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.
Preventer inhalers — usually brown, red or orange — work 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 your symptoms, but your treatment should be reviewed if 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. 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. 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 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. These are usually but not always purple, red and white, or maroon. 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:. 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. Long-term use of oral steroids has serious possible side 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, 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. The National Institute for Heath and Care Excellence NICE recommends that omalizumab can be used in people with allergy-related asthma who need 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.
Bronchial thermoplasty is a relatively new procedure that can be used in some cases of severe asthma. It works by destroying some of the muscles surrounding the airways in the lungs, which can reduce 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 nose so 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 least three weeks between each session. There is some evidence to show this 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. Relievers are a safe and effective medicine, and have few 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 are very 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 after using your 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 keep side effects to a minimum. 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. 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:. 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. A personal asthma action plan will help you recognise the initial symptoms of an asthma attack, know how to respond, and when to seek medical attention.
If your symptoms improve and you do not need to phone , 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. 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 you've 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. 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. 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.
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 may sometimes be possible to substitute or remove the substance triggering your occupational asthma from your workplace, to redeploy you to 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.
However, there is little evidence that any of these treatments, other than breathing exercises, are effective. There is some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some people. These include breathing exercises taught by a physiotherapist, yoga and the Buteyko method a technique involving slowed, controlled breathing.
With the right treatment and management, asthma shouldn't 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.
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 child should sleep better. Read about living with insomnia for more tips on getting better sleep. 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 sure the condition is under control.
Read about health and fitness for more information on simple ways to exercise. 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. It's important to identify possible asthma triggers by making a note of any worsening symptoms or by using your peak flow meter during exposure to certain situations.
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. Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in:.
Research has yet to show a definitive cause of asthma. However, researchers have determined several risk factors that can lead to asthma development. Children of mothers with asthma are three times more likely to suffer from asthma, and 2. More than 30 genes have been linked to asthma so far, and gene-gene interactions, gene-environment interactions and epigenetic modifications also play a part. Genetic differences also play a role in differences in response to treatment.
People are more likely to have asthma if they have certain types of allergies, such ones which can affect the eyes and nose. However, not everyone who has allergies will get asthma and not everyone who has asthma is affected by allergies. Respiratory allergies and some types of asthma are related to an antibody called immunoglobulin E IgE , which the immune system produces in response to allergens.
To protect the body, the IgE causes allergic reactions that can affect the eyes, nose, throat, lungs and skin. Children born before 37 weeks are at increased risk of developing asthma later in life. Babies or small children may be at risk of developing asthma later in life if they had certain lung infections at a very early age. There are more than substances including gases, dust participles and chemical fumes and vapours that can cause asthma in the workplace. This type of asthma is known as occupational asthma, and is a common cause of adult onset asthma.
Women can develop adult-onset asthma during or after menopause. Smoking, exhaust fumes and airborne particulate matter can be linked to causing asthma. Extra weight around the chest might squeeze the lungs and make it more difficult to inhale. Fat tissue produces inflammatory substances that might influence the lungs and affect asthma. What is asthma? Breathing: Normal Airways Vs. Asthma Airways Normal: In someone with optimal lung function, air is inhaled through the nose and mouth, passing through the trachea windpipe before moving into the bronchi large airways.
What are the symptoms? The common signs and symptoms of poorly controlled asthma include: Shortness of breath Regular coughing Wheezing Chest tightness Increased mucus production Trouble sleeping because of breathing difficulty Being unable to take part in physical activities without breathing difficulty These symptoms can occur slowly over hours or days, or they can come on as sudden, recurring attacks after which the symptoms can persist for some time before disappearing.
Being exposed to things in the environment, like mold or dampness, some allergens such as dust mites, and secondhand tobacco smoke have been linked to developing asthma. Air pollution and viral lung infection may also lead to asthma.
Occupational asthma occurs when someone who never had asthma develops it because he or she is exposed to something at work. This can happen if you develop an allergy to something at work such as mold or if you are exposed to irritants such as wood dust or chemicals at work over and over at lower levels or all at once at higher levels. It can be hard to tell if someone has asthma, especially in children under age 5.
Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma. During a checkup, a doctor will ask if you cough a lot, especially at night. He or she will also ask whether your breathing problems are worse after physical activity or at certain times of year.
The doctor will then ask about chest tightness, wheezing, and colds lasting more than 10 days. He or she will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems. Finally, the doctor will ask questions about your home and whether you have missed school or work or have trouble doing certain things. The doctor may also do a breathing test, called spirometry, to find out how well your lungs are working by testing how much air you can breathe out after taking a very deep breath before and after you use asthma medicine.
An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk.
During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways.
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