TAKING CONTROL OF ASTHMA
"Before I took my asthma seriously it knocked me from pillar to
post"
This information has been written by people with asthma and is based upon
the latest medical opinion. It covers a range of subjects that should interest
both those with asthma and those who care for people with asthma. Please share
this information with your family.
Asthma is very common indeed. Over three million people in Britain have the
condition including more than one million school children. It is the most
common chronic illness to affect children, causing them more time off school
than any other condition.
Asthma can be distressing. Some people have serious problems which restrict
what they can do and may even be dangerous. Many people put up with symptoms
that could be controlled.
This information will show how life with asthma can usually be more
trouble-free and enjoyable. If after reading it you have more questions and
opinions about asthma you should speak to your doctor or nurse. You can also
call the Campaign's Asthma Helpline (0345 01 02 03) which is staffed by
specialist asthma nurses and open from 9am to 9pm, Monday to Friday. Calls are
charged at local rates.
Asthma is the most common chronic disease in the developed world; affects
over three million people in the UK, including more than one million school
children; is the most common reason for children to take medication at school;
attacks cause around 150,000 people to be admitted to hospital every year;
causes nearly 2,000 deaths each year (80 per cent could be avoided); costs the
UK an estimated £1 billion every year.
Describing asthma
"It's like having a heavy weight placed suddenly on my
chest"
No one knows everything there is to know about asthma. Understanding about
asthma grows as doctors' knowledge increases and more experiences (symptoms)
are now being described as asthma.
Lungs have hundreds of tiny corridors, called airways, that carry the air we
breathe in and out. People with asthma have airways that are almost always red
and sensitive (inflamed). Because they are inflamed their airways are quick to
respond to anything that triggers (irritates) them.
Triggers vary from person to person. Most people will have several. Airways
react to a trigger by becoming narrower: the surrounding muscles tighten, and
inflammation inside the airways causes swelling and often sticky mucus. This
causes a wheezing noise when breathing and seems to stay there even when
coughing.
Common causes of attacks - the triggers
Allergies
Some airways may be triggered into narrowing because they are allergic to
something that is touching them. Allergies can include furry or feathery
animals, dust, certain foods and pollen. There are many others and you may have
any number of them (see page 8).
Air temperature
Changing weather conditions often affect people with asthma. This is
particularly the case when breathing in large amounts of cold, dry air during
exercise or laughter.
Environment
Pollutants such as car fumes, cigarette smoke and certain chemicals can
trigger an attack.
Infections
Flu, colds and other viral infections can start an attack.
Stress
Some people find that being under stress brings on an attack.
Medicines Those who first developed asthma as adults may be triggered by
aspirin, non-steroidal anti inflammatory tablets (eg Nurofen), some blood
pressure tablets, and some eyedrops for glaucoma. Paracetamol is usually safe.
Hormones
Some women find their asthma varies in response to changing hormone levels
and before periods.
You may be affected by any one or more of these triggers at different times.
Spotting asthma the symptoms
Once the airways have narrowed the result is usually one or more of the
following symptoms (they are often worse at night and in the early morning or
after exercise):
Coughing
A cough is often a sign of asthma. Sometimes the cough produces mucus which
can be white, yellow or green.
Tight chest
This is a popular description among people with asthma. It feels as if a
large elastic band has been placed around your chest.
Wheezing
You can hear a whistling noise and often feel as though something (mucus)
is catching inside the lungs.
Shortness of breath
You cannot finish each breath before you need another.
Who gets asthma?
Asthma, like its related conditions eczema and hay fever, often runs in the
family and may be inherited. Smoking during pregnancy increases the risk of the
baby developing a wheezy illness.
Stress and pollution have not been proven to cause asthma although certain
chemicals in the workplace can.
Predicting Asthma
Asthma is an unpredictable illness. It can change as you get older and be
triggered unexpectedly; symptoms come and go: they can last for a few moments
or keep going for days.
There are some times of the day that are predictably low points. Breathing
may become more difficult late at night or early in the morning. This is called
nocturnal asthma. In this state people are frequently awoken by their coughing
or breathlessness. There are also many people who only get the symptoms of
asthma during the day. In general people with asthma are at their best by late
afternoon.
Allergies
Many people have allergies that can trigger their asthma: people whose
asthma starts in school-age are more likely to be allergic. An allergy is an
over-reaction by the body to something which doesn't affect non-allergic
people. It may take a long time for an allergy to develop and some people may
have a number of allergies.
