Introduction

Asthma is a common lung condition that causes occasional breathing difficulties.

It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults.

There's currently no cure, but there are simple treatments that can help keep the symptoms under control so it doesn't have a big impact on your life.

Symptoms

The main symptoms of asthma are:

  • wheezing (a whistling sound when breathing)
  • breathlessness
  • a tight chest, which may feel like a band is tightening around it
  • coughing

The symptoms can sometimes get temporarily worse. This is known as an asthma attack.

Read more about the symptoms of asthma.

When to see a GP

See your GP if you or your child may have asthma.

Several conditions can cause similar symptoms, so it's important to get a proper diagnosis and correct treatment.

Your GP will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests.

Read more about how asthma is diagnosed.

Treatments

Asthma is usually treated by using an inhaler, a small device that lets you breathe in medicines.

The main types are:

  • reliever inhalers – used when needed to quickly relieve asthma symptoms for a short time
  • preventer inhalers – used every day to prevent asthma symptoms occurring

Some people also need to take tablets.

Causes and triggers

Asthma is caused by inflammation (swelling) of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.

It may occur randomly or after exposure to a trigger. Common asthma triggers include:

  • allergens - to house dust mites, animal fur or pollen, for example
  • smoke, pollution and cold air
  • exercise
  • infections like colds and flu

Identifying and avoiding your asthma triggers can help you keep your symptoms under control.

Read more about the causes of asthma.

How long does it last?

Asthma is a long-term condition for many people, particularly if it first develops when you're an adult.

In children, it sometimes disappears or improves during the teenage years, but it can come back later in life.

The symptoms can usually be controlled with treatment. Most people will have normal, active lives, although some with more severe asthma may have persistent problems.

Complications

Although asthma can normally be kept under control, it's still a serious condition that can cause a number of problems.

This is why it's so important to follow your treatment plan and not ignore your symptoms if they're getting worse.

Badly controlled asthma can cause problems such as:

  • feeling tired all the time
  • underperformance at or absence from work or school
  • stress, anxiety or depression
  • disruption of your work and leisure because of unplanned visits to your GP or hospital
  • lung infections (pneumonia)
  • delays in growth or puberty in children

There's also a risk of severe asthma attacks, which can be life-threatening.

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Symptoms

Most children and adults with asthma have times when their breathing becomes more difficult.

Some people with severe asthma may have breathing problems most of the time.

The most common symptoms of asthma are:

  • wheezing (a whistling sound when breathing)
  • breathlessness
  • a tight chest – it may feel like a band is tightening around it
  • coughing

Many things can cause these symptoms, but they're more likely to be asthma if they:

  • happen often and keep coming back
  • are worse at night and early in the morning
  • seem to happen in response to an asthma trigger like exercise or an allergy (such as pollen or animal fur)

See a GP if you think you or your child may have asthma, or you have asthma and are finding it hard to control.

Asthma attacks

Asthma can sometimes get worse for a short time, this is known as an asthma attack. It can happen suddenly, or gradually over a few days.

Signs of a severe asthma attack include:

  • wheezing, coughing and chest tightness becoming severe and constant
  • being too breathless to eat, speak or sleep
  • breathing faster
  • a rapid heartbeat
  • drowsiness, confusion, exhaustion or dizziness
  • blue lips or fingers
  • fainting
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Causes

The exact cause of asthma is unknown.

People with asthma have inflamed (swollen) and "sensitive" airways that become narrow and clogged with sticky mucus in response to certain triggers.

Genetics, pollution and modern hygiene standards have been suggested as causes, but there's not enough evidence to know if any of these do cause asthma.

Who is at risk?

A number of things can increase your chances of getting asthma. These include:

  • having an allergy-related condition, such as eczema, a food allergy or hay fever - these are known as atopic conditions
  • having a family history of asthma or atopic conditions
  • having had bronchiolitis - a common childhood lung infection
  • exposure to tobacco smoke as a child
  • your mother smoking during pregnancy
  • being born prematurely (before 37 weeks) or with a low birthweight

Some people may also be at risk of developing asthma through their job.

