Asthma

What is asthma?

Asthma is a long-term condition that can cause wheezing, breathlessness and coughing. It often starts in childhood, but can happen for the first time at any age. The severity of symptoms varies from person to person. Asthma can be controlled well in most people most of the time.

Asthma is caused by inflammation of the airways, in particular, small tubes called bronchi. If you have asthma, the bronchi will be more sensitive than normal because of this inflammation.

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 production of sticky mucus (phlegm). This makes it difficult to breathe and causes wheezing and coughing. It may also make your chest feel tight.

A doctor explains what asthma is

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Asthma is a condition in which the bronchial tubes are unduly irritable, so that if they are exposed to something like cold air or an infection they narrow down and then produce difficulty in getting air in and out and therefore breathlessness.

But they equally then will relax, either because of treatment or spontaneously and it’s that irritability due to an underlying inflammation of the airways which is what asthma is.

So are there different types of asthma?

There are many, many different types of asthma and you can classify them in all different sorts of ways and sometimes that’s helpful, sometimes it’s not.

For instance there is one form of asthma which is due to allergy called atopic asthma. There is another form, all the rest if you like, which are not, don’t have anything to do with allergy. Equally it may have something to do with age of onset. You can have early onset asthma in childhood, you can have late onset asthma occurring in adults. It might be due to causation, such as occupation. So there are many different ways of classifying it. But at the end of the day in terms of management, there isn’t very much difference across the spectrum

So could you describe the common symptoms of asthma?

The main symptoms are wheezy breathlessness. Those are the classical symptoms of asthma and they are (usually) intermittent. You can have periods of completely being symptom free in some people, whereas others will have symptoms all the time.

Classically these symptoms will wake people from sleep and so nocturnal asthma is something which raises our concerns, because it indicates that the asthma is not being very well controlled.

The other main symptom of asthma which really wasn’t recognized until about twenty, thirty years ago is cough. And this can either be a dry cough or it can be a cough where phlegm is produced. So it’s those three symptoms, wheeze, breathlessness and cough.

Catherine explains how important it is to know what things trigger your asthma.

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Age at interview: 39

Sex: Female

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In the beginning, especially before diagnosis, because you haven’t, you might have no idea why you’re ill. Why you feel like you have no energy, why you can’t do certain things, why you can’t do certain jobs. You career can be affected by it. Your home life is affected by it. Your social life is affected by it. And I think people who are newly diagnosed have got to give themselves time to come to terms with it.And that doesn’t necessarily mean accepting it. For some people accepting you’re ill will never happen. But it doesn’t mean that you can’t get your head round it and deal with it. I think some people think the only way they can move forward is if they accept it, but you don’t have to.

You just have to find your way with it. And then try and get on with life and accept that you will have bad days. There will be days where you just think, “Oh, for God’s sake”. [laughs] “Give me a break and let me live my life”. But those days, the further you get on past the diagnosis, the less those days become, because it becomes normal... ... in inverted commas.

There is a wide variation of experience of asthma ranging from very mild and occasional breathlessness and wheezing, through to very debilitating symptoms. Symptoms can come and go throughout life.

Alastair has mild asthma that only affects him during the summer months. He treats it with an inhaler.

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Age at interview: 31

Sex: Male

Age at diagnosis: 10

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I’ve never had an asthma attack as such. You hear about people have like a heavy asthma attack and not being able to breathe at all. Mine is just annoying. You know, it will sort of graduate up to the point where it’s just uncomfortable and without an inhaler that uncomfortable feeling lasts, you know, it could be a, you know, a couple of hours. But using the inhaler will stop it and until the next either dawn or dusk when it comes back on again. Or exercise during the summer as well.

Will make it worse?

Yes, but that’s usually a strange one. I’ll exercise for say ten minutes and also running for ten fifteen minutes and I won’t have a problem but as soon as I stop my asthma will kick in and then I have to use the inhaler and then I’ll be able to carry on again.

Jenny has severe brittle asthma but doesn’t let her asthma define who she is as a person.

