Asthma

What is asthma?

Asthma is a common long-term condition affecting the airways in your lungs, causing them to become inflamed and narrowed. It can't currently be cured, but with the right treatment most people don't have ongoing problems with symptoms.

What are the symptoms of asthma?

The main symptoms are:

• wheezing
• coughing
• shortness of breath
• a tight feeling in your chest.

Symptoms can be mild or severe, tend to come and go, and are often worse at night and first thing in the morning. They typically follow a pattern: flaring up with colds or other infections, triggered by exercise, allergies, cold air, or breathing hard from laughing or crying.

An asthma attack is when symptoms become severe and breathing becomes difficult; this can be life-threatening. Children's symptoms can look different from adults': they may cough in their sleep, wake often, avoid energetic play, tire quickly, or seem more irritable, without necessarily reporting breathlessness in the way an adult would.

What causes asthma, and who's at risk?

It's not fully understood what causes asthma, and it likely results from a mix of genetic and environmental factors. Asthma usually starts in childhood, while the body's defences are still developing, though it can also begin in adulthood.

You may be more likely to develop asthma if:

• you have other allergic conditions, such as eczema, hay fever or food allergies
• a close family member, especially your mother, has asthma, hay fever, eczema or allergies
• you were born prematurely or with a low birth weight
• you were exposed to high levels of air pollution or cigarette smoke as a child
• you had a childhood illness that affected your breathing, such as bronchiolitis or croup
• you're living with obesity
• you're regularly exposed to certain chemicals or dust at work.

Once you have asthma, symptoms are commonly set off or worsened by triggers such as indoor allergens (dust mites, mould, pet dander), outdoor allergens (pollen, mould), emotional stress, viral infections, poor air quality, very cold air, and certain medicines, including aspirin, which can cause serious breathing problems in some people with harder-to-treat asthma.

Are there different types of asthma?

Asthma isn't usually divided into strict types, but a few recognisable patterns are common:

• allergic asthma, triggered by allergens such as pollen, dust mites or animals
• exercise-induced symptoms, where physical activity triggers narrowing of the airways; this shouldn't put you off exercise altogether, as your GP or nurse can advise on managing it safely
• occupational asthma, caused or worsened by substances breathed in at work; if your symptoms are consistently worse at work and better on holiday, mention this to your GP
• severe asthma, where symptoms are harder to control even on high levels of treatment, and additional options such as tablets or injectable (biological) therapies may be needed.

How is asthma diagnosed?

There's no single test that confirms asthma. A GP or nurse will ask about your symptoms and listen to your chest, and you may be offered a simple breathing test and sometimes a blood test. You might also be given a peak flow meter, a small handheld device, to use at home over a few weeks to track how well your lungs are working.

Diagnosis can take time, partly because symptoms vary and can have several possible causes. If asthma seems likely, you may be offered asthma medicines as a trial, to see whether they improve your symptoms.

How is asthma treated?

The main treatment is medicine breathed in through an inhaler, which works well for most people when used correctly and correctly fitted to your level of symptoms. Depending on how severe your symptoms are, your care team may offer:

• an anti-inflammatory reliever (AIR) inhaler, used only when you have symptoms
• a maintenance and reliever therapy (MART) inhaler, one combination inhaler used every day to help prevent symptoms as well as when you get them
• 2 separate inhalers: a preventer inhaler used daily, and a blue reliever inhaler used for symptoms (a blue reliever should never be used on its own, without a preventer).

If you were diagnosed some time ago, you may only be familiar with the traditional 2-inhaler approach; AIR and MART are newer options your care team may discuss at your next review. Whichever you use, it's worth having a doctor, nurse or pharmacist check your inhaler technique, since using it correctly makes a real difference to how well the medicine works.

If inhalers alone aren't enough, options include tablets such as montelukast, and, for severe asthma not controlled by inhalers and tablets, injectable (biological) therapies. Long-term steroid tablets are only used once other treatments have been tried, because of their side effects; if prescribed, you'll be given a steroid treatment card.

A severe attack that doesn't settle may need hospital treatment, which can include oxygen, a nebuliser (a device that delivers a high dose of medicine as a fine mist), and steroid tablets or injections.

When you're not using an inhaler any more, return it to a pharmacy rather than putting it in the bin: the gases inside can leak out and contribute to climate change if disposed of incorrectly.

Complementary approaches

Evidence doesn't support using complementary approaches instead of prescribed asthma treatment. Used alongside it, some approaches that help with stress, anxiety or low mood, such as yoga, may lead to modest improvements in quality of life and symptoms; breathing exercises show similar modest benefits for quality of life, though not clearly for asthma symptoms specifically. There's no strong evidence that dietary supplements, including herbs, omega-3s, probiotics, selenium, soy isoflavones or vitamins C and D, are beneficial. Over-the-counter products labelled 'homeopathic' for asthma haven't been evaluated for safety or effectiveness, so shouldn't be relied on. If you're interested in trying any complementary approach, discuss it with your care team first, particularly before starting a new supplement, in case it interacts with your asthma medicines.

When should you see a doctor?

See a GP if you or your child have asthma symptoms, or if you've been diagnosed and your treatment isn't helping, you're needing your inhaler more often, your symptoms are affecting your usual activities or waking you at night, or you need advice on inhaler use.

If you're having an asthma attack

Sit up straight and try to stay calm. Use your reliever inhaler:

• blue reliever inhaler: 1 puff every 30–60 seconds, up to 10 puffs, shaking between puffs and using a spacer if you have one
• AIR or MART inhaler: 1 puff every 1–3 minutes, up to 6 puffs.

Follow your personal asthma action plan if it gives different guidance.

Call 999 if you or someone else having an attack feels worse at any point, doesn't improve after the maximum dose, or doesn't have an inhaler. Warning signs of a severe attack include being unable to speak in full sentences, little or no relief from your reliever, or lips or face looking bluish or pale. If symptoms are no better after 10 minutes and an ambulance hasn't arrived, repeat the maximum dose if you have an inhaler. For a young child having an attack, also call 999 if they seem drowsy, confused, have a bluish tint to the skin or lips, or have a fast heartbeat.

Even if you feel better without needing 999, see a GP or asthma nurse within 2 days of any attack to review your treatment and help prevent another one.