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Dr Samantha Miller

Reviewed by Dr Samantha Miller MB ChB
(2017, University of Glasgow)
GMC number: 7561464

Information last reviewed 26/06/2021

About

What is asthma?

Asthma is a long-term condition affecting the lungs. It causes the airways to become inflamed, leading to difficulty breathing. The symptoms include wheezing, coughing, breathlessness and chest tightness. Inhalers can be used to ease breathing and to prevent and treat asthma attacks. Asthma usually begins in childhood but it can affect people of any age.

How common is asthma?

Asthma is common, with 12% of the populating having been diagnosed with asthma. Over 5 million people in the UK are currently being treated for asthma, 1 in 12 adults and 1 in 11 children.

What are the different types of asthma?

There are several different types of asthma related to the trigger of your asthma or the time at which it developed. The different types of asthma are: 

  • Childhood asthma - this is where asthma begins during childhood
  • Adult-onset asthma - this is where asthma develops during adulthood
  • Occupational asthma - this occurs due to factors in the workplace such as exposure to harmful chemicals or dust
  • Allergic asthma - this type of asthma is triggered due to coming into contact with an allergen
  • Seasonal asthma - some people only experience asthma during the winter months, or the summer if they have hay fever 
  • Severe asthma - this affects around 4% of people with asthma and describes people who struggle with their symptoms all the time and do not find relief from inhalers alone

How to live with asthma?

Learning to manage your asthma will help you to lead a normal, happy life. If you have been prescribed a preventer inhaler, ensure you use this correctly every day to widen the airways and reduce inflammation so you can breathe properly. Quitting smoking will help as this exacerbates asthma and is a major trigger for symptoms. Getting active and eating a healthy diet will help you to take care of yourself. It's advisable to get the annual flu jab if you have asthma, as the flu can cause difficulties for asthma sufferers. Keeping a diary to record where and when your symptoms flare up is a helpful way to identify what your triggers are. Once you know what they are, you can take steps to either avoid them or manage them accordingly.

What can trigger an asthma attack?

Exposure to triggers can cause an asthma attack. These include: 

  • Allergic reactions to pollen (hay fever,0 dust mites or pet dander
  • Exercise 
  • Cold weather
  • Smoking
  • Pollution 
  • The cold or flu
  • Strong emotions 

You should always carry your reliever inhaler with you in case an attack should occur.
 

Symptoms

What are the symptoms of asthma?

The symptoms of asthma are: 

  • Breathlessness 
  • Wheezing
  • Coughing 
  • A tight feeling in the chest

What is an asthma attack?

During an asthma attack, the muscles around the airways tighten and make it difficult to breathe. The symptoms include:

  • Worsening of asthma symptoms- coughing, wheezing, chest tightness and breathlessness 
  • Having difficulty catching your breath 
  • Being too breathless to speak or eat
  • Your blue reliever inhaler is not providing relief 
  • You have a lower peak flow than usual 
  • A tummy or chest ache in children

An asthma attack is a medical emergency. If you, or anyone around you, has an asthma attack, it’s important to call 999 for an ambulance.
 

How is asthma diagnosed?

Asthma is usually diagnosed by a GP based on your symptoms, but occasionally you may be referred to a specialist for a second opinion. They will discuss the symptoms you are experiencing when they occur and if there is anything triggering them. They may ask if you have a family history of asthma or allergies. They will also get you to do some tests to determine whether or not you have asthma. 

These may include: 

  • A chest x-ray: this is to check for any underlying lung abnormalities
  • Blood tests: these are to check for any other reason behind your symptoms, such as anaemia or infection
  • Peak flow test: this measures how fast you can breathe out. You will usually take the plastic device home to measure this over a couple of weeks and determine your peak flow score
  • Spirometry: this involves blowing into a device resembling a plastic tube which measures how much air your lungs can hold
  • FeNo test: this is a machine you blow into which will measure how much nitric oxide is in your breath. This is usually a sign of an allergic response causing lung inflammation
  • Allergy testing: these are to determine if there is an allergic component to your symptoms, and what substances you may be sensitive to.

