Asthma

Your health expert: Dr Richard Russell, Consultant Chest Physician
Content editor review by Sarah Smith, April 2021
Next review due April 2024

Asthma is a common, long-term condition that affects the airways in your lungs. It can make you cough and wheeze. You may also feel like your chest is tight and you’re short of breath.

Many people who have the symptoms of asthma will have them for life – there's no cure. But taking your asthma medicines and avoiding the things that trigger it will help to keep it under control.

About asthma

Asthma affects your airways. These are the tubes that carry air in and out of your lungs. Your airways become inflamed and over-sensitive to things that can cause allergies (allergens – for example pollen, cats or dogs). That leads to narrow airways and more mucus, which can block your airways too. This makes it more difficult for air to flow in and out of your lungs, which makes it harder for you to breathe.

There are many things that can make your asthma symptoms flare up. These are called triggers and may include:

a recent cold or sinusitis
allergies to pollen, animals (commonly cats, dogs and horses), house dust mites or certain foods
air pollution, including cigarette smoke
exercise, especially in cold or dry environments
emotions such as laughing, anger or stress, especially in children
changes in the weather
certain medicines, such as aspirin and beta-blockers

It's common to develop asthma as a child, but it can start at any age. Over five million people in the UK are being treated for asthma, including just over one million children.

Sometimes children ‘grow out of it’, which means the symptoms get less and less as they grow older until they’re not affected. Most children under two with asthma tend to grow out of their symptoms by the time they're 11.

Asthma symptoms can vary from mild to severe. When asthma is severe, and someone is having a flare-up of symptoms (an asthma attack) it can be serious and even life-threatening. This is more likely to happen in older people. Asthma attacks are less likely to happen if you manage your condition well, and many asthma attacks can be prevented.

Asthma symptoms

The main symptoms of asthma are:

coughing
wheezing
finding it difficult to breathe
tightness in your chest

You may not have all the symptoms listed above. But you'll probably have at least a couple if you have asthma. If you have these symptoms, see your GP.

You may find the symptoms are worse at night, or early in the morning. Symptoms usually come and go. You might notice that something specific started the symptoms, such as high pollen levels or being in a house where there is a cat living.

When your symptoms flare up suddenly, it’s called an ‘asthma attack’. If you're having an asthma attack, you may find that you're struggling to talk or breathe, your chest feels very tight and you’re coughing a lot. If this is happening, you need to get help straightaway.

Asthma diagnosis

There's no single test that can be used to diagnose asthma. But there are tests that can give doctors a good idea of how likely you are to have it.

When you see your GP, they'll ask about your symptoms and examine you. Your GP will also ask about your medical history and whether anyone in your family has asthma, allergies or related conditions such as hay fever. If you think you know what might have triggered or started your symptoms, tell your GP.

Your GP may use a stethoscope to listen for wheezing sounds in your lungs.

If your GP thinks that you have asthma, you may be asked to have one or more of these tests.

Spirometry. This measures how much air you can breathe out in one breath. It’s sometimes done before and after taking asthma medications to see how well they work.
Peak flow. For this test you blow a breath out into a machine as hard as you can. You may be asked to do the test several times a day over a few weeks and keep a diary of your readings.
A FeNO (fractional exhaled nitric oxide) test which measures the amount of a gas called nitric oxide in your breath.

Tests for asthma tend not to work well in children under five or for some older children. If your child is under five, and sometimes if your child is older, your GP is likely to treat the symptoms they’ve seen, rather than carrying out tests.

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Asthma treatment

Treating asthma means taking medicines to control your symptoms. When you’re diagnosed, your doctor will prescribe medicines depending on your symptoms, and then increase or reduce them until your symptoms are well controlled. The aim is for you to take the smallest amount you need to stay free of symptoms. That means having no symptoms during the day, no waking up due to asthma, no asthma attacks and no limits to the activities you can do.

You usually take the medicines by breathing them in, often by using an inhaler. There are two basic types of inhaler medicines for asthma.

Relievers. These are called beta-2-agonists and you would use one to treat your symptoms as soon as they start. Everyone with asthma should have one and for some people it’s all the treatment they need. If you need to use it more than twice a week, or your asthma is worse at night, you should talk to your GP. They might suggest taking a preventer medication as well. Reliever inhalers are usually coloured blue.
Preventers. If you’re having symptoms and using your reliever more than three times a week, or having symptoms at night more than weekly, you’ll be given a preventer inhaler. This has steroids in it and can help to prevent your symptoms. Use it once or twice every day, even if you don’t have asthma symptoms. Preventer inhalers are often brown, but the colour can vary.

Your GP or nurse should give you a personalised asthma action plan. This has information about how and when you should use your asthma inhalers, as well as what to do if your asthma is getting worse.

Other medicines

Sometimes asthma inhalers may not be enough to control your asthma. If that happens, your doctor may suggest adding other medicines. These may include a leukotriene receptor antagonist or a long-acting reliever. You may need to try some of these medicines for a few weeks or months to see how well they work. If your asthma is severe and not well controlled after trying these medicines, your GP is likely to refer you to a specialist.

Inhalers, spacers and nebulisers

Many of the medicines used to treat asthma are taken by breathing them in. There are several ways you can do that.

