Asthma

Published by Bupa's Health Information Team, July 2010.

This factsheet is for people who have asthma, or who would like information about it.

Asthma is a common condition that 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 the airways. Very rarely, a severe asthma attack can be fatal.

How an asthma attack occurs

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About asthma

Asthma is a common condition - it affects about five million people in the UK. It often starts in childhood, but it can happen for the first time at any age.

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 into and out of your lungs.

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 and may stop and start. They are often worse at night.

Causes of asthma

The cause of asthma isn't 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 the 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
• medicines - certain medicines can trigger asthma

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

Diagnosis of asthma

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. 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.
• Chest X-rays - these may be done to make sure you don't have any other lung disease.
• Allergy test - this can help to find out whether you're allergic to certain substances.

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

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

Inhalers contain gas or dry powder that propels the correct dose of medicine either when you press the top down or when you inhale. The medicine is 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

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

If you're given a preventer you should use it every day - even if you don't have symptoms. 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. Long-acting relievers contain medicines such as salmeterol (eg Serevent) or formoterol (eg Oxis). Often these medications are combined with steroid inhalers such as symbicort (eg Seretide).

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 helpful for children - 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 the 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 water and 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 the 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.

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).

Asthma attacks - what to do

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

• Take your reliever treatment immediately, preferably with a spacer.
• Sit down (don't lie down) and try to relax.
• Wait five to 10 minutes - if there is no improvement repeat one puff of your reliever treatment every minute for five minutes until your symptoms go away.
• If your symptoms don't go away, you should call your GP or an ambulance, but continue taking your reliever, preferably with a spacer, every few minutes until help arrives.
• If you go to hospital, take your asthma treatments with you.

Make sure you see your GP so he or she can review your treatment.

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.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.