Asthma

Asthma - Illnesses and conditions Lungs and airways Asthma Asthma About asthma Symptoms of asthma Causes of asthma Diagnosing asthma Treating asthma Living with asthma About asthma Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems. Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an asthma attack, although doctors sometimes use the term exacerbation. Severeattacks may require hospital treatment and can be life threatening, although this is unusual. Read more about the symptoms of asthma and diagnosing asthma What causes asthma? Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs  known as a trigger  your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm). Common asthma triggers include: house dust mites animal fur pollen cigarettesmoke exercise viral infections Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday. The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition. Asthma can develop at any age,including in young children and elderly people. Read more about the causes of asthma Who is affected? In the UK, around 5.4 million people are currently receiving treatment for asthma. Thats the equivalent of 1 in every 12 adults and1 in every 11 children. Asthma in adults is more common in women than men. Howasthma is treated While there is no cure for asthma, there are a number of treatments that can help control the condition. Treatment is based on two important goals, which are: relieving symptoms preventing future symptoms and attacks For most people, this will involve the occasional  or, more commonly, daily  use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important. You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so. Read more about treating asthma and living with asthma Outlook For many people, asthma is a long-term condition  particularly if it first develops in adulthood. Asthma symptoms are usually controllable and reversible with treatment, although some people withlong-lasting asthma maydevelop permanent narrowing of their airways and more persistent problems. For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on. Symptoms of asthma The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time. The main symptoms of asthma are: wheezing (a whistling sound when you breathe) shortness of breath a tight chest  which may feel likea band is tightening aroundit coughing These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen. Read our page on the causes of asthma for more information about potential triggers. Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms. Asthma attacks When asthma symptoms get significantly worse, it is known as an asthma attack or acute asthma exacerbation. Asthma attacks often develop slowly, sometimes taking a couple of days or more to become serious, although some people with asthma are prone to sudden, unexpected severe attacks. It is important to recognise attacks early and take appropriate action. During an asthma attack, the symptoms described above may get worse and  if youre already on treatment  your inhaler medication may not workas well as it normally does. You might be monitoring your asthma using a device called a peak flow meter, and theremay be a drop in your peak expiratory flow. Read about diagnosing asthma for more information. Signs of a particularly severe asthma attack can include: your reliever inhaler (which is usually blue) is not helping symptoms as much as usual, or at all wheezing, coughing and chest tightness becoming severe and constant being too breathless to eat, speak or sleep breathing faster a rapid heartbeat feeling drowsy, exhausted or dizzy your lips or fingersturning blue (cyanosis) Phone 999 to seek immediate help if you or someone else has symptoms of a severe asthma attack. Causes of asthma Its not clear exactly what causes asthma, although it is likely to be a combination of factors. Some of these may be genetic. However, a number of environmental factors are thought toplay a role in the development of asthma. These include air pollution, chlorine in swimming pools and modern hygiene standards (known as the hygiene hypothesis). There is currently not enough evidence to be certain whether any of these can cause asthma, although a variety of environmental irritants, such as dust, cold air and smoke, may make it worse. Who is at risk? Although the cause of asthma is unknown, a number of things that can increase your chances of developing the condition have been identified. These include: a family history of asthma or other related allergic conditions (known as atopic conditions) such as eczema, food allergy or hay fever havinganother atopic condition having bronchiolitis (a common childhood lung infection) as a child childhood exposure to tobacco smoke, particularly if your mother also smoked during pregnancy being born prematurely, especially if you needed a ventilator to support your breathing after birth having a low birth weight as a result of restricted growth within the womb Some people may also be at risk of developing asthma through their job. Asthma triggers In people with asthma, the small tubes (bronchi) that carry air in and out of the lungs become inflamed and more sensitive than normal. This means that when you come into contact with something that irritates your lungs (a trigger), your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm). Asthma