Asthma is a chronic inflammatory disease that affects the airways of the lungs. It is characterised by recurrent wheezing, breathlessness, chest tightness, and coughing. These symptoms occur due to the narrowing and obstruction of the airways, which are caused by inflammation, mucus production, and muscle tightening around the airways.
The underlying causes of asthma are multifactorial, involving genetic predisposition and environmental factors. Individuals with a family history of asthma or other allergic conditions are at a higher risk of developing the disease. Environmental factors, such as exposure to allergens, air pollution, respiratory infections, and specific occupational exposures, can trigger or exacerbate asthma symptoms.
Asthma is a common health condition affecting 5.4 million people in the UK. This means that 1 in every 12 adults and 1 in every 11 children are living with asthma. Interestingly, more women than men have asthma, with 11% of women and 9% of men currently managing the condition.
Furthermore, 17% of men and 18% of women have been diagnosed with asthma at some point in their lives. Despite no cure for asthma, with proper management and treatment, most affected people can lead everyday and active lives.
Types of asthma
There are two main types of asthma:
- Neutrophilic asthma.
- Allergic (eosinophilic) asthma.
Neutrophilic asthma occurs when too many neutrophils (a type of white blood cell) are in the airways. These neutrophils can cause inflammation and make it harder for air to pass through the airways. Infections, pollution, or irritants can trigger this type of asthma.
Allergic asthma is caused by your body’s overreaction to things like pollen, dust mites, or pet dander. When exposed to these allergens, your body produces too many eosinophils (another type of white blood cell) in your airways. This can cause inflammation and make it harder to breathe.
It’s important to know which type of asthma you have because the treatments may be different. Your doctor can help determine your type and develop a treatment plan that is best for you.
Symptoms
The symptoms of asthma can be different for everyone, and they can range from mild to severe. Some people with asthma may experience symptoms only occasionally, while others may have persistent symptoms that require daily treatment.
Common asthma symptoms include:
- Wheezing (a whistling sound when you breathe)
- Shortness of breath
- Tightness or pain in your chest
- Coughing, especially at night or early morning
- Difficulty sleeping due to shortness of breath, coughing, or wheezing
Risk factors
Some things can increase one’s chances of getting asthma or make it worse. These are called risk factors.
According to the NHS, risk factors for asthma include:
- Having allergies or conditions like eczema, hay fever, or a food allergy
- Having family members with asthma or allergies
- Having had a lung infection (bronchiolitis)
- Exposure to a lot of smoke as a child
- Maternal smoking during pregnancy
- Being born prematurely (before 37 weeks of gestation) or having a low birth weight.
- Some people might get asthma because of the kind of work they do.
What Can Make IT Worse?
Asthma can get worse when you’re around certain things. These are called triggers.
Common triggers include:
- Getting sick with a cold or the flu
- Being around things you’re allergic to, like pollen, dust, or animals
- Smoke, fumes, and dirty air
- Some medicines, like ibuprofen and aspirin
- Feeling strong emotions, like stress or even laughing
- Weather changes include cold air, heat, humidity, wind, and thunderstorms.
- Being around mould or dampness
- Exercise
What Happens During an Asthma Attack?
An asthma attack is characterised by worsening symptoms, indicating that the airways are increasingly obstructed.
Signs that you may be experiencing an asthma attack include:
- Worsening asthma symptoms such as coughing, breathlessness, wheezing, or a tight feeling in the chest
- Lack of relief from using a reliever inhaler (usually blue)
- Severe breathlessness that makes speaking, eating, or sleeping difficult
- Rapid, shallow breathing and a feeling of being unable to catch your breath
- Lower than normal peak flow meter readings
- In children, abdominal or chest pain
These symptoms might not occur suddenly; they often happen slowly over a few hours or days.
What to Do During an Asthma Attack?
If you suspect you are experiencing an asthma attack, it is crucial to take immediate action. Follow these steps:
- Sit upright and try to remain calm, as panic can worsen symptoms.
- Use your reliever inhaler (usually blue) and take one puff every 30 to 60 seconds, up to a maximum of 10 puffs.
- If your symptoms worsen at any point or do not improve after ten puffs, call emergency services (999) immediately for an ambulance.
- If the ambulance has not arrived within 10 minutes and your symptoms persist, repeat the process of taking one puff of the reliever inhaler every 30 to 60 seconds, up to 10 puffs.
- If there is still no improvement after repeating the inhaler use and the ambulance has not arrived, contact emergency services (999) again without delay.
If your symptoms improve and emergency services are not required, schedule an urgent same-day appointment with your GP or asthma nurse for evaluation.
