DEFINITIVE GUIDE

Asthma symptoms and treatment

We rely on our airways to carry air in and out of our lungs, but what happens if they don’t function properly? Asthma is a common cause – a chronic condition that affects 5.4 million people in the UK, making it difficult for air to reach the lungs and causing uncomfortable and sometimes dangerous symptoms.

Written by Dr Sufian Ali and Dr Anna Murphy. Reviewed by Dr Abby Hyams. Last reviewed on 01/03/2019. Next review date 01/03/2022.

Fast facts

What is asthma?

Asthma is a common lung disease that causes difficulty breathing, wheezing and coughing. Asthma triggers (like exercise, cold air, allergens or infections) cause the airways to narrow, restricting the amount of air that can be carried in and out of the lungs. Each person has their own set of triggers - things that irritate their sensitive airways and provoke symptoms.

Is asthma genetic?

The exact cause of asthma is unknown. There is thought to be a genetic link in people that suffer with asthma. If a parent has asthma, there is an increased risk that the child will also develop asthma. Other factors such as pollution and modern hygiene standards are also thought to be linked. However, there is not currently enough evidence to determine if any of these are causes.

CHAPTER ONE

Asthma signs and symptoms

There are many signs and symptoms of asthma. Not everyone will experience all of the symptoms of asthma and some people might only experience symptoms in response to asthma triggers.

If you are experiencing any of the symptoms of asthma, you might have the condition. However, symptoms of asthma overlap with many other conditions so it can often be difficult to tell. We can help with:

How do I know if I have asthma? And what are the signs of an asthma attack?

How to know if you have asthma

Common symptoms of asthma include:

  • wheezing
  • breathlessness
  • chest tightness
  • coughing, especially at night
  • trouble sleeping
  • tiredness
  • allergies

It can be difficult to tell if you have asthma because many conditions cause these symptoms. It is more likely to be asthma if you experience these symptoms often, they tend to be worse in the morning and at night and seem to happen in response to an asthma trigger like exercise or an allergy.

When to see a GP about asthma

If you believe that you might have asthma, speak with your GP who will be able to diagnose the condition. It’s important to receive a proper diagnosis of asthma as the symptoms can be related to a number of different conditions. Each condition may need slightly different treatments.

What to expect at your appointment

In most cases, your GP will be able to make a diagnosis of asthma. However, in some cases, your GP might refer you to a specialist for a diagnosis if they are not sure. During your appointment, your GP or practice nurse might ask you questions about your symptoms, including:

  • What symptoms are you experiencing?
  • When do your symptoms show and how often?
  • Does anything seem to trigger your symptoms?
  • Is there a history of asthma in your family?
  • Whether you have any conditions such as eczema or allergies or a family history of them

In addition to these questions, your GP will usually carry out some tests for asthma.

Tests for asthma

Asthma is usually tested for using the following methods:

  • Spirometry. This is when you are tested on how fast you can breathe out and how much air you can blow out of your lungs. This is carried out by blowing into a machine. It can only be done in older children and adults.
  • Peak flow. This involves blowing into a handheld device which measures how fast you can breathe out. Your GP or nurse might ask you to do this several times over the course of a few weeks to monitor any changes.
  • FeNO (fractionated exhaled nitric oxide) test. This is when you breathe into a machine which measures the level of nitric oxide in your breath. This can be an indication of any inflammation in your lungs.

In addition to these tests, your GP might also suggest a blood or skin prick test to check if your asthma symptoms might be triggered by an allergy.

Asthma trial of treatment

While tests for asthma are often the best way to determine if you have asthma or not, your GP might also suggest a trial of treatment to confirm or rule out asthma. This involves prescribing you with one or more asthma medicines to see if they help relieve your symptoms.

Your GP might ask you to do breathing tests before and after your treatment trial to see how well the treatment worked. Your GP might also want to test the effectiveness of your treatment by stopping the treatment to see if your symptoms return again.

What happens after being diagnosed with asthma?

At first, it can be scary to be diagnosed with asthma. The good news is that lots of asthma treatments are available to help you manage your symptoms and reduce the impact of asthma on your day-to-day life.

Asthma UK suggests that after being diagnosed with asthma, you should work with your GP or asthma nurse to complete an asthma action plan. This has all of the information you need to know about your asthma in one place, reminding you which medicines you need to take each day, how to detect if your asthma is getting worse, and what you should do if it is getting worse or in the event of an asthma attack. It has been shown that you are four times less likely to need to go to the hospital with asthma if you have one. You can download an asthma action plan from Asthma UK.

CHAPTER TWO

Types of asthma

There are various terms used to describe different types of asthma, including ‘occupational’, ‘nocturnal’ and ‘seasonal’ asthma. The type of asthma you have depends on its causes and severity.

Sometimes these terms and categories can overlap with each other so you might experience more than one of the following types. We can help with:

What types of asthma are there? And what type of asthma do I have?

Difficult to control asthma

Around 12% of people with asthma have difficult to control asthma. This is defined as regularly having difficult asthma symptoms or finding it difficult to manage your asthma well. Having difficult to control asthma usually requires some extra support and treatment to help you effectively manage your asthma symptoms. Most of the time, with the right support, understanding and medicines, most people with difficult to control asthma can treat their symptoms.

