Spotlight on Health: Living with asthma

Asthma in adults is more common in women than men. The severity of the symptoms varies from person to person. Asthma can be controlled well in most people, most of the time.

Who is at risk of developing asthma?

Things known to increase the likelihood of developing asthma include:

• a family history of asthma or other related allergic conditions (known as atopic conditions), such as eczema, food allergy or hay fever

• developing another atopic condition such as a food allergy

• having bronchiolitis as a child (a common lung infection among children)

• being exposed to tobacco smoke as a child, particularly if your mother smoked during pregnancy

• being born prematurely (especially if you needed a ventilator)

• being born with a low birth weight (less than 2kg or 4.5 pounds)

What is asthma?

Asthma is caused by inflammation of the airways. These are 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. For some people with chronic (long-lasting) asthma, long-term inflammation of the airways may lead to more permanent narrowing. If you are diagnosed with asthma as a child, the symptoms may disappear during your teenage years. However, asthma can return in adulthood. Moderate to severe childhood symptoms are more likely to persist or return later in life, although asthma does not only start in young people and can develop at any age.

What are the symptoms?

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 feeling of breathlessness. You may: l gasp for breath l experience a tight chest, like a band tightening around it l wheeze, making a whistling sound when you breathe l cough, particularly at night and early morning Symptoms that are worse during the night or with exercise can mean your asthma is getting worse. If you notice these signs, do not ignore them. Contact your GP or asthma clinic or consult your asthma action plan, if you have one.

Asthma attack

A severe onset of symptoms is known as an asthma attack or an 'acute asthma exacerbation'. A severe attack usually develops slowly, taking six to 48 hours to become serious. However, for some people, asthma symptoms can get worse quickly.

Signs include:

• the reliever inhaler, which is usually blue, does not help symptoms at all

• the symptoms of wheezing, coughing, tight chest are severe and constant

• you are too breathless to speak

• your pulse is racing

• you feel agitated or restless

• your lips or fingernails look blue

Severe asthma attacks may require hospital treatment and can sometimes be life-threatening, although this is rare. Call 999 to seek immediate help if you or someone else has severe symptoms of asthma.

Common triggers

A trigger is anything that irritates the airways and brings on the symptoms of asthma. These differ from person to person and people with asthma may have several triggers. Common triggers include house dust mites, animal fur, pollen, tobacco smoke, exercise, cold air and chest infections.

Asthma can also be made worse by certain activities, such as work. For example, some nurses develop asthma symptoms after exposure to latex. This is often referred to as work-related asthma or occupational asthma. Once you know your asthma triggers, you can try to avoid them.

Triggers include:

• Airway and chest infections. Upper respiratory infections, which affect the upper airways, are often caused by cold and flu viruses and are a common trigger of asthma. • Allergens. Pollen, dust mites, animal fur or feathers, for example, can trigger asthma.

• Airborne irritants. Cigarette smoke, chemical fumes and atmospheric pollution may trigger asthma.

• Medicines. The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma for some people, although are fine for most. Children under 16 years of age should not be given aspirin.

• Emotional factors. Asthma can be triggered by emotional factors, such as stress or laughing.

• Foods containing sulphites. Sulphites are naturally occurring substances found in some food and drink. They are also sometimes used as a food preservative. Food and drinks high in sulphites include concentrated fruit juice, jam, prawns and many processed or pre-cooked meals. Most people with asthma do not have this trigger, but some may. Certain wines can also trigger asthma in susceptible people.

• Weather conditions. A sudden change in temperature, cold air, windy days, poor air quality and hot, humid days are all known triggers for asthma.

• Indoor conditions. Mould or damp, house dust mites and chemicals in carpets and flooring materials may be triggers.

• Exercise. Sometimes, people with asthma find their symptoms are worse when they exercise.

• Food allergies. Although uncommon, some people may have allergies to nuts or other food items, known as an anaphylactic reaction. If so, these can trigger severe asthma attacks.

Treating asthma

While there is no cure for asthma, there are a number of treatments that can help effectively control the condition. Treatment is based on two important goals:

• relieving symptoms

• preventing future symptoms and attacks from developing

Treatment and prevention involves a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers. 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 other times.

The aim of treatment is to get your asthma under control and keep it that way. Everyone with asthma should be able to lead a full and unrestricted life. The treatments available are effective in most people and should enable you to be free from symptoms.

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 good control and your treatment is right for you (which should be at least once a year)

• a written personal asthma action plan agreed with your doctor or nurse As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse. Your action plan should be reviewed at least once a year, or more frequently if your symptoms are severe.

As part of the plan, you may be given a peak flow meter. This is a small hand-held device which can be used to measure how fast you can blow air out of your lungs in one breath. This will give you another way of monitoring your asthma, rather than relying only on symptoms.

Reliever Inhalers

Everyone with asthma should have a reliever inhaler. Reliever inhalers are usually blue. Relievers are medicines that are taken immediately to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again.

Relievers are essential in treating asthma attacks. You should take a dose of reliever inhaler when you are having asthma symptoms. If you are using your reliever inhaler three or more times a week, your asthma may not be well controlled and you should go back to your doctor or asthma nurse and have your symptoms reviewed.

Preventer inhalers

Preventers control the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks.

Not everyone with asthma will be prescribed preventer medicine. The protective effect builds up over a period of time so they need to be taken every day (usually morning and evening) even when you are feeling well.

Preventers do not give immediate or quick relief when you are breathless but instead they reduce long-term inflammation. Preventer inhalers usually contain a low dose of steroid medicine.

There are several kinds of preventers, but they all work in the same way. You will be started on an appropriate level of treatment to get your symptoms under control; once this has been achieved the treatment will be reduced to the lowest possible dose.

Preventers are usually brown, red or orange inhalers.

Whichever inhaler you have, it is important that your GP or pharmacist teaches you how to properly use it as this is an essential part of good asthma care.

Treatment available at your local pharmacy

Pharmacists can answer any questions you may have about your asthma medicines.

If you find it difficult to use your inhaler, or feel that it is not controlling your symptoms, talk to your pharmacist. Finding yourself short of breath during the day or if your asthma wakes you up at night may mean it isn’t as well controlled as it could be.

Next time you’re in your local pharmacy take a minute to talk to your pharmacist and find out if you’re getting the most from your medicines. If you’re a smoker and have asthma you’ve got a good incentive to quit.

Smoking worsens asthma and counteracts asthma medication by worsening the inflammation of the airways that the medicine tries to ease. However mild or severe your asthma is, stopping smoking can reduce your symptoms, making asthma easier to manage. So when you are ready to quit smoking, your pharmacist can offer you advice and support in confidence if you wish.

If you are prescribed a new medicine for the first time for asthma, you may be able to get extra help and advice about your medicine from your local pharmacist through a free NHS-funded scheme called The New Medicine Service (NMS).

The NMS focuses on patients with long term conditions that have been prescribed new medicines. The service allows people to discuss any concerns, eg side effects or what to do if you miss a dose. It can take place over the phone or in a pharmacy consultation room for approximately 15 minutes. You will receive a telephone call a couple of weeks later (or meet at the pharmacy) to resolve any outstanding issues – or you can be referred back to your GP if you need more help.

If you are taking two or more prescribed medicines, the NHS Medicines Use Review is another free NHS service that can help you get maximum benefit from your medicines. Ask at your local pharmacy for more information or, alternatively, your GP can refer you to your pharmacist.

Pharmacists can advise you on other services and support groups that may help you.

For more information on asthma and its treatment visit www.asthma.org.uk or www.nhs.uk