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Asthma

Asthma is a common condition that affects your airways and causes difficulty with breathing. Most people with asthma who take the appropriate treatment can live normal lives, but left untreated, asthma can cause permanent damage to your airways. Very rarely, a severe asthma attack can be fatal.

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. Adult-onset asthma can be caused by irritants in your workplace (occupational asthma), or can develop after a viral infection.

If you have asthma, your airways become irritated and inflamed. As a result, they:

  • become narrower
  • produce extra mucus

This makes it more difficult for air to flow in and out of your lungs.

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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

    Asthma symptoms may be mild, moderate or severe. They may include:

    • coughing
    • wheezing
    • shortness of breath
    • tightness in your chest

    These symptoms tend to be variable – not everyone gets all the symptoms and they may stop and start. They are often worse at night or in the early morning.

  • Diagnosis Diagnosis of asthma

    Your GP will ask if you have noticed any factors that trigger your symptoms.

    Your GP may do one or more of the following tests to make a diagnosis.

    • Peak flow measurement – this test measures how fast the air is expelled from your lungs.
    • Spirometry – this test also measures the speed of the air flow as well as how much air is flowing. This provides more detailed information than a peak flow meter and can help show how well your lungs are functioning.
    • Allergy test – this can help to find out whether you're allergic to certain substances.
    • Chest X-rays – these aren’t usually used to diagnose asthma, but may be done to make sure you don't have any other form of lung disease.

    In children under five, a diagnosis may be made just by seeing if they respond to asthma treatments.

  • Treatment Treatment of asthma

    There isn't a cure for asthma. However, treatments are available to help manage your symptoms. Your treatment plan will be individual to you, combining medicines and asthma management in a way that works best for you.

    Inhalers

    There are many types of inhalers that enable medication to be delivered directly into your airways. They may contain a dry powder or produce an aerosol of medication when you activate the device. The medicine is then inhaled into your airways. You will need to use your inhaler correctly in order for it to work properly, so ask your GP for advice.

    There are two basic categories of inhaler medicines that are used for asthma:

    • relievers – to treat your symptoms
    • preventers – to help prevent your symptoms and treat the inflammation of asthma

    You should use relievers when your asthma symptoms occur. They can be short- or long-acting. Short-acting relievers (known as bronchodilators) help to relax and widen (dilate) your airways. They contain medicines such as salbutamol (eg Ventolin) and terbutaline (eg Bricanyl) and quickly ease your symptoms.

    If you need to use your reliever inhaler three or more times a week, your asthma may not be well controlled and your GP may need to review your symptoms.

    If you're given a preventer, you should use it every day – even if you don't have symptoms – as the protective effect builds up over time.

    Your GP will prescribe a preventer inhaler if you have any of the below.

    • You feel breathless, have a cough or a tight chest three or more times a week when you do everyday activities.
    • You need to use your reliever inhaler three times a week or more.
    • You suffer from breathlessness when you have a chest infection or are in a smoky atmosphere.
    • You regularly have your sleep disturbed by chest tightness or a cough.

    Preventers usually contain a steroid medicine, such as beclometasone (eg Qvar) or fluticasone (eg Flixotide), that work to reduce the inflammation of your airways. It can take up to 14 days for preventer medicines to work, but once they do, you may not need to use your reliever inhaler at all.

    A long-acting reliever can be added to your treatment if your symptoms aren't well controlled with a regular steroid (preventer) and occasional use of a short-acting reliever. They work in a similar way to short-acting relievers, but their effects last for longer – up to 12 hours, compared to four. Long-acting relievers contain medicines such as salmeterol (eg Serevent) or formoterol (eg Oxis). Often these medications are combined together with a steroid. This means both medicines are taken in one inhaler, such as in Symbicort, Seretide or Fostair inhalers.

    Spacers

    If you use a gas propelled inhaler, you may also be given a spacer. Spacers are devices that can help you use your inhaler correctly and are particularly useful for children, or anyone who finds it difficult to use their inhaler when they have an asthma attack. Children as young as three can learn to use an inhaler with a spacer, and for babies and very young children a face mask can be attached. A spacer is a long tube which clips onto the inhaler. You breathe in and out of a mouthpiece at the other end of the tube. It's easier to use because it allows you to activate the inhaler and then inhale in two separate steps. Using a spacer also reduces your risk of getting a sore throat from using a steroid inhaler. When used correctly they can be as effective as nebulisers in the treatment of an acute asthma attack.

    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. This is particularly important if you have a severe asthma attack and you require emergency treatment in your home or hospital setting. However, if you use a spacer with your asthma medicines, it may be just as effective as a nebuliser at treating most asthma attacks. If your child has asthma, ask your GP for advice as a nebuliser may not be suitable.