Asthma vs. COPD

Asthma is a long term respiratory condition that can occur at any age. It causes inflammation in the lungs and airways, resulting in breathing difficulties. It can be triggered by many things including allergies, cold weather, viruses or exercise. Chronic obstructive pulmonary disease (COPD) is an umbrella term for a group of progressive lung conditions including emphysema and chronic bronchitis. Emphysema refers to damage to the air sacs, the end part of the airway where oxygen exchange takes place. Bronchitis refers to damage to the airways due to long-term inflammation. While the symptoms of COPD are similar to those of asthma, the condition is caused by damage to the lungs, the most common cause of which is smoking.

Treatment

What are the different types of asthma inhaler?

There are two main types of asthma inhalers. The primary inhaler that every person diagnosed with asthma will get is known as a “reliever” inhaler. This is usually blue in colour and typically contains a medicine called salbutamol. Salbutamol is available under various brand names such as Ventolin. These inhalers are used to relieve symptoms as they occur, or to treat an asthma attack. 

The second type of inhaler is known as a preventer inhaler. This will typically be given to asthma patients who make use of their reliever inhaler three times a week or more, or whose symptoms are uncontrolled using their reliever inhaler alone. Often brown in colour, this inhaler is used daily to prevent asthma symptoms. It cannot be used to treat an asthma attack. 

Combination inhalers are also available which usually contain two different types of medication.

How to prevent asthma?

It's impossible to prevent asthma but you can learn to manage the condition effectively to prevent your symptoms from flaring up. The best way to do this is to identify what your triggers are. These are things that cause your symptoms to flare up. The most common triggers are allergies such as hay fever, animal hair or dust mites, the cold or flu virus, cold weather, dampness, exercise, smoking and polluted air. If hay fever causes your asthma to worsen, then you may want to try antihistamines alongside your inhaler for example. Having regular checkups with your GP, using your inhaler correctly and avoiding smoking are all important steps to keeping your asthma under control.

How to manage asthma?

There is no cure for asthma but with adequate treatment, you can manage the condition so that it provides as little disruption as possible to your life. The first thing to do is to follow the plan provided to you by your GP and make sure you know how to use your inhaler correctly. Poor inhaler technique may mean that not all the medicine is distributed to your lungs and you may not get the full benefit. Keeping a diary to record when your symptoms occur and the details of your surrounding environment will help to identify what your triggers are. This goes a long way to managing your asthma as you can then take steps to prevent symptoms. If you have been prescribed a preventer inhaler, using it every day will reduce inflammation in the airways and stop symptoms from flaring up. It's important to keep using it, even when you are feeling well.

How is asthma treated?

Asthma is mainly treated through the use of inhalers, either just “as required”, when symptoms arise, or in combination with a preventer inhaler which is taken daily to control inflammation in the lungs. Every person diagnosed with asthma In the first instance will be given a blue reliever inhaler which they can use to ease symptoms as they occur. 

If you find you are using this more than three times per week, or you feel your symptoms are not controlled, it’s important to speak to your GP, who may prescribe you a preventer inhaler which is used daily to help stop symptoms from flaring up. In more serious cases oral medication is given if inhalers alone are not enough to manage your asthma.

How to cope with an asthma attack?

An asthma attack can be fatal and it's a frightening thing to experience. Knowing what to do in the event of an asthma attack is important to help you remain calm and treat it properly. The signs of an asthma attack are: 

  • You are wheezing or coughing a lot and your chest feels very tight
  • Your reliever inhaler isn't helping 
  • You are too breathless to walk or talk
  • Your breath is faster than usual and you find it difficult to catch your breath 
  • Children may complain of a sore stomach

Take action right away if you are having an asthma attack. Sit up straight and try to take slow, steady breaths. Take one or two puffs of your reliever inhaler as you have been directed. Do this every 30–60 seconds until you reach a maximum of ten puffs. Call 999 if this does not help, or if you feel your symptoms are worsening at any point. If you are in any doubt then call 999 right away. If it has been more than 15 minutes since you took a puff of your inhaler, then repeat the first steps while you are waiting for help to arrive. 

