Infections, particularly colds, coughs, and chest infections.
Pollens and Moulds; Asthma is often worse in the hay
Exercise; however, sport and exercise are good for
you if you have Asthma; if necessary, you can use an inhaler before
exercise to prevent the symptoms from developing, but, as a rule, exercise
induced Asthma often represents undertreated Asthma; if it occurs, it
may indicate a need to step up your usual preventative treatment.
Certain Drugs; for example, about 1 in 50 people with
Asthma is allergic to aspirin which can trigger symptoms; other drugs
that can cause Asthma sympoms are anti-inflammatory painkillers such
as iIbuprofen (eg NurofenŽ), Diclofenac, etc, and betablockers such
as Propranolol, Atenolol, Timolol and the betablocker eye drops used
to treat glaucoma.
Smoking and Cigarette Fumes; smoking is not good for
anyone, at any time, but if you smoke and have Asthma, you should make
every effort to stop; seek help from your doctor if you find it difficult;
passive smoking can also make Asthma worse, even where adults smoke
away from the presence of children; the smoke on clothes, hair, etc,
may make the Asthma worse and all children deserve to live in a smoke
free home, in particular, children with Asthma.
Other Fumes and Chemicals, for example, fumes from
paints, solvents and pollution; the increase in air pollution may be
a reason why Asthma is becoming more prevalent.
Emotion; Asthma is not due to nerves, but such things
as stress, emotional upset, or laughing may trigger symptoms.
Allergies to Animals; for example, pet cats, dogs,
and horses; animals do not trigger symptoms in most cases, but some
people notice that their symptoms become worse when close to certain
House Dust Mites; this is a tiny creature which lives
in mattresses and other fabrics around the home; if you are allergic
to it, it may make symptoms worse; it is impossible to get rid of house
dust mites completely; to greatly reduce their number takes a lot of
time and effort and involves using special mattress covers, removing
carpets, removing or treating soft toys, etc; however, if symptoms are
difficult to control with treatment and you are confirmed to be allergic
to house dust mites, then it may be worth considering trying to reduce
Some Foods; most people with Asthma do not have to
follow a special diet and it is uncommon for food to trigger Asthma
symptoms; however, there are the unlucky few where certain foods such
as cow’s milk, eggs, fish, shellfish, yeast products, nuts and
some food colourings and preservatives, can make symptoms worse.
Some people only develop symptoms when exposed to a certain trigger;
for example, exercise, as I have already mentioned, can make Asthma
symptoms worse, but, some people only develop symptoms when they exercise
and are fine for the rest of the time; another example is that some
people only develop symptoms when exposed to specific chemicals.
How is Asthma Diagnosed?
Sometimes symptoms are typical and the diagnosis is easily made by a
doctor, but if there is any doubt then some simple tests may be arranged;
the two most commonly used tests are called Spirometry and Assessment
with a peak flow meter.
The Spirometry Test:
This test measures how much air you can blow out into a machine called
a spirometer; two results are important the amount of air you can blow
out in one second, called the Forced Expiratory Volume in 1 second (FEV1)
and the total amount you can blow out in one breath, called the Forced
Vital Capacity (FVC); your age, height and sex affect your lung volume,
so your results are compared with the average predicted for your age,
height and sex.
A value is calculated from the amount of air that you can blow out in
one second divided by the total amount of air that you blow out in one
breath, called the FEV1/FVC ratio; a low value indicates that you have
narrowed airways which are typical in Asthma, but a low value can occur
in other conditions too; therefore, the Spirometry Test may be repeated
after treatment; an improvement in the value after treatment to open
up the airways is typical of Asthma.
NB. Spirometry may be normal in people with Asthma
who do not have any symptoms when the test is done; remember, the symptoms
of Asthma typically come and go; therefore, a normal result does not
rule out Asthma, but, if your symptoms suggest that you have Asthma,
ideally the test should be repeated when your symptoms are present.