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Age at interview: 34

Sex: Female

Age at diagnosis: 18

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Asthma is a very small world, word, but it’s a very big condition, and being diagnosed with asthma is not the end of the world. It’s not a death sentence, but it means different things to different people. I mean, for me, asthma is a huge part of my life it impacts on everything and I’ve got various conditions because of other… because of the medications I take for the asthma, but as a big picture, I’m, you know, I’m quite happy, or I’ve, no, I’ve learnt to be happy with the way that I am. Asthma is, asthma it’s an annoying condition because there’s no cure, all you can do is minimise the triggers, minimise what sets you off and then learn to deal with the condition when it does kick off. But it’s so, it has, the emotional impact on the sufferer but also the sufferer’s family, friends, you know, it is quite, it’s quite, it’s a big impact, it’s a big thing. But, again, it’s important not to live it… you know, I’m a person with asthma, I’m not the asthma first.

Dee has had a severe asthma attack in the past, but now her asthma is successfully controlled and she sometimes forgets she has it. [AUDIO ONLY]

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Age at interview: 52

Sex: Female

Age at diagnosis: 23

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I can go for years without needing medication or needing to think about it and if people ask me, you know if you’re filling in forms and they ask you about your health or whatever, I do have a tendency to forget that I’m asthmatic.

But if I am in a smoky atmosphere, which doesn’t happen as much now with the smoking ban, or under a sort of prolonged period of stress of tiredness or lack of sleep or any combination of all of those put together, I would be susceptible to just, out of the blue, you know, feeling really breathless.

So it doesn’t it doesn’t impede my life. It doesn’t get in the way but I think if you’ve had a really serious asthma attack, you don’t forget the fear factor. So, you know, there’s a little voice in the back of your head constantly, which means if you’re going on holiday, you know, you can manage without your tan lotion but you will not manage without your asthma medication

Peter explains how his asthma has changed over time, and how it affects his life.

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Age at interview: 62

Sex: Male

Age at diagnosis: 45

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It’s quite perplexing when you are first diagnosed because you don’t really know what it means and how it’s going to affect you. I have to say in the first several years, three or four years of having asthma it didn’t affect me too badly. I just used a reliever inhaler. And not all that often but over the years it has deteriorated. Such that I’ve probably used 12 or 15 different medications over the years. I’m now using a fair old cocktail three every day and two others as a result of having asthma, one of them to treat a potential side effect rather than actually to treat the asthma.

The symptoms I have I think are the same as what other people have. And they vary in severity from being very mild to being quite debilitating and that seems to be a bit of a characteristic of the condition called asthma. It not only affects different people in different ways, and to different degrees but any one individual can be affected in a different way over the course of a year let’s say.

So I reckon typically I probably have nine months of the year when I’m pretty fine. I can do most of what I want to do. And I probably have two or three months of the year when I’m restricted to a greater or lesser extent. Sometimes quite badly restricted. So it is variable.

The symptoms are yes, tightness in the chest coughing, wheezing. I think probably the, oh and shortness of breath. The shortness of breath and the coughing are the things that trouble me most. It may be mild and I might not notice it until I’m sort of walking up a steep hill for a few minutes or it may affect me just going up a few stairs. and I may not be able to hold a normal conversation because I haven’t got enough breath to keep it going.

If there’s a bad cough alongside that as well then you can’t sleep. As soon as you lie down it starts you off coughing so you have to sit up. And if you’re doing that for several days on end or a couple of weeks, or three weeks, coughing and coughing and coughing and coughing then you pull all your muscles in your upper body and so it hurts like mad whenever you do cough. And you really can’t sleep partly because you’re coughing, partly because you can’t get comfortable anywhere.

And that’s when I’m at my worse because you’re run down anyway with not being able to sleep and so on and so forth and you’re run short of breath quickly and so on. For a while it really is quite debilitating. And I go from there at worse to sort of where I am now where I can probably do as much as any 62 year old can.

A number of treatments can help control the condition very effectively. Treatment is based on two important goals:

relief of symptoms
preventing future symptoms and attacks from developing

The treatment of asthma has been steadily improving in the last few decades. Treatment options have increased and there is a greater awareness about asthma both among health professionals and the public. Many practices now have specialist asthma nurses.

Nicola says if you get the right treatment and use the medication correctly asthma need not interfere with your life.

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Age at interview: 24

Sex: Female

Age at diagnosis: 7

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Just that, you know it doesn’t have to take over your life. You can. If you try and see somebody to talk to somebody about it and get all the right information and make sure you’re on the right medication and then you know you can less it, you know not let it affect you day-to-day because it really shouldn’t and it doesn’t need to be a big thing.

