Asthma
Asthma
Asthma is a long-term condition caused by inflammation of the airways in your lungs. It can develop at any age, whether in childhood or later in life.
Common Symptoms
Emergency Warning Signs
When to get medical advice
Phone 999 or go to A&E if:
You have asthma and:
- you have severe difficulty breathing – for example, you struggle to speak without pausing, gasping or choking
- you have severe chest pain in the middle of your chest that isn’t going away – it may feel like pressure, tightness or squeezing
- you have pain that spreads to your arms, back, neck and jaw
- you feel more drowsy than usual or find it more difficult to wake up
- your lips or skin are turning pale, blue or grey – on brown or black skin this is easier to see on the palms of your hands
Information on breathing problems in children
Contact your GP practice urgently if you:
- are more short of breath than usual, whilst using your inhalers as prescribed
- have pain when breathing in or coughing
- are feeling confused, dizzy, or lightheaded
- have a tight chest that is tighter than usual
- feel sick or are being sick – for example, you can’t keep food or fluids down
- are coughing up blood (haemoptysis)
- have pain or swelling in 1 of your legs
- have heart palpitations – this may feel like your heart is racing, going too slowly or skipping a beat or like a fluttering feeling in your chest
If your GP practice is closed, phone 111.
Speak to your GP practice if you:
- have symptoms that are not improving
- have asthma and your symptoms are affecting your daily life
- have had a cough for more than 3 weeks
What to do if you’re having an asthma attack
- Take 1 to 2 puffs of your reliever inhaler immediately. Use a spacer if you have one. If it is 2 puffs, these should be 1 at a time.
- Sit down and try to take slow, steady breaths.
- If you do not start to feel better, take 1 puff of your reliever inhaler every 1 minute. If you have a blue reliever inhaler, you can take up to 10 puffs. If you have an anti-inflammatory reliever (AIR) inhaler or a maintenance and reliever therapy (MART) inhaler, take 1 puff every 1 to 3 minutes. You can take up to 6 puffs.
- If you do not feel better after taking your inhaler or if you’re worried, phone 999.
- If an ambulance does not arrive within 10 minutes and you’re still feeling unwell, repeat step 3.
Your inhaler could be empty. Change to another inhaler if you can to check if it helps.
If your symptoms improve and you do not need to phone 999, you still need to see a doctor or asthma nurse within 24 hours.
What to do after an asthma attack
If you’ve had an asthma attack, you should make an appointment with your GP practice within 48 hours. This will make sure you’re getting the right treatment.
If you have asthma that isn’t being controlled well, talk to your healthcare professional about AIR or MART therapy.
You should make sure that you’re using your inhaler correctly and as prescribed. You should also think about how to reduce your exposure to anything you know that triggers your asthma.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
When to get medical advice
Phone 999 or go to A&E if:
You have asthma and:
- you have severe difficulty breathing – for example, you struggle to speak without pausing, gasping or choking
- you have severe chest pain in the middle of your chest that isn’t going away – it may feel like pressure, tightness or squeezing
- you have pain that spreads to your arms, back, neck and jaw
- you feel more drowsy than usual or find it more difficult to wake up
- your lips or skin are turning pale, blue or grey – on brown or black skin this is easier to see on the palms of your hands
Information on breathing problems in children
Contact your GP practice urgently if you:
- are more short of breath than usual, whilst using your inhalers as prescribed
- have pain when breathing in or coughing
- are feeling confused, dizzy, or lightheaded
- have a tight chest that is tighter than usual
- feel sick or are being sick – for example, you can’t keep food or fluids down
- are coughing up blood (haemoptysis)
- have pain or swelling in 1 of your legs
- have heart palpitations – this may feel like your heart is racing, going too slowly or skipping a beat or like a fluttering feeling in your chest
If your GP practice is closed, phone 111.
Speak to your GP practice if you:
- have symptoms that are not improving
- have asthma and your symptoms are affecting your daily life
- have had a cough for more than 3 weeks
What to do if you’re having an asthma attack
- Take 1 to 2 puffs of your reliever inhaler immediately. Use a spacer if you have one. If it is 2 puffs, these should be 1 at a time.