Severe asthma

Around 5% of people with asthma have severe asthma. It can often be difficult to distinguish severe asthma from difficult to control asthma. The difference between the two is that severe asthma has symptoms that do not respond to usual asthma medicines. Unlike difficult to control asthma, severe asthma is more complex and requires ongoing care and treatment.

There are also different types of severe asthma. Around half of the people diagnosed with severe asthma have what is known as eosinophilic asthma. This type of severe asthma usually affects adults and is related to allergies and allergic triggers. If you’re diagnosed with this specific asthma, a specialist may offer you treatment in addition to your inhaled corticosteroids that also focus on reducing the number of eosinophil cells in your lungs (this affects the allergic response from your body).

Here's what asthma campaigner and blogger, Stephen Gaudet, has to say about living with very severe asthma:

"While my asthma doesn't control me, it affects everything I do in one way or another. Essentially, my day revolves around how short of breath I am and/or how many medical appointments I need to attend. It's difficult to stay positive when you have a disease that makes it difficult to breathe, and I'll admit that there are times where I just feel like giving up, but I try my best to stay focused on the better days ahead. All asthmatics, no matter how severe, always have at least a few good days in between the bad ones, I plan around those days. I try to live my life as though I'm totally healthy and consider my asthma more of an inconvenience than a deadly and debilitating disease. When I find it difficult to do something because of my breathing, I find ways to adapt."

Occupational asthma

Occupational asthma is sometimes also referred to as work-related asthma. This is asthma that is directly caused by the work that you do and certain triggers or exposures you are subject to at work. Signs your asthma is occupational include:

  • You started experiencing symptoms of asthma as an adult
  • Your childhood asthma symptoms have returned since starting work
  • Your asthma tends to improve on days you are not at work
  • Your symptoms often get worse after work
  • You have other symptoms which are usually linked to occupational asthma, such as conjunctivitis (red, itchy and inflamed eyes) or rhinitis (sneezing, itchy, runny rose)

High-risk occupations include laboratory work, baking, animal handling, welding, and paint spraying. If you think you may be experiencing occupational asthma, visit your GP at your earliest convenience to get a diagnosis, treatment and a plan for managing your asthma symptoms.

Aspirin-induced asthma

Aspirin-induced asthma is used to define asthma where taking aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) triggers an asthma attack. This includes medicines such as ibuprofen (e.g. Nurofen) and naproxen. It is estimated that between 2-25% of adults with asthma have a sensitivity to aspirin. Aspirin-induced asthma is sometimes also referred to as aspirin-exacerbated respiratory disease (AERD).

Aspirin-induced asthma is usually diagnosed in adulthood and can often present alongside nasal polyps and chronic sinusitis.

Exercise-induced asthma

Exercise is a common trigger for people with underlying asthma. This is when the airways narrow during or after exercise. There are varying symptoms of exercise-induced asthma, with people showing some or all of the typical asthma symptoms. Most experts will see exercise-induced asthma as asthma which is uncontrolled and is triggered by exercise. Adjusting your treatments will usually mean that most people with asthma can exercise with no problems.

Adult-onset or late-onset

Asthma is often seen as a condition which is first diagnosed in childhood. However, it is also quite a common diagnosis as an adult. This type of asthma is often referred to as adult-onset asthma or late-onset asthma. It is more common for women to be diagnosed with asthma for the first time as an adult than men.

It’s difficult to say what exactly causes asthma to develop in adulthood but research suggests:

Symptoms of adult-onset asthma are less likely to be triggered by allergies. Instead, symptoms in adults are more likely to be triggered by:

  • Cold and flu infections. Sinusitis is one of the most important triggering factors, 50% have concurrent sinus disease.
  • Exercise
  • Laughing and excitement
  • Hormonal changes
  • Anxiety and depression
  • Irritants such as chemical fumes and cold air
  • Acid reflux
  • Some medicines

Childhood asthma

The term childhood asthma is used to define asthma which was diagnosed in childhood. Asthma is the most common chronic disease in childhood and is more prevalent in boys than girls. Some children may find that their symptoms improve or disappear completely over time. However, even if symptoms do disappear, they can return again in adulthood. If your child has moderate or severe asthma, it is more likely for their symptoms to return later in life than if they have mild asthma. For more information, read our parents’ guide to asthma in children.

Seasonal asthma

Some people only experience their asthma symptoms at certain times of the year. This is known as seasonal asthma. This type of asthma is often triggered by things that are only present at certain times of the year, such as pollen or cold weather. Despite asthma being a long-term condition, it is possible to be symptom-free at times when your asthma triggers are not present. If you believe you may have seasonal asthma, it’s important to speak with your GP or asthma nurse about how to manage your asthma all year round.

CHAPTER THREE

How to treat asthma

There are many different ways to treat asthma. The right asthma treatment for you will depend on the causes and the severity of your asthma.

The most common method of treating asthma is by using an inhaler. If inhalers aren’t helping to control your asthma, your GP will check that you are using them correctly. If you are, they might also prescribe you with tablets or refer you to an asthma specialist for injections and other treatments in rare cases. We can help with:

How can I get rid of asthma? And can asthma be cured?

Can asthma be cured?

There is currently no cure for asthma. However, there are many treatments available to help with managing your asthma symptoms.

