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Asthma in adults

This factsheet is for adults with asthma. If your child has asthma, please see the separate BUPA factsheet:
Asthma in children

Asthma is a common condition that causes coughing, wheezing, tightness of the chest and breathlessness. About 1 in 12 adults are treated in the UK for asthma each year. Asthma can start at any age.

Most people with asthma who take the appropriate treatment can live normal lives. But left untreated, asthma can cause permanent damage to the airways. Very rarely, a severe asthma attack can be fatal.

What is asthma?

Asthma is a condition where the airways become irritated and inflamed.

As a result, they:

• become narrower
• produce extra mucus

This makes it more difficult for air to flow into and out of the lungs and causes the symptoms of asthma.

Asthma symptoms

Asthma symptoms may be mild, moderate or severe. They may include:

• coughing
• wheezing
• shortness of breath
• tightness in your chest

These symptoms tend to be variable and may stop and start. They are usually worse at night.

Causes

The exact cause of asthma isn't fully understood at present. Sometimes, the symptoms flare up for no obvious reason, but you may notice certain triggers that set off an asthma attack or make your symptoms worse. These triggers irritate the airways in your lungs and can include:

• infections such as colds and flu
• irritants such as dust, cigarette smoke, fumes
• chemicals found in the workplace - this is called occupational asthma
• allergies to pollen, medicines, animals, house dust mite or certain foods
• exercise - especially in cold, dry air
• emotions - laughing or crying very hard can trigger symptoms, as can stress

Risk factors

Factors thought to affect your risk of developing asthma include those listed below.

• asthma often runs in families and you can inherit the tendency to get inflamed bronchial tubes
• if you are a woman, you are more likely to have asthma, whereas boys are more likely than girls to get asthma as a child
• there is a theory (called the hygiene hypothesis) that people in developed countries are no longer exposed to the kinds of infections they would have had to deal with in the past so the immune system over-reacts to harmless substances

Diagnosis

If you think you have asthma, consult your GP. He or she will ask you about your symptoms and if you have noticed any factors that trigger the symptoms. Your GP will also do a physical examination.

Your doctor may do one or more of the tests listed below.

• a device called a peak flow meter can help your doctor to diagnose asthma. A peak flow meter measures how much, and how fast, air can be expelled from your lungs. This device can also be used to monitor whether a treatment works for you
• a spirometry test can also measure how well your lungs are functioning but provides more detailed information than a peak flow meter
• less commonly, other tests such as chest X-rays are done to make sure you do not have any other breathing problems. For example, a disease called chronic obstructive pulmonary disease has similar symptoms to asthma. For more information, please see the separate BUPA factsheet:
  Chronic obstructive pulmonary disease (COPD)
• an allergy skin test may be done to find out whether you are allergic to certain substances

Treatment

Asthma cannot be cured. Treatments will aim to reduce the frequency, severity and length of your asthma attacks. Because a lot of different factors are involved in asthma, your treatment plan will be individual to you, combining medicines and asthma management in the way that works best for you.

Inhalers

These devices (sometimes called 'puffers') contain a gas that will propel the correct dose of medication when the top is pressed down. This is inhaled into your airways. You will need to use your inhaler correctly in order for it to work properly, so ask your doctor for advice.

There are two basic categories of inhaler medicines that are used for asthma:

• relievers - which treat your symptoms
• preventers - which can prevent your symptoms

Relievers are to be used when your asthma symptoms occur. They can be short-acting or long-acting. Short-acting relievers (known as bronchodilators) contain medicines such as salbutamol (eg Ventolin) and terbutaline (Bricanyl) that work to widen your airways and quickly ease your symptoms.

If your asthma is not well-controlled using a regular steroid (see preventers below) and occasional use of a short-acting reliever, a long-acting reliever can be added to your treatment. Long-acting relievers contain medicines such as salmeterol (Serevent) or formoterol (eg Oxis).

Reliever inhalers are usually a blue or green colour.