Asthma triggers

Asthma symptoms often occur in response to a trigger. Common triggers include:

  • infections like cold and flu
  • allergies – such as pollen, dust mites, animal fur or feathers
  • smoke, fumes and pollution
  • medicines – particularly anti-inflammatory painkillers like aspirin and ibuprofen
  • weather – such as sudden changes in temperature, cold air, wind, thunderstorms, heat and humidity
  • mould or damp
  • exercise

Once you know your triggers, trying to avoid them  may help control your asthma symptoms.

Asthma UK has more information on asthma triggers.

Work-related asthma

In some cases, asthma is associated with substances you may be exposed to at work. This is known as occupational asthma.

Some of the most common causes of occupational asthma include:

  • isocyanates (chemicals often found in spray paint)
  • flour and grain dust
  • colophony (a substance often found in solder fumes)
  • latex
  • animals
  • wood dust

Paint sprayers, bakers, pastry makers, nurses, chemical workers, animal handlers, timber workers, welders and food processing workers are all examples of people who may have a higher risk of being exposed to these substances.

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Diagnosis

Asthma can usually be diagnosed from your symptoms and some simple tests.

Your GP will probably be able to diagnose it, but they may refer you to a specialist if they're not sure.

Seeing your GP

Your GP may ask:

  • what symptoms you have
  • when they happen and how often
  • if anything seems to trigger them
  • if you have conditions such as eczema or allergies, or a family history of them

They may suggest doing some tests to confirm if you have asthma.

These can't always be done easily in young children, so your child may be given an asthma inhaler to see if it helps relieve their symptoms until they're old enough to have the tests.

Tests for asthma

The main tests used to help diagnose asthma are:

  • FeNO test - you breathe into a machine that measures the level of nitric oxide in your breath, which is a sign of inflammation in your lungs
  • Spirometry - you blow into a machine that measures how fast you can breathe out and how much air you can hold in your lungs
  • peak flow test - you blow into a handheld device that measures how fast you can breathe out, and this may be done several times over a few weeks to see if it changes over time

After you're diagnosed with asthma, you may also have allergy tests to see if your symptoms might be triggered by an allergy.

Asthma UK has more information on diagnosing asthma.

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Treatment

There's currently no cure for asthma, but treatment can help control the symptoms so you're able to live a normal, active life.

Inhalers - devices that let you breathe in medicine - are the main treatment. Tablets and other treatments may also be needed if your asthma is severe.

You'll usually create a personal action plan with your doctor or asthma nurse. This includes information about your medicines, how to monitor your condition and what to do if you have an asthma attack.

Inhalers

Inhalers can help:

  • relieve symptoms when they occur (reliever inhalers)
  • stop symptoms developing (preventer inhalers)

Some people need an inhaler that does both (combination inhalers).

Reliever inhalers

Most people with asthma will be given a reliever inhaler. These are usually blue.

You use a reliever inhaler to treat your symptoms when they occur. They should relieve your symptoms within a few minutes.

Tell your GP or asthma nurse if you have to use your reliever inhaler 3 or more times a week. They may suggest additional treatment, such as a preventer inhaler.

Reliever inhalers have few side effects, but they can sometimes cause shaking or a fast heartbeat for a few minutes after they're used.

Asthma UK has more information on reliever inhalers.

Preventer inhalers

If you need to use a reliever inhaler often, you may also need a preventer inhaler.

You use a preventer inhaler every day to reduce the inflammation and sensitivity of your airways, which stops your symptoms occurring. It's important to use it even when you don't have symptoms.

Speak to your GP or asthma nurse if you continue to have symptoms while using a preventer inhaler.

Preventer inhalers contain steroid medicine. They don't usually have side effects but can sometimes cause:

You can help prevent these side effects by using a spacer - a hollow plastic tube you attach to your inhaler - as well as by rinsing your mouth or cleaning your teeth after using your inhaler.

Asthma UK has more information on preventer inhalers.

Combination inhalers

If using reliever and preventer inhalers doesn't control your asthma, you may need an inhaler that combines both.

