What is asthma?
Asthma is a variable condition that affects the airways – the small tubes that carry air in and out of the lungs. People with asthma have airways that are sensitive and become inflamed.
Their airways can react badly when they have a cold or other viral infection, or when they come into contact with an asthma trigger (a trigger is something that sets off asthma symptoms – see section below)
When this happens the muscles around the walls of the airways tighten and they become narrower. The lining of the airways swell and often produce a sticky mucus. As the airways narrow, the air has to squeeze in and out, and this is what causes difficulty in breathing. Asthma symptoms can include coughing, wheezing, shortness of breath or a tight feeling in the chest.
Asthma affects millions upon millions of people throughout the world , including one in eight school children and one in 13 adults. With the correct treatment, support and advice, most people with asthma can lead full and active lives.
What are the causes of asthma?
Asthma, like its related allergic conditions eczema and hay fever, often runs in the family and may be inherited. There are probably a number of other, environmental, factors that contribute to someone developing asthma – many aspects of modern lifestyles, such as housing and diet, might be responsible. We also know that smoking during pregnancy increases the chance of a child developing asthma. Poor air quality can make your asthma worse.
What are the things that can set off (or trigger) asthma symptoms?
A trigger is anything that irritates the airways and sets off the symptoms of asthma. Common triggers include colds or flu, cigarette smoke, exercise and allergies to things like pollen, furry or feathery animals or house-dust mite. Everyone with asthma is different and has different trigger factors.
Asthma symptoms include:
• shortness of breath,
• wheezing (a whistling noise in the chest),
• cough and chest tightness.
Not everybody will have all these symptoms. Young children often present only with a cough with no other symptoms hence often the asthma diagnosis is overlooked or misdiagnosed. A history of asthma, eczema or hay fever in the family may mean that your chances of developing asthma are slightly higher than those without.
If you suspect that you may have asthma, it is important to see your doctor or asthma nurse. They will discuss your medical history and your current symptoms. They may want to measure your peak flow using a peak flow meter. This measures the amount of air you can blow out of your lungs in a fraction of a second.
Each time you use the meter (usually morning and evening) the result is marked on a chart. It can help (along with keeping a record of your symptoms) to give the doctor a better picture of how well controlled your asthma is. The doctor may decide to give you your own peak flow meter and ask you to keep a diary of readings. They will be able to assess the pattern from the readings and observe the variability between the morning and evening measurements which is a good indicator of asthma control.
Most GP practices / Asthma Nurses perform spirometry testing ( blowing tests) Spirometry testing may assist in diagnosing asthma.
Is there a cure for asthma?
Currently there isn’t any cure for asthma. However, a considerable amount of research into asthma is being conducted out all around the world.
Researchers are tackling asthma from many directions: indoor and outdoor air pollution, allergies, gene therapy, cell biology and chemical structures to name but a few. The results of their work will help us understand much more about how and why this common condition develops. It might also lead to even more effective asthma treatments – and an even better quality of life for everyone who has asthma.
Current research suggests that taking certain preventative measures in the home can lessen your chances of developing asthma, or reduce your symptoms. These steps include reducing the amount of dust in your home and can be achieved using simple measures like damp dusting and opening windows.
Although there is no cure for asthma, there are many safe and effective asthma treatments available that can help to control your symptoms.
The aim of your asthma treatment is to keep you free from asthma symptoms during the day and the night and to reduce the amount of time that you have to take off work. If any of the points below apply to yourself then it indicates that your asthma is not adequately controlled and you should consult your GP or asthma nurse.
Signs of poor asthma control include:-
• Night time awakenings with coughing, wheezing, shortness of breath or a chest tightness
• being short of breath on waking up in the morning
• needing more and more reliever treatment, or reliever not working very well
• being unable to continue your usual level of activity or exercise
• finding that you are too breathless to talk or eat
There are two main kinds of asthma treatment that your doctor may prescribe for you. They are called relievers and preventers.
Everyone with asthma should have a reliever inhaler. Relievers are treatments taken to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways (within 5-10 minutes), making it easier to breathe again. Reliever inhalers are usually blue in colour and are often referred to as the “blue inhaler”.
If you need to use your reliever inhaler more than once in any day, or more than 3-4 times a week, you will need an additional preventer treatment to keep your asthma symptoms under control. This is because relievers do not reduce the inflammation and swelling in the airways there fore are not treating the underlying cause.
