Asthma FAQs

What causes it?

The muscle around the airways tightens making the airway narrower. The airway lining starts to swell and sticky mucus or phlegm may be produced. 

What are the main symptoms?

The usual symptoms of someone with asthma are:

• coughing
• wheezing, or a whistling noise in the chest
• shortness of breath
• tightness in the chest

Most people don't get these symptoms all the time. Only if they get a cold, or come into contact with one of their asthma triggers. For some people they are worst at night, for others in the morning, for others after exercise. 

What's the risk?

Pretty high. Asthma is very common. Around 5.1 million people in the UK are receiving treatment for the condition - one in 13 adults and one in eight children. The condition is also on the increase with four times as many children being diagnosed today as in the 1960s. Two-thirds of people get their first symptoms during childhood, but it can begin to affect you at any time - even into your seventies. 

Asthma, like its related allergic conditions eczema and hay fever, often runs in families and may be inherited. There are also probably environmental factors such as housing and diet that may increase the risk of someone developing asthma. Living in a cleaner environment with less infection in early life may also make us predisposed to developing allergic diseases. Smoking during pregnancy increases the chance of the baby developing asthma. Air pollution has not been proven to cause asthma but can make the symptoms worse. 

What causes it?

Everyone's asthma is different so the triggers vary from individual to individual. But as well as cold and flu, they include cigarette smoke, air-pollutants, certain weather conditions, chemicals, mould, stress, excitement, certain medicines (such as aspirin, anti-inflammatories and beta-blockers), exercise and things to which you might be allergic like pollen, furry or feathery animals or house-dust mite.

According to Asthma UK, food is rarely a trigger. But some people have an allergy to specific foods (eg dairy products, fish, nuts or yeast) which can bring on an asthma attack. If you suspect you may be affected, talk to your GP. 

Should I see a doctor?

Asthma should be diagnosed by a doctor so go and see your GP if you are concerned. There is no cure as yet although symptoms can usually be effectively controlled. After diagnosis, most people will be able to manage their condition themselves with only the occasional visit to the doctor necessary.

When doctors decide how to treat your asthma, they use a nationally-agreed 'stepwise treatment plan' called the British Guideline on the Management of Asthma to help them. Each step shows what treatment is needed to control your asthma. Click here for step by step guide.

The doctor will probably measure your peak flow. This is a measurement of how hard you can blow air out of your lungs. You blow into a small plastic tube called a peak flow meter. The meter has a marker which slides up the scale as you blow out. The better controlled your asthma, the harder you'll be able to blow and the higher your peak flow score will be. Your score will vary according to your age, gender and height.

Your doctor or nurse may ask you to take a series of peak flow readings over a couple of weeks. You may be asked to take readings every morning and early evening, before you use your inhalers. You can plot the results to see how well your asthma is controlled.

These are signs that your asthma may be getting out of control. See you doctor if you are:

• Waking at night or in the morning with coughing, wheezing, shortness of breath or a tight chest
• Needing to use you reliever more often or if it doesn't last four hours
• Unable to keep up with your usual level of activity or exercise
• Finding that you are too breathless to talk or eat. 

What are the main treatments?

The best treatment is to try to avoid your asthma triggers but this is often easier said than done. House dust, for example, is almost impossible to escape.

Your doctor can prescribe treatments to both prevent symptoms occuring in the first place (called 'preventers' by doctors) and to reduce them them when they do (relievers). Both are generally given in the form of inhalers. Whichever inhaler you have, it's important that you use it correctly so that the medicine goes where it's needed: the airways of your lungs. Your doctor, practice nurse or pharmacist will show you how to use an inhaler. If they forget, ask them.

Sometime they might suggest a spacer which is a large plastic container, usually in two halves that fit together. At one end there is a mouthpiece and at the other a hole for the aerosol inhaler to fit in. They make inhalers easier to use and get more medicine into your lungs than you could using just the inhaler on its own. They appear to work just as well as nebulisers in acute attacks of asthma and help reduce the possibility of side effects from the higher doses of inhaled steroids by reducing the amount of medicine which is swallowed and absorbed into the body. If you think a spacer would be easier for you, ask your doctor.