Asthma treatment

  • Inhalers. Reliever inhalers, preventer inhalers and combination inhalers are the main treatment for asthma. Find out more about asthma inhalers.
  • Tablets. Your GP might prescribe you with tablets to help manage your symptoms.
  • Injections. For people with severe asthma, there are a number of injections that a specialist might recommend to help control your symptoms.
  • Surgery. To help prevent your airways from narrowing, a specialist might suggest that you undergo a surgical procedure under general anaesthetic.

Asthma inhalers are the main treatment for asthma.

Tablets

If your inhaler alone isn’t helping your asthma symptoms, your GP might prescribe you with tablets. The main tablets your GP might consider prescribing are:

  • Leukotriene receptor antagonists (LTRAs). Also known as preventer tablets. These are the main tablets for treating asthma and are usually prescribed if you are using your preventer inhaler (i.e. steroid containing inhaler) correctly but your asthma is still not well controlled. LTRAs should be taken every day; you should also continue your preventer inhaler to help prevent your symptoms from showing. If you’re unable to take tablets, LTRAs are also available in syrup, chewable tablets and granules. Possible side effects of these tablets include stomach ache, headaches and occasionally they may affect your dreams.
  • Theophylline. If other treatments aren’t working, your doctor might prescribe you theophylline tablets. These tablets are to be taken every day, usually twice a day to help prevent your symptoms from appearing. Side effects of taking these tablets include headaches and feeling sick. You will need regular blood tests to make sure the dose of this tablet is correct. Many other drugs interact with theophylline so it is important that you let your doctor, nurse or pharmacist know you are taking theophylline tablets.
  • Steroid tablets. If other treatments aren’t working, your GP might prescribe you with steroid tablets, e.g. prednisolone. These tablets are usually taken as an immediate treatment when an asthma attack occurs or you are having a period of worsening of your asthma. Sometimes they are used as a long-term treatment to help prevent symptoms from appearing but generally, this is avoided if possible. It’s important to note that taking steroid tablets long-term or frequently can come with side effects including increased appetite, easy bruising, fragile bones, mood changes and high blood pressure. While taking steroid tablets, you’ll be monitored for signs of these problems to help prevent them from occurring. If your doctor has advised that you should be taking steroids for a longer period, they would only do so if they feel that the benefits outweigh the risks and potential side effects and will try to keep the dose of steroid as low as possible. If you are prescribed steroid tablets you should carry a blue steroid card with you at all times.

Injections

If you have severe asthma, your GP might write a referral letter for you to see an asthma specialist who may be able to prescribe injections for asthma.

The main injections for asthma treatment are:

  • Omalizumab (Xolair)
  • Reslizumab (Cinqaero)
  • Mepolizumab (Nucala)
  • Benralizumab (Fasenra)
Important

Injections are not suitable for everyone with asthma. An asthma specialist will determine whether injections are right for you.

Medical procedure

A procedure known as bronchial thermoplasty is sometimes offered to people with severe, resistant asthma. This is carried out under general anaesthetic so you will be sedated or put to sleep while the surgery is happening. The procedure involves using heat on the muscles around your airways to help stop them narrowing by passing a thin, flexible tube down your throat and into your lungs. This is a fairly new procedure but has been shown to be an effective treatment for people with severe asthma so far. Only a few specialist centres in the UK will provide this procedure.

Annual asthma review

Guidelines state that everyone with asthma should have an annual review with their GP or asthma nurse. This appointment gives you the chance to talk about how to manage your asthma symptoms better and make sure your treatment is right for you. Often, your GP surgery will invite you for your annual asthma review. If you haven’t received an invitation, you should book an appointment to see a GP or practice nurse yourself. Correct management of your asthma can help to relieve ongoing symptoms and helps to prevent asthma attacks and long term damage to your lungs, allowing you to live a normal life.

Getting your flu jab

The flu can be very serious for people with asthma. It is recommended that everyone with asthma who is on a regular steroid inhaler or has been admitted to hospital for asthma gets vaccinated for the flu.

Asthma support

If you’re feeling down about a diagnosis of asthma, you might find it comforting to know that others have the same feelings after being first diagnosed. Some people find an asthma diagnosis difficult to come to terms with. While some feel worried about how asthma will affect their day-to-day lives, others feel relief that they know what is going on with their health and take a positive approach to work with their GP or specialist to find the best medicines for them. Over time, people tend to become more confident with their diagnosis and believe they are in a better position to get the treatment and support they need.

You might find it helpful to talk to someone about how you are feeling after being diagnosed with asthma. There are many places you can go to find support:

  • You can discuss how you are feeling with your GP, asthma nurse or specialist.
  • Asthma UK has a helpline which allows you to speak with a nurse weekdays between 9 am and 5 pm (0300 222 5800).
  • Asthma UK also has a forum where you can talk with other people who have been diagnosed with severe asthma.
  • You can try talking to a friend or family member for emotional support.

Asthma UK has a useful resource which helps with spotting any negative thoughts you might be having after an asthma diagnosis.

CHAPTER FOUR

Asthma inhalers: what you need to know

Asthma inhalers come in different shapes and sizes. Most people with asthma will be prescribed with two different inhalers: a preventer inhaler and a reliever inhaler.

In some cases, your GP might prescribe a combination inhaler which acts as both a reliever and a preventer inhaler. Some people find it easier to use their inhaler with a spacer if it is a spray type (aerosol). We can help with:

What are the types of asthma inhalers? And what are the asthma inhaler colours?

