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Asthma

Asthma is a common condition that affects your airways. It can make you cough, wheeze and you can even find it difficult to breathe.

Asthma affects over five million people in the UK, including over one million children. It often starts in childhood, but it can occur for the first time at any age.

If you have asthma, during an attack your airways become irritated and inflamed. They then become narrower and produce extra mucus. This makes it more difficult for air to flow in and out of your lungs, meaning it gets harder to breathe.

Most people with asthma can lead normal lives. You can control your asthma by taking asthma medicines regularly, avoiding anything that triggers your symptoms and getting help if your symptoms get worse.

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How an asthma attack occurs
What happens in your lungs when you have an attack?
An image showing the different parts of the lung

Details

  • Symptoms Symptoms of asthma

    The symptoms of asthma, and how severe they are, can vary from person to person. You may find that you’re more likely to have symptoms at particular times throughout the day. Asthma symptoms include:

    • coughing − especially at night
    • wheezing − especially in the morning
    • finding it difficult to breathe
    • tightness in your chest

    You may find that your symptoms flare up and then calm down again. They may also have specific triggers such as being around certain types of animal (for example cats or dogs) or pollen. When your symptoms flare up suddenly, this is called an ‘asthma attack’.

  • Diagnosis Diagnosis of asthma

    Your GP will ask you about your symptoms and whether anything in particular makes them worse, such as exercise or cold air. They may ask whether you’re prone to allergies or have a family history of asthma and allergies.

    Your GP may use a stethoscope to listen to your chest to see whether they can hear any wheezing sounds. Sometimes it’s possible to hear the wheezing without a stethoscope. If your GP thinks that you may have asthma, they may also ask you to have one or more of the following tests.

    • Peak flow measurement – this test measures how fast you can blow air out of your lungs in one hard blow.
    • Spirometry – this test measures how well you breathe out for a complete breath.
    • Allergy tests – these can help to find out whether you’re allergic to certain substances.
    • Chest X-rays – these aren’t usually used to diagnose asthma. Your GP may suggest that you have an X-ray to rule out other possible causes of your symptoms, such as infections

    Peak flow measurement and spirometry don’t work well in children under five. If your child is under five, your GP may diagnose their asthma by seeing if they respond to asthma medicines.

  • Treatment Treatment of asthma

    Your GP may prescribe several different medicines for your asthma. You may need to use stronger medicines when your symptoms get worse and milder ones when your symptoms get better. Your GP or nurse will create a personalised asthma plan for you. Your asthma plan will include how and when you should use your asthma medicines. Your GP or nurse should review your asthma plan regularly to make sure it’s right for you.

    Inhalers

    Asthma medicines are usually given by an inhaler. There are many types of inhalers and these all work slightly differently. Metered-dose inhalers come in the form of a pressurised can. Some people, especially older people and children, find these difficult to use. Your GP may prescribe a dry powder inhaler or a breath-activated inhaler instead. You’ll need to use your inhaler correctly to make sure it works properly. Your GP, nurse or pharmacist can show you how to use it.

    There are two basic types of inhaler medicines for asthma:

    • relievers – to treat your symptoms as soon as they occur
    • preventers – to help prevent your symptoms

    If your asthma symptoms are flaring up, you can use a short-acting reliever called a bronchodilator. A reliever quickly eases your asthma symptoms by helping to relax and widen your airways. It contains medicines such as salbutamol (eg Ventolin) and terbutaline (eg Bricanyl). If you need to use your reliever more than twice a week, or your asthma is worse at night, you should contact your GP surgery. Your asthma nurse or GP may then suggest you use a preventer medication. If you’re already using preventer medication, this may need to be adjusted.

    If you’re prescribed a preventer inhaler, you should use it every day, even if you don’t have asthma symptoms. The protective effect builds up over time. Preventers usually contain a corticosteroid medicine, such as beclometasone (eg Qvar) or fluticasone (eg Flixotide). These work by reducing the inflammation of your airways. It can take up to seven days for preventer medicines to work. Once they start working, you may not need to use your reliever inhaler at all.

    Sometimes you may not be able to control your asthma symptoms with a preventer and short-acting reliever. Your doctor or nurse may add a long-acting reliever to your treatment. A long-acting reliever works in a similar way to a short-acting reliever but its effects last for up to 12 hours. It contains medicines such as salmeterol (eg Serevent) or formoterol (eg Oxis). You can only use a long-acting reliever if you’re already using a corticosteroid preventer. You may be prescribed a long-acting reliever and corticosteroid in one inhaler.