Allergies that trigger asthma attacks
Dust mites
You can become allergic to the droppings of house-dust mites that live in
beds and soft furnishings.
Animals
Close contact with furry or feathery animals can trigger asthma.
Pollen
Grass pollen grains (mainly found from mid May through to late July), tree
pollens in the spring and weed pollens in the spring and autumn sometimes
trigger asthma.
Mould spores
These are tiny seed-like particles that are released from mould which grows
in almost any warm and damp areas. Mostly released in summer or on damp days,
they remain active until late autumn and are common in damp housing.
Drugs
Aspirin triggers asthma in up to 1 in 30 people. Other pain relievers and
medicines are known to trigger asthma. Paracetamol is usually safe.
Chemicals
The number of agents used in industry which are now recognised as causing
asthma is over 200.
Food
Food allergy is not very common and may be difficult to diagnose. Dairy
products, alcohol, shellfish, yeast and peanuts are some of the offenders.
Controlling Asthma
"I had no idea that I could do so much to improve my asthma"
At most times the symptoms of asthma can be controlled. It is not easy to
avoid the triggers but the symptoms usually respond well to modern medicines.
Practical ways of avoiding trouble
Without doubt the most important part of controlling your asthma is the
carefuhy planned use of modern treatments. However, it seems wise to look at
the ways of avoiding asthma before looking at how the medicines can help to
control it.
Given that there are many different things that cause asthma attacks
(triggers) it is unlikely that you can avoid them all. You should consider the
way you live your life carefully and, before you visit the doctor to discuss
them, draw up a list of things that make your asthma worse. The doctor will
help you to avoid only the triggers that affect you. For instance there is no
point in avoiding cats if you are not allergic to them. Most steps that you can
take to avoid the triggers are commonsense.
In general
- Always tell pharmacists that you have asthma.
- Avoid cigarette smoke. Do not smoke yourself. For advice and support on
giving up smoking call Quitline on 020-7487 3000.
- Place a scarf around your face on cold days.
Exercise outside on warmer days (unless pollution levels are high) and inside
on cold ones. Although exercise can cause breathing problems modern treatments
mean people with asthma can still participate.
- Ease yourself gently into vigorous exercise.
- Avoid rushing around; keep stress to a minimum.
- Keep healthy and avoid people who have a cold if possible.
- Avoid furry or feathery animals if they affect you.
Allergic triggers
- Do not keep furry or feathered pets.
- Use special non-fabric mattress covers if you are allergic to house-dust
mite droppings. If you are not allergic to them there is no need to use barrier
bedding.
- Check to see if food labels include ingredients that you are allergic to.
- On hot, dry days avoid spending too much time outdoors, avoid long grass
and keep car windows closed.
- Use synthetic pillows and duvets. Wash bedding every week at 60°C.
- Use vinyl for flooring in your home.
- Soft toys should be washable; if they are not place them in the freezer
regularly.
- Let others vacuum using a cleaner that retains most of the dust.
- Have moulds removed quickly, avoid damp houses and do not hoard old
clothes.
Desensitisation, a treatment that reduces your allergic reactions, is no
longer thought to be safe or effective for the vast majority of people with
asthma.
At work
- Keep away from industrial fumes. Consult the local Health and Safety
Executive if you are concerned.
- Work in a smoke-free area. Contact Action on Smoking and Health (ASH) on
020-7935 3519.
- Be aware of stress at work and consider ways to avoid it.
Modern treatments
Asthma needs to be regularly treated so you can get on with your life.
There are two types of treatment:
Preventers are those that guard against asthma happening at all.
Relievers are those that rescue you from breathing difficulties as
they happen.
There is no connection between the effects of reliever drugs and preventer
drugs. They do quite separate things.
Please note that the names of drugs beginning with a capital letter are
their trade names (the ones you will see in shops) and ones beginning with a
small letter refer to their chemical name (used by chemists and doctors).
Preventers
As there is no cure for asthma itself, if you want to stop having attacks
and being restricted in what you can do, then preventing the symptoms is the
best answer.
Treatments, called preventers, damp down the twitchiness and irritability of
the airways, making them less likely to narrow when triggered. They do not
bring any instant relief from symptoms of asthma and will not work unless they
are taken every day, regardless of symptoms. Preventers save lives and may
restore the quality of day-to-day living.
Sodium cromoglycate (Intal and Cromogen) and Tilade are non-steroid
preventers. Cromoglycate and low dose inhaled steroids are first-line
treatments for children with asthma. Tilade may be used together with higher
doses of steroids.
Low dose inhaled steroid treatments are the modern answer for adults.