Inhalers are plastic devices with a mouthpiece, and a pressurised can containing the medication. You push down on the can and a measured amount comes out as a fine mist. Inhalers can be hard to use, especially for young children. If you find it difficult, you can try a spacer with your inhaler, a dry powder inhaler or a breath-activated inhaler instead.
Spacers are plastic cylinders that you attach to the end of your inhaler. You use the inhaler as normal but breathe the medicine in from the spacer mouthpiece. You don't need to time your breathing with squirting the inhaler, which makes it easier to do. Spacers work well for children and are good for anyone who finds an inhaler alone hard to use. Keep your spacer clean by washing it once a month in mild detergent.
Nebulisers are machines that turn liquid asthma medications into a fine mist that you breathe in using a mouthpiece or face mask. You might be given a nebuliser if you’re having a severe asthma attack.

Whatever device you’re using to take your medicines, it’s important to use it properly. It can make a real difference to how well your asthma is controlled. If the way you use it isn’t quite right, it’s easy to end up with side-effects, such as thrush and a sore mouth. It can also mean that the medicine isn’t getting right into your airways and if that happens, it won’t work as well as it should. If you are not sure how to use your inhaler correctly, you should ask you GP or asthma nurse for help.

What to do if you have an asthma attack

An asthma attack is a sudden flare-up of your symptoms and it can be frightening. So, it’s a good idea to have a plan and know what you’ll do it if happens. Your personal asthma plan should have information about how to manage your asthma and what to do if you think you’re having an attack.

You’re having an asthma attack if:

your symptoms are getting worse – you’re wheezing or coughing a lot and your chest feels tight
you’re too out of breath to talk or walk
your breathing is getting faster and you can't catch your breath
your reliever inhaler isn't helping, or isn't lasting more than four hours

If you’re having an asthma attack, you need to get help straightaway. Be as calm as you can and take the following steps.

Sit up – don’t lie down.
Take four puffs of your reliever inhaler immediately. If you have a spacer, use it. Children should have a puff every 30–60 seconds, up to 10 puffs.
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, call an ambulance.

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

Managing your asthma

Asthma is a long-term condition and that means it’s important for you to work with health professionals to look after yourself and keep your symptoms under control. This is sometimes called self-management. As part of this you’ll be given information about asthma and how to manage it and your own action plan.

Your action plan could include:

how to recognise if your asthma is getting worse
changes to your medicines and when you will make those changes
how to monitor your asthma

If you use your action plan, your asthma is likely to be better controlled and you’re less likely to need to go into hospital for treatment.

As well as having an action plan, you’ll also have a review of your asthma and medicines at least once a year. You might have one more often if you’ve had an asthma attack recently or have severe asthma. During the review your nurse or GP should also check how you’re using your inhaler.

As well as managing your asthma symptoms, there are also things you can do that may improve your symptoms. These include losing any extra weight and stopping smoking if you’re a smoker. It’s also a good idea for children to have all their routine vaccinations and for adults to have a yearly flu vaccination.

Breathing exercises may help to control your asthma symptoms too. Your GP may be able to refer you to a physiotherapist, who can show you the exercises.

Asthma causes

Asthma is caused by more than one thing – usually your genetics and something in your environment. These are some of the things that make developing asthma more likely:

a family history of the condition
having other allergy-related conditions, such as eczema and hay fever
chest infections caused by a virus when you’re a child
being exposed to allergens, such as pollen, cats and dogs
being exposed to cigarette smoke when you’re in the womb and as a baby
coming into contact with certain substances through your work, such as flour, hairdressing and cleaning products, chemicals and sawdust

Breastfeeding has many health benefits for your baby, and it’s recommended that you breastfeed for at least six months if you can. The research about whether breastfeeding can prevent asthma in your baby is a bit mixed, though. Some research studies don’t show a link, whereas others do.

The latest guidance from the British Thoracic Society says that on balance it’s worth breastfeeding. Research shows that there are benefits and it does offer a protective effect, especially if your baby is at high risk of developing asthma. You need to breastfeed for at least four months for breastfeeding to have any preventive effects.

If you have any questions about breastfeeding or want to find out more, talk to your midwife or health visitor.

Passive smoking is likely to make a child’s asthma symptoms worse. If you smoke when you’re pregnant or after your baby is born, they’re more likely to have wheezy breathing and to develop asthma.

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, stop if you can. Your GP can give you support and advice on how to stop smoking.

Most women with well-controlled asthma have normal pregnancies with few problems.

In general, about one in three women with asthma find it gets worse during pregnancy, one in three find it gets better and one in three find it stays the same. There is no way of telling beforehand how it’s going to be, but it’s likely to be the same in all your pregnancies. Research shows that if your symptoms do get worse, it’s most likely to be in the second and third trimester.

If your asthma isn’t well-controlled, it can lead to health problems in pregnancy for you and your baby. These include conditions, such as pre-eclampsia and high blood pressure, and an increased chance that your baby will be born early. So, it’s important to keep your symptoms well controlled using your medicines.

Many asthma medicines are safe to take during your pregnancy, including reliever and preventer inhalers. Talk to your midwife or pharmacist for more information.

Asthma

About asthma

Asthma symptoms

Asthma diagnosis

Need a GP appointment? Telephone or Video GP service

Asthma treatment

Other medicines

Inhalers, spacers and nebulisers

What to do if you have an asthma attack

Managing your asthma

Asthma causes

More on this topic

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Asthma

About asthma

Asthma symptoms

Asthma diagnosis

Need a GP appointment? Telephone or Video GP service

Asthma treatment

Other medicines

Inhalers, spacers and nebulisers

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