    Spacers

    Your GP, nurse or doctor may prescribe you a spacer. A spacer is a cylinder that’s usually made out of plastic. You attach it to the end of your inhaler and breathe in through the spacer’s mouthpiece. You activate the inhaler and then inhale through the spacer. This allows more medication to get to the lungs and you do not need to be able to coordinate your breathing with activating the inhaler. This makes the whole thing easier to do.

    You may find them useful if you find it difficult to use a metered dose inhaler. Spacers can help you use your inhaler correctly and may be helpful for children under five. Babies and very young children can use a spacer with a face mask if they can’t use the mouthpiece.

    Nebulisers

    Nebulisers make a mist of asthma medicine that you breathe in. They can help to deliver more of the medicine to exactly where it’s needed. A nebuliser may be useful if you have a severe asthma attack and you need emergency treatment.

    Other medicines

    If you have severe asthma symptoms, your GP may prescribe a course of corticosteroid tablets such as prednisolone. Your doctor can prescribe several other medicines as tablets and inhalers if you can’t take the standard asthma treatments. These include montelukast (eg Singulair) or zafirlukast (eg Accolate).

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  • How to use your metered-dose inhaler How to use your metered-dose inhaler

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    How to use your metered-dose inhaler
  • Causes Causes of asthma

    It’s not clear what causes asthma, but asthma may run in families. Some research studies suggest that if you smoke during pregnancy, your baby is more likely to get asthma. They also show that if you smoke and have young children, they are more likely to get asthma as well.

    Certain triggers may make your symptoms flare up. These include:

    • respiratory infections – such as a cold or flu
    • anything that irritates your lungs – such as dust, cigarette smoke and traffic fumes
    • allergies to pollen, medicines, animals, house dust mites or certain foods
    • exercise, especially in cold or dry environments
    • emotions – laughing, anger or stress
    • changes in the weather – especially changing temperatures
    • medicines – certain medicines can trigger asthma

    Most medicines are safe, but if you have moderate to severe asthma it’s best not to take the painkillers aspirin and ibuprofen. These are also known as nonsteroidal anti-inflammatory drugs (NSAIDS). Beta-blockers, used to treat high blood pressure or angina, may make asthma worse.

    You may develop occupational asthma if you work with particular chemicals and other substances. You’re most at risk if you’re a baker, farmer or carpenter. If you have occupational asthma, you may notice that your symptoms are better on a weekend or holidays.

  • Asthma attacks - what to do Asthma attacks - what to do

    An asthma attack is a sudden flare up of your symptoms. You need to treat an asthma attack straight away.

    You’re having an asthma attack if:

    • your symptoms are getting worse (cough, breathlessness, wheezing or tight chest) 
    • you’re too breathless to speak

    If you have an asthma attack, it’s important to stay calm. You should take the following steps.

    • Take one to two puffs of your reliever inhaler immediately, if possible, using a spacer. 
    • If your symptoms don’t get better, take two puffs of your inhaler every two minutes. You can take up to 10 puffs until your symptoms go away. 
    • If your symptoms don’t go away, you should call an ambulance. 
    • If you go to hospital, take your asthma treatments and, if possible, your personalised asthma plan, with you.

    If your symptoms improve and you don’t need to call an ambulance, you still need to see your GP or asthma nurse within 48 hours. They may need to review your treatment.

  • Living with asthma Living with asthma

    Medicines are only part of how you can manage your asthma. You also need to see if anything makes your symptoms worse, such as house dust mite allergy, and try to avoid any triggers. Keep a diary to record anything that triggers your asthma – this can help you to discover a pattern. Your personalised action plan will include information about avoiding your symptom triggers as much as possible. Some common triggers (such as the weather) can’t be avoided, but you may be able to avoid other triggers (such as being around pets).

    You can keep an eye on your asthma by measuring your peak flow at home using a peak flow meter. These are hand-held tubes that you breathe into as fast as possible. They measure how well you can breathe out. There’s no proof that using a peak flow meter regularly will improve your asthma control. But if your asthma seems to be getting worse, you can use a peak flow meter for a few days to monitor your symptoms. Always take the recordings with you when you have an asthma review. Your personalised asthma plan should include advice on what to do if your peak flow reading falls below a certain level.

    Stopping smoking is good for your overall health and will also improve your asthma symptoms. Ask your nurse, GP or pharmacist for advice about quitting. If you don’t smoke, avoiding smoky environments may also help your symptoms.

    If you need regular treatment for your asthma, your GP or nurse may recommend that you have a flu vaccination each year. Your GP or nurse may also recommend that you have the pneumococcal vaccination as well.

    Breathing exercises may help to control your asthma symptoms. In some situations, your GP may be able to refer you to a respiratory physiotherapist. This is a healthcare professional who can help you with your breathing.