Sometimes the symptoms of asthma may worsen or be difficult to control. A severe onset of symptoms is known as an asthma attack or an 'acute asthma exacerbation'. Asthma attacks may require hospital treatment and can sometimes be life-threatening, although this is rare.

A doctor explains how a person having an acute asthma attack is treated in hospital. This may include oral steroid tablets and using a nebuliser to get medication into the airways effectively. Some people may need to go to hospital.

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An asthma attack is where the airways narrow rather quickly and so they have a relatively rapid onset of breathlessness and wheeze. Under those circumstances, they’ll know, the individual will know what to do themselves. But if that fails then they need to seek medical advice. Either go to their GP or if necessary go to the accident and emergency department at the nearest hospital. Treatment then is usually with what’s called a nebuliser, which is a, a mask whereby a solution of bronchodilator, which is the same stuff as we give in the blue relief inhaler as a mist and its basically given in, in large dose, so that you get a larger dose of drug, getting into the airways. And that’s very effective.

But if an individual needs nebulised therapy, then, very strong and careful consideration needs to be given to whether they need a course of oral steroids to try and cut down the inflammation, which was, which flared up, and therefore gave rise to the attack.

Now some people may be admitted to hospital. Some people may be discharged after a period of observation in, in the A & E department. It really depends upon how quickly an individual responds and so on. If they’re admitted to hospital, then in general terms they’ll be admitted for two or three days, sometimes longer. For children it’s usually 24, 48 hours tops.

And other than nebulised treatment and possibly some oral steroids, what other treatments?

Well sometimes we will give intravenous dosing of the bronchdilator drug again. Solely because if the airways are very, very narrow, trying to get air, the stuff into the lungs by inhalation is, the problem is that the airways are narrowed. And therefore you can’t get the drugs out to the very smallest airways. That’s sometimes then you have to give the drugs intravenously, so that they just get to the lungs by another route. And of course, if you need intravenous drugs like that, then usually people are kept in hospital for longer.

And so they would stay in hospital until their condition…?

Until their condition is stabilised, peak flows have started to settle down and so on.

Margaret describes an occasion when she had to go to hospital for an acute asthma attack.

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Age at interview: 62

Sex: Female

Age at diagnosis: 47

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Can you describe when you had catastrophic attack how that, actually what you were feeling. Did it come on quite suddenly?

It did. I, we went to, we went to the doctor very early on, I said, you know, I woke up and I could tell the night before I wasn’t feeling too good. And I said to my husband, “I just need to go.” You know, and we, it was at the time when it was walk in appointments. So we walked in and we, we were given the standard prescription for oral steroids and we then went, we went to Sainsbury’s shopping and I can remember just sort of, I don’t know how I got round, but there was a pharmacy there and that’s why we’d been there. And we got back and I said to my husband, “I’ve, I’ve just got to sit in the car.” Because we live up 25 steps so [laughs] it wasn’t a case of just walking into our house. And he just took me back down to the doctor, who then, you know, rang forward to the hospital. And when I got in there, I wasn’t actually frightened, I can actually remember actually kneeling by the bed, because that was the most comfortable way. You kneel and you lean forward. And I actually can remember thinking if I die. I die.

Did you think it could happen?

It could happen, but there was no sort of panic about it because you get to a point where you think…

You go with it…?

Let’s just go with it. You can’t, you can’t really fight. You know, you can only just do whatever you know, sort of, sort of try and relax yourself. And it was just, there was a 20 minute period where it was really bad. And I was being monitored every ten minutes. You know, blood pressure and I couldn’t when you’re in that state you can’t do a peak flow you know, [laughs] You know, you’ve got to use your, your breath for other things, than to give measurements to, to medical staff.

Did you have a nebuliser at that time?

Yes, I’d had a nebuliser and there was only, I mean I was having a nebuliser every, I don’t know, twenty minutes, you know.

And how soon did it pass off?

It passed off to bearable within less than two to three hours.

The number of both children and adults diagnosed with asthma has risen over the last few decades. It is not clear how far this is because there are more people with the condition or because diagnosis is now more accurate.

There are some concerns that it is being ‘over-diagnosed’ in people with very mild and temporary symptoms.

Some people we talked to felt that the rise in the number of people with the condition has made it more visible, and that it is therefore better understood and accepted by others than it was in the past.

Last reviewed: August 2017.

Last updated: August 2017.