Reliever inhalers

Reliever inhalers help to quickly treat asthma symptoms and give emergency relief in the event of an asthma attack. They do this by quickly getting the medicine straight to your lungs, relaxing the muscles around your airways to open them up and allowing you to breathe more easily. It should only take a few minutes for the effect of a reliever to kick in.

Anyone with asthma or children under 5 years of age with suspected asthma will be prescribed with a reliever inhaler to use when symptoms of asthma start to show.

Most people with asthma will also need to use a preventer inhaler in addition to their reliever inhaler. If your asthma is well controlled you should very rarely need to use your reliever medicine. Using it three times a week or more shows your asthma is not controlled and your other medicines may need to be adjusted.

Reliever inhalers are usually blue and look like this:

Preventer inhalers

Most people with asthma will need a preventer inhaler in addition to their reliever inhaler. Preventer inhalers are to be used every day. They help prevent asthma symptoms by making your airways less sensitive. If you use your preventer inhaler every day as prescribed even when you feel well, and follow the correct inhaler technique, you will be less likely to react to your asthma triggers which means your asthma is likely to be controlled and you have little or no symptoms.

Very few people with asthma will not need a preventer inhaler. Your GP will prescribe you with a preventer inhaler if:

  • You don’t have good control over your asthma
  • You need to use your reliever inhaler more than 3 times a week
  • You feel breathless, coughing or have a tight chest during normal activities at least three times a week
  • You find your sleep is disturbed by coughing or a tight chest once a week

The protective effect of preventer inhalers builds up over time, so it is advised that you use your preventer inhaler every day as prescribed to give you better defence against your asthma triggers.

Long-acting reliever inhalers

Long-acting reliever inhalers, called long-acting beta agonists (LABA), are prescribed to some people with asthma in addition to their steroid preventer inhaler. While long-acting reliever inhalers do help to relieve ongoing asthma symptoms, not all of them will help in the event of an emergency. They work by relaxing the muscles and opening up the airways over a longer period. Long-acting beta agonists should always be prescribed to you together with a steroid in the same inhaler, known as a combination inhaler.

Sometimes another type of bronchodilator, called a long acting muscarinic antagonist may be given to you in an inhaler. This is called Spiriva (Tiotropium) Respimat inhaler. It may help to relax the muscles in the airways and to reduce breathlessness.

Combination inhalers

A combination inhaler combines two medicines in one inhaler: a long-acting reliever to provide on-going relief from symptoms such as breathlessness and tightness of the chest, and a steroid preventer to help control and prevent inflammation in your airways in the long-term.

Despite there being reliever medicine in your combination inhaler, you will most likely also need a separate reliever inhaler. There are some cases where you will only need a combination inhaler. This is called the MART or SMART way.

Make sure to use your combination inhaler every day as prescribed, even if your asthma isn’t troubling you. This is because combination inhalers are designed to be preventative and help to relieve ongoing symptoms. If you feel you no longer need to take it every day you must discuss it with your GP or asthma nurse before stopping it. It is likely that your asthma symptoms will return if you just stop this inhaler.

Maintenance and Reliever Therapy (MART)

Maintenance and Reliever Therapy (MART) is when you are prescribed with a combination inhaler to use as both your reliever and preventer inhaler. You will be told to use it twice a day but you can also use it if you become short of breath or have chest tightness.

Sometimes, MART regimes are also referred to as SMART regimes. These both work in the same way and are just different brands. The most common MART regimes in the UK are:

  • Symbicort MART Regime (sometimes called SMART)
  • Fostair MART Regime
  • DuoResp Spiromax MART Regime
  • Fobumix Easyhaler MART Regime

A MART regime might be prescribed to you by your GP or asthma nurse if you’re struggling with your asthma symptoms and you’ve already tried a regular combination inhaler.

CHAPTER FIVE

Best inhaler technique and using spacers

Some people find inhalers tricky to use, while others don’t realise they are using their inhaler incorrectly.

There are two groups of inhalers; those that are aerosols, such as puffers or spray type and those that are called dry powder inhalers.

To get the best from your medication, many people find that spacers help if they are prescribed a puffer or spray type (aerosol) inhaler. This type of inhaler may be called a metered dose inhaler (MDI). We can help with:

How do I use a spacer? And what’s the best inhaler technique?

What are spacers?

Spacers are large tubes that are made out of plastic. There are many different types available which fit on to different inhalers. Spacers can help you to get the best out of your asthma medicine.

Sometimes, using a spacer means that you don’t require as much medicine. This is because spacers slow down the speed of your medicine and help it to get down into your lungs, instead of the back of your throat. This also helps to reduce the side effects of using your inhaler.

Spacers are available on prescription and can also be purchased from your local pharmacy.

How to use spacers

To get the most effective dose, ask your GP, asthma nurse or pharmacist how to use your spacer with your inhaler. You should also have your technique checked again at your annual asthma review (or more often if possible). Sometimes a face mask is also used for children and babies who have trouble using a regular spacer with a mouthpiece.

How to clean your spacer

Is inhaler technique important?

Getting the right inhaler technique is essential for the medicine to work and to help avoid side effects of using your inhaler. If you are using your inhaler incorrectly, you might be putting yourself more at risk of side effects such as oral thrush or a sore throat. This is because the medicine might be hitting the back of your throat or staying on your tongue or in your mouth. The medicine needs to be able to go down into your airways and a good inhaler technique is essential for this to happen.