Combination inhalers are used every day to help stop symptoms occurring and provide long-lasting relief if they do occur.

It's important to use it regularly, even if you don't have symptoms.

Side effects of combination inhalers are similar to those of reliever and preventer inhalers.

Asthma UK has more information on combination inhalers.

Tablets

You may also need to take tablets if using an inhaler alone isn't helping control your symptoms.

Leukotriene receptor antagonists (LTRAs)

LTRAs are the main tablets used for asthma. They also come in syrup and powder form.

You take them every day to help stop your symptoms occurring.

Possible side effects include tummy aches and headaches.

Asthma UK has more information on LTRAs.

Theophylline

Theophylline may also be recommended if other treatments aren't helping to control your symptoms.

It's taken every day to stop your symptoms occurring.

Possible side effects include headaches and feeling sick.

Asthma UK has more information on theophylline.

Steroid tablets

Steroid tablets may be recommended if other treatments aren't helping to control your symptoms.

They can be taken either:

  • as an immediate treatment when you have an asthma attack
  • every day as a long-term treatment to prevent symptoms – this is usually only necessary if you have very severe asthma and inhalers don't control your symptoms

Long-term or frequent use of steroid tablets can occasionally cause side effects such as:

  • increased appetite, leading to weight gain
  • easy bruising
  • mood changes
  • fragile bones (osteoporosis)
  • high blood pressure

You'll be monitored regularly while taking steroid tablets to check for signs of any problems.

Asthma UK has more information on steroid tablets.

Other treatments

Other treatments, such as injections or surgery, are rarely needed but may be recommended if all other treatments aren't helping.

Injections

For some people with severe asthma, injections given every few weeks can help control the symptoms.

The main injections for asthma are:

  • omalizumab (Xolair)
  • mepolizumab (Nucala)
  • reslizumab (Cinqaero)

These medicines aren't suitable for everyone with asthma and can only be prescribed by an asthma specialist.

The main side effects is discomfort where the injection is given.

Asthma UK has more information on Xolair and new treatments for severe asthma.

Surgery

A procedure called bronchial thermoplasty is very occasionally used as a treatment for severe asthma.

It involves passing a thin, flexible tube down your throat and into your lungs. Heat is then used on the muscles around the airways to help stop them narrowing and causing asthma symptoms.

There's some evidence to suggest this may reduce asthma attacks, but it's relatively new treatment and the long-term effects aren't yet fully understood.

Asthma UK has more information on bronchial thermoplasty.

Complementary therapies

Several complementary therapies have been suggested as possible treatment for asthma, including:

  • breathing exercises - such as techniques called the Papworth method and the Buteyko method
  • traditional Chinese herbal medicine
  • acupuncture
  • ionisers - devices that use an electric current to charge molecules of air
  • manual therapies - such as chiropractic
  • homeopathy
  • dietary supplements

There's little evidence to suggest many of these treatments help.

There's some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some people, but they shouldn't be used instead of your medicine.

Asthma UK has more information on complementary therapies for asthma.

Work-related asthma

If you seem to have occupational asthma, where your asthma is linked to your job, you'll be referred to a specialist to confirm the diagnosis.

If your employer has an occupational health service, they should also be informed, along with your health and safety officer.

Your employer has a responsibility to protect you from the causes of occupational asthma. It may sometimes be possible to:

  • substitute or remove the substance that's triggering your asthma from your workplace
  • redeploy you to another role within the company
  • provide you with protective breathing equipment

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Living with

With treatment, most people with asthma can live normal lives. There are also some simple ways you can help keep your symptoms under control.

Things you can do

  • use your inhaler correctly - Asthma UK has information about using your inhaler, and you can ask your nurse or GP for advice if you're still not sure
  • use your preventer inhaler or tablets every day - this can help keep your symptoms under control and prevent asthma attacks
  • check before taking other medicines - always check the packet to see if a medicine is suitable for someone with asthma, and ask a pharmacist, doctor or nurse if you're not sure
  • don't smoke - stopping smoking can significantly reduce how severe and frequent your symptoms are
  • exercise regularly - exercise shouldn't trigger your symptoms once you're on appropriate treatment; Asthma UK has advice about exercising with asthma
  • eat healthily - most people with asthma can have a normal diet
  • get vaccinated - it's a good idea to have the annual flu jab and the one-off pneumococcal vaccination

Identify and avoid your triggers

It's important to identify possible asthma triggers by making a note of where you are and what you're doing when your symptoms get worse.

