with your clinician if the treatment is offered.
Read further information:
NICE: bronchial thermoplasty for severe asthma
Side effects of relievers and preventers
Relievers are a safe and effective medicine, and have few side effects as long as they are not used too much. The main side effects include a mild shaking of the hands (tremors), headaches and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes.
Preventers are very safe at usual doses, although they can cause a range of side effects at high doses, especially with long-term use.
The main side effect of preventer inhalers is a fungal infection of the mouth or throat (oral candidiasis). You may also develop a hoarse voice and sore throat.
Using a spacer can help prevent these side effects, as can rinsing your mouth or cleaning your teeth after using your preventer inhaler.
Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keep side effects to a minimum.
Side effects of add-on therapy
Long-acting relievers may cause similar side effects to short-acting relievers. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped.
Theophylline tablets have been known to cause side effects in some people, including nausea, vomiting, tremors and noticeable heartbeats (palpitations). These can usually be avoided by adjusting the dose according to periodic measurement of the theophylline concentration in the blood.
Side effects of leukotriene receptor agonists can include tummy (abdominal) pain and headaches.
Side effects of steroid tablets
Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (more than three or four courses of steroids a year). Side effects can include:
osteoporosis (fragile bones)
high blood pressure (hypertension)
diabetes
increased appetite, leading to weight gain
cataracts and glaucoma (eye disorders)
thinning of the skin
easy bruising
muscle weakness
With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon.
However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma.
You will need regular appointments to check for these.
Read further information:
Asthma UK: side effects of asthma medicines
Preventer inhalers – usually brown, red or orange – work over time to reduce the amount of inflammation and sensitivity of the airways, and reduce the chances of asthma attacks occurring.
They must be used regularly (typically twice or occasionally once daily) and indefinitely to keep asthma under control.
You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the blue reliever inhaler to relieve your symptoms, but your treatment should be reviewed if you continue to need them often.
The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone, ciclesonide and mometasone.
Preventer treatment should be taken regularly if you have anything more than occasional symptoms from your asthma, and certainly if you feel the need to use a reliever inhaler more than twice a week.
Some inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so make sure you rinse your mouth thoroughly after inhaling a dose. The use of a spacer device also reduces this risk.
Smoking can reduce the effects of preventer inhalers.
Read further information:
Asthma UK: preventer inhalers
In rare cases, asthma can lead to a number of serious respiratory complications, including:
pneumonia
the collapse of part or all of the lung
respiratory failure – where levels of oxygen in the blood become dangerously low, or levels of carbon dioxide become dangerously high
status asthmaticus (severe asthma attacks that do not respond to normal treatment)
All these complications are life threatening and will need medical treatment.
Atopic eczema causes areas of skin to become itchy, dry, cracked, sore and red.
There will usually be periods where the symptoms improve, followed by periods where they get worse (flare-ups). Flare-ups may occur as often as 2 or 3 times a month.
Atopic eczema can occur all over the body, but is most common on the hands (especially fingers), the insides of the elbows or backs of the knees, and the face and scalp in children. The face is more commonly involved in adults.
The severity of atopic eczema can vary a lot from person to person. People with mild eczema may only have small areas of dry skin that are occasionally itchy. In more severe cases, atopic eczema can cause widespread red, inflamed skin all over the body and constant itching.
Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can also make itching worse, and a cycle of itching and regular scratching may develop. This can lead to sleepless nights and difficulty concentrating at school or work.
Areas of skin affected by eczema may also turn temporarily darker or lighter after the condition has improved. This is more noticeable in people with darker skin. It’s not a result of scarring or a side effect of steroid creams, but more of a “footprint” of old inflammation and will eventually return to its normal colour.
Atopic eczema often occurs on the insides of the elbows.Source: https://dermnetnz.org/
Atopic eczema can occur on the face.Source: https://dermnetnz.org/
The exact cause of atopic eczema is unknown, but it’s clear it’s not down to one single thing. It often occurs in people who get allergies – “atopic” means sensitivity to allergens.
