Asthma

Asthma is a long-term condition where the airways in your lungs become inflamed. You can develop it at any age.

Asthma shows up in a few main ways:

• coughing
• wheezing
• chest tightness
• breathlessness

These symptoms can differ from one person to another. They're often worse at night and early in the morning, or when something sets them off.

Asthma is well controlled in most people most of the time. It shouldn't limit your daily life in any way, and that includes your sleep. Work with your doctors and other health professionals to help keep your asthma under control.

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)

• are more short of breath than usual, even though you're using your inhalers as prescribed
• have pain when you breathe in or cough
• feel 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 you can't reach a doctor, phone a doctor or the 16263 health line.

• your symptoms are not getting better
• you have asthma and your symptoms are affecting your daily life
• you have had a cough for more than 3 weeks

• Take 1 to 2 puffs of your reliever inhaler straight away. Use a spacer if you have one. If you're taking 2 puffs, take them 1 at a time.
• Sit down and try to breathe slowly and steadily.
• If you don't 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 don't feel better after using your inhaler, or if you're worried, phone 999.
• If an ambulance doesn't arrive within 10 minutes and you still feel unwell, repeat step 3.

Your inhaler could be empty. If you can, switch to another inhaler to check whether it helps.

If your asthma symptoms improve and you don't need to phone 999, you still need to see a doctor or asthma nurse within 24 hours.

If you've had an asthma attack, see your doctor within 48 hours. This is to make sure you're getting the right treatment.

If your asthma isn't being controlled well, talk to your doctor about AIR or MART therapy.

Make sure you're using your inhaler correctly and as prescribed. It's also worth thinking about how you can reduce your exposure to anything you know triggers your asthma.

If you have symptoms of asthma, your doctor 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

Your doctor may offer you some of these tests for asthma:

• testing for 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

There is no cure for asthma, but there are treatments that can help:

• prevent future symptoms and attacks
• relieve your symptoms

Most people take medicines once or twice a day, usually with an inhaler. Your nurse, doctor or pharmacist will teach you how to use your inhaler properly. Asthma + Lung UK, a charity in the UK, has videos on how to use your inhaler, and you can watch them too.

Finding and avoiding your possible triggers matters as well. Some treatments may have side effects.

If you're diagnosed with asthma, your doctor or nurse will agree a personal asthma action plan with you. It could include things 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.

Maintenance and reliever therapy (MART) is a way of treating asthma that both prevents and relieves symptoms. You use 1 combination inhaler instead of 2 separate ones, a preventer and a reliever.

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. You don't need a separate reliever inhaler.

Doctors may prescribe this treatment for children aged 5 and over.

Asthma + Lung UK, a charity based in the UK, has further information on MART inhalers.

Preventer inhalers work slowly, over time. They bring down the inflammation and sensitivity in your airways, which lowers the chance of an asthma attack. You should use one every day, as your doctor or other health professional has prescribed.

Blue reliever inhalers act quickly on asthma symptoms. They widen your airways, so breathing becomes easier again. The medicine lasts for around 4 hours.

A blue reliever inhaler should never be given to you to use on its own. You should always have a preventer inhaler as well to treat your asthma.

There is no recycling scheme for used inhalers. Take all your used or expired inhalers back to your pharmacy, so they can be disposed of safely.

If you use a spacer regularly, replace it every year. You can put the old spacer in the household bin.

If you use your preventer inhaler correctly and keep your asthma symptoms under control, you're doing something good for your health and for the environment too. Some inhalers have a lower carbon footprint than others, so they are better for the environment. Still, the best inhaler is the one that works well for you. Talk to your doctor about whether an inhaler with a lower global warming potential would suit you.

If your asthma isn't controlled by inhalers alone, your doctor may prescribe other medicines:

• 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

If your asthma still isn't under control, your doctor may prescribe a short course of oral steroid tablets. More rarely, you may be given steroid tablets to take regularly. A hospital asthma specialist should monitor this treatment.

Using oral steroids over a long time can cause serious side effects, so they're only used after other treatments have been tried. Your doctor should talk with you about the risks and the benefits. You should also be given a steroid treatment card by your doctor.

Breathing exercises can improve asthma symptoms and reduce the need for reliever medicines in some people. This includes breathing exercises taught by a physiotherapist, and also yoga.

Breathing and relaxation exercises

Doctors don't know exactly what causes asthma. It's likely to be a mix of factors.

You have a higher chance of having asthma if you have or had:

• an allergy such as eczema, allergic rhinitis, food allergy or hay fever
• a family history of asthma or other similar conditions
• bronchiolitis (a common childhood lung infection) as a child
• childhood exposure to tobacco smoke, particularly if your mother also smoked during pregnancy
• been born prematurely, especially if you needed a ventilator to support your breathing after birth
• a low birth weight as a result of restricted growth within the womb

Some people may also be at risk of developing asthma through their job.

An asthma trigger is something that irritates your lungs. When you come into contact with one, your airways narrow, the muscles around them tighten, and you make more sticky mucus (phlegm).

Common asthma triggers include:

• infections in the upper airways like colds and the 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
• non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
• beta-blockers sometimes given for high blood pressure or some types of heart disease
• foods containing sulphites, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals

Asthma may also be triggered by allergens or chemicals you breathe in at work. Speak to your doctor if you think your symptoms are worse at work and get better on holiday.

You may be able to ease your asthma symptoms by avoiding your triggers.

If you get asthma symptoms during or after exercise, speak to your nurse, doctor or pharmacist. They may review your asthma plan to check that your symptoms are under control.

They may also advise that you:

• make sure the people you're exercising with know you have asthma
• increase your fitness levels slowly
• always have your reliever inhaler (usually blue) with you when you exercise
• always warm up and cool down

If symptoms start while you're exercising, stop, take your reliever inhaler, and wait until you feel better before you start again.

Hormones can change asthma symptoms. You may notice this around the time of your period, during menopause and during pregnancy. Whatever the stage, keep managing your asthma in the same way.

Make sure your asthma is well controlled during pregnancy.

Most medicines used for asthma are safe to take during pregnancy and when breastfeeding. But you should not take leukotriene receptor antagonists if you're pregnant, unless a doctor advises you to.