Relievers

Relievers are medicines that you can take immediately to treat an asthma attack. They relieve symptoms by relaxing the muscles around the narrowed airways making it easier to breathe again but do not reduce the actual inflammation. Taken before exercise they may reduce your chances of an asthma attack

Relievers usually come in blue inhalers. Salbutamol (trade name: Ventolin) and terbutaline (Bricanyl) are two relievers which reduce symptoms almost immediately. Ipratropium bromide (Atrovent) is slower acting (it takes around 45 minutes to work) and is most commonly used by children under two or in older people.

There are also longer-lasting relievers such as inhaled salmeterol (Serevent), formoterol (Oxis) and theophylline tablets (Slo-Phyllin and Uniphyllin are two examples). They go on working for a longer time than rescue relievers and usually need to be taken twice a day to have an effect. Your doctor may give you a long-acting lasting reliever if your normal dose of preventer isn't controlling your asthma symptoms. (You should not be using a long-acting reliever unless you are also on a preventer treatment.)

Relievers can temporarily increase your heartbeat and give you mild muscle shakes, particularly when taking high doses. They usually wear off in a few minutes. Xanthine tablets can sometimes make you feel sick and can react with other medicines such as antibiotics. The National Asthma Campaign say relievers are a 'very safe and effective medicine and have very few side effects'.

If you are using a blue reliever inhaler more than once daily, you may need to use a preventer treatment to keep your asthma symptoms under control. 

Preventers

Preventers control the swelling in your airways making them, hopefully, less sensitive to your asthma triggers. They reduce the risk of severe attacks so keep yours handy. As their protective effect builds up over time, they are taken every day, usually morning and evening, even if you are feeling well. It can take up to two weeks before they are fully effective.

Preventer inhalers are usually brown, white, red or orange. They usually contain a steroid medication. Examples of steroid inhalers include beclomethasone (Becotide, Becloforte and Qvar), budesonide (Pulmicort) and fluticasone (Flixotide).

Sodium cromoglycate (Intal or Cromogen) and nedocromil sodium (Tilade) are non-steroid preventers. They must be taken more regularly - usually three or four times a day - and are generally not as effective as inhaled steroids.

There are also two types of preventer tablets now available: montelukast (Singulair) and zafirlukast (Accolate) which are taken once or twice daily. They are usually taken alongside inhaled steroids.

There are other treatments available (such as Seretide and Symbicort) which combine a long-acting reliever and inhaled steroid preventer in one device. You can use these instead of two separate inhalers.

Talk to your doctor or practice nurse about whether these new treatments are suitable for you. 

What are the side-effects?

The milder side-effects from relievers are discussed above but there are also concerns about steroids. The steroids used in asthma are corticosteroids which try to replicate the steroids produced naturally in our bodies rather than the anabolic steroids sometimes abused by body-builders.

Asthma UK says: 'Most people use inhaled steroids which go straight down to the airways, so very little is absorbed into the rest of the body. There is 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 well afterwards. Using a spacer will also reduce the possibility of thrush.'

If your asthma gets really bad, your doctor may give you a short course of steroid tablets as well as your usual inhalers. They usually work quickly and, say Asthma UK, 'short courses of tablets, anything from 3-14 days in adults or 3-5 days in children, will not give any long-term side effects. Steroid tablets can lower the body's resistance to chickenpox, so you should contact your doctor if you are taking steroids and come into contact with chickenpox.'

A small minority of people with severe asthma need to take steroid tablets for a longer period. They should discuss the possibly more serious side-effects with their doctor or practice nurse. Click here for more on steroids from Asthma UK.

How can I deal with an attack?

1. Take two puffs or more of your reliever straight away, preferably using a spacer (your doctor or nurse will advise you on how many puffs to take) 

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 repeat the dose until help arrives.

Remember, deaths from asthma are extremely rare. In the last ten years, the number of deaths from asthma has decreased in every age group except for those over 75. Having said that, do not be afraid of causing a fuss, even at night.

Always discuss what to do in an asthma attack with your doctor or asthma nurse and tell them about any attacks you have between appointments. 

How can I help myself?