It can run in families, and often develops alongside other conditions, such as asthma and hay fever.
The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema.
Read more about the causes of atopic eczema.
Atopic eczema is likely to be caused by a combination of things.
People with atopic eczema often have very dry skin because their skin is unable to retain much moisture.
This dryness may make the skin more likely to react to certain triggers, causing it to become red and itchy.
You may be born with an increased likelihood of developing atopic eczema because of the genes you inherit from your parents.
Research has shown children who have 1 or both parents with atopic eczema, or who have other siblings with eczema, are more likely to develop it themselves.
Atopic eczema is not infectious, so it cannot be passed on through close contact.
Your GP will usually be able to diagnose atopic eczema by looking at your skin and asking questions about your symptoms.
These questions may include asking:
whether the rash is itchy and where it appears
when the symptoms first began
whether it comes and goes over time
whether there is a history of atopic eczema in your family
whether you have any other conditions, such as allergies or asthma
You should tell your pharmacist or GP if your condition is affecting your quality of life – for example, if you have difficulty sleeping because of itching, or your eczema limits your everyday activities.
Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and 3 or more of the following:
visibly irritated red skin in the creases of your skin, such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional
a history of skin irritation occurring in the same areas mentioned above
generally dry skin in the last 12 months
a history of asthma or hay fever– children under 4 must have an immediate relative, such as a parent, brother or sister, who has one of these conditions
the condition started before the age of 2 (this does not apply to children under the age of 4)
There is currently no cure for atopic eczema, but treatment can help relieve the symptoms and many cases improve over time.
However, severe eczema often has a significant impact on daily life and may be difficult to cope with physically and mentally. There is also an increased risk of skin infections.
Many different treatments can be used to control symptoms and manage eczema, including:
self care techniques, such as reducing scratching and avoiding triggers
emollients (moisturising treatments) – used on a daily basis for dry skin
topical corticosteroids– used to reduce swelling, redness and itching during flare-ups
Pharmacy First Scotland: Atopic eczema treatment from your pharmacyIf you have atopic eczema or symptoms of atopic eczema you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you
Atopic eczema isn’t usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required.
Read more about treating atopic eczema and the complications of atopic eczema.
There is no cure for atopic eczema, but treatments can ease the symptoms. Many children find their symptoms naturally improve as they get older.
The main treatments for atopic eczema are:
emollients (moisturisers) – used every day to stop the skin becoming dry
topical corticosteroids– creams and ointments used to reduce swelling and redness during flare-ups
Other treatments include topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment, antihistamines for severe itching, bandages or special body suits to allow the body to heal underneath, or more powerful treatments offered by a dermatologist (skin specialist).
The various treatments for atopic eczema are outlined below.
People with atopic eczema can sometimes develop further physical and psychological problems.
Symptoms of ADHD tend to be noticed at an early age. They may become more noticeable when a child’s circumstances change, like when they start school.
The main symptoms of ADHD in children and teenagers are:
Inattentiveness
The main signs of inattentiveness are:
having a short attention span
being easily distracted
making careless mistakes
appearing forgetful
losing things
being unable to stick at tedious or time-consuming tasks
appearing to be unable to listen to or carry out instructions
constantly changing activity or task
having difficulty organising tasks
Hyperactivity and impulsiveness
The main signs of hyperactivity and impulsiveness are:
being unable to sit still, especially in quiet surroundings
constantly fidgeting
being unable to concentrate on tasks
excessive physical movement
excessive talking
being unable to wait their turn
acting without thinking
interrupting conversations
little or no sense of danger
If you’re an adult with ADHD, you may find that:
you get easily distracted and find it hard to notice details, particularly with things you find boring
it’s hard to listen to other people – you may find yourself finishing their sentences for them or interrupting them
it’s hard to follow instructions
you find it hard to organise yourself – you start a lot of things without ever finishing them
you find it hard to wait
you fidget and can’t sit still when there’s nothing much going on
you’re forgetful and tend to lose or misplace things
you easily get irritable, impatient or frustrated and lose your temper quickly
you feel restless or edgy, have difficulty turning your thoughts off
you find stress hard to handle
you tend to do things on the spur of the moment, without thinking, which gets you into trouble
Some people with ADHD have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious.
