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In the UK, 5.4 million people are living with asthma. It accounts for up to 3% of primary care consultations and 60,000 hospital admissions per year.
Asthma is a common and non-infectious respiratory condition that is usually managed by medication that is breathed in using an inhaler.
What is asthma?
Asthma can cause breathing difficulties that vary in severity. It often starts in early childhood although can begin at any stage of life.
Asthma sufferers have inflamed and narrowed airways compared to non-asthma sufferers, which can restrict the ease with which air can get into and out of the lungs.
What are the signs and symptoms of asthma?
The most common symptoms associated with asthma are:
- Wheezing (a whistling sound in your chest when you breathe in or out).
- Tightness in the chest / feeling like your chest is constricted.
People with asthma can have asthma attacks. An asthma attack is when their symptoms come on suddenly and can make them feel extremely unwell. Symptoms are characterised by a significant struggle to breathe.
It is important that people having an asthma attack have access to their inhaler, a piece of equipment that allows them to breathe in medicine to relieve their symptoms.
Signs that you are experiencing an asthma attack may be:
- Your symptoms including coughing, wheezing and breathlessness get suddenly worse.
- Your reliever inhaler is not helping.
- You feel like you cannot catch your breath.
- Breathing is fast and erratic.
- You feel too breathless to perform normal functions such as talking, eating or sleeping.
- Your chest feels tight and you may experience pain (children sometimes complain of pain in the abdominal area).
If you experience an asthma attack you need to:
1. Try not to panic and sit up straight.
2. Administer 1-2 puffs of your blue inhaler (reliever inhaler), up to 10 puffs in one minute.
3. Call 999 if you feel worse or taking 10 puffs has not helped the situation.
4. After 10 minutes if you are still not with paramedics and your symptoms remain the same, repeat step 2.
5. If symptoms have not improved by taking a further 10 puffs call 999 again to let them know you require urgent assistance.
If you see someone experiencing an asthma attack, try to help them with the above steps. It is important to try to keep them calm as difficulty breathing can cause panic which will make the situation worse. You can also help them with timing by using your watch or the clock on your phone.
If you have to be taken to hospital for treatment, you need to make an urgent appointment with your GP or asthma nurse within 48 hours of being discharged.
If you did not need to go to hospital following your asthma attack, ideally you should see someone the same day. They will be able to check your medication and may change the dose or talk to you about changes that need to be made in your treatment plan to prevent future attacks.
Around 1 in 6 people who receive hospital treatment for asthma need to be treated in hospital again within 6 weeks. This is why it is important to make a follow-up appointment, continue with your medicines and treatment and avoid any asthma triggers as far as possible.
What causes and triggers asthma?
Asthma happens when the tubes that allow air in and out of the lungs become inflamed. When this happens, the tubes become temporarily narrower which results in difficulty breathing.
Asthma can happen at random; however, it is more likely to occur after exposure to a trigger, such as:
It is also common for people with asthma to experience symptoms during, or after, exercise sessions, especially if doing vigorous exercise such as running, football or cardio workouts.
How serious is asthma?
The symptoms of asthma vary from person to person. Some people will only have mild symptoms, while others can experience severe breathing issues as a result of having asthma. Symptoms can also lessen or get worse over time.
If a person has an asthma attack and does not get the treatment that they need, the consequences can be severe and sometimes fatal. Around three people die in the UK every day from an asthma attack.
Occupational asthma accounts for a significant proportion (up to 15%) of asthma that first occurs during adulthood. This is when asthma is caused by breathing in substances such as dust, chemicals and fumes in the workplace. It is important that you see your GP as soon as you notice changes in your health and that you always use the correct PPE at work.
How long does asthma last?
Asthma is often a long-term condition. This is especially true if you only develop asthma symptoms as an adult. Children can sometimes appear to ‘grow out’ of the condition either during childhood or adolescence, although symptoms of asthma can disappear and then reappear later in life.
For some people, asthma can have a significant impact on their life, including their ability to work and perform day-to-day activities. For the majority of people with asthma, with the correct treatment and management, asthma symptoms can usually be controlled. Most asthma sufferers can live healthy and active lifestyles.
To try to minimise the impact asthma has on your life. It is a good idea to:
- Have an asthma action plan.
- Take your inhalers with you whenever you go out.
- Always make sure that you have enough medication so you never run out.
- Know what to do if you have an asthma attack.
- Make sure those around you know that you have asthma, what an asthma attack is and how they can help.
- Avoid any known triggers as far as possible.
Never ignore it if your symptoms are getting worse. Always tell your GP or asthma nurse immediately so that they can adjust your medication or suggest a new treatment.
How is asthma diagnosed?
If you are concerned that you or your child might have asthma you should make an appointment to see your GP as soon as possible.
Your GP may want to examine you and will need some information about your symptoms and lifestyle, including:
- Whether you smoke / are regularly exposed to cigarette smoke.
- Any family history of asthma or lung/breathing problems.
- What symptoms you are experiencing and how long it has been happening for.
- Whether you have allergies such as hay fever, or eczema.
- If you have noticed any triggers that seem to accompany your symptoms.
There are several other problems and conditions that can mimic asthma symptoms, such as:
- Bronchitis – Both asthma and bronchitis cause the airways to become inflamed and swell up. This makes it more difficult to get air into the lungs.
- Chest infections – Chest infections can also cause coughs and tightness in the chest. They usually result in the coughing up of phlegm which is often green and may clear up on their own after several days or weeks or may require a course of antibiotics.