The Assessment Test with a Peak Flow Meter:
This is an alternative test and a Peak Flow Meter is a small device
that you blow into; a doctor or nurse will show you how; it measures
the speed of air that you can blow out of your lungs; no matter how
strong you are, if your airways are narrowed, your peak flow reading
will be lower than expected for your age, size and sex; if you have
untreated Asthma, then you will normally have low and variable peak
flow readings; also, peak flow readings in the morning are usually lower
than the evening if you have Asthma.
You may be asked to keep a diary over two weeks or so of peak flow readings;
typically, a person with Asthma will usually have low and variable peak
flow readings over several days; peak flow readings improve when the
narrowed airways are opened up with treatment; regular peak flow readings
can be used to help assess how well the treatment is working.
If after performing the above tests, the diagnosis remains in doubt
then a specialist may perform further, more complex tests, but these
are not needed in most cases.
What are the Treatments for Asthma?
For most people with Asthma, the symptoms can be prevented most of the
time with treatment, so that you are able to get on with normal life,
school, work, sport, etc.
Most people with Asthma are treated with inhalers; these deliver a small
dose of drug directly to the airways, which is enough to treat the problem
and the amount of drug that gets into the rest of your body is so small
that side effects are unlikely, or at least minor; there are various
inhaler devices made by different companies; different ones suit different
people; a doctor or nurse will advise on the different types; drugs
delivered by inhalers can be grouped into Relievers, Preventers and
Long Acting Bronchodilators.
A reliever inhaler is taken as required to ease symptoms, which relaxes
the muscle in the airways, making the airways open wider and the symptoms
usually ease; these drugs are also called Bronchodilators as they dilate
(widen) the bronchi and bronchioles (airways); there are several different
reliever drugs, for example, Salbutamol and Terbutaline and these come
in various brands made by different companies; if you only have symptoms
every now and then, then the occasional use of a reliever inhaler may
be all that you need; however, if you need a reliever inhaler three
times a week or more to ease symptoms, a preventer inhaler is usually
A preventer inhaler is taken every day to prevent symptoms from developing;
the drug commonly used in preventer inhalers is a steroid and these
come in various brands made by different companies; steroids work by
reducing the inflammation in the airways; when the inflammation has
gone, the airways are much less likely to become narrow and cause symptoms;
it takes 7 to 14 days for the steroid in a preventer inhaler to build
up its effect; therefore, it will not give any immediate relief of symptoms;
however, after a week or so of treatment, the symptoms have often gone,
or are at least much reduced; it can take up to six weeks for maximum
benefit, which means that you should then continue with the preventer
inhaler every day even when your symptoms have gone, in order to prevent
the symptoms from coming back.
Long Acting Bronchodilator Inhalers:
A long acting bronchodilator may be advised in addition to a preventer
inhaler; one may be needed if symptoms are not fully controlled by the
preventer inhaler alone; the drugs in these inhalers work in a similar
way to reliever inhalers, but work for up to 12 hours after taking each
dose; they include Salmeterol and Formoterol; some brands of inhaler
contain a steroid plus a long acting bronchodilator for convenience.
Spacer devices are used with some types of inhaler; these are commonly
used by children, but many adults also use them; a spacer is like a
small plastic chamber that attaches to the inhaler; it holds the drug
like a reservoir when the inhaler is pressed; a valve at the mouth end
ensures that the drug is kept within the spacer until you breathe in;
when you breathe out, the valve closes, so you don't need to have good
co-ordination in order to inhale the drug if you use a spacer device;
a face mask can be fitted on to some types of spacers, instead of a
mouthpiece, which is sometimes done for young children and babies who
can then use the inhaler simply by breathing in and out normally through
Tablets to Open up the Airways:
Most people do not need tablets as inhalers usually work well; however,
in some cases a tablet, or in liquid form for children, is prescribed
in addition to inhalers if symptoms are not fully eased by inhalers
alone; various tablets may be used which aim to open up the airways.