  • Can breastfeeding help prevent asthma? Can breastfeeding help prevent asthma?

    Answer

    Some scientific research has shown that breastfeeding your baby in their first few months may help to reduce their risk of developing asthma.

    More information

    Breastfeeding your baby has many long-term health benefits. It may help prevent many health conditions, including ear infections, stomach upsets, diabetes and eczema. Some studies have found that breastfeeding in the first few months of life may reduce the chance of a baby developing asthma. But more research is needed to confirm this. It’s still unclear whether breastfeeding has a role in the development of asthma in later life or what effect it has on allergic asthma.

    The Department of Health suggests that all babies are breastfed for the first six months of their life without any solid foods or other fluids. After this time, babies can be introduced to solid foods and other fluids, as well as continuing with breast milk.

    If you have any questions or concerns about asthma and breastfeeding, talk to your GP.

  • Can children grow out of asthma? Can children grow out of asthma?

    Answer

    Yes, some children who have asthma will have fewer asthma symptoms as they get older. They may even become symptom-free by the time they are adults.

    More information

    Over a million children in the UK have asthma. Asthma symptoms often improve as children get older. Children under two who are diagnosed with asthma tend to grow out of their symptoms by the time they go to school.

    Children who have regular or severe asthma or have a family history of asthma or allergies are less likely to grow out of their asthma. If you have any questions or concerns about your child’s asthma, talk to your GP or asthma nurse.

  • Can passive smoking cause asthma in children? Can passive smoking cause asthma in children?

    Answer

    Some scientific research shows that passive smoking can increase the risk of asthma in children.

    More information

    Passive smoking is when you breathe in other people’s second-hand tobacco smoke. Children breathe more quickly than adults, so they breathe in more of the harmful chemicals.

    Some scientific research suggests that if a child breathes in second-hand smoke regularly, they’re more likely to develop asthma. A child is at the highest risk of asthma if their mother smokes more than 10 cigarettes a day. If children already have asthma, passive smoking can make their symptoms much worse. If a pregnant woman is exposed to passive smoking, her developing baby may be more likely to develop asthma during childhood.

    It’s best that all children – whether they have asthma or not – are kept away from smoky environments. If you have children or are pregnant and smoke, consider quitting. Your GP can give you support and advice on how to stop smoking.

    If you aren't ready to quit, try not to smoke around your children. Smoke outside your home rather than indoors. Don’t smoke in your car either. Cigarette smoke can linger for several hours in a room after you have stopped smoking. This means your children will continue to be exposed until the smoke has completely disappeared. If you can’t quit completely, cutting down on cigarettes will still benefit your child’s health. If you’re going to be spending a long time with your family (for example, on holiday), try using nicotine replacement products instead of smoking.

    If you have any questions or concerns about passive smoking and asthma, talk to your GP or nurse.

  • What is cough-variant asthma? My child has just been diagnosed with cough-variant asthma. What is it?

    Answer

    Cough-variant asthma is when you have asthma without any wheezing. You have a dry cough instead.

    More information

    Wheezing is one of the most recognisable symptoms of asthma. But some people can have asthma without any wheezing – instead, their main symptom is a dry cough. This type of asthma is called cough-variant asthma.

    Cough-variant asthma is more common in adults than in children. Children are more likely to develop cough-variant asthma if they are prone to allergies. If your child has cough-variant asthma, their cough is likely to be worse at night. You may find that it gets worse after exercise too.

    The treatment for cough-variant asthma is the same as for regular asthma. Your child will be prescribed a short-acting reliever inhaler, such as salbutamol (eg Ventolin), and/or an inhaled corticosteroid preventer, such as beclometasone (eg Asmabec). If you have any questions or concerns about cough-variant asthma, talk to your GP.

  • Will pregnancy make my asthma worse? Will pregnancy make my asthma symptoms worse? Should I still take my asthma medicines?

    Answer

    During pregnancy, your asthma may get better, get worse or stay the same. You should continue taking your asthma medicines as normal throughout your pregnancy. If your asthma is well controlled, it should have little or no effect on your pregnancy.

    More information

    If your asthma symptoms are well controlled, your pregnancy and developing baby shouldn’t be affected by your asthma. Your asthma nurse will closely monitor you to make sure your symptoms are well controlled though, even if you’re not having any problems.

    If your asthma is severe, you may find that your symptoms get worse during pregnancy, particularly in the last few weeks before the birth. If your symptoms do get worse, your GP may refer you to a doctor who specialises in treating and identifying lung conditions. Poorly controlled asthma during pregnancy has been linked to a number of complications, including low birth weight.