Important

If you have an incorrect inhaler technique, you won’t be able to control your asthma and you’ll likely suffer from asthma symptoms despite taking your inhaler at the prescribed dose.

How to use your inhaler

The best way to check your inhaler technique is to take your inhaler to your GP, asthma nurse or pharmacist and ask them to check how you are using it. There are many different types of inhalers that work in different ways so if you’ve been prescribed an inhaler for the first time or you’re using a different type that you’re not used to, it’s best to get advice on how you’re using it. Pharmacists at your local pharmacy can support you in using your inhalers. Sometimes, the design of inhalers can change and your technique will need to be updated. Asthma UK has a number of how-to videos based on the type of inhaler you are using. It is recommended to rinse your mouth by gargling water after using an inhaler that contains a steroid. This helps along with a good inhaler technique to reduce the chance of you getting thrush.

Generally, there are ‘7 Steps to Success’ using an inhaler:

  1. Prepare the inhaler (e.g. remove the cap, hold it upright)
  2. Prepare the dose (e.g. shake the inhaler, load the dose)
  3. Breathe out (but not into the inhaler)
  4. Put the inhaler in your mouth
  5. Inhale: Aerosol-type devices – inhale slow and steady. Dry powder devices – inhaler quick and deep.
  6. Breath hold for up to 10 seconds
  7. Repeat the dose or replace cap etc.

How to clean your inhaler

If you’re using your inhaler every day there is usually no need to clean it. However, if you need to clean your ‘press and breathe’ metered-dose inhaler (MDI), follow these simple steps:

  1. Take out the metal canister from its plastic casing and take off the mouthpiece cover
  2. Use warm running water to rinse the plastic casing thoroughly
  3. Dry the plastic casing completely, inside and out
  4. Put the metal canister back into the casing and test it with a puff before replacing the mouthpiece cover

To clean a dry powder inhaler, simply wipe the mouthpiece with a dry cloth at least once every week.

Important

Do not use water to clean a dry powder inhaler as the powder is very sensitive to moisture.

CHAPTER SIX

What to do: asthma attack

Asthma attacks can be a very frightening experience. During a mild attack, you might have a feeling of breathlessness or chest tightness while walking but feel better once you sit down.

During a severe asthma attack, your symptoms might be uncontrollable and considerably more dangerous. This is a life-threatening emergency and can be fatal if emergency treatment is not available. We can help with:

What is an asthma attack? What is the best thing to do when having an asthma attack?

What is an asthma attack?

Every 10 seconds someone has a potentially life-threatening asthma attack.

If you are experiencing any of the following, you are having an asthma attack:

  • You are experiencing a lot of wheezing, have a very tight chest, or cough excessively
  • You are breathless and find it difficult to walk or talk
  • Your breathing gets faster and you feel like you’re not getting your breath in properly
  • Your peak expiratory flow reading (if you have measured it) is reduced by at least 70% compared to your best reading

What to do when having an asthma attack

  1. Sit up straight and try to keep calm.
  2. Take one puff of your reliever inhaler (usually blue) every 30-60 seconds up to 10 puffs (ideally through a spacer if you have one available to you).
  3. Call 999 for an ambulance if you feel worse at any point or if you still don’t feel better after 10 puffs.
  4. After 15 minutes, repeat step 2 while you wait for the ambulance to arrive.
Important

This is not applicable to people who are on MART/SMART regimes. For more information, speak with your GP.

How serious is an asthma attack?

How serious an asthma attack depends on the intensity of the symptoms. You should seek emergency attention immediately if you are showing signs or symptoms of a severe asthma attack. This includes:

  • Severe breathlessness or wheezing, especially at night or early in the morning
  • You can’t speak more than short phrases due to shortness of breath
  • You have to strain your chest muscles to breathe
  • You have low peak flow readings when you use a peak flow monitor, usually 50% or less of your best
  • There is no improvement after using your reliever inhaler (usually blue), or you need to use it more than every 4 hours

You should have been given an asthma action plan. This will remind you of what actions to take should you have an asthma attack. Take a photograph of this plan on your phone if you have one so that you can easily find it when you need it. If you don’t have your own asthma action plan speak to your GP or practice nurse and ask them to write one for you. You can download an asthma action plan from the Asthma UK website.

How to prevent an asthma attack

The best way to prevent an asthma attack is to make sure it is well-controlled in the first place. That means having a personal asthma plan and using your inhalers and medication as prescribed. While preventative medication does not guarantee that you will not encounter an asthma attack, it certainly helps to reduce your chances if your current treatment is keeping your asthma under control.

Complications of asthma attacks

Asthma attacks can be very disruptive. They can disturb your sleep, school, work and exercise, reducing your quality of life and causing disruption to the lives of people around you.

Very severe asthma attacks can lead to respiratory arrest and death.

CHAPTER SEVEN

Lifestyle and home remedies for asthma

There are many ways to help to keep your asthma symptoms under control at home. Simple breathing exercises, herbal remedies and staying healthy can help you to manage your symptoms better.

However, lifestyle and home remedies for asthma are not a replacement for your asthma medicines. We can help with:

What are some home remedies for asthma? And how can I avoid asthma triggers?

Breathing exercises

There is some evidence to show that breathing exercises can improve asthma symptoms and reduce the amount of medication you need to keep your asthma under control. However, breathing exercises should not be used as a replacement for your medicine.