After having an asthma attack, make an appointment to see your GP as soon as possible and inform them you had an asthma attack. You should do this even if you received treatment at a hospital.

How to help children with asthma?

If your child has asthma, there are lots of ways you can help them to manage it. Having a copy of their asthma action plan visible to everyone in the household, printing off copies to give to school teachers and friend's parents will ensure that everyone knows what to do in case an asthma attack should occur. Get them into a good routine with using their inhaler and noticing symptoms. Encouraging them to use an asthma chart can help to identify what their triggers are. You can assist them to use their inhaler with a spacer, a plastic device that attaches to the inhaler allowing children to inhale the medication in a slower and easier way. 

How to help someone with their inhaler?

If someone is experiencing breathlessness or an asthma attack they may need help using their inhaler. Reassure the person and get them to sit up straight and talk to them in a calm manner. Ask them where you can find their blue inhaler and locate it for them. Shake the inhaler and remove the cap. Guide them to breathe out as steadily as they can before getting them to seal their lips around the mouthpiece. Depending on the type of inhaler, they may need to press down on the canister and breathe in at the same time, holding their breath for up to ten seconds or for as long as they can manage before exhaling. If they need to take another puff, wait at least 30 seconds before repeating.

Can exercise improve asthma?

Regular exercise can have a positive effect on asthma. It will help to improve the functioning of the lungs and increase stamina to allow your breathing to get easier. It also boosts the immune system which means the body can fight off infections or viruses which may contribute to triggering your asthma symptoms.   

Reliever inhalers

What is a reliever inhaler?

A reliever inhaler is key in treating an asthma attack. They are usually blue in colour and act to widen the airways rapidly to help resolve the symptoms of asthma.

 

How do reliever inhalers work?

During an asthma attack, the reliever inhaler delivers the medicine straight to your airways. The medication facilitates the widening of your airways by causing relaxation of the muscles surrounding them. This makes it easier to breathe again.

 

How long does it take for reliever inhalers to work?

Reliever inhalers only take a few seconds to minutes to work as the medicine goes straight to your airways. The effects of the inhaler can last up to 5 hours. 

 

When is a reliever inhaler prescribed?

Reliever inhalers are usually the first line of treatment after asthma diagnosis. They are used when you experience breathing difficulties. If you are using your reliever inhaler more than 3 times a week, it is important to let the doctor know, and they might prescribe you another inhaler to use daily (a preventer inhaler).

 

What are the different types of reliever inhalers?

Most reliever inhalers contain a medication known as a short-acting beta2 agonist (SABA), most commonly salbutamol. Ventolin and Salamol are two of the most commonly prescribed reliever inhalers, both containing salbutamol as the active ingredient. 

 

Preventer inhalers

What are preventer inhalers?

Preventer inhalers are used to manage respiratory conditions like asthma. The medicine is released as a spray or fine powder from the inhaler to help to dampen inflammation in the airways, making it easier to breathe. These inhalers are used every day to prevent asthma symptoms from flaring up and potentially leading to an asthma attack.

 

How do preventer inhalers work?

Preventer inhalers contain longer-acting medications which function to either reduce inflammation in the airways or to provide long-acting widening of the airways. There are several different preventer inhalers that may be prescribed, the most common of which is a corticosteroid or “steroid” inhaler. Steroid inhalers contain a synthetic version of the chemical produced by the adrenal glands which helps to fight inflammatory responses in the body. The medicine is inhaled directly into the lungs and acts to reduce inflammation and allow the airways to remain open. They are designed to be used every day to maintain good respiratory health and prevent symptoms from flaring up.

 

Who needs to use preventer inhalers?

If you have asthma, you will normally be prescribed a preventer inhaler if you make use of your reliever inhaler more than three times per week, or if you feel your symptoms are not controlled. A preventer inhaler may also be prescribed for people with COPD (chronic obstructive pulmonary disease) who have problems breathing. 

