What is asthma?
Asthma is a long-term condition of the airways, the tubes that carry air in and out of the lungs. In people with asthma, the airways are sensitive and inflamed. When they meet a trigger, the muscles around them tighten, the lining swells and extra mucus is made. This narrows the airways and makes breathing difficult.
Asthma often starts in childhood but can begin at any age. It often runs in families and is common in people with allergies, eczema or allergic rhinitis. Asthma cannot be cured, but it can be controlled so well that symptoms are rare and attacks are prevented.
Symptoms of asthma
Symptoms come and go and may be worse at night or early morning, with exercise, during colds, or in certain seasons. Some people only have a long-lasting dry cough, especially at night. In children, repeated cough and wheeze with colds may be a sign of asthma. Common symptoms include:
Asthma symptoms can change from day to day and season to season. Many people notice more trouble during the monsoon and winter months, or around festivals when firecrackers and smoke fill the air. A sudden worsening of symptoms is called an asthma attack and needs quick action with your reliever and, if it does not settle, urgent medical help.
- Wheezing: a whistling sound when breathing out
- Shortness of breath
- Tightness in the chest
- Cough, often at night or with exercise or cold air
Common triggers
Triggers differ from person to person. In India, common triggers include house dust and dust mites, smoke from cooking fires, mosquito coils, incense sticks and firecrackers, tobacco smoke, vehicle pollution, pollen, mould during the monsoon, pet fur, cockroaches, and cold air in winter. Viral infections like colds and flu are major triggers, especially in children.
Exercise, strong smells, stress, and some medicines such as aspirin, ibuprofen and beta blockers can also trigger asthma in some people. Learning your own triggers and reducing them helps keep asthma under control. Some people also react to certain food additives or to cold drinks.
How asthma is diagnosed
A doctor diagnoses asthma from your symptoms, examination and breathing tests. Spirometry, also called a pulmonary function test, measures how much and how fast you can breathe out. It is often repeated after an inhaler to see if breathing improves, which supports asthma. A peak flow meter can be used at home to track changes over days.
Your doctor may also order a chest X-ray to rule out other problems, and a blood count, IgE level or allergy tests to look for an allergic cause. In young children, diagnosis is often based on symptoms and response to treatment.
Inhalers: the main treatment
Inhalers deliver medicine directly to the airways, so only a small amount is needed and side effects are fewer than with tablets. Preventer (controller) inhalers contain a low-dose steroid, often combined with a long-acting reliever, and are used every day to calm airway inflammation. Reliever inhalers open the airways quickly during symptoms.
All asthma inhalers, and especially steroid-containing ones, should be used only on a doctor's prescription. Do not stop your preventer when you feel well; it keeps asthma controlled. Inhaled steroids at usual doses are safe for long-term use in adults and children, and are much safer than repeated courses of steroid tablets.
Using your inhaler correctly
Many people do not get full benefit because of poor technique. Ask your doctor or pharmacist to show you how to use your inhaler and check it at every visit. A spacer used with a metered-dose inhaler helps more medicine reach the lungs, and is recommended for children and older adults. Young children may need a spacer with a face mask.
Rinse your mouth and gargle with water after using a steroid inhaler to prevent mouth thrush and hoarseness. Keep your reliever with you at all times, and check the expiry date and dose counter regularly. Never share your inhaler with others, and replace spacers when they crack.
Asthma action plan and special groups
Ask your doctor for a written asthma action plan that tells you what to take every day, what to do when symptoms get worse, and when to seek emergency help. Needing your reliever more than a few times a week, waking at night with asthma, or limiting activities are signs that your asthma is not well controlled and your treatment needs review.
Continue asthma treatment in pregnancy, as uncontrolled asthma is riskier for the baby than the medicines. Get flu vaccination as your doctor advises. Stop smoking and avoid second-hand smoke. For any concerns about your inhalers, speak with your doctor or pharmacist.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Inhaled corticosteroids such as budesonide, fluticasone or beclomethasonePreventer inhalers that reduce airway inflammation and prevent attacks when used daily.Only on a doctor's prescription; rinse your mouth after use and do not stop on your own.
- Short-acting reliever inhalers such as salbutamol or levosalbutamolQuickly open the airways during symptoms or an attack.Needing it often means asthma is not controlled; see your doctor.
- Combination inhalers such as budesonide with formoterolCombine a steroid with a long-acting reliever for daily control, and in some plans also for quick relief.Only on a doctor's prescription; follow your action plan exactly.
- MontelukastA tablet sometimes added to reduce inflammation, especially with allergies.Only on a doctor's prescription; report mood changes, bad dreams or behaviour changes, especially in children.
- Oral corticosteroids such as prednisoloneShort courses used for severe flare-ups.Only on a doctor's prescription; frequent courses have side effects, so good daily control matters.
See a doctor urgently if
- Reliever inhaler is not helping, or is needed more than every few hours
- Too breathless to speak full sentences, eat or sleep
- Blue or grey lips or fingernails
- Chest or neck muscles pulling in with each breath, or a child breathing very fast
- Drowsiness, confusion or exhaustion during an attack
- Peak flow falling to the danger zone in your action plan
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.