Related conditions
Some people might have other conditions alongside ADHD.
Related conditions in children and teenagers with ADHD
Some children may also have signs of other problems or conditions alongside ADHD, like:
anxiety disorder
oppositional defiant disorder (ODD) – this involves negative and disruptive behaviour, particularly towards figures of authority
conduct disorder – this often involves antisocial behaviour, like stealing and harming people or animals
depression
sleep problems
autistic spectrum disorder (ASD)
epilepsy
Tourette’s syndrome
learning difficulties, like dyslexia
The symptoms of ADHD can improve with age. Although many adults diagnosed with the condition at a young age continue to experience problems.
Related conditions in adults with ADHD
ADHD in adults can occur alongside several related problems or conditions.
One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include:
personality disorders
bipolar disorder
obsessive-compulsive disorder (OCD)
ADHD can also cause problems like difficulties with relationships and social interaction.
The exact cause of ADHD isn’t fully understood.
A combination of the following factors might be responsible:
Genetics
ADHD tends to run in families. The genes you you inherit from your parents are a factor in developing the condition. The way ADHD is inherited is complex and isn’t thought to be related to a single gene.
Brain function and structure
Research has identified some possible differences in the brains of people with ADHD.
Some studies involving brain scans have suggested that certain areas of the brain may be a different size in people with ADHD.
Other studies have suggested that people with ADHD may have a chemical imbalance in the brain. Or that some chemicals may not work properly.
Groups at risk
Certain people are also believed to be more at risk of ADHD, including people:
who were born prematurely (before the 37th week of pregnancy) or with a low birthweight
with epilepsy
with brain damage – which happened either in the womb or after a severe head injury later in life
Speak to your GP if you think that you or your child may have ADHD.
If you’re worried about your child, it may help to speak to their teachers before seeing your GP. This means you can find out if they have any concerns about your child’s behaviour.
Your GP can’t formally diagnose ADHD. They can discuss your concerns with you and refer you for a specialist assessment, if necessary.
Treatment for ADHD can help relieve the symptoms.
ADHD can be treated using medication or therapy. A combination of both is often best. Treatment is usually arranged by a specialist, like a paediatrician or psychiatrist.
Treatment of ADHD might include:
Medication
Medication might help you or your child concentrate better, be less impulsive and feel calmer.
Therapy
You might be offered therapy. This might be:
psychoeducation
behaviour therapy
parent training
education programmes
cognitive behavioural therapy
social skills training
There are other treatments that involve altering your diet or taking supplements.
The signs of autism can be different depending on the person and how old they are.
Because autism is present from birth, it can usually be diagnosed in childhood. However, it may only be recognised later in life. Understanding of autism has grown over time, so more people are now being diagnosed when they’re older if the signs weren’t recognised when they were children.
These are signs of autism that health professionals look for when making a diagnosis, but an autistic person may not have all of these signs. For example, delayed speech (learning to speak later than most children), or a child not speaking at all, can be a sign of autism. However, many autistic children talk at the same age a child without autism would.
It’s also possible that these signs are there, but they aren’t caused by autism.
If you think you or your child might be autistic, talk to your GP or health visitor.
Signs of autism in children
The signs of autism can change as children grow – babies and toddlers show different signs of autism than children aged 4 and older.
Babies and toddlers
Signs of autism in babies and toddlers can include a number of things that affect different parts of their life and behaviour.