- Respiratory syncytial virus (RSV) – This is a virus that is characterised by wheezing and pneumonia. It is common in infants/young children and is thought to be linked to childhood asthma.
- Chronic obstructive pulmonary disease (COPD) – COPD encompasses various lung diseases including emphysema and chronic bronchitis. It is strongly linked to cigarette smoking and tends to affect adults who are middle-aged or older. It causes breathlessness, coughing and wheezing.
So that they can ensure you get the correct diagnosis, your GP may want to run some tests. They may also wish to refer you to a specialist.
Common tests for asthma include:
- FeNO test – This requires you to breathe into a machine that will measure the levels of nitric oxide in your breath. Increased levels of nitric oxide can be an indicator that there is swelling in the airways.
- Spirometry – This is a common test used by doctors to assess how well a patient’s lungs are functioning. You will be required to take a deep breath and blow it out into a machine; this will show how much air you can blow out at once and how fast.
- Peak flow test – This test may be repeated several times over a fixed period to see if the results change. You will have to breathe into a small, handheld device called a peak flow meter, that measures how fast you can breathe out after inhaling a full breath in. It can also be used to monitor whether asthma symptoms are getting worse.
How is asthma treated?
Currently, there is no cure for asthma although treatments to keep the condition under control are widely available. The most common treatments for asthma are inhalers. These are small, plastic devices that are inserted into the mouth. By pressing a button and breathing in, you can release medicine directly to the lungs.
There are two main types of inhalers:
- Reliever inhalers (also known as rescue inhalers) – These help to relieve symptoms when they happen.
- Preventer inhalers – These are designed to stop symptoms from developing.
Reliever inhalers are the standard blue inhalers that are given to asthma sufferers. They contain medicine such as fast-acting salbutamol, which can provide quick relief from asthma symptoms by relaxing the muscles in the airways and making it easier to breathe.
Side effects of using reliever inhalers can include increased heartbeat or feeling shaky soon after they are used. If you need to use your reliever inhaler three times per week or more it is recommended that you talk to your asthma nurse or GP who may suggest further treatment such as a preventer inhaler.
Preventer inhalers are used every few days to reduce the chance of asthma symptoms occurring. They contain a steroid medicine that reduces inflammation in the airways and makes them less sensitive.
Preventative inhalers should be administered as directed and have to be used on a regular basis (even if you currently have no symptoms). If symptoms persist despite regularly using your preventative inhaler, you need to discuss this with your GP or asthma nurse.
Side effects of preventative inhalers include:
- Sore throat.
- Hoarse voice.
- Occasionally, oral thrush (a fungal infection that affects the mouth and/or throat).
Rinsing out your mouth after using your preventative inhaler can reduce the chance of getting side effects.
You may also be advised to use a ‘spacer’ which is a piece of plastic that attaches to the inhaler. Spacers allow users to inhale their medicine more easily and smoothly as the medicine goes into the plastic tube first, rather than directly into the mouth.
If reliever and preventative inhalers fail to keep your asthma symptoms under control, you may be asked to try a combination inhaler.
These are used on a daily basis to:
- Keep symptoms under control.
- Provide long-lasting relief.
They can have similar side effects to other types of inhalers and must be used as directed and on a regular basis (even if you start to feel better). You should never stop taking your asthma medication without speaking to your GP or asthma nurse first.
For those who suffer severe asthma that is not relieved by using an inhaler, various other treatments are available including tablets, injections and even surgery.
Steroid tablets can be used as either immediate treatment (during an asthma attack) or taken as a long-term solution to prevent asthma if inhalers do not work. Steroid medication can have a lot of side effects and is not suitable for everyone.
In cases of severe asthma, a biologic therapy may be required in the form of an injection. These injections are administered every few weeks by a specialist to keep asthma symptoms under control.
Surgery is also an option in cases of severe asthma. It involves placing a thin, flexible tube down the patient’s throat and into the lungs. Heat is then applied to the muscles that surround the airways to stop them from narrowing. This procedure is known as a bronchial thermoplasty and is done under general anaesthetic or sedation.
Some people have also found that doing breathing exercises, such as Buteyko, can help with their asthma.
Living with asthma
If your child has asthma you will need to inform their school and any childcare providers they attend, as well as any clubs or activities they go to.
Asthma sufferers need to have their inhaler with them at all times and know how to use it correctly.
The charity Asthma + Lung UK recommends having an asthma action plan, which is unique to you and contains important information about your asthma triggers and what medicines you take to keep your condition under control.
You can download and print out an action plan and take it along with you to medical appointments with your GP or asthma nurse. You can also share it with others, such as friends, colleagues, teachers or sports coaches, so they have information about your asthma and know what to do if you have an asthma attack.
To maximise your asthma action plan, you should:
- Make sure it is visible – Either pin it to your refrigerator or notice board or get a digital copy that you can save on your phone.
- Share it – In case you have an asthma attack, it is important that those around you have the information that they need so that they can help you.
- Check it periodically – Set yourself a reminder to check your action plan every month or two, just so you can make sure you are on track with your medicines and know what to do if you start to feel worse or experience any changes in your health.
Consistent treatment and avoiding triggers should usually keep your asthma under control. However, you should always see your GP or asthma nurse if you notice that your asthma symptoms are getting worse or you are needing to use your inhaler more than usual (even if your peak flow scores are normal).