    If you own a nebuliser, make sure it’s serviced regularly, so it’s in good working order if you need to use it. Nebuliser servicing is available from some local lung function laboratories in hospitals, or from the equipment manufacturers.

    Other medicines

    If you have severe asthma symptoms, your GP may prescribe a course of steroid tablets such as prednisolone.

    Several other medicines are available as tablets and inhalers if the standard treatments aren't suitable for you. 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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  • Causes Causes of asthma

    The causes of asthma are not always clear. However, there are often triggers that can result in a flare-up of symptoms. Common triggers include:

    • respiratory infection – such as a cold or flu
    • irritants – such as dust, cigarette smoke and fumes
    • chemicals (and other substances) found in your workplace – this is called occupational asthma
    • allergies to pollen, medicines, animals, house dust mites or certain foods
    • exercise – especially in cold, dry air
    • emotions – laughing or crying very hard can trigger symptoms, as can stress
    • changes in the weather – especially changes in temperature
    • 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. Beta-blockers, used to treat high blood pressure or angina, may make asthma worse

    In children, asthma is more common in boys than in girls but in adults, women are more likely to have asthma. Asthma may run in families.

    If you smoke during pregnancy, your baby is more likely to get asthma. If you smoke and have young children, they are more likely to get asthma. Premature or low birth weight babies are also more likely to develop asthma.

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

    You're having an asthma attack if any of the following happens:

    • taking your reliever inhaler does not help with your symptoms
    • your symptoms are getting worse (cough, breathlessness, wheezing or tight chest)
    • you’re too breathless to speak, eat or sleep

    If you have an asthma attack you should take the following steps.

    • Take one to two puffs of your reliever inhaler immediately, if possible, using a spacer.
    • Sit down (don't lie down) and try to relax and take steady breaths.
    • If there is no improvement, take two puffs of your inhaler – one puff at a time – 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 an ambulance takes longer than 10 minutes to arrive and you still feel unwell, take two more puffs of your inhaler every two minutes, as before.
    • If you go to hospital, take your asthma treatments with you.

    If your symptoms improve and you don’t need to call an ambulance, make sure you see your GP or asthma nurse within 24 hours so he or she can review your treatment.

  • Living with asthma Living with asthma

    Medicines are only part of your treatment for asthma. You will also need to deal with the things that make it worse. Keep a diary to record anything that triggers your asthma – this can help you to discover a pattern. Using a peak flow meter to monitor your lung function can also help. If you have repeatedly low readings in a certain situation (for example, at the end of a working day, after exercise or after contact with an animal) this may indicate the trigger.

    Stopping smoking is good for your health and will improve your asthma symptoms.

    With good management and appropriate treatment, most people with asthma lead completely normal lives.

  • FAQs FAQs

    Can breastfeeding help to prevent asthma?

    Answer

    Yes, some research has shown that breastfeeding your baby in the first few months can help reduce his or her risk of developing asthma.

    Explanation

    Breastfeeding your baby has many long-term health benefits. For example, it can help prevent many health conditions, including ear infections, stomach upsets, eczema and asthma.

    A recent study has found that breastfeeding in the first few months of life may reduce the likelihood of a baby developing asthma. However, more research is needed in this area to confirm the findings, as it’s still unclear whether breastfeeding has a role in the development of asthma in later life or the effect it has on allergic asthma.

    The Department of Health suggest that all babies are breastfed for the first six months of their life without any water, other fluids or solid foods. After this time, they can be introduced to solid foods and 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 their asthma?

    Answer

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

    Explanation

    Over a million children in the UK have asthma. Asthma symptoms improve with age in most children with asthma. Those who have mild, infrequent symptoms will often grow out of the condition altogether.

    For children who have frequent asthma symptoms or have chronic asthma, the chances of their condition disappearing when they are older are far less likely. This risk is further increased if your child:

    • has ongoing eczema
    • has chronic lung disease
    • starts smoking at a young age
    • is sensitive to household dust mites

    If you have any questions or concerns about your child's asthma, talk to your GP.

    Can passive smoking cause asthma in children?

    Answer

    Yes, there is evidence to show that passive smoking can cause asthma and other respiratory symptoms in children.

    Explanation

    Passive smoking is when you breathe in other people's second-hand smoke. Passive smoking is potentially harmful to everyone, but especially to children. When children are growing, their lungs are still developing and can be particularly sensitive to pollutants in the air. Babies can also be affected by smoking when they are still in the womb.