Avoid asthma triggers

Taking steps to reduce exposure to asthma triggers can help to reduce your asthma symptoms and chances of an asthma attack. This includes:

  • Airing out your rooms to keep dust particles down. You should try to keep your windows closed when the pollen count is high.
  • Use a dehumidifier. If you live in a damp environment, you might want to consider using a dehumidifier.
  • Reduce dust. Clean your home regularly to reduce your exposure to dust. If possible, replacing carpets with hardwood flooring can help.
  • Prevent mould. Clean damp areas in the bathroom, kitchen and around the house. This helps to prevent mould spores from appearing.
  • Stay away from pet dander. If you are allergic to pet dander, you should stay away from pets with fur or feathers. Alternatively, having your pets groomed regularly might help to keep pet dander down to a manageable level. Cockroaches are also a common trigger for asthma.
  • Wear a face mask. When the weather is cold, consider wearing a face mask or scarf outside. This can help if your asthma is worsened by cold or dry air.

Staying healthy

Taking care of yourself can help to keep your asthma symptoms under control. This includes:

  • Exercising regularly. Exercise can sometimes be more difficult with asthma. However, regular exercise helps to strengthen your heart and lungs, relieving asthma symptoms. While exercising in cold temperatures, try wearing a snood to help warm the air you breathe.
  • Maintaining a healthy weight. Being overweight has been shown to worsen asthma symptoms and put you at a higher risk of other health problems.
  • Keeping acid reflux under control. Gastroesophageal reflux disease (GORD) can irritate airways and make your asthma worse over time. If you’re struggling with frequent symptoms of GORD, speak to a doctor. Patients with asthma are three times more likely to have GORD.
  • If you smoke it’s important that you stop. Smoking makes your asthma worse and you could start to develop COPD – chronic obstructive pulmonary disease. Also, smoking makes your airways less sensitive to the steroid inhaler meaning you will need a higher dose to control your asthma.
CHAPTER EIGHT

Know what causes asthma

It is not yet known what the exact cause of asthma is and your likelihood of having asthma can depend on a number of different factors.

There are a number of common asthma triggers including dust, pollution and exercise that can flare up asthma symptoms in some people. We can help with:

What causes asthma? And can asthma be cured?

What causes asthma?

It’s not yet known what the exact cause of asthma is. It has been suggested that genetics, pollution and modern hygiene standards are potential causes for the condition. However, there is not currently enough evidence to conclude that any of these cause asthma.

What causes asthma is different from what triggers asthma. Causes are the underlying reason why a person has asthma, whereas triggers can flare up asthma symptoms.

Who is at risk of asthma?

There are a number of different factors that can increase your likelihood of having asthma, including:

  • Having a condition related to allergies (atopic conditions), e.g. hay fever and eczema
  • A family history of eczema, asthma or other atopic conditions
  • Previously having bronchiolitis
  • Being exposed to cigarette smoke as a child
  • Your mother smoking during pregnancy
  • You were a premature birth (born before 37 weeks old) or had a low birthweight

What can I do to prevent asthma?

Asthma cannot always be prevented. Some causes, such as asthma running in the family or being born early are outside of our control. However, there are some factors such as smoking that can be prevented to reduce your chances of getting asthma. There is some evidence to show that rural living, less frequent use of antibiotics, and early contact with other children can also reduce the chance of getting asthma. It is also possible to keep your asthma well-managed and not have any symptoms for periods of time. Taking your medicine correctly and avoiding asthma triggers are some things you can do to avoid asthma symptoms.

Asthma triggers

Asthma triggers can cause your asthma symptoms to flare up and can result in an asthma attack if your asthma is not kept under control. Asthma triggers vary from person to person. Common asthma triggers include:

  • Infections such as cold and flu
  • Allergies, including pollen, dust mites, animal fur or feathers
  • Anti-inflammatory painkillers, like ibuprofen and aspirin, and other medicines
  • Stress and extreme emotions
  • Smoke, fumes and pollution
  • Sudden changes in temperature, cold air, wind, thunderstorms, heat and humidity
  • Mould and damp
  • Exercise
CHAPTER NINE

For parents: asthma in children

At first, it can be very worrying for parents to hear their child has been diagnosed with asthma. It’s important to remember that there are many treatments available to help children deal with their asthma.

We have some useful advice and support to help your child manage their asthma symptoms. We can help with:

How can I manage my child’s asthma? And what should I do if my child has an asthma attack?

Getting your child diagnosed

If you suspect your child might have asthma or they are showing symptoms of asthma, it’s important to take them to see a GP for a proper diagnosis. Signs of asthma in children include:

  • A cough that won’t go away or keeps coming back. It’s common for children with asthma to cough at night time or early in the morning. Your child might also cough after doing exercise or other activities.
  • Wheezing. Listen out for a whistling sound when your child breathes. This is a common sign of asthma.
  • Tight chest. Children often describe this feeling as a ‘tummy ache’ and might rub their tummy or chest.
  • Breathlessness. Your child might be breathing fast. Observe your child’s body as they breathe. Are they shrugging their shoulders up and down or is the skin at their ribs being sucked in as they breathe?

To prepare for your appointment with your GP, it’s helpful to make notes on your child’s symptoms, particularly what and when they have the symptoms. It’s often quicker and easier to show your GP what they are experiencing. Recording your child’s coughing or wheeze sounds can help your doctor understand their condition, especially if your child is not experiencing symptoms during the appointment.