A short course of steroid tablets, such as prednisolone, is sometimes
needed to ease a severe or prolonged attack of Asthma; steroid tablets
are good at reducing the inflammation in the airways; for example, a
severe attack may occur if you have a cold or chest infection.
Some people worry about taking steroid tablets; however, a short course
of steroid tablets, for a week or so usually works very well and is
unlikely to cause any side effects; most of the the side effects caused
by steroid tablets occur if you take them for a long time, more than
several months, or if you take frequent short courses of high doses.
Omalizumab is a drug that is only used in a small number of people who
have severe persistent allergic Asthma that has not been controlled
by other treatments, so it is not a common treatment; it is given by
injection and works by interfering with the immune system to reduce
inflammation in the airways, which is present in Asthma.
What are the Dosages of Treatment?
Everyone is different; the correct dose of a preventer inhaler is the
lowest dose that prevents symptoms; a doctor may prescribe a high dose
of a preventer inhaler at first, to get on top of the symptoms quickly,
but when the symptoms have gone, the dose may then be reduced by a little
every few weeks; the aim is to find the lowest regular dose that keeps
the symptoms away.
Some people with Asthma put up with symptoms; they may think that it
is normal to still to have some symptoms even when they are on treatment;
a common example is a night time cough, which can cause disturbed sleep,
but if this occurs and your symptoms are not fully controlled, tell
your doctor or nurse; symptoms can often be prevented, for example,
by adjusting the dose of your preventer inhaler, or by adding in a long
A Typical Treatment Plan:
A common treatment plan for a typical person with moderate Asthma is
a preventer inhaler used each morning and at bedtime; this usually prevents
symptoms throughout the day and night; but a reliever inhaler may be
needed now and then if breakthrough symptoms occur, for example, if
symptoms flare up when you have a cough or cold; if exercise or sport
causes any symptoms, then a dose of a reliever inhaler just before the
exercise usually prevents the symptoms; the dose of the preventer inhaler
may need to be increased for a while if you have a cough or cold, or
during the hay fever season; some people may need to add in a long acting
bronchodilator, or tablets, if symptoms are not controlled with the
above; at first, adjusting the doses of inhalers is usually done on
the advice of a doctor or nurse, but in time, you may agree an Asthma
action plan with your doctor or nurse.
What is an Asthma Action Plan?
An Asthma action plan is a plan agreed by you with your doctor or nurse;
it enables you to make adjustments to the dose of your inhalers, depending
on your symptoms and/or peak flow readings and is tailored to your individual
circumstances; the plan is written down, usually on a standard form,
so that you can refer to it at any time; research studies suggest that
people who complete personal Asthma action plans find it easier to manage
their Asthma symptoms and that their plan helps them to go about their
lives as normal.
Does Asthma Go Away?
There is no once and for all cure; however, about half of the children
who develop Asthma grow out of it by the time they are adults; for many
adults Asthma is variable with some good spells and some bad spells;
some people are worse in the winter months and some are worse in the
hay fever season; although not curable, Asthma is treatable; therefore,
stepping up the treatment for a while during bad spells will often control
Some other General Points about Asthma:
It is vital that you learn how to use your inhaler(s) correctly; in
some people, symptoms persist simply because they do not use their inhaler
properly and the drug from the inhaler does not get into the airways
properly; seek advice from your practice nurse or doctor if you are
not sure if you are using your inhaler properly.
See a doctor or nurse if symptoms are not fully controlled, or if they
are getting worse, for example, if a night- time cough or wheeze is
troublesome; if Sport is being affected by symptoms; if your peak flow
readings are lower than normal; if you need a reliever inhaler more
often than usual, an adjustment in inhaler timings or doses may control
See a doctor immediately if you develop severe symptoms that are not
eased by a reliever inhaler; in particular, if you have difficulty talking
due to shortness of breath; you may need emergency treatment with high
dose reliever drugs and other treatments, sometimes in hospital.