By avoiding your triggers. Chest infections are the top trigger for both adults and children. These are best avoided through a healthy diet with plenty of fruit, veg and vitamin C. Here's how to avoid other common triggers:

House-dust mite

About 0.3mm long, they live in the dust that builds up around the house in carpets, bedding, beds, soft furnishings and soft toys.

• Try barrier covers for your mattress, duvet and pillow (there is no conclusive evidence to show that synthetic, 'hypo-allergenic' pillows are any better) and wipe them with a damp cloth once a week.
• Hot wash (at 600C) sheets, duvet covers and pillow cases once a week.
• Put soft toys into a bag in the freezer for six hours to kill mites.
• Vacuum carpets frequently with a cleaner with good suction and a filtered exhaust that doesn't scatter dust.
• Damp dust surfaces daily.
• Use cotton or synthetic blankets instead of wool.
• Short-pile synthetic carpet may be better than pure wool. Or try lino, tiled or wood flooring.
• Plain, wooden beds are preferable to upholstered ones with or headboards.
• Keep rooms well aired.
• Remove damp and mould in the house quickly.
• If hanging wet clothes indoors, open windows or use a tumble drier with an outside vent.

Pets

Up to 50 per cent of children with asthma are triggered by an allergy to cats and/or dogs. The urine from guinea pigs, rats, rabbits and gerbils can cause problems too. Bathing cats and dogs once a week may help and a vacuum cleaner with a filter can reduce levels of cat allergen in the air. (Since these levels can increase by more than three times immediately after vacuuming, it might be a good idea to persuade someone else to do the vacuuming and stay out of the room until the allergens have settled!)

Pollen

There are many different types of pollen grains (from grasses, trees and plants) that can trigger asthma symptoms in some people. Grass pollen is the most likely problem. On hot, dry days avoid spending too much time outdoors, avoid long grass and keep car windows closed.

Poor air quality

Be aware that air pollutants like cigarette smoke and car exhaust fumes release gases and particles into the atmosphere which can irritate your airways. The UK National Air Quality Information Archive provides local forecasts. Ground level ozone can also be a problem for some people. Wearing a face mask is unlikely to help.

Weather

Sudden changes in temperature, cold air, windy days, poor air quality on dry, still days can all affect your asthma. Wearing a scarf over your face when it's cold will help warm the air up before you breathe it in. Avoid going out in the middle of the day on hot, smoggy days. Thunderstorms too can release large quantities of pollen into the air. 

Exercise

Exercise is good for everyone, including those with asthma. Paula Radcliffe, Ian Wright, Paul Scholes and Karen Pickering all have the condition

Take your usual dose of reliever about 5-10 minutes before you start and keep it close at hand at all times. If you need to use it, wait for it to take effect before exercising again. Warm up properly. Long spells of exercise are more likely to bring on asthma symptoms than short bursts. If exercise still brings on symptoms, your asthma might not be properly under control. Go and see your doctor or nurse.

If your asthma is under control, you should be able to do any sport or exercise that you enjoy. Swimming is particularly suitable though the chemicals used in pools may be a trigger for a small number of people. Yoga can improve your breathing technique.

Some sports and activities, for example, scuba diving, climbing, hiking or skiing at high altitudes, can cause problems for some people with asthma. Speak to your doctor if you're considering these.

Complementary therapies

Many people find that complementary therapies and medicines, particularly yoga, acupuncture, Alexander technique, chiropractic and homoeopathy, seem to improve their asthma symptoms. Certainly few complementary treatments (and none of those mentioned here) will make your asthma worse so if you fancy one, try one. Tell you doctor and don't stop taking your normal asthma medication. 

What's the outlook?

If you use your medication as prescribed, there's no reason why things should get worse. Indeed, some children find their asthma gets better during the teenage years. Having said that only about one in three children lose their asthma completely as they grow older and it may come back in later life. 

Who else can help?

Asthma UK
Telephone: 020 7226 2260

Other websites

• Action Asthma
• Asthma News in the UK and Ireland
• Asthma and Allergy Foundation of America

Compiled from information supplied by Asthma UK and updated by Susan Aldridge. Updated by malehealth for 2005.

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