    Smoking can make your asthma worse and may make your asthma treatments work less well. If you smoke during pregnancy, your baby is more likely to have breathing problems, such as asthma. It’s important to quit smoking before or during your pregnancy. If you smoke, your GP can give you advice on quitting.

    During pregnancy, it’s important to continue taking your asthma medicines as usual. Asthma medicines such as bronchodilators (relievers) and corticosteroid inhalers (preventers) are safe to take before, during and after your pregnancy (including while breastfeeding). You and your baby are more at risk if you don’t take your usual medicines and your asthma isn't properly controlled. Your GP may wish to monitor you more closely so that your medicine can be adjusted if your asthma symptoms change.

    If you’re pregnant and have asthma, you should have the influenza (flu) vaccination during the flu season. During pregnancy, you’re more likely to catch flu and develop flu complications, especially if you have asthma.

    If you’re worried about whether your asthma could affect your pregnancy, talk to your GP.

  • Resources Resources

    Further information

    Sources

    • Asthma. NICE Clinical Knowledge Summaries. cks.nice.org.uk, reviewed December 2013
    • Asthma UK Strategy 2014−2017: Reduce risk of asthma attacks. Asthma UK. www.asthma.org.uk, published 2014
    • Asthma. The Merck Manuals. www.merckmanuals.com, reviewed July 2014
    • Bronchial asthma. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 11 November 2014
    • Chest medicine. Emergencies. Oxford handbook of clinical medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, published January 2014 (online version)
    • British Guidelines on the Management of Asthma. Scottish Intercollegiate Guidelines Network (SIGN), 2014. www.sign.ac.uk
    • Asthma in adults. BMJ Best Practice. www.bestpractice.bmj.com, published 20 October 2014
    • Spirometry. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 10 December 2013
    • Child health. Emergencies in general practice. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014 (online version)
    • Asthma. Medscape. www.emedicine.medscape.com, published 14 May 2015
    • Asthma. National Institute for Health and Care Excellence (NICE), 2013. QS25. www.nice.org.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 4 June 2015
    • Spacers. Asthma UK. www.asthma.org.uk, reviewed April 2015
    • Which device in asthma. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 11 November 2014
    • Asthma and smoking. Action on Smoking and Health. www.ash.org.uk, reviewed February 2015
    • Acute asthma exacerbation in adults. BMJ Best Practice. www.bestpractice.bmj.com, published 15 September 2014.
    • Asthma attacks. Asthma UK. www.asthma.org.uk, accessed 4 June 2015
    • Dogaru CM, Nyffenegger D, Pescatore A, et al. Breastfeeding and childhood asthma: systematic review and meta-analysis. Am J Epid 2014; 179(10):1153−67. doi: 10.1093/aje/kwu072
    • Infant feeding. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 7 July 2013
    • Asthma in children. BMJ Best Practice. www.bestpractice.bmj.com, published 20 October 2014
    • Passive smoking in children. Royal College of Physicians Parliamentary Briefing, 2012. www.rcplondon.ac.uk
    • Secondhand smoke in the home. Action on Smoking and Health. www.ash.org.uk, published April 2015
    • Tobacco: harm reduction approaches to smoking. National Institute for Health and Care Excellence (NICE), 2013. www.nice.org.uk
    • Shields M, Curran, G, O’Connor B. Guidelines: How can I assess and manage cough in children? British Journal of Primary Care Nursing 2008. www.bjpcn-respiratory.com
    • Assessment of chronic cough. BMJ Best Practice. www.bestpractice.bmj.com, published 18 August 2014
    • Morice AH, McGarvey L, Pavord I. Recommendations for the management of cough in adults. Thorax 2006; 61(1):i1–124. doi:10.1136/thx.2006.065144
    • Asthma in pregnancy. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 11 November 2014
    • Asthma in pregnancy. Medscape. www.emedicine.medscape.com, reviewed 17 December 2014
    • Quitting smoking in pregnancy and following childbirth. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
    • Flu immunisation 2014/2015. GOV.UK, 2014. www.gov.uk
    • Davidson R, Roberts SE, Wotton CJ et al. Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study. BMC Pulm Med 2010; 10:14. doi:10.1186/1471-2466-10-14
    • Ciaccio D, Gentile D. Effects of tobacco smoke exposure in childhood on atopic diseases. Curr Allergy Asthma Rep 2013; 13(6). doi: 10.1007/s11882-013-0389-1
    • Ding G, Ji R, Bao Y. Risk and protective factors for the development of childhood asthma. Paediatr Respir Rev 2015; 16(2):133–9. doi: 10.1016/j.prrv.2014.07.004
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