- Sit down and try to take slow, steady breaths.
- If you do not start to feel better, take 1 puff of your reliever inhaler every 1 minute. If you have a blue reliever inhaler, you can take up to 10 puffs. If you have an anti-inflammatory reliever (AIR) inhaler or a maintenance and reliever therapy (MART) inhaler, take 1 puff every 1 to 3 minutes. You can take up to 6 puffs.
- If you do not feel better after taking your inhaler or if you’re worried, phone 999.
- If an ambulance does not arrive within 10 minutes and you’re still feeling unwell, repeat step 3.
Your inhaler could be empty. Change to another inhaler if you can to check if it helps.
If your symptoms improve and you do not need to phone 999, you still need to see a doctor or asthma nurse within 24 hours.
What to do after an asthma attack
If you’ve had an asthma attack, you should make an appointment with your GP practice within 48 hours. This will make sure you’re getting the right treatment.
If you have asthma that isn’t being controlled well, talk to your healthcare professional about AIR or MART therapy.
You should make sure that you’re using your inhaler correctly and as prescribed. You should also think about how to reduce your exposure to anything you know that triggers your asthma.
Causes
What causes asthma?
We don't fully know what causes asthma. It usually comes from a mix of different factors working together.
You have a higher chance of developing asthma if you have:
- an allergy such as eczema, allergic rhinitis, food allergy or hay fever
- a family history of asthma or similar conditions
- had bronchiolitis (a common childhood lung infection) as a child
- been exposed to tobacco smoke as a child, particularly if your mother also smoked during pregnancy
- been born prematurely, especially if you needed a ventilator to help you breathe after birth
- had a low birth weight because of restricted growth in the womb
Some people may also be at risk of developing asthma because of their job.
Triggers
An asthma trigger is something that irritates your lungs. When you come into contact with a trigger, your airways narrow, the muscles around them tighten, and you produce more sticky mucus (phlegm).
Common asthma triggers include:
- infections in the upper airways, like colds and flu
- dust mites
- animal fur
- feathers
- pollen
- cigarette smoke
- chemical fumes
- pollution
- exercise
- mould or damp
- emotions, including stress or laughing
- food allergies
- certain weather conditions
- non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
- beta-blockers, sometimes given for high blood pressure or certain heart conditions
- foods containing sulphites, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals
Asthma can also be triggered by allergens or chemicals breathed in at work. If you notice your symptoms are worse at work and improve when you're away from it, such as on holiday, it's worth talking to your doctor about this.
Avoiding your known triggers, where possible, may help you manage your symptoms.
Diagnosis
If you have symptoms of asthma, your GP may ask you:
- when your symptoms happen
- how often you get symptoms
- if you have noticed any triggers
- if you have eczema or hay fever
Tests
Tests you may be offered include:
- testing airway inflammation, either with a blood sample or by measuring your nitric oxide concentration (a high level can be a sign of airway inflammation)
- spirometry, where you breathe into a machine to check how well your lungs work
- peak expiratory flow test, which uses a small hand held device to measure how fast you can blow air out of your lungs in one breath
- allergy tests, to check if your asthma is linked to allergies like dust mites, pollen, or food
- airways responsiveness, which measures how your airways react when they come into contact with a trigger
Treatment
Treatment for asthma
There is no cure for asthma but there are treatments that can help:
- prevent future symptoms and attacks
- relieve your symptoms
Most people will take medications once or twice daily, usually using an inhaler. Your nurse, doctor or pharmacist will teach you how to properly use your inhaler.
Watch Asthma + Lung UK’s videos on how to use your inhaler
Finding and avoiding your possible triggers is also important.
Some treatments may have side effects.
Personal asthma action plan
If you’re diagnosed with asthma, your healthcare professional will agree a personal asthma action plan with you. This could include information like:
- the medicines you need to take
- how to recognise when your symptoms are getting worse
- what to do if your symptoms get worse
Your personal asthma action plan should be reviewed with your nurse, doctor or pharmacist at least once a year. If your symptoms are severe, it can be reviewed more regularly.