Talking and showing emotions
Autistic babies and toddlers might:
start talking later than most children
seem less aware of others around them – for example, they might not respond to their name being called
make repetitive movements when excited or upset – for example flapping their hands, rocking back and forth, or making the same noise repeatedly
Autistic babies and toddlers might not:
smile back when you smile at them
point to show when they want something
point to show you something they find interesting
share when they’re feeling happy – for example, they might be having fun playing, but they might not turn around and smile at you
Playing
Autistic babies and toddlers might:
spend a long time setting up toys in a certain way, and set them up the same way every time
enjoy lining toys up in order, or watching parts of them move
Autistic babies and toddlers might not:
seem interested in playing with other children their age
seem to use their toys to make up stories or pretend – they might also start pretend play at a later age than most children
Sensory (sights, smells, sounds, touch, and tastes)
Autistic babies and toddlers might:
react strongly to sounds, smells, touch, tastes, or things they can see – for example, if they like the way a stuffed toy feels, they want to spend a lot of time stroking the toy
become upset if given something to eat or drink that’s new to them
eat a limited range of foods
Children aged 4 and up
As children grow and experience different environments, such as nursery and school, the characteristics of autism can appear differently.
Communicating
Autistic children might:
speak differently to most children – for example, they might use an unusual accent, talk slowly or quickly compared to others, speak in a ‘flat’ tone that doesn’t change, or use a ‘sing-song’ voice
use longer or more complicated words than most children, even in relaxed situations
struggle to ask other people questions about themselves
find it hard to keep a conversation going
Relationships
Autistic children might:
show a great deal of enthusiasm for talking about subjects that interest them, but experience significant difficulty when talking about other people’s interests
find it difficult to make and keep friends
want to play with other children, but find it hard to ask if they can join in
have 1 or 2 good friends that they spend a lot of time with
spend free time, such as school break times, by themselves
find it hard to tell the difference between someone being friendly or joking and someone trying to bully them or hurt their feelings
get on better with adults than other children their age
get on better with children who are younger or older than them
spend time with a group of children, but find it hard to join in with other children’s play, and so spend a lot of time on the edge of the group
have friends at school, but show little to no interest in seeing them outside of school
Different situations and routine
Autistic children might:
accidentally make social mistakes, for example correcting a teacher about classroom rules
find some social situations, like parties or busy places, overwhelming and difficult to cope with
be passive around other children or adults, agreeing to everything and doing everything people ask
often tell others what to do, including while playing
struggle with social situations with no timetable or clear ‘rules’, such as free play or school break times
find it difficult to cope with changes to their routine, especially if the change is unexpected – for example, having a different teacher for a day or having plans change due to bad weather
Sensory (sights, smells, sounds, touch, and tastes)
Autistic children might:
react strongly to sounds, smells, touch, tastes, or things they can see – for example, being unable to cope with seams in their socks or the noises in supermarkets
find certain sounds, smells, feelings or tastes particularly calming or enjoyable – for example, coloured lights or being tucked tightly into bed
make repetitive movements when excited or upset – for example flapping their hands, rocking back and forth, or making the same noise repeatedly
Signs of autism in teenagers and adults
The characteristics of autism can affect you differently as you get older – you may also recognise some of the signs of autism in children in yourself as an adult. Many people are diagnosed with autism as teenagers or adults based on noticing that they think and behave differently from most other people.
Signs of autism in teenagers
As you age and experience different environments, you might notice different signs of autism.