 

What should you do if you miss a dose?

If you miss a dose of your preventer medication, then take it as soon as you remember. If it is close to the time you are due to have your next dose then simply leave the missed one. Do not double up the dose to make up for missing one. 

 

How to stop using a preventer inhaler?

You should continue to use your preventer inhaler even if you feel your asthma has improved. This is a sign that the medicine is working. If you stop taking it then your lungs are likely to become inflamed again and you may need to rely more on your reliever inhaler.  Don't stop using a preventer inhaler unless your doctor says so.

 

Which types of preventer inhalers are available?

Preventer inhalers typically contain a corticosteroid. Some may contain additional medications such as a long-acting beta2 agonist (LABA).

There are three types of preventer inhalers: 

  • Metered-dose inhaler (MDI): these produce a fine mist or spray and can be used with a spacer. They often require the user to press down on a canister to release the medication at the same time as taking a breath
  • Dry powder inhaler (DPI): instead of a spray, the medicine is released as a powder. They are usually easier to use for children and teenagers as they often automatically release a powdered dose as you inhale quickly
  • Breath actuated inhaler (BAI): this type of inhaler releases the medicine automatically as you breathe in

Common brands include: 

Combination inhalers

What is a combination inhaler?

A combination inhaler contains two types of medicine that work together to control your asthma. They typically contain a corticosteroid to reduce inflammation, and a long-acting bronchodilator to keep the airways open. A combination inhaler may be prescribed for more severe asthma or if you are struggling to manage your asthma with a corticosteroid inhaler alone. 

 

How do combination inhalers work?

Combination inhalers work in two ways. They contain corticosteroids to reduce inflammation in the lungs and airways so that air can flow in and out more easily. They also contain a long-acting bronchodilator which widens the airways and relieves symptoms that may occur in response to triggers. 

 

How long does it take for combination inhalers to work?

Your combination inhaler will start to work in the first couple of minutes. After several weeks of use, you should notice a big improvement. It won't provide instant relief like your reliever inhaler so it's important to still use your blue inhaler if you experience an asthma attack. 

 

When is a combination inhaler prescribed?

A combination inhaler is prescribed if a corticosteroid preventer inhaler is not enough to manage your symptoms alongside your reliever inhaler. If you are using a corticosteroid preventer inhaler and still getting breathless and experiencing chest tightness, wheezing or coughing then report this to your GP who will review your condition and current medication. 

 

How often do you take a combination inhaler?

A combination inhaler should be used every day in order to prevent and manage ongoing symptoms. Even if you feel better, continue taking your inhaler daily otherwise your airways will become inflamed again and your symptoms will return. Combination inhalers are typically taken twice per day. Always use your asthma medication as instructed and ask your doctor if you are unsure. 

 

How effective are combination inhalers?

Combination inhalers are effective if they are taken correctly, this means you will experience fewer asthma attacks. Everyone's asthma is different, however, what works for one person may not suit another. That's why it's important to see your GP regularly to review your symptoms and how well you are managing your asthma. 

 

What are the different types of combination inhalers?

Combination inhalers contain both a corticosteroid and a bronchodilator. These combinations include: 

  • Fluticasone and salmeterol (Seretide)
  • Budesonide and formoterol (Symbicort)
  • Mometasone and formoterol (Dulera)
  • Fluticasone and vilanterol (Breo)

Side Effects

Are asthma inhalers safe to use during pregnancy?

Asthma inhalers are safe to use during pregnancy. It's very important to manage your asthma and keep taking your medication if you are pregnant. For some women with asthma, their condition gets worse during pregnancy. Using your inhaler regularly ensures that you are keeping both yourself and your baby healthy.  

Comparison Table

*If your inhaler does not last this long, you may be using it too much. If you need to use your reliever inhaler more than three times per week, you should speak to your doctor as other inhalers may be more suitable. 
**This depends on the prescribed dose. Always use your inhaler as instructed by the prescribing doctor. 

Q&A

What is exercise-induced asthma?