Preventers are used every day - even if you do not have symptoms. They are used to help you prevent symptoms. Preventers usually contain a steroid medicine, such as beclometasone (eg Becotide) or fluticasone (Flixotide) that work to reduce the inflammation of your airways. Side-effects are unusual at normal doses (although they can sometimes cause a sore mouth or throat). It can take up to six weeks for the full effect of preventer medicines to build up, but once they do, you may not need to use your reliever inhaler at all.

Preventer inhalers are usually a brown, orange or red colour.

Spacers

A device called a 'spacer' can help you use your inhaler correctly. A spacer is a long tube which clips onto the inhaler. At the other end of the tube is a mouthpiece to breathe in and out of.

It is easier to use because it enables you to activate the inhaler, then inhale in two separate steps. Using a spacer also reduces the risk of getting a sore throat from using a steroid inhaler.

Other medicines

If you have a severe asthma attack you may be treated with a course of steroid tablets, such as prednisolone. In this case, steroids are used as a 'reliever' therapy. If you take steroid tablets for about a week there are few side-effects. Side-effects of steroids are usually associated with taking tablets for several months or at high doses.

Several other medicines are available as tablets and inhalers if the standard treatments are not suitable for you, either because of side-effects or if your asthma is still not adequately controlled. These include tablets of montelukast (Singulair), zafirlukast (Accolate) or theophylline (eg Slo-Phyllin).

Nebulisers

Nebulisers make a mist of water and asthma medicine that you breathe in. They can deliver more of the drug to exactly where it's needed than conventional inhalers can. This is particularly critical if you have a moderate or severe asthma attack.

Nebulisers are often used in hospital, but occasionally people buy them to use at home. Nebulisers are not available on the NHS in England and Wales but you can purchase one - most manufacturers sell them by mail order.

Asthma attacks - what to do

In the event of an asthma attack you should:

• take your reliever treatment immediately, preferably with a spacer
• sit down (don't lie down) and try to relax
• wait 5-10 minutes - if your symptoms disappear you do not need to do anything
• if your symptoms do not go away, then you should call a doctor or an ambulance
• continue taking your reliever, preferably with a spacer, every few minutes until helps arrives

If you go to hospital, take details of your asthma treatments with you.

Visit your GP after you are discharged from hospital so you can review your treatment.

Asthma management

Medicines are only part of your treatment for asthma. Asthma also needs to be managed by dealing with the things that make it worse. Identifying and avoiding the things that trigger your asthma are an essential part of your overall treatment plan.

Keeping a diary to record anything that triggers your asthma can help you to discover a pattern. Using a peak flow meter to monitor your lung function can also help. Repeatedly low readings in a certain situation may indicate the trigger.

If you smoke, you should give up as this is good for your health and will improve your asthma symptoms. For more information on how to quit, please see the separate BUPA factsheet:
Giving up smoking

With good management and appropriate treatment, most people with asthma lead completely normal lives.

Further information

• Asthma UK
  0845 701 0203
  www.asthma.org.uk
• The British Thoracic Society
  020 7831 8778
  www.brit-thoracic.org.uk

References

• Where do we stand? Asthma UK.
  www.asthma.org.uk
  accessed 6 September 2005
• Asthma. British Lung Foundation.
  www.lunguk.org
  accessed 2 September 2005
• Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002.
• British guideline on the management of asthma - A national clinical guideline. British Thoracic Society, Scottish Intercollegiate Guidelines Network. April 2004.
• PRODIGY Guidance - Asthma. UK Department of Health. PRODIGY.
  www.prodigy.nhs.uk
  accessed 2 September 2005
• British National Formulary 49, March 2005.
• Inhalers for Asthma. PRODIGY patient information leaflet. UK Department of Health. PRODIGY.
  www.prodigy.nhs.uk
  accessed 31 August 2005
• Six step plan. Asthma UK.
  www.asthma.org.uk
  accessed 2 September 2005

Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP. partner/principal general practitioner at Rowcroft Medical Centre.

Published by BUPA's health information team, healthinfo@bupa.com, October 2005

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