Your GP might ask you the following questions. It’s a good idea to have answers to these questions ready before your appointment.

  • Was your child born early?
  • Did your child have a low birth weight?
  • Did you/your child’s mother smoke during pregnancy?
  • Do people sometimes smoke around your child?
  • Does your child have eczema, hay fever or other allergies?
  • Does anyone in your family have asthma, eczema, hay fever or other allergies?
  • Does your child live or go to school in an area with high pollution?
  • Do you have damp or mould in your home?
  • Has your child had a chest infection like bronchiolitis?
Important

Call 999 if your child is struggling to breathe. Look out for their tummy sucking in, ribs standing out, sucking in at the front of their throat or not being able to finish their sentences.

Understanding your child’s inhalers and medicine

Once your child is diagnosed with asthma, your GP will likely prescribe them with inhalers or other medications and treatments to help keep their asthma symptoms under control. Whatever treatment your GP prescribes for your child, you should help them to take the correct dose, in the correct way and at the correct time(s). This is important because asthma medications often won’t work properly unless they are taken correctly.

Often, your child will require a spacer to use with their inhaler to help get the correct amount of medicine to their lungs and reduce side effects. Learn more about spacers.

Managing your child’s asthma

One of the best ways to manage your child’s asthma is to make sure they’re using an asthma action plan. You can download an asthma action plan for children from Asthma UK to complete with your GP or asthma nurse. You should also take this plan to all of your child’s asthma appointments to make sure all of the information is up-to-date.

You should make sure to take your child for an asthma review every year, in accordance with the guidelines. This appointment is a great way to make sure your child is using their medications correctly and to review their current prescriptions.

Tip

Put up copies of your child’s asthma action plan on the fridge, take a photo of it and send it to friends and family and share a copy with your child’s school and any clubs they attend. This helps make everyone aware of your child’s asthma and what to do if they have an asthma attack.

How do I know if my child has had an asthma attack?

An asthma attack doesn’t always result in your child going to the hospital. Sometimes, your child might have an asthma attack and their blue reliever inhaler helps to relieve their symptoms and prevent a visit to the hospital. It’s important to be aware of when your child has an asthma attack by looking out for the following signs:

  • They needed more puffs on their blue reliever inhaler
  • Their reliever didn’t help
  • Unable to talk or walk easily
  • Breathing hard and fast
  • Wheezing
  • A lot of coughing

What to do if your child has an asthma attack

It can be very shocking and frightening for parents to see their child having an asthma attack, especially if they end up in an ambulance or in hospital. Some parents feel guilty afterwards and wonder what they could have done differently to prevent it from happening. It’s not surprising that parents tend to panic when their child is having an asthma attack, however, it is important to stay calm and follow these steps:

  1. Help your child to sit up straight and stay calm.
  2. Help them take a puff on their blue reliever inhaler every 30-60 seconds up to 10 puffs.
  3. Call 999 for an ambulance if your child still does not feel well after 10 puffs, their symptoms get worse or you are worried at any time.
  4. Repeat step 2 until the ambulance arrives.

Helping make life easier with asthma

Having asthma doesn’t mean that your child can no longer exercise and take part in activities. Exercise is good for your child’s asthma and you should encourage your child to be as active as possible. If your child gets wheezy, breathless or has chest tightness when they exercise it’s most likely a sign their asthma is not as well controlled as it could be. Make an appointment to see your child’s GP or practice nurse.

It’s also important to keep an eye on your child’s weight. Being overweight can make asthma symptoms worse so it is important for your child to have a healthy and balanced diet. If you are worried that your child is overweight, speak to your GP who will be able to offer advice on how they can lose weight in a sensible way and can make referrals to a dietician for specialist advice if necessary.

Help reduce exposure of your child’s asthma triggers. This might include making sure your home is regularly cleaned to reduce dust, using air conditioning to filter out airborne pollen indoors and reducing pet dander by having pets regularly groomed.

CHAPTER TEN

For parents: asthma in babies

Often, asthma is not thought of as a condition that affects babies. However, 80% of children with asthma had symptoms that started before they were 5 years old.

It can sometimes be difficult to tell if your baby’s symptoms are caused by asthma or a different condition because babies cannot communicate how they are feeling. We can help with:

How can you tell if your baby has asthma? And what treatments are available for babies?

How to tell if your baby has asthma

It can be difficult to tell if your baby has asthma because they are unable to communicate their symptoms effectively. However, there are a few signs you can look out for, including:

  • Trouble breathing. You might be able to notice this by checking if your baby’s nostrils flare or their tummy is moving more than normal.
  • Breathing heavily or panting during normal activities.
  • Coughing frequently.
  • Wheezing. You might be able to hear a whistling noise when your baby is breathing. It’s important to note that wheezing can only be diagnosed with a stethoscope and can often be confused with other types of noisy breathing.
  • Fast, shallow breathing.
  • Tiredness. Your baby might seem less interested in activities that they usually enjoy.
  • Trouble eating or sucking.
  • Pale or blue face and lips. You might also notice your baby’s fingernails turning blue.

Note: Asthma symptoms are similar to other conditions like chest infections. It’s important to take your baby to see a GP for a proper diagnosis. However, it can be difficult for your doctor to diagnose asthma in children under the age of 5. They may just treat your babies symptoms instead without a formal diagnosis.