Examples are beclomethasone (eg Becotide or Beclofortc), budesonide (Pulmicort)
or fluticasone (Flixotide). They work by acting slowly on the airways to reduce
the inflammation and mucus.
We will discuss any risks of taking steroids in the section covering
medicines.
Preventers must be used every day and may take up to 14 days to build up the
preventive effect.
Relievers
Reliever treatments or bronchodilators are the ones that rescue you
from breathing difficulties as they happen. They relax the muscles surrounding
your airways by opening them and allowing you to breathe again. Relievers do
not reduce the inflammation in your airways.
The reliever should only be used when the symptoms of asthma appear or, if
recommended, before exercise. The only exceptions to this rule are the slow
acting, long lasting reliever drugs that need to be taken regularly.
Short acting rescue relievers
The most commonly used relievers are based on adrenaline, the chemical
produced by the body naturally when taking exercise. It opens the airways and
makes your heart beat faster so that the body is prepared for action. Doctors
call this beta-agonists. The relievers have their main effect on the lungs and
much less effect on the heart. Salbutamol (eg Ventohn) and terbutaline for
around four hours but don't stop symptoms coming back. Ipratropium bromide
(Atrovent) is not an adrenergic but is a short-acting reliever.
Slow acting, long lasting relievers
The slow acting, long lasting reliever drugs include the inhaled oxitropium
(Oxivent), salmetcrol (Serevent) and the xanthine tablets (Slo-Phyllin and
Uniphyllin are two examples). Serevent and Oxivent go on working for a longer
time than the short acting relievers but they do not deal with the inflammation
in your airways. Because they are long acting doctors may use them on a regular
basis to keep control of asthma that lingers despite regular preventer medicine
and short acting relievers. The xanthine tablets last for around eight hours.
Relievers show how wll your asthma is being controlled. If you are using
them more frequently than prescribed it could mean that your asthma is not
under control or is getting worse. Don't be embarrassed if you feel that you
are using too much of the reliever - it is important to let your doctor know.
Puffers and pills
Because asthma is in the lungs most of the drugs used to control it are
designed to be breathed in (inhaled). This means that they reach the airways
quickly and the doses needed are small. There are also medicines which can be
swallowed (taken orally) or injected. We will look closely at the most common
type, inhaled medicines. There are may variations of inhaler, so if one does
not work very well your doctor or nurse can recommend another.
Aerosol Inhalers (Puffers)
These are the most popular devices for both reliever and preventer
treatments. They work in the same way as other sprays: the medicine is mixed
i*to a liquid and forced under pressure into a small canister. When used the
liquid quickly evaporates leaving the active medicine as a fine dust which is
breathed in. Each time the canister is pushed down a measured (metered) amount
of the medicine is released and takes half a minute to recharge ready for the
next dose.
Autohaler
The autohaler is another type of aerosol inhaler. Rathe than waiting until
the caniste is pushed down, the autohaler works automatically as you breath in.
Spacers
Spacers are plastic containers which are put onto the aerosol inhaler
before using it. As the canister is pushed down the medicine is trapped inside
the spacer and then you breathe it in. This means that you do not need to time
pushing down and breathing in quite so precisely. It also means that there is
no jet of inhaled medicine so you avoid it landing on your throat and being
swallowed. They are often recommended to reduce the side effects from the
higher doses of inhaled steroids and for children who cannot co-ordinate using
their inhalers.
Powder Inhalers
These inhalers use a dry powder version of the medicine. This may come
inside a small container (capsule). The capsule is broken open inside the
inhaler device and you breathe in the fine powder. In othe devices the powder
comes inside a disk or compartment inside the inhaler. Powder inhalers are used
for both preventer and reliever medicines. Examples include the Spinhaler,
Acuhaler, Roahaler, Diskhaler and Turbohaler.
Nebuliser
Nebulisers work by forcing air or oxygen through the medicine to make a
fine mist. They are occasionally used so that very young children can take
their preventers, such as Intal or Pulmicort. More often nebulisers are used to
give reliever medicines to those with severe asthma. Here the nebuliser is
useful because it allows bigger doses of medicine to be taken, but there are
other ways to have bigger doses, for instance by using a spacer. If you use a
nebuliser to take reliever medicines it is very important to follow your
doctor's instructiosn carefully an not to take extra doses. For further
information about nebulisers please read our 'Spacers and nebulisers'
information booklet.
Tablets
When your asthma is severe steroid tables are sometimes taken for a short
while. You can be given a supply of tablets to use when the asthma slips out of
control; the tablets generally used are called prednisilone or prednisone.