Anti-inflammatory reliever (AIR) therapy
Anti-inflammatory reliever (AIR) therapy involves using a combination inhaler containing 2 types of medicine. These are:
- steroids – used to treat inflammation in your airways.
- formoterol – quickly opens up your airways when you have asthma symptoms or an asthma attack
You should only use your AIR inhaler if you experience asthma symptoms. A separate blue reliever inhaler is not needed.
This treatment may be prescribed for children aged 12 and over.
Asthma + Lung UK has further information on AIR therapy
Maintenance and reliever therapy (MART)
Maintenance and reliever therapy (MART) is an asthma treatment plan used for preventing and relieving symptoms. It involves using 1 combination inhaler rather than 2 separate preventer and reliever inhalers.
MART inhalers can lower the risk of asthma symptoms and attacks by:
- reducing inflammation in your airways
- preventing symptoms like breathlessness and a tight chest
- acting quickly to help with asthma symptoms or an asthma attack
- lowering the risk of an asthma attack or flare-up
You should use your MART inhaler every day to help prevent symptoms. A separate reliever inhaler is not needed.
This treatment may be prescribed for children aged 5 and over.
Asthma + Lung UK has further information on MART inhalers
Other preventer medicines
If your asthma isn’t controlled by using inhalers alone, you may be prescribed:
- Montelukast – tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways
- theophyllines – tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents
- biological treatments
Oral steroids
If your asthma is still not under control, you may be prescribed a short course of oral steroid tablets or, more rarely, regular steroid tablets. This treatment should be monitored by a hospital asthma specialist.
Long-term use of oral steroids has serious possible side effects, so they’re only used once other treatments have been tried. Your healthcare professional should talk about the risks and benefits with you. You should be given a steroid treatment card by your healthcare professional.
Complementary therapies
Breathing exercises can improve symptoms and reduce the need for reliever medicines in some people. These include breathing exercises taught by a physiotherapist and yoga.
Breathing and relaxation exercises
Prevention
Preventer inhalers work over time to calm the inflammation and sensitivity in your airways, lowering your chances of having an asthma attack. For this to work, they need to be used every day, exactly as your healthcare professional has prescribed, even on days when you feel fine.
Blue reliever inhalers act fast. They open up your airways so you can breathe more easily again, and the relief usually lasts about 4 hours. A blue reliever should never be given to you as your only treatment. You should always be using a preventer inhaler alongside it to manage your asthma properly.
Used inhalers
There is currently no recycling scheme for used inhalers. Instead, take all your used or expired inhalers back to your community pharmacy so they can be disposed of safely. If you use a spacer regularly, it should be replaced once a year; an old spacer can simply go into the household bin.
Inhalers and the environment
Using your preventer inhaler correctly and keeping your asthma well controlled is good for both your health and the environment. Some inhalers have a smaller carbon footprint than others, but the right inhaler for you is ultimately the one that works well for you. If you would like to know more, ask your healthcare professional whether a lower global warming potential inhaler might be a suitable option for you.
Complications
If you have asthma symptoms while or after you exercise, talk to your nurse, doctor or pharmacist. They may look again at your asthma plan to make sure things are properly under control.
They may also suggest that you:
- let the people you exercise with know that you have asthma
- build up your fitness level gradually, rather than pushing too hard too soon
- always carry your reliever inhaler (usually blue) with you when you exercise
- always warm up before and cool down after
If symptoms come on while you are exercising, stop what you are doing, use your reliever inhaler, and wait until you feel better before you start again.
Read further information about keeping active.
Pregnancy, periods, menopause and asthma
Hormones can affect asthma symptoms. This can happen around the time of your period, during menopause, and during pregnancy. You should carry on managing your asthma in the usual way.
Make sure your asthma stays well controlled during pregnancy.
Most asthma medicines are safe to use during pregnancy and while breastfeeding. However, you should not take leukotriene receptor antagonists during pregnancy unless a healthcare professional has advised you to.