Asthma treatment for babies

Babies are usually prescribed medication in inhaled forms. Asthma medications that are given to older children are usually acceptable for babies in smaller doses. As babies cannot use inhalers correctly, their medications are usually administered via a spacer.

Tip

Sometimes babies don’t like having their mask put on, even though it only covers the mouth and nose. Try using toys to reassure and distract your baby while putting it on them.

When to see a GP about asthma in babies

If your baby is showing any symptoms of asthma, take them to see a GP who will be able to provide proper treatment.

Important

Seek immediate medical attention if your baby is finding it difficult to breathe or changes colour in the face and lips. Severe asthma attacks can be a medical emergency.

How babies are diagnosed with asthma

It’s often difficult to diagnose a baby with asthma because they cannot communicate their symptoms and many symptoms of asthma can also be symptoms of other conditions such as a chest infection. Your GP will help your baby based on their symptoms, medical history, your family history and an examination.

Complications of asthma in babies

Asthma attacks in babies can lead to long-term breathing difficulties. This is because an asthma attack which is not well controlled can lead to the airways thickening. In the short-term, you might find that your baby is more uncomfortable, tired and agitated.

In cases of a severe asthma attack that cannot be treated with fast-acting medication, you should seek immediate medical attention by calling 999. This could mean just a visit to A&E or a hospital stay may also be required.

CHAPTER ELEVEN

What to do: asthma when pregnant

Pregnancy can be a difficult and stressful time without having to also deal with asthma symptoms.

Some women may find that their asthma symptoms improve or stay the same, while others might find their asthma gets worse while they are pregnant. We can help with:

Can I still use my inhaler while pregnant? And can I use asthma medication while breastfeeding?

How pregnancy affects asthma

How pregnancy affects asthma varies from person to person. Some women find that during pregnancy, their asthma symptoms improve and they don’t have to use their reliever inhaler as much as they did before pregnancy. Others find that their asthma gets worse during pregnancy or stays the same as it was before they were pregnant.

When to see a GP about asthma during pregnancy

As soon as you find out you are pregnant, you should speak to your GP or asthma nurse for advice on how to manage your asthma during pregnancy. You will have a midwife to offer you support during pregnancy but your GP or asthma nurse will continue to manage your asthma.

You should also visit your GP or asthma nurse if you are experiencing any of the following:

  • You are using your reliever inhaler (usually blue) more than usual
  • You are coughing or wheezing more than usual, especially at night time
  • You are feeling shortness of breath or tightness in the chest
Important

Call 999 if you experience symptoms of an asthma attack and you do not have your inhaler with you, if your inhaler does not seem to be working, or if you do not feel better after taking 10 puffs on your inhaler.

Asthma medication and pregnancy

Most asthma medication is suitable to use during pregnancy. You should not stop using your asthma medication during pregnancy unless advised by your GP or asthma nurse. There is a chance of your asthma symptoms becoming worse if you stop taking your medicine which can post a risk to your health and your baby. Speak to your GP or pharmacist if you are worried about using your medicines while pregnant.

Asthma medication and breastfeeding

It is safe to continue using your asthma medication while breastfeeding. It’s important not to neglect your own health and to keep your asthma under control, even if you are busy with your new baby. Speak to your GP or pharmacist if you are worried about using your medicines while breastfeeding.

Managing your asthma during pregnancy

In addition to recommendations from your GP or asthma nurse, there are some things you can try to help manage your asthma during pregnancy:

  • Keep using your preventer inhaler all the time. Speak to your GP or asthma nurse about using preventer inhalers while pregnant.
  • Don’t smoke. Not only does smoking cause harm to you and your baby, it also makes your asthma symptoms worse. Call 0300 123 1044 to get advice and support from the Smokefree helpline.
  • Avoid your asthma triggers.
  • Take antihistamines to keep your hay fever or allergies under control. Speak with a GP or pharmacist about which antihistamines are safe to take while you are pregnant.
  • Continue to exercise and eat a healthy and well-balanced diet.
  • Have the annual flu immunisation.
CHAPTER TWELVE

Get same day treatment with Medicspot

We’re on a mission to make healthcare more accessible and convenient. We have over 70 private doctor clinics across the UK – simply find your nearest one and see a GP today.

Our private doctors can help with managing your asthma and provide expert treatment and advice. Find out what treatment is available to you and start feeling better today. We can help with:

Where is your walk in clinic? And how can Medicspot help?

How it works

The Medicspot Clinical Station allows doctors to remotely listen to your chest, measure your oxygen levels, and take your temperature to effectively manage your condition.

CHAPTER THIRTEEN

About the authors

Dr Sufian Ali

Dr Sufian Ali is a Medicspot GP based in the West of Scotland, having attended Aberdeen Medical School and completed his GP training in Glasgow. He has enjoyed working in a number of specialties including paediatrics, psychiatry and emergency medicine; while also working in a variety of settings.

Dr Anna Murphy

Dr Anna Murphy is a Consultant Respiratory Pharmacist based in Leicester. She has worked in the field of respiratory medicine for over 20 years working mainly in hospital but also in GP practices. She is a member of many national organisations helping to support enhanced respiratory care.

Dr Abby Hyams

Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because the wide spectrum of people she encounters every day.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.