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.

How an asthma attack occurs

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About asthma

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.

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.

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.

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 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).

How to use your metered-dose inhaler

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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

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.

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

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

For sources and links to further information, see Resources.