Doctors also occasionally prescribe relievers as tablets: salbutamol,
terbutaline and theophylline are common examples.
Side effects
The treatments used for asthma do not generally have any serious side
effects. Some relievers can produce effects such as 'the shakes' or a rapid
heart beat. These effects are more common when taking high doses. They can be
distressing, but are usually harmless.
Steroids
The word 'steroid' covers many groups of chemical substances produced
naturally by the body. Only one group, the corticosteroids, is used to treat
asthma. Corticosteroids are simply steroids manufactured by pharmaceutical
companies to match the body's own steroids. They are not the same as anabolic
steroids used by athletes to improve their performance.
Steroids are mostly inhaled in small doses where they can't get into your
system. They carry a very small risk of mouth infection or voice 'huskiness'.
If you need higher doses of inhaled steroid (more than 1,000 micrograms per day
of budesonide or beclomethasone) to control your asthma it is possible that you
may absorb some steroid. Even if this happens the dose is likely to be smaller
than the smallest steroid tablet. You can reduce the risk by using a spacer
device and by rinsing your mouth after using the inhaler.
The main serious risk comes from steroid tablets taken over a long period of
time. These are only used for people with very severe asthma. Because there is
a risk of side effects (weight gain, thinning of bones and increased blood
pressure) the doctor will agree with you first whether the benefits outweigh
the risks. Occasional short courses of steroid tablets (for 7 to 14 days)
should not cause any long term side effects.
Complementary treatments
Many people have suggested that complementary treatments have improved their
asthma. Because most complementary treatments have not undergone the same
strict trials that medicines have, doctors will rarely recommend them with the
same certainty that they can with preventers and relievers.
Some trials have been made and there are some positive results. The evidence
that acupuncture can relax wheezing, for instance, is quite good and it can be
shown to protect against exercise-induced asthma. Acupuncture does not,
however, seem to be of use in the long term treatment of asthma.
Hypnosis and relaxation techniques such as yoga may relieve stress in an
individual and this can help those whose asthma is triggered by stress. Many
products claim to help control dust or clean air, but most are unproven. For
further information please see our 'Dust control' factsheet.
The choice to take complementary treatment is yours. It is worth remembering
that asthma varies from person to person and just because someone else improves
it is not proof that it will help others.
Complementary treatments are often wrongly called 'alternative' treatments:
there are no alternatives to modern medicines. If you decide to consult someone
other than your doctor remember to continue using your preventer and reliever
medicines.
Keeping asthma controlled
Working as a team
We have seen what the two types of treatment on offer do for you. Now it is
worth looking at how they be used to control your asthma.
Asthma is a condition that gives people a lot of responsibility to manage
things for themselves. Generally speaking people are good judges of their own
day-to-day health and can decide whether to increase or decrease the treatment
being taken.
Doctors have made what they cab the 'stepwise treatment plan'. Each step
shows what treatment is needed to control your asthma. If the treatment on one
step is not controlling your asthma then your doctor will recommend moving up
to the next step. If your asthma well controlled then your doctor may recommend
moving down to the next step. You may start at any step. Often you doctor will
think it wise to start at a higher step to gain control of your asthma and then
step down.
The success of stepwise treatment relies on you reporting back to the doctor
or asthma clinic, telling them about any difficulties and how you are doing.
Your doctor must know that you have taken the treatment on that step, otherwise
he/she will not have a clear idea of how you are doing and wiH be less able to
help.
Managing adult asthma in steps
Step 1
You occasionahy use a short acting reliever (usually a blue inhaler). If
you are using it more than once a day you should go onto the next step.
Step 2
In addition to your short acting reliever you will now need to take regular
preventer treatment (drugs that reduce the inflammation in your airways). This
can be a sodium cromoglycate-type drug or a steroid inhaler.
Step 3
In addition to your short acting reliever, you will now need to take higher
doses of the regular preventer treatment. Your doctor may also ask you to use a
spacer. Some people may be given long lasting, slow acting relievers plus the
low dose steroid preventer, instead of the higher dose preventer.
Step 4
In addition to your short acting reliever and higher dose preventer with
spacer you may also need to try other types of reliever and preventer.
Step 5
In addition to your short acting reliever, higher dose preventer using a
spacer and one or more of the long lasting, slow acting relievers, you may be
given regular steroid tablets in single daily doses.
Measuring your performance
One way in which you can help yourself and your doctor is to measure how
your lungs are performing. This will give a picture of when your asthma is
worse and when it is better. Using this information you can better predict an
attack, adjust your treatment accurately and see the benefits of any new
treatment.