There are many different types of asthma that are triggered by certain environmental factors or activities. Exercise-induced asthma is when physical exertion triggers asthma symptoms either during or after strenuous exercise.

Can some medications cause asthma?

Certain types of medications can trigger asthma symptoms. These include beta-blockers, aspirin, anti-inflammatory painkillers and angiotensin-converting enzyme inhibitors (ACE inhibitors). If you are purchasing over the counter medicines then always check the instructions to ensure they are suitable for people with asthma.

What is the connection between asthma and eczema?

Scientific studies indicate that children with eczema are 50–70% more likely to develop asthma. This is thought to be due to the excess release of pro-inflammatory proteins called cytokines. 

Is asthma caused by lifestyle?

The cause of asthma is not fully understood and there are many factors that contribute to a person developing the condition. These include genetics, allergies, childhood bronchitis, being born prematurely and being exposed to tobacco smoke as a young child or while in the womb.

Is asthma caused by allergies?

People with allergies are more likely to develop asthma and coming into contact with an allergen is a major trigger for asthma symptoms. These commonly include hay fever, dust mites, animal fur or food allergies. 

Can asthma be cured?

There is no cure for asthma. It is a long term condition that is managed with appropriate treatment to prevent flare-ups and help you lead a normal, fulfilling life. 

Can stress cause an asthma attack?

Stress is a common trigger for asthma symptoms. It can lead to feelings of anxiety which produce physical symptoms such as a racing heart, sweating, dry mouth and breathlessness. This can escalate into a panic attack which causes difficulty breathing. If you have asthma, this can trigger an asthma attack. In general, stress can make your body more susceptible to common asthma triggers, especially if you are feeling run down, in turn causing an asthma attack.

Is asthma genetic?

Asthma is not always genetic but if there is a family history of asthma then you are more likely to develop it. There are certain genes that are associated with the development of asthma, however, the exact mechanisms of this are not fully understood.

Does city pollution cause asthma?

Pollution is a common trigger that can cause asthma symptoms to flare up. Research also shows that adults and children living in areas of high pollution are more at risk of developing asthma.

Can air purifiers and dehumidifiers help asthma sufferers?

Air purifiers and dehumidifiers can be helpful for asthma sufferers. Air purifiers trap allergens such as pollen or dust via a filter which reduces the likelihood of breathing them in. A dehumidifier reduces moisture caused by humidity which can allow mould or bacteria to grow. Both these devices help to create a cleaner environment which may help to prevent the triggering of your asthma symptoms.

Are asthma inhalers steroids?

Preventer inhalers typically contain corticosteroids. These are a type of steroid which fights inflammation and stops the airways from becoming narrowed. They are not the same as anabolic steroids which are used in bodybuilding.

Are asthma inhalers vegan?

Many asthma inhalers contain lactose which is derived from animal milk and is therefore not strictly vegan. Inhalers only contain trace amounts of lactose, and while a vegan lifestyle may be important to you, an inhaler can be life-saving. The Vegan Society recognises that it is not always possible to avoid animal products in medication and they encourage people to look after their health.

Are steroid inhalers safe?

Preventer (steroid) inhalers are safe to use and are designed for everyday use. Short term symptoms can occur which include a sore or hoarse throat, oral thrush or a headache. These can be avoided by ensuring you are adhering to the correct inhaler technique and rinsing out your mouth after using your inhaler. In the long term, there is a minor risk that long term high-dose use can lead to systemic effects such as Cushing's syndrome, stunted growth in children and adolescents, a decrease in bone mineral density, cataracts, glaucoma, sleep disturbance and mood changes.

Are preventer inhalers steroids?

Preventer inhalers contain a type of steroids known as a corticosteroid, which is a synthetic version of the chemicals produced naturally in the body by the adrenal glands. This is not the same type of steroids used in bodybuilding e.g. anabolic steroids.

Will preventer inhalers affect my drug test?

Preventer inhalers contain corticosteroids which are a synthetic version of chemicals produced naturally by the body so they will not affect the results of a drug test unless the drug test is specifically looking for corticosteroids.

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