Overview
Asthma is a long-term condition of the airways, the tubes carrying air in and out of the lungs. In asthma they are easily irritated: the lining swells, the muscle around them tightens and mucus builds up, so less air passes.
The narrowing comes and goes, so breathing can feel normal in between. Asthma usually starts in childhood but can begin at any age. It cannot be cured, though well treated it rarely limits life.
Symptoms
The usual symptoms are wheezing, a whistling sound while breathing out, coughing, shortness of breath and a tight chest. They are often worse at night, in the early morning, during exercise, or after a trigger such as dust.
In children a cough returning night after night is a common sign. An asthma attack is a spell when symptoms worsen sharply and breathing is difficult, and it can be life threatening.
When to see a doctor
See a doctor within two days after any attack. Make an appointment if the reliever is needed more than twice a week, if symptoms wake you at night, or if asthma limits work, school or exercise.
Causes
The exact cause is not known. Asthma runs in families and is closely linked with eczema and hay fever.
Triggers are easier to name: house dust and dust mites, tobacco smoke, smoke from cooking fuel or burning rubbish, air pollution, pollen, animals, cold air, chest infections, exercise, and dust or fumes at work. A few people react to aspirin or ibuprofen.
Risk factors
- Asthma, eczema or hay fever in a close relative
- Allergies, eczema or hay fever of your own
- Being born early or with a low birth weight
- Chest infections in early childhood
- Tobacco smoke, air pollution, or indoor cooking smoke
- Dust, fumes or chemicals at work
Complications
Asthma that is ignored, or treated only when symptoms appear, can lead to:
- Attacks needing emergency treatment or a hospital stay
- Broken sleep, and days lost from school or work
- Lasting narrowing of the airways over many years
Prevention
Asthma itself cannot be prevented, but attacks very often can.
- Taking the preventer daily as prescribed, even when breathing feels fine
- Learning correct inhaler technique, and using a spacer when advised
- Keeping a written action plan and a reliever inhaler within reach
- Keeping the home smoke free, and airing the kitchen while cooking
- Cutting down dust, damp and mould at home
Diagnosis
A doctor asks about the pattern of symptoms, what sets them off and about allergies in the family, then examines the chest.
measures how much air can be blown out and how fast, and a peak flow meter used at home over a few weeks shows how readings swing. A breath test can show airway inflammation, and allergy tests are sometimes added.
Treatment
Asthma is treated mainly with inhalers, which deliver medicine straight into the lungs. Reliever medicine opens the tightened airways quickly. Preventer medicine, usually an inhaled steroid, calms the inflammation and works only while taken regularly.
Some people are given a separate preventer and reliever, others a single combination used both daily and when symptoms come.
If symptoms continue although the inhaler is used correctly, extra medicines may be added, and severe asthma can be treated with injections under specialist care. A bad attack is treated with oxygen, nebulised medicine and steroid tablets.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Inhalers are for severe asthma only, so tablets or home remedies should be tried first.”What is true?
Fact
An inhaler is the usual first treatment for asthma, not a last resort. It puts the medicine directly into the airways, which is why it can control the disease and let people lead a normal, active life.
Myth“Inhalers are addictive, so you should use them only when you cannot manage without.”What is true?
Fact
Asthma inhalers are not habit-forming. A preventer inhaler works only for as long as it is being used, so needing it every day reflects the asthma continuing, not a dependence on the medicine. Stopping it is what brings symptoms and attacks back.
Myth“Asthma is catching, so a child with asthma should be kept away from other children.”What is true?
Fact
Asthma is a noncommunicable disease. It does not spread from person to person. Children with asthma belong in school and at play like anyone else, with their inhaler nearby.
Myth“All children grow out of asthma, so there is no need to treat it.”What is true?
Fact
Asthma is often a lifelong condition, although asthma that starts in young children sometimes goes away by the time they are teenagers or adults. There is no way to know in advance, and untreated asthma costs sleep, school and fitness in the meantime.
Myth“People with asthma should not run, play sport or go to the gym.”What is true?
Fact
Regular exercise is recommended for people with asthma, and well controlled asthma should not stop sport. If exercise sets off symptoms, the answer is to ask the doctor or nurse how to exercise safely rather than to give it up.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Will my child grow out of asthma?
Asthma is often a lifelong condition, although asthma that starts in young children sometimes goes away by the time they are teenagers or adults. Symptoms can also return later in life. Because there is no way to know in advance, treatment is changed or stopped only by the doctor who is following the child.
Can I play sport or go to the gym with asthma?
Yes. Regular exercise is recommended, and well controlled asthma should not keep anyone off the field. Exercise does trigger symptoms in some people, so ask your doctor or nurse how to exercise safely, warm up properly, and keep the reliever inhaler with you.
Are steroid inhalers the same as steroid tablets?
They are not the same. An inhaler puts the medicine directly into the airways, and an inhaled steroid is the standard long-term preventer treatment for asthma. Steroid tablets are used in short courses when asthma flares badly. If you are worried about side effects, raise it at your review rather than stopping the inhaler on your own.
How do I know whether my cough is asthma or an infection?
A chest infection usually comes with fever and settles within a few weeks. A cough that keeps returning over months, is worse at night or with exercise, and comes with wheeze or a tight chest, points more towards asthma. Only an examination and breathing tests can tell, so a cough that keeps coming back is worth showing to a doctor.
