Asthma Management Guide

Affecting approximately 5 million people in the UK alone, asthma is a very common condition. It is a long-term affliction that while incurable, can be easily managed with the right treatment. Asthma can affect anyone and start from any age but tends to occur more frequently in women and children. While some children may grow out of asthma as they reach their teens, asthma that develops in adulthood is more likely to be chronic.

Asthma and its causes

The symptoms of asthma vary from mild to severe – in the worst cases, it can be life-threatening. Sufferers experience inflammation in the lungs and a narrowing of the airways, which leads to feelings of breathlessness, coughing and wheezing. The bronchi – small tubes that carry air in and out of the lungs – become sensitive and inflamed, and therefore less able to distribute oxygen efficiently. Currently, 1 out of 5 homes in the UK have a person living with asthma.

Asthma can be brought on by a combination of things. There is no one definitive cause. On one hand, it can be genetic, influenced by factors such as family history, obesity, allergies and stress. It can also be a product of your environment, triggered by pollutants and allergens. Children who are born prematurely or exposed to tobacco smoke are at particular risk of developing asthma, as are those who already suffer from conditions like eczema and hay fever. It can also be brought on by certain types of medication, or a bad respiratory infection.

What triggers asthma?

Asthma becomes much easier for the sufferer to manage and control once they have identified their triggers. As the sufferer gets to know which triggers are prone to exacerbating their asthma, they can try to avoid them. Common asthma triggers include:

• Allergens such as dust, pollen and animal fur
• Airborne irritants, such as pollution and tobacco smoke
• Moderate to intense exercise
• Strong emotional reactions, such as laughter, stress or anxiety
• Food allergies and food containing sulphites
• Weather conditions such as temperature changes, strong winds and humidity
• Respiratory infections, colds and flu
• Certain types of medication, including NSAIDs and Beta-Blockers
• Mould and damp
• Alcohol

How is asthma treated and controlled?

Asthma is treated by a combination of prevention and cure, usually as part of a personalised asthma management plan created by a medical professional. Depending on the severity of the condition, the sufferer may need to take medication regularly or occasionally, as well as taking steps to avoid their known triggers. This medication will mostly come in the form of an inhaler. Asthma inhalers are used for two reasons – relieving the symptoms of asthma, and preventing attacks from happening in the first place.

Asthma inhalers: relief and prevention

There are two types of asthma inhalers – reliever inhalers (normally blue) and preventer inhalers (normally brown, purple or green).

Reliever inhalers

Every asthma sufferer should have a reliever inhaler, the most popular being Ventolin. These are the blue inhalers that are used to ease the symptoms of an asthma attack when they occur, providing short-term relief. The medicine contained in a reliever inhaler, usually Salbutamol or Terbutaline, contains a short-acting beta-2-agonist that relaxes the muscles around the airways, so the sufferer can breathe more easily.

However, what it doesn’t do is reduce the inflammation – this is where the preventer inhaler comes in. If asthma is well-managed then it should not be necessary to use the reliever inhaler too often. Any more than three times a week is excessive and should be reviewed with the doctor.

Ventolin Inhaler & AccuhalerVentolin (blue) inhalers are the most widely used treatment to relieve the symptoms of wheezing and breathlessness associated with asthma.

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Preventer inhalers

Where the reliever inhaler works in the short term, the preventer inhaler works long-term. These inhalers work slowly to reduce the inflamed lungs and airways, helping to prevent an asthma attack from happening at all. Usually red, brown or orange, these inhalers are usually prescribed to be taken once or twice daily. The most common preventer inhalers are Clenil and Qvar. The effects are noticed gradually over time, and in the beginning, sufferers may find themselves needing to use both a reliever and a preventer to manage their asthma. Combination inhalers do exist and are sometimes prescribed as a rescue treatment – Symbicort, for example.

The medicine in preventer inhalers usually contains an inhaled corticosteroid, such as Beclometasone, Budesonide, Ciclesonide, Fluticasone or Mometasone. Users should rinse their mouths after using the preventer inhaler and preferably use a spacer device, as they can sometimes cause mild fungal infections in the mouth or throat, such as oral candidiasis.

Symbicort Turbohaler (100, 200 & 400)Symbicort Turbohaler is a combined corticosteroid and long-acting beta-agonist preventative inhaler used daily to prevent symptoms of asthma and future attacks.

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Side effects

There are very few other side effects to speak of when using inhalers, assuming the medication is taken in normal doses. Using a reliever inhaler too often can sometimes cause muscle tremors, cramps and headaches. It’s worth speaking to your doctor or nurse if you experience any side effects or are struggling to control your symptoms and dosage.

How to control an asthma attack

There is a difference between the mild everyday symptoms of asthma and having an asthma attack. While it is normal for asthma sufferers to feel slightly breathless or wheezy from time to time, an asthma attack is when the symptoms become much more extreme. This can happen swiftly, or build up slowly over the course of a few days. In the case of an asthma attack, preventative action should be taken immediately.

Signs of an asthma attack

• Breathing too quickly
• Rapid heartbeat
• Feeling dizzy or tired
• Reliever inhaler becomes less effective
• Tightness in the chest
• Wheezing and coughing
• Breathlessness
• Finding it difficult to speak
• Lips or fingers turning blue (Cyanosis)

If you or someone you know is experiencing an asthma attack, the best course of action (in most cases) is as follows:

1. Inhale 1-2 puffs from your reliever inhaler
2. Attempt to take slow, steady breaths
3. If there is no improvement, take 2 more puffs from your reliever inhaler

The dose is 1 puff at a time, with a 2-minute gap between puffs. You can take a maximum of 10 puffs. Using a spacer device can make this easier. If there is still no improvement or you are worried, call 999. If an ambulance does not arrive within 10 minutes, take 2 more puffs from your reliever inhaler.

If you go to the hospital, you will likely be given a combination of oxygen, reliever and preventer medication to bring your asthma back under control. If your symptoms improve and there is no need for an ambulance, you will still need to visit a doctor or asthma nurse within 24 hours of the asthma attack, as your action plan may need reviewing to prevent them from happening in future.

Seeking diagnosis and treatment

If you think you might have asthma, you will need to be diagnosed by your doctor before you can seek treatment. Go as soon as possible if you believe this to be the case. The doctor will run some breathing tests and likely ask about existing conditions such as hay fever and eczema, which often occur alongside asthma.

The Independent Pharmacy cannot sell asthma treatment to you unless you have been diagnosed by your doctor – after which you can get repeat prescriptions. Find asthma treatments here.

Asthma can be managed easily enough, but can quickly escalate without the appropriate action and treatment. Around 3 people die each year in the UK due to having an asthma attack, and on average, 2 out of 3 of these deaths are preventable. However with the correct knowledge and medication, it is possible to manage asthma effectively and live a normal life.

Find out more about asthma by visiting Asthma UK.