symptoms can have a range of triggers, such as: respiratory tract infections  particularly infections affecting the upper airways, such as colds and the flu allergens  including pollen, dust mites, animal fur or feathers airborne irritants  including cigarette smoke, chemical fumes and atmospheric pollution medicines  particularly the class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) , which includes aspirin and ibuprofen , and beta-blockers sometimes given for high blood pressure or some types of heart disease emotions  including stress or laughing foods containing sulphites  naturally occurring substances found in some food and drinks, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals weather conditions  includinga sudden change in temperature, cold air, windy days, thunderstorms, poor air quality and hot, humid days indoor conditions  including mould or damp, house dust mites and chemicals in carpets and flooring materials exercise food allergies  including allergies to nuts or other food items Once you know your asthma triggers, youmay be able tohelp control your condition by tryingto avoid them. Further information Asthma UK: asthma triggers A-Z Occupational asthma In some cases, asthma isassociated with substancesyou may be exposed toat work. This is known as occupational asthma. Some of the most commonly reportedcauses of occupational asthma include exposure to: isocyanates (chemicals often found in spray paint) flour and grain dust colophony (a substanceoften found in solder fumes) latex animals wood dust You may be at an increased risk of developing occupational asthma if you are regularly exposed to substances such as these throughyour work. Occupations that are commonly associated with the condition include paint sprayers, bakers and pastry makers, nurses, chemical workers, animal handlers, welders, food processing workers and timber workers. Further information Asthma UK:occupational asthma Health and Safety Executive: asthma Diagnosing asthma If you have typical asthma symptoms, your GP will often be able to make a diagnosis. Theywill want to know whenthe symptoms happen and how often, and if you have noticed anything that might trigger them. Your GP may also ask whetheryou have any allergic (atopic) conditions such as eczema and hay fever , which often occur alongside asthma. A number of tests can be carried out to confirm the diagnosis. These are described below. In children, asthma can be difficult to diagnose because many other conditions can cause similar symptoms in infants. The tests outlined below are also not always suitable forchildren. Your GP therefore may sometimes suggestthat your child usesan asthma inhaler as a trial treatment. If this helps improve your childs symptoms, it is likelythey have asthma. Spirometry A breathing test calledspirometry will often be carried out to assess how well your lungs work. This involves taking a deep breath and exhaling as fast as you can through a mouthpiece attached to a machine called a spirometer. The spirometer takes two measurements  the volume of air you can breathe out in the first second of exhalation (the forced expiratory volume in one second, or FEV1) and the total amount of air you breathe out (the forced vital capacity or FVC). You may be asked to breathe into the spirometer a few times to get an accurate reading. The readings are then compared with average measurements for people your age, sex and height, which can show if your airways are obstructed. Sometimes an initial set of measurements is taken, and you arethen given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing when another reading is taken. This is known as reversibility testing, and it can be useful in distinguishing asthma from other lung conditions, such as chronic obstructive pulmonary disease (COPD) . Peak expiratory flow test A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test. This test requires a bit of practise to get it right, so your GP or nurse will show you how to do it and may suggest you take the best of two or three readings. You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day. Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take. To help diagnose asthma that may be related to your work (occupational asthma), your GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work. Your GP may then refer you to a specialist to confirm the diagnosis. Other tests Some people may also need anumber of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment. Airways responsiveness This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger. You will be asked to breathe in a medication that deliberately irritates or constricts your airways slightly if you have asthma, causing a small decrease in your FEV1 measured using spirometry and possibly triggering mild asthma symptoms. If you do not have asthma, your airways will not respond to this stimulus. The test often involves inhaling progressively increasing amounts of the medication at intervals, with spirometry measurement of FEV1 in between to see if it falls below a certain threshold. In some cases, however, exercise may be used as a trigger. Testing airway inflammation It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways: amucus sample  the doctor may take a sample of mucus (phlegm)so it can be tested for signs ofinflammation in the airways nitric oxide concentration  as you breathe out, the level of nitric oxide in your breath is measured using a special machine;a high level of nitric oxide can be a sign of airway inflammation Allergy tests Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies,such asdust mites, pollen or foods. Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma. Read more about diagnosing allergies Treating asthma Reliever inhalers Reliever inhalersusually blueare taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist, which works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. Reliever inhalers do not reduce the inflammation in the airways, so they do not make asthma better in the long term  they are intended only for the relief of symptoms. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless overused. However, they should rarely, if ever, be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed. Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. Read further information: Asthma UK: relievers Preventer inhalers Preventer inhalersusually brown, red or orangework over time to reduce the amount of inflammation and sensitivity of the airways, and reduce the chances of asthma attacks occurring. They must be used regularly (typically twice or occasionally once daily) and indefinitely to keep asthma under control. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the blue reliever inhaler to relieve yoursymptoms, but your treatment should be reviewedif you continue to need them often. The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone, ciclesonide and mometasone. Preventer treatment should be taken regularly if you have anything more than occasional symptoms from your asthma, and certainly if you feel the need to use a reliever inhaler more than twice a week. Some inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so make sure you rinse your mouth thoroughly after inhaling a dose. The use of a spacer device also reduces this risk. Smoking can reduce the effects of preventer inhalers. Read further information: Asthma UK:preventer inhalers Other treatments and add-on therapy Long-acting reliever inhalers If your asthma does not respond to initial treatment, the dose of preventer inhaler you take may be increased in agreement with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long-acting beta2-agonist, or LABA) to take as well. These work in the same way as short-acting relievers. Although they take slightly longer to work, their effects can last for up to 12 hours. This means that taking them regularly twice a day provides 24-hour cover. Regular use of long-acting relievers can also help reduce the dosage of preventer medication needed to control asthma. Examples of long-acting relievers include formoterol and salmeterol, and recently vilanterol, which may last up to 24 hours. However, like short-acting relievers, long-acting relievers do not reduce the inflammation in the airways. If they are taken without a preventer, this may allow the condition to get worse while masking the symptoms, increasing the chance of a sudden and potentially life-threatening severe asthma attack. You should therefore always use a long-acting reliever inhaler in combination with a preventer inhaler, and never by itself. In view of this, most long-acting relievers are prescribed in a combination inhaler, which contains both an inhaled steroid (as a preventer) and a long-acting bronchodilator in the one device. Examples of combination inhalers include Seretide, Symbicort, Fostair, Flutiform and Relvar. These are usually (but not always) purple, red and white, or maroon. Other preventer medicines If regular efficient administration of treatment with a preventer and a long-acting reliever still fails to control asthma symptoms, additional medicines may be tried. Two possible alternatives include: leukotriene receptor antagonists tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways theophyllines tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents Oral steroids If your asthma is still not under control, you may be prescribed regular steroid tablets. This treatment is usually monitored by a respiratory specialist (an asthma specialist). Oral steroids are powerful anti-inflammatory preventers, which are generally used in two ways: to regain control of asthma when it is temporarily upsetfor example, by a lapse in regular medication or an unexpected chest infection; in these cases, they are typically given for one or two weeks, then stopped when long-term control of asthma remains a problem, despite maximal dosages of inhaled and other medicationsin these cases, oral steroids may be given for prolonged periods, or even indefinitely, while maintaining maximum treatment with inhalers asthis maximises the chance of being able to stop the oral steroids again in the future Long-term use of oral steroids has serious possibleside effects, so they are only used once other treatment options have been tried, and after discussing the risks and benefits with your healthcare team. Omalizumab (Xolair) Omalizumab, also known as Xolair, is the first of a new category of medication that binds to one of the proteins involved in the immune response and reduces its level in the blood. This lowers the chance of an immune reaction happening and causing an asthma attack. It is licensed for use in adults and children over six years of age with asthma. The National Institute for Heath and Care Excellence (NICE) recommends that omalizumab can be used in people with allergy-related asthma whoneed continuous or frequent treatment with oral corticosteroids. Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped. Read further information: Asthma UK:other treatments and add-on therapies Asthma UK:steroid tablets NICE: omalizumab for severe persistent allergic asthma Bronchial thermoplasty Bronchial thermoplasty is a relatively new procedurethat can be usedin some cases of severe asthma. It worksby destroying some of the muscles surrounding the airways in the lungs, which canreduce their ability to narrow the airways. The procedure is carried out either with sedation or under general anaesthetic . A bronchoscope (a long, flexible tube) containing a probe is inserted into the lungs through the mouth or noseso it touches the airways. The probe then uses controlled heat to damage the muscles around the airways. Three treatment sessions are usually needed, with at leastthree weeks between each session. There is some evidence to showthis procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma. However, the long-term risks and benefits are not yet fully understood. There is a small risk it will trigger an asthma attack, which sometimes requires hospital admission. You should discuss this procedure fully with your clinician if the treatment is offered. Read further information: NICE:bronchial thermoplasty for severe asthma Side effects of treatments Side effects of relievers and preventers Relievers are a safe and effective medicine, and havefew side effects as long as they are not used too much. The main side effects include a mild shaking of the hands (tremors), headaches and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes. Preventers arevery safe at usual doses, although they can cause a range of side effects at high doses, especially with long-term use. The main side effect of preventer inhalers is a fungal infection of the mouth or throat (oral candidiasis) . You may also develop a hoarse voice and sore throat . Using a spacer can help prevent these side effects, as can rinsing your mouth or cleaning your teeth afterusingyour preventer inhaler. Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keepside effects to a minimum. Side effects of add-on therapy Long-acting relievers may cause similar side effects to short-acting relievers. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped. Theophylline tablets have been known to cause side effects in some people, including nausea, vomiting, tremors and noticeable heartbeats (palpitations). These can usually be avoided by adjusting the dose according to periodic measurement of the theophylline concentration in the blood. Side effects of leukotriene receptor agonists can include tummy (abdominal) pain and headaches. Side effects of steroid tablets Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (more than three or four courses of steroids a year). Side effects can include: osteoporosis (fragile bones) high blood pressure (hypertension) diabetes increased appetite, leading to weight gain cataracts andglaucoma (eye disorders) thinning of the skin easy bruising muscle weakness With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon. However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma. You will need regular appointments to check for these. Read further information: Asthma UK:side effects of asthma medicines Asthma attacks Apersonal asthma action plan will help you recognise the initial symptoms of an asthma attack, know how to respond, and when to seek medical attention. In most cases, the following actions will be recommended: Take one to two puffs of your reliever inhaler (usually blue) immediately. Sit down and try to take slow, steady breaths. If you do not start to feel better, take two puffs of your reliever inhaler (one puff at a time) every two minutes(you can take up to 10 puffs)this is easier using a spacer, if you have one. If you do not feel better after taking your inhaler as above or if you are worried at any time, phone 999. If an ambulance does not arrive within 10 minutes and you are still feeling unwell, repeat step three. If your symptoms improve and you do not need to phone 999, you still need to see a doctor or asthma nurse within 24 hours. If you are admitted to hospital, you will be given a combination of oxygen, reliever and preventer medicines to bring your asthma under control. Your personal asthma action plan will need to be reviewed after an asthma attack, so reasons for the attack can be identified and avoided in future. Read further information: Asthma UK: what to do in an asthma attack Personal asthma action plan As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. If youve been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home. The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack. Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe. As part of your asthma plan, you may be given a peak flow meter . This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps. Read further information: Asthma UK: personal asthma action plan What is good asthma care? Your doctor or nurse will tailor your asthma treatment to your symptoms. Sometimes you may need to be on higher levels of medication than at others. You should be offered: care at your GP surgery provided by doctors and nurses trained in asthma management full information about your condition and how to control it involvement in making decisions about your treatment regular checks to ensure your asthma is under control and your treatment is right for you (this should be at least once a year) a written personal asthma action plan agreed with your doctor or nurse It is also important that your GP or pharmacist teaches you how to properly use your inhaler, as this is an important part of good asthma care. Occupational asthma If it is possible you have asthma associated with your job (occupational asthma), you will be referred to a respiratory 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 maysometimes be possible to substitute or remove the substance triggering your occupational asthma from your workplace, to redeploy youto another role within the company, or to wear protective breathing equipment. However, you may need to consider changing your job or relocating away from your work environment, ideally within 12 months of your symptoms developing. Some people with occupational asthma may be entitled to Industrial Injuries Disablement Benefit. Read further information: Asthma UK: occupational asthma GOV.UK: Industrial Injuries Disablement Benefit Health and Safety Executive: asthma Complementary therapies A number of complementary therapies have been suggested for the treatment of asthma, including: breathing exercises traditional Chinese herbal medicine acupuncture ionisersdevices that use an electric current to charge (ionise) molecules of air manual therapiessuch as chiropractic hypnosis homoeopathy dietary supplements However, there is little evidence that any of these treatments, other than breathing exercises, are effective. There is some evidence that breathing exercisescan improve symptoms and reduce the need for reliever medicines in some people. These includebreathing exercises taught by a physiotherapist, yoga and the Buteyko method (a technique involving slowed, controlled breathing). Read further information: Asthma UK: complementary therapies Living with asthma With the right treatment and management, asthma shouldnt restrict your daily life (including your sleep) in any way. You should work with your healthcare professionals and strive to achieve this goal. You should also be confident about how to recognise when your asthma is getting out of control, and what to do if it does. Sleeping Asthma symptoms are often worse at night. This means you might wake up some nights coughing or with a tight chest. If your child has asthma, poor sleep can affect their behaviour and concentration, as well as their ability to learn. Effectively controlling asthma with the treatment your doctor or nurse recommends will reduce the symptoms, so you or your childshould sleep better. Read about living with insomnia for more tips on getting better sleep. Exercise Very occasionally, people with asthma develop symptoms only during exercise. However, usually this is a sign that your asthma could be better controlled generally. If you or your child have asthma symptoms during or after exercise, speak to your doctor or asthma nurse. It is likely they will review your general symptoms and personal asthma plan to make surethe conditionis under control. Your doctor or asthma nurse may also advise that: you make sure the people you are exercising with know you have asthma you increase your fitness levels gradually you always have your reliever inhaler (usually blue) with you when you exercise you use your reliever inhaler immediately before you warm up you ensure that you always warm up and down thoroughly if you have symptoms while you are exercising, stop what youre doing, take your reliever inhaler and wait until you feel better before starting again Read about health and fitness for more information on simple ways to exercise. Diet Most people with asthma can eat a normal, healthy diet. Occasionally, people with asthma may have food-based allergic triggers and will need to avoid foods such as cows milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives. However, this is uncommon. Read more about eating well Read further information: Asthma UK: exercise Asthma UK: diet and food Know your triggers Its important to identify possible asthma triggers by making a note of any worsening symptoms or by using yourpeak flow meter during exposure to certain situations. Read our page on the causes of asthma for more information about potential triggers. Some triggers, such as air pollution, illnesses and certain weather conditions, can be hard to avoid. However, it may be possible to avoid other triggers, such as dust mites, fungal spores, pet fur and certain medications that trigger your symptoms. Make sure your healthcare team knows about and investigates triggers for your symptoms that you may have noticed yourself. Read further information: Allergy prevention Asthma UK: asthma triggers A-Z Complications of asthma Quality of life Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in: fatigue (extreme tiredness) underperformance or absence from work or school psychological problems  including stress, anxiety and depression disruption of your work and leisure because of unexpected visits to your GP or hospital in children, delays in growth or