Do treatments have side effects?
Reliever treatments are very safe and effective and have few side effects. Sometimes, high doses of reliever treatment can slightly increase your heart beat or give you mild muscle shakes. These effects are harmless and generally wear off after a short period of time.
Preventers help to control swelling and inflammation in the airways. They also stop the airways from being so sensitive to asthma triggers. The protective effect of preventer treatments builds up over a period of time. The full effects when starting on a preventer inhaler are not achieved for several weeks so it is important to keep taking them even when you feel better.
If you take your preventer treatment regularly you will improve your long-term chances of controlling your asthma and reduce the likelihood of permanently damaging your airways.
Preventer inhalers are usually brown, red or orange.
What about side effects?
Preventer treatments usually contain corticosteroids (a copy of the steroids produced naturally in our bodies) in low doses. These steroids are safe, not addictive and are completely different and not to be confused with the anabolic steroids used by body builders and athletes.
Using a preventer inhaler brings a small risk of a mouth infection called thrush and hoarseness of the voice. You can avoid this by using your inhaler before brushing your teeth and by rinsing out your mouth afterwards. Using a spacer device will also reduce the chances of these side effects. A spacer device also gives a much better delivery of the drug and delivers it to your lungs more effectively.
How do I take my treatment?
One of the most common ways of taking your asthma treatment is to use an inhaler device. Inhalers are useful because they help to get your treatment straight to the airways where it is needed. Inhalers can be in a spray form (aerosol) or dry powder form. If you use an aerosol inhaler, using a spacer device with your inhaler can also help.
Inhalers and spacers can be tricky to use at first and good technique is important in getting the most from your medication. Ask your doctor or practice nurse to check you are using your inhaler correctly the next time you see them.
Sometimes, when your asthma is first diagnosed, or if you have had a bad asthma attack, your doctor may give you a short course of a tablet form of preventer treatment (steroids). These tablets will help you to gain control of your symptoms quickly.
Add on treatments
If your asthma symptoms are not controlled by regular inhaled preventer and ‘as needed’ reliever, you may be prescribed an add on treatment to take in addition to your relievers and preventers.
The add on treatments currently available are:
Long acting reliever inhalers
The effects of these inhalers are similar to the blue reliever inhalers but the effects last for approximately 12 hours so are taken morning and evening on a regular basis along with the preventer inhaler.
They help to control symptoms by relaxing the muscles of the airways to keep the airways open.
As both the long acting reliever and the preventers are both taken morning and evening they are sometimes available in a combination 2 in one inhaler for convenience.
If your asthma symptoms are not controlled by regular inhaled preventer and ‘as needed’ reliever, you may be prescribed a daily preventer tablet treatment. These are not steroids and are usually taken alongside inhaled preventers to try and control symptoms if they are still present after the first lines of treatment mentioned above have been taken.
About Asthma attacks
Sometimes, no matter how careful you are about taking your asthma treatment and avoiding your triggers, you may find that you have an asthma attack. Most people find that severe asthma symptoms are the result of a gradual worsening of symptoms over a few days.
If your asthma symptoms slowly get worse – don’t ignore them! Quite often, using your reliever is all that is needed to get your asthma under control again. At other times, symptoms are more severe and more urgent action is needed. Your asthma nurse or Doctor can help you devise an asthma action plan so that you know what to do in the event of a worsening of asthma and how to recognise the signs.
What to do if you have an asthma attack
1. Take your usual dose of reliever straight away, preferably using a spacer
2. Keep calm and try to relax as much as your breathing will let you. Sit down, don’t lie down. Rest your hands on your knees to help support yourself. Try to slow your breathing down as this will make you less exhausted
3. Wait 5-10 minutes
4. If the symptoms disappear, you should be able to go back to whatever you were doing
5. If the reliever has no effect, call the doctor or ambulance
6. Continue to take your reliever inhaler every few minutes until help arrives preferably using a spacer. It is safe to keep taking your reliever inhaler until help arrives.
Do not be afraid of asking for help, even at night. A severe asthma attack can be life threatening and must be treated promptly.
If you are admitted to hospital or an Accident & Emergency department because of your asthma, take details of your treatment with you. You should also make an appointment with your doctor or practice nurse after you have been discharged from hospital so that you can review your asthma treatment and devise a plan if you didn’t previously have one so that you know what to do if the situation arises again.