    Studies have shown that exposure to tobacco smoke in the home can increase the risk of your child developing asthma and can cause asthma attacks. In children who already have asthma, it can make their symptoms much worse.

    It’s best that all children – whether they have asthma or not – are kept away from smoky atmospheres. 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 rather than indoors. Cigarette smoke can linger for several hours in a room after you have stopped, so your children will continue to be exposed until it has completely disappeared. If you’re going to be spending long periods of time with your family (for example, when you’re 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.

    My child has just been diagnosed with non-wheezy asthma, what is it?

    Answer

    Non-wheezy asthma is when you have asthma without any wheezing – instead you have a dry cough. This type of asthma can affect both children and adults.

    Explanation

    One of the most recognisable symptoms of asthma is wheezing. However, it’s possible to have asthma without any wheezing – instead your main symptom is a dry cough. This type of asthma is also called atypical asthma, hidden asthma, cough-variant asthma and cough-type asthma. It's common in families that have a history of allergies, and, although it can affect anyone at any age, it's the most common cause of long-term coughing in children.

    The cough is dry and repetitive, and your child may have it during the day but it mainly occurs at night. You may find that it gets worse if your child has a cold, when he or she is exercising or breathing in cold air. If your child has any of these symptoms, it's important to see your GP to get a diagnosis and treatment.

    Treatment for non-wheezy asthma is the same as for regular asthma. Your child will be prescribed a short-acting inhaler (reliever) such as salbutamol (eg Ventolin), and/or an inhaled steroid medicine (preventer) such as beclometasone (eg Asmabec).

    If you have any questions or concerns about non-wheezy asthma, talk to your GP.

    What is exercise-induced asthma?

    Answer

    Exercise-induced asthma is when you get symptoms of asthma during or shortly after doing physical exercise. This can happen even if you don't have asthma symptoms at any other time.

    Explanation

    Exercise is a common trigger of asthma. It's not clear exactly how it brings on symptoms, but it's thought to be related to breathing in cold, dry air. When you breathe quickly during exercise, it's more difficult for your nose and upper airways to warm and add moisture to the air coming in. This means that the air going into your airways is colder and drier than usual.

    Symptoms of exercise-induced asthma can include:

    • coughing
    • wheezing
    • shortness of breath
    • tightness in your chest

    You may find that your symptoms begin with exercise and worsen until about 15 minutes after you have stopped. Also, you may only have symptoms during or after exercise and not at any other time. It's important that you see your GP for a diagnosis and treatment if you have these symptoms with exercise.

    Treatment is usually with a short-acting relieving inhaler. Or you may be prescribed inhaled steroids or longer-acting beta2 agonists. The short-acting inhalers need to be used before you start exercising.

    Some forms of exercise may make your symptoms worse than others. Long-distance cross-country running can bring on symptoms if the air is cold because you’re active for a long period of time with no breaks. Team sports, such as netball and football, are less likely to bring on symptoms because they are usually made up of short bursts of activity followed by rest breaks. Swimming is a great exercise for people who have asthma because of the warm, humid air around the pool. However, swimming in cold water or pools with a lot of chlorine in may trigger asthma. Relaxation exercises and yoga may also be helpful to relax your body to focus on your breathing.

    If you’re planning to do any adventure sports, such as scuba-diving, mountaineering or skiing, it's important that you talk to your GP first and make sure you inform the instructor leading the activity.

    If you already have asthma and are receiving treatment, but you’re still getting asthma symptoms when exercising, it's important that you see your GP. This is usually a sign that your asthma is not being properly controlled.

    If you have any questions or concerns about exercise-induced asthma, talk to your GP.

    What is occupational asthma?

    Answer

    Occupational asthma is caused by exposure to certain chemicals and other substances in your workplace. You’re most at risk if you’re a baker, metalworker or spray painter.

    Explanation

    Over 200 industrial materials are known to cause occupational asthma. It can occur as a result of exposure to substances such as flour or wood dust found where you work. These substances can make your airways become hypersensitive, making the muscles in your airways narrow and tighten. With repeated exposure to these substances, you’re more likely to have problems with asthma.

    According to the Health and Safety Executive (HSE), the following jobs are at the highest risk of developing occupational asthma.

    • Bakers – caused by the flour and enzymes used in the baking process.
    • Vehicle spray painters – caused by the chemicals used in spray paints.
    • Metalworkers (solderers) – caused by the fumes produced when soldering.
    • Woodworkers – caused by hardwood, softwood and wood dusts from wood machining and sanding.
    • Healthcare workers – caused by powdered latex gloves, biocides and chemical disinfectants.
    • Laboratory animal workers – caused by contact with animals, animal handling and cage or enclosure cleaning.
    • Agricultural workers – caused by grain dust from harvesting, moving and processing cereal crops.
    • Engineering workers – caused by the mist or vapour from metalworking fluids during machining or shaping operations.