Some triggers can be hard to avoid, but it may be possible to avoid some, such as dust mites, pet fur and some medicines. See allergy prevention for more information.

Speak to your doctor or asthma nurse for advice if you think you have identified a trigger for your symptoms.

Asthma UK has more information about asthma triggers.

Regular check-ups

You'll have regular contact with your doctor or asthma nurse to monitor your condition.

These appointments may involve:

  • talking about your symptoms – for example if they're affecting your normal activities or are getting worse
  • a discussion about your medicines – including if you think you might be experiencing any side effects and if you need to be reminded how to use your inhaler
  • breathing tests

It's also a good chance to ask any questions you have or raise any other issues you want to discuss

You may be asked to help monitor your condition between appointments. For example, you may be advised to check your peak flow if you think your symptoms may be getting worse.

Your personal action plan should say what to do if your symptoms get gradually or suddenly worse. Contact your doctor or asthma nurse if you're not sure what to do.

Cold weather and asthma

Cold weather is a common trigger for asthma symptoms. Asthma UK advises the following to help you control your symptoms in the cold:

  • carry your reliever inhaler with you at all times and keep taking your regular preventer inhaler as prescribed
  • if you need to use your inhaler more than usual, speak to your doctor about reviewing your treatment
  • keep warm and dry – wear gloves, a scarf and a hat, and carry an umbrella.
  • wrap a scarf loosely over your nose and mouth – this will help warm up the air before you breathe in
  • try breathing in through your nose instead of your mouth - your nose warms the air as you breathe

Travelling with asthma

Asthma shouldn't stop you from travelling, but you will need to take extra precautions when going on holidays and long trips.

Make sure you have enough medicine with you, and keep your reliever inhaler easily accessible.

If you've not seen your doctor or asthma nurse for a while, it's a good idea to see them before you travel to review your personal action plan and make sure it's up-to-date.

Your doctor or asthma nurse can also advise you about travelling with asthma.

Asthma UK has more about asthma and travel.

Asthma and pregnancy

Asthma doesn't affect your chances of having children, and the vast majority of women with asthma will have a normal pregnancy.

Generally, treatment stays the same during pregnancy. Most asthma medicines, particularly inhalers, are considered safe while pregnant or breastfeeding.

But you should speak to your doctor or asthma nurse for advice if you become pregnant or are planning a pregnancy, because:

  • your symptoms may get worse during pregnancy - although some women find they improve - so your treatment may need to be reviewed regularly
  • poorly controlled asthma in pregnancy can increase the risk of complications such as pre-eclampsia and premature birth
  • extra precautions may need to be taken during labour to avoid an asthma attack, although attacks during labour are rare

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Asthma at school

Most children with well-controlled asthma can learn and participate in school activities without being affected by their condition.

But it's important to ensure the school has up-to-date written information about your child's asthma medicines, including what they are, how much they take and when they need to take them.

You may also need to supply the school with a spare reliever inhaler for use if your child experiences symptoms during the school day.

Staff at the school should be able to recognise worsening asthma symptoms and know what to do in the event of an attack, particularly staff supervising sport or physical education.

Your child's school may have an asthma policy in place, which you can ask to see.

Asthma UK has more about asthma at school and nursery.

Talking to others

Many people with long-term health conditions such as asthma experience feelings of stress, anxiety and depression.

You may find it helpful to talk about your experience of asthma with others. Patient organisations have local groups where you can meet people who have been diagnosed with asthma and undergone treatment.

If you feel you're struggling to cope, talk to your GP. They will be able to give advice and support. Alternatively, you can find depression support services in your area.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 27/07/2018 14:19:44