Communicating
As an autistic teenager, you might:
find it hard to be understood in conversations,
find it hard to work out when to talk in conversations – you might never get to say what you want to say, or find yourself talking over other people
find it easier to communicate with other autistic people
be able to talk for a long time about the subjects that particularly interest you
show a great deal of enthusiasm for talking about subjects that interest you, but experience significant difficulty when trying to talk about other people’s interests
be able to answer other people’s questions, but struggle to know what questions to ask or how to answer when someone tells you something about themselves
find other people say you use a lot of long words, or use longer or more complicated words than most people
often use the same phrases when you’re talking
struggle with hidden meanings when other people are talking to you – it might be difficult for you to understand a ‘hint’, or notice when someone is flirting with you
find people can take the wrong meaning from your words or behaviour – for example, if you make a lot of eye contact, they might think you’re flirting with them
Behaviour and different situations
As an autistic teenager, you might:
find eye contact uncomfortable, or struggle to know how much eye contact to use
do well when you’re in your routine, but find it difficult when routines change – changes might make you feel anxious, make it hard to concentrate, or mean you have to work harder on things it’d normally be easy to do
struggle to imagine things that you haven’t experienced before – for example, if you’re going to a party for the first time, it might be hard for you to imagine what will happen and what you’ll be expected to do
find yourself making social mistakes without realising why – for example, during conversations you might not realise there are things other people would rather not talk about, or don’t think are important to talk about
Learning and hobbies
As an autistic teenager, you might:
have a lot of knowledge on particular topics, and spend a lot of time learning about them and telling others about them
have a hobby you feel very passionate about and spend a lot of time on
find it hard to start a new activity but get very focused on it once you get started – you might be able to focus on it better than most people
find it difficult to stop doing an activity you’re very focused on, even if you need to move on to something else – you might forget to eat or sleep
Emotions and relationships
As an autistic teenager, you might:
spend a lot of time being careful to avoid making social mistakes, or trying to make sure you don’t accidentally hurt anyone’s feelings
find that other people struggle to understand your feelings from your face or tone of voice
find that your friends are often older or younger than you
find that your friends tend to be autistic people
have to ask people to explain idioms (phrases that say one thing, when they’re actually talking about something else), for example: “we’ll cross that bridge when we come to it”, which means “we’ll talk about that problem later”
have a clear idea of right and wrong, and strong views on issues that are important to you – you might struggle to understand exceptions to rules, or ‘grey areas’
find a lot of people don’t understand your sense of humour, and you might not understand why their jokes are funny
be trusting, and find people can often take advantage of you
find it hard to work out when someone is being unkind
Sensory (sights, smells, sounds, touch, and tastes)
As an autistic teenager, you might:
have a strong negative reaction to sounds, smells, sights, and things you can touch – for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like gyms
have a strong positive reaction to sounds, smells, sights, and things you can touch – for example, enjoying flashing, multi-coloured lights in nightclubs or how loud the music is at a concert
seek out certain sounds, smells, feelings or tastes because you find them particularly calming – for example, coloured lights or soft clothing and blankets
find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable
Signs of autism in adults
As you age and experience different environments, life events, and circumstances, you might notice different signs of autism. You might also have developed coping strategies for environments you find difficult, changing the way you manage them.
Work and education
As an autistic adult, you might:
find it more difficult than most people to communicate in interviews – for example, talking about your skills – which can make it hard to get a job
find it more difficult than most people to keep a job – you may be good at your work, but it might be hard to have good relationships with colleagues and managers
have a lot of knowledge or feel very passionate about a subject that’s useful for your work or studies
find it difficult or frustrating when rules or ways of doing things don’t make sense to you
find it more difficult than most people would to work on a project or task that has unclear instructions for how to complete it
Relationships and being social
As an autistic adult, you might:
find socialising hard work – when others seem to have a lot of energy after meeting a group of friends, for example, you might feel exhausted
have had relationships with friends or partners end because you couldn’t understand how each other thought, behaved, and communicated