    It can be difficult to know if your job is causing your asthma. Symptoms don't always occur as soon as you have been exposed to the substance, they can happen after work or at night. You may find that your asthma symptoms improve when you have a day off work or are on holiday.

    If you have asthma symptoms, it's important to see your GP. He or she may refer you to a respiratory physician – a doctor who specialises in treating and identifying lung conditions.

    The doctor will ask about your symptoms and any exposure you have to substances which could cause asthma. Sometimes you may need to have a skin patch test to look for an allergic reaction, or your doctor may recommend a special inhalation test to monitor your reaction to certain substances.

    When your doctor has confirmed a relationship between your asthma and exposure to substances at work, you will be diagnosed with occupational asthma.

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

    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. If your asthma is well controlled, it may have little or no effect on your pregnancy.

    You should continue taking your asthma medicines as normal throughout your pregnancy.

    Explanation

    For most women with well controlled asthma, the condition has no effect on their pregnancy, giving birth or their baby.

    However, women with severe asthma may find that their symptoms get worse during pregnancy. If you have severe asthma, it's important to see your GP on a regular basis to make sure your symptoms are well controlled. If you have problems, your GP may refer you to a respiratory physician (a doctor who specialises in treating and identifying lung conditions).

    Poorly controlled asthma symptoms during pregnancy have been linked with a number of complications including low birth weight, premature birth and pre-eclampsia. Also, if you smoke, it's important to quit as smoking lessens the effect of your asthma treatment and poses long-term health risks to you and your baby. If you smoke during pregnancy, your baby is more likely to have breathing problems, such as asthma.

    During pregnancy, it's very important to continue taking your asthma medicines as usual. There are more risks to both you and your baby if you don’t take your usual medicines and your asthma becomes uncontrolled.

    Your GP may wish to monitor you more closely so that your medicine can be adjusted in response to any changes. It may be helpful to talk to your GP before becoming pregnant. If you smoke, he or she can give you advice on quitting.

    Standard asthma treatments such as bronchodilators (salbutamol, terbutaline, theophylline) and inhaled corticosteroids are safe to take before, during and after your pregnancy (including while breastfeeding). If you’re pregnant and have asthma, it’s also important to be vaccinated against the influenza (flu) virus during the flu season, as pregnant women can be more susceptible to infections.

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

  • Resources Resources

    Further information

    Sources

    • Asthma. British Lung Foundation. www.blf.org.uk, accessed 2 May 2012
    • Facts for journalists. Asthma UK. www.asthma.org.uk, accessed 2 May 2012
    • About asthma. Asthma UK. www.asthma.org.uk, accessed 3 May 2012
    • Asthma. Prodigy. www.prodigy.clarity.co.uk, published June 2011
    • Joint Formulary Committee, British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2012
    • British guideline on the management of asthma: a national clinical guideline. Scottish Intercollegiate Guidelines Network (SIGN). www.sign.ac.uk, published January 2012
    • Passive smoking and children. Tobacco Advisory Group of the Royal College of Physicians. www.rcplondon.ac.uk, published March 2010
    • Asthma. Health and Safety Executive. www.hse.gov.uk, accessed 3 May 2012
    • Occupational asthma: a guide for employers, workers and their representatives. British Occupational Health Research Foundation. www.bohrf.org.uk, published March 2010
    • Cates CJ, Crilly JA, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database of Systematic Reviews 2009, Issue 1. doi: 10.1002/14651858.CD000052
    • Asthma. The Merck Manuals. www.merckmanuals.com, published April 2008
    • Asthma during pregnancy. The Merck Manuals. www.merckmanuals.com, published December 2008
    • Occupational asthma. The Merck Manuals. www.merckmanuals.com, published April 2008
    • Asthma in children. The Merck Manuals. www.merckmanuals.com, published February 2009
    • Exercise and asthma. Asthma UK. www.asthma.org.uk, published July 2009
    • Novey H. Asthma without wheezing. Western J Med 1991; 154(4):459–60
    • Pregnancy. Asthma UK. www.asthma.org.uk, published August 2011
    • Nebulisers. British Lung Foundation. www.blf.org.uk, published July 2012
    • Breastfeeding could protect against asthma. Asthma UK. www.asthma.org.uk, accessed 3 May 2012
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  • Author information Author information

    Produced by Rebecca Canvin, Bupa Health Information Team, September 2012.

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