If you end up going to the hospital, make sure to see your doctor within two days of leaving, or better yet, the same day if you don’t have to stay overnight.
The key is to act quickly, stay calm, and not be afraid to get help.
Asthma at Work
Sometimes, asthma can be caused by things you’re around at work. This is called occupational asthma.
Certain occupations can increase someone’s chances of developing asthma. Jobs like spraying paint, baking, nursing, working with chemicals, handling animals, working with wood, welding, and processing food may put people at higher risk for asthma.
Remember, everyone is different. What causes asthma or makes it worse can be different for each person. It’s essential to be aware of your risk factors and take steps to avoid or minimise exposure to potential triggers.
treatments
There is no cure for most types of adult asthma. Therefore, the primary goal is to manage rather than cure the condition. This includes achieving and maintaining control of symptoms and preventing worsening symptoms and asthma attacks.
Healthcare professionals use the term’ asthma control’ to refer to how well the symptoms are managed and their impact on daily activities. The term’ asthma severity’ describes the difficulty in controlling asthma with treatment and helps doctors decide what level of treatment is required.
Management of the condition includes:
- Avoiding passive or active smoking
- Identifying any factors that trigger or worsen symptoms
- Avoiding exposure to airborne allergens
- Avoiding exposure to high levels of air pollution
Asthma control remains relatively poor in the UK despite the increasing use of asthma medications.
Medications include:
- Controller medication: This medication is taken regularly to build up a protective effect against asthma symptoms. This medication is usually in the form of inhaled corticosteroids (ICS), used with or without long-acting β-agonists (combination inhalers)
- Reliever medication: These are taken to relieve asthma symptoms. They relax the muscles surrounding the narrowed airways and can be used in the event of an asthma attack or worsening of symptoms. These are usually in the form of short-acting β-agonists. They contain drugs like salbutamol or terbutaline and relieve symptoms within a few minutes. If you must use your reliever inhaler thrice a week, your doctor may suggest additional treatment.
In addition to inhalers, other treatments may be needed if your asthma is severe:
Leukotriene receptor antagonists (LTRAs):
These are used to complement inhaled steroids for people with moderate to severe asthma and are not controlled by inhaled steroids alone.
This is a bronchodilator drug used to treat asthma. It relaxes smooth bronchial muscles and lessens the chance of bronchospasms.
These may be recommended if you’re pregnant and have severe asthma. This is because the risk to your baby from uncontrolled asthma is higher than from the medication.
Each person is different and will not require the same level of treatment. Therefore, the doses of medication are modified according to a person’s individual symptoms. It is vital that people learn which treatment works for them to help them manage their condition independently.
About 10% of adults with asthma have persisting symptoms and exacerbations that they are unable to control despite taking adequate treatment. This asthma is referred to as ‘difficult-to-treat’ asthma and can often have a damaging effect on a person’s quality of life.
Preventing Asthma Attacks
To prevent your asthma attacks, you should follow specific steps:
- Strictly follow your prescribed asthma action plan and take all medications as prescribed by your doctor.
- Schedule and attend regular asthma review appointments with your GP or asthma nurse at least once per year. These annual check-ups are essential.
- Ensure you use your inhaler correctly by having your GP or asthma nurse observe and provide guidance as needed.
- Figure out what things cause your asthma symptoms and try to stay away from those triggers as much as you can.
- If your asthma symptoms are getting worse or you need to use your rescue inhaler more often than usual, don’t ignore it. Follow the steps in your action plan immediately and schedule an urgent visit with your doctor or asthma nurse.
Advice for Friends and Family
Proper preparation and education of friends and family members can be crucial in effectively managing an asthma attack. Ensuring that those close to you know the necessary steps to take in an emergency is essential. Here are some recommendations:
- Your asthma action plan has all the steps for what to do during an attack. Make copies of your action plan and distribute them to the individuals who may need to assist you.
- If no printed copies are available, download a blank template from the Asthma + Lung UK website, fill it out, and share those copies.
- Take a photo of your action plan, and you can quickly show it or send it to anyone who needs that information.
Concerned you may have asthma?
Asthma can profoundly affect your physical and mental well-being. It is essential to contact the right doctors and specialists if you think you may be struggling with your breathing. If left untreated or unchecked, asthma can become severe and life-threatening.
As a leading sleep and respiratory physician specialising in asthma and sleep-related breathing disorders, I offer consultations to diagnose and treat these conditions. Please get in touch with me if you have any further queries about asthma or would like further advice on the potential treatments available.