find dating challenging
prefer to be alone during breaks at work
find it difficult to make ‘small talk’ – meaning conversation about day-to-day things such as the weather – or understand the reasons for making small talk
enjoy spending time with other people, but find activities that don’t have clear ‘rules’ or a schedule – for example, going to parties or nightclubs – difficult because you aren’t sure what to do
prefer meeting up with people to do structured activities, like cooking or taking part in a shared hobby or interest
Hobbies and skills
As an autistic adult, you might:
have a lot of detailed knowledge about a particular topic or hobby and feel very passionate about it
find that the hobbies or topics you’re particularly passionate about have changed several times in your life
Communication and emotions
As an autistic adult, you might:
find other people often misunderstand you, or seem upset by things you say even if you don’t mean to upset them
find it hard to understand why people around you see a situation one way, and not the way you understand it
find change more difficult than most people do – things that disrupt your daily routine, like changes to your job or going on holiday, can make you feel stressed and anxious
Sensory (sights, smells, sounds, touch, and tastes)
As an autistic adult, you might:
have a strong negative reaction to sounds, smells, sights, and things you can touch – for example, being unable to wear certain types of clothing or find it overwhelming being in places with a lot of different noises, like busy buses or trains
have a strong positive reaction to sounds, smells, sights, and things you can touch – for example, enjoying lying under a weighted blanket, or the loudness of the music at a concert
seek out certain sounds, smells, feelings or tastes because you find them particularly calming – for example, coloured lights or soft clothing and blankets
find making repetitive movements (often with your hands, fingers or legs) or sounds calming or enjoyable
Autistic traits and diagnosis
Autistic traits – meaning things that autistic people often do, think, and feel – are often shared by people who don’t have autism too. This doesn’t mean that everyone is ‘a little bit autistic’, or that autistic people don’t need support.
To be diagnosed with autism, a person has to have a lot of autistic traits from birth, and those traits need to have a big effect on their life. In order to be diagnosed with autism, those traits must cause what a healthcare professional would call ‘clinically significant difficulties’ in their day-to-day life. This means that they have difficulties with day-to-day life due to their autistic traits and need to use their own ways of overcoming those difficulties, or the people in their life need to help them to overcome them, or both.
Being in a supportive environment makes a big difference to an autistic person’s wellbeing and quality of life.
Learn more about how autism is diagnosed
Other health conditions
People who have these conditions can be more likely to also have autism:
developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or learning disability
muscular dystrophy
Down’s syndrome
cerebral palsy
epilepsy
neurofibromatosis – a number of genetic conditions that cause tumours to grow along the nerves (the main types are neurofibromatosis type 1 and neurofibromatosis type 2)
rare genetic conditions, including fragile X syndrome, tuberous sclerosis and Rett syndrome
Causes of autism
The exact cause of autism is unknown, but researchers think it’s at least partly genetic – that autism can run in the family. However, autism can also develop when there’s no family history. There’s no way to predict whether a child will be autistic, even if one or both of their parents are autistic.
More research is being done to find out which genes cause autism – it’s thought to be caused by more than one.
Often there are no symptoms of bacterial vaginosis. Some women may notice a change in the normal secretions from the vagina.
This discharge will usually be white or grey, thin or watery and have a strong, unpleasant fishy smell. This can be more noticeable during and after sex, and during periods.
Bacterial vaginosis does not usually cause itching or irritation.
If you think you have bacterial vaginosis you can make an appointment with your GP or local sexual health services.
Your nurse or doctor may perform an internal examination to check the vagina for signs of bacterial vaginosis and use a swab to collect a sample of the discharge from your vagina.
A swab looks a bit like a cotton bud and collecting a sample only takes a few minutes. Although not painful, it may be a little uncomfortable for a moment.
A specially coated paper may be used to test the pH (alkaline/acid balance) of your vagina.
Sometimes a diagnosis can be made straightaway because of the distinctive appearance of the discharge. Sometimes the sample will be sent to a lab for testing.
Bacterial vaginosis is treated with antibiotics. An antibiotic cream or gel to use in the vagina may be given instead of antibiotic tablets by mouth.
While you’re there, make sure you tell the doctor or nurse if you:
are pregnant
think you might be pregnant
are breastfeeding
These may affect the type of treatment you’re given.
Bacterial vaginosis recurrence
Bacterial vaginosis can recur. Most recurrences will respond to the treatments described.