Peak flow meters
Peak flow meters are the best way of measuring your lungs' performance.
This can help to diagnose asthma and warn of trouble. They can be prescribed
for use at home.
The meters have a marker which slides up a scale as you blow into it. At the
point when you blow hardest the marker stops next to a number. Each time you
use the meter (every morning and evening) the best result from three blows is
marked onto a chart. By comparing it with your previous pattern of results you
can look for gradual changes for better or worse.
Signs that your asthma is getting worse
As well as checking your lungs with a peak flow meter there are
other signs that show whether you are in control of your asthma or not. If you
have any of the following signs, then you should see your doctor who can help
to bring your asthma back under control:
- needing your reliever more often, or if it is less effective and doesn't
last for long.
- waking at night with coughing, wheezing, shortness of breath or chest
tightness.
- cannot keep up with your usual level of activity or exercise.
Asthma attacks
As a part of your asthma management you should discuss with your doctor what
to do in the event of an asthma attack.
What is an attack?
When the reliever treatment is not rescuing you from breathing difficulties
within 5-10 minutes of taking it.
What to do
- Take a reliever again after 5-10 minutes.
- Try to stay cahn; relax as much as your breathing will let you.
- Sit in a position that you find comfortable. Do not lie down.
- Rest your hands on your knees to help support your back.
- Try to slow your breathing down as this will make you less exhausted.
Whom to ask for help
Each situation is different and you should discuss with your GP whom to
contact in the event of an asthma attack. In rural areas, particularly, it may
be the case that the GP is quicker at getting to the scene and can help you
avoid being admitted to hospital. If you are having difficulties contacting
your GP during an attack or are away from home call an ambulance.
Do not be afraid of causing a fuss, even at night. Doctors prefer to be
called early so that they can easily alter your medication to make you well
again.
What next?
We know about asthma in the present - but what about the future?
Growing out of asthma
It is impossible to decide whether any one person is likely to 'grow out
of' asthma. Many children do grow out of asthma - but if you have asthma at the
age of 14 there is an 80 per cent chance of it continuing into adult life.
If you are an adult with asthma the chances are that it will not go away,
although the symptoms can often be controlled by treatment and avoiding known
triggers if possible.
Will my asthma get worse as I get older?
Not necessarily; in fact asthma can get better during adult life. Being
realistic we should accept that asthma is a long term condition, but it is not
necessarily a deteriorating one. If you take your preventer treatments
regularly this will improve your chances of controlling asthma.
A cure for asthma?
As this information is being written there is no cure for asthma. One thing
is for certain though: the outlook for asthma research has never looked so
good.
Researchers are tackling asthma from many different directions: pollution,
allergies, infant asthma, cell biology and chemical structures are just a few.
Not only are they looking for a cure, they are also looking at ways to improve
asthma care and the quality of life for people with asthma today.
National Asthma Campaign
The National Asthma Campaign is
the only charity dealing exclusively with asthma and related allergy. It funds
research into asthma and provides information to a host of people including
doctors, nurses, people with asthma and their friends, teachers and employers.
The Campaign has a network of local branches around the UK. Each branch
offers support to local people and raises money to help support the charity.
The National Asthma Campaign works
to promote the interests of people with asthma; to raise the publi's awareness
of asthma; and to do everything in its power to ensure that no person with
asthma suffers needlessly.
Getting more information
Use your local health services; they are free and with regular visits and
teamwork you have the best chance of controlling your asthma. If you would like
additional information you may like to do the following:
- To speak to a specialist asthma nurse call the Asthma Helpline on 0345
010203 between 9am and 9pm Monday to Friday. Calls are charged at local rates.
- Subscribe to Asthma News, the National Asthma Campaign's quarterly
magazine, by becoming a member.
- Contact your local branch of the National Asthma Campaign
- If you are 12 or under you may like to join the junior Asthma Club.
- Write to the National Asthma
Campaign, enclosing a self-addressed envelope at least 10 inches by 7
inches, for an information booklet on any of the following subjects:
- Asthma in the under fives
- Spacers and nebulisers
- Exercise and asthma
- Asthma at school: a teacher's guide
- Asthma and holidays
- Asthma and pregnancy
- Self-management and peak flow measurement
- Asthma at work: are you eligible for compensation?
- Hay fever
- Steroid treatment for asthma
- Asthma and the environment
We also have a range of factsheets covering the latest developments and
ongoing issues.
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