Overview

Asthma is a common lung condition that causes occasional breathing difficulties.

It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults.

There's currently no cure, but there are simple treatments that can help keep the symptoms under control so it does not have a big impact on your life.

Get the flu vaccine

Flu can be very serious for some people with asthma. You may be able to get a free flu vaccine from:

• your GP surgery
• a local pharmacy that has a flu vaccine service

Symptoms of asthma

The main symptoms of asthma are:

• a whistling sound when breathing (wheezing)
• breathlessness
• a tight chest, which may feel like a band is tightening around it
• coughing

The symptoms can sometimes get temporarily worse. This is known as an asthma attack.

When to see a GP

See your GP if you think you or your child may have asthma.

Several conditions can cause similar symptoms, so it's important to get a proper diagnosis and correct treatment.

The GP will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests.

Me and My Health

If you have a long-term physical or mental health condition, this scheme aims to help you and your carer to provide clear information to health and care staff who may need to visit your home in an emergency. See here for more information.

Treatments for asthma

Asthma is usually treated by using an inhaler, a small device that lets you breathe in medicines.

The main types are:

• reliever inhalers – used when needed to quickly relieve asthma symptoms for a short time
• preventer inhalers – used every day to prevent asthma symptoms occurring

Some people also need to take tablets.

Causes and triggers

Asthma is caused by swelling (inflammation) of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.

It may occur randomly or after exposure to a trigger. Common asthma triggers include:

• allergies (to house dust mites, animal fur or pollen, for example)
• smoke, pollution and cold air
• exercise
• infections like colds or flu

Identifying and avoiding your asthma triggers can help you keep your symptoms under control.

How long does it last?

Asthma is a long-term condition for many people, particularly if it first develops when you're an adult.

In children, it sometimes goes away or improves during the teenage years, but can come back later in life.

The symptoms can usually be controlled with treatment. Most people will have normal, active lives, although some with more severe asthma may have ongoing problems.

Complications

Although asthma can normally be kept under control, it's still a serious condition that can cause a number of problems.

This is why it's so important to follow your treatment plan and not ignore your symptoms if they're getting worse.

Badly controlled asthma can cause problems such as:

• feeling tired all the time
• underperformance at or absence from work or school
• stress, anxiety or depression
• disruption of your work and leisure because of unplanned visits to a GP or hospital
• lung infections (pneumonia)
• delays in growth or puberty in children

There's also a risk of severe asthma attacks, which can be life-threatening.

Symptoms

Most children and adults with asthma have times when their breathing becomes more difficult.

Some people with severe asthma may have breathing problems most of the time.

The most common symptoms of asthma are:

• wheezing (a whistling sound when breathing)
• breathlessness
• a tight chest – it may feel like a band is tightening around it
• coughing

Many things can cause these symptoms, but they're more likely to be asthma if they:

• happen often and keep coming back
• are worse at night and early in the morning
• seem to happen in response to an asthma trigger like exercise or an allergy (such as to pollen or animal fur)

See a GP if you think you or your child may have asthma, or you have asthma and are finding it hard to control.

Asthma attacks

Asthma can sometimes get worse for a short time – this is known as an asthma attack. It can happen suddenly, or gradually over a few days.

Signs of a severe asthma attack include:

• wheezing, coughing and chest tightness becoming severe and constant
• being too breathless to eat, speak or sleep
• breathing faster
• a fast heartbeat
• drowsiness, confusion, exhaustion or dizziness
• blue lips or fingers
• fainting

Who can get it

Diagnosis

Asthma can usually be diagnosed from your symptoms and some simple tests.

A GP will probably be able to diagnose it, but they may refer you to a specialist if they're not sure.

Seeing a GP

The GP may ask:

• what symptoms you have
• when they happen and how often
• if anything seems to trigger them
• if you have conditions such as eczema or allergies, or a family history of them

They may suggest doing some tests to confirm if you have asthma.

These cannot always be done easily in young children, so your child may be given an asthma inhaler to see if it helps relieve their symptoms until they're old enough to have the tests.

Tests for asthma

The main tests used to help diagnose asthma are:

• FeNO test – you breathe into a machine that measures the level of nitric oxide in your breath, which is a sign of inflammation in your lungs
• spirometry – you blow into a machine that measures how fast you can breathe out and how much air you can hold in your lungs
• peak flow test – you blow into a handheld device that measures how fast you can breathe out, and this may be done several times over a few weeks to see if it changes over time

After you're diagnosed with asthma, you may also have allergy tests to see if your symptoms might be triggered by an allergy.

Treatment

There's currently no cure for asthma, but treatment can help control the symptoms so you're able to live a normal, active life.

Inhalers – devices that let you breathe in medicine – are the main treatment. Tablets and other treatments may also be needed if your asthma is severe.

You'll usually create a personal action plan with a doctor or asthma nurse.

This includes information about your medicines, how to monitor your condition and what to do if you have an asthma attack.

Inhalers

Inhalers can help:

• relieve symptoms when they occur (reliever inhalers)
• stop symptoms developing (preventer inhalers)

Some people need an inhaler that does both (combination inhalers).

Reliever inhalers

Most people with asthma will be given a reliever inhaler. These are usually blue.

You use a reliever inhaler to treat your symptoms when they occur. They should relieve your symptoms within a few minutes.

Tell your GP or asthma nurse if you have to use your reliever inhaler 3 or more times a week. They may suggest additional treatment, such as a preventer inhaler.

Reliever inhalers have few side effects, but they can sometimes cause shaking or a fast heartbeat for a few minutes after they're used.

Asthma + Lung UK has more information on reliever inhalers.

Preventer inhalers

If you need to use a reliever inhaler often, you may also need a preventer inhaler.

You use a preventer inhaler every day to reduce the inflammation and sensitivity of your airways, which stops your symptoms occurring. It's important to use it even when you do not have symptoms.

Speak to a GP or asthma nurse if you continue to have symptoms while using a preventer inhaler.

Preventer inhalers contain steroid medicine.

They do not usually have side effects but can sometimes cause:

• a fungal infection of the mouth or throat (oral thrush)
• a hoarse voice
• a sore throat

You can help prevent these side effects by using a spacer, which is a hollow plastic tube you attach to your inhaler, as well as by rinsing your mouth or cleaning your teeth after using your inhaler.

Asthma + Lung UK has more information on preventer inhalers.

Combination inhalers

If using reliever and preventer inhalers does not control your asthma, you may need an inhaler that combines both.

Combination inhalers are used every day to help stop symptoms occurring and provide long-lasting relief if they do occur.

It's important to use it regularly, even if you do not have symptoms.

Side effects of combination inhalers are similar to those of reliever and preventer inhalers.

Asthma + Lung UK has more information on combination inhalers.

Did you know that by managing your lung condition well you can feel your best and help the environment?

NHS Wales are working to support you to make changes so you can live better with your lung condition and help the environment at the same time.

Here are four quick and simple things you can do today:

• Use your preventer inhaler every day, as prescribed, to lower your risk of asthma attacks.
• Check your technique and use the right inhaler technique.
• Find out more about low carbon inhalers, and together with a healthcare professional, change to a lower-carbon inhaler.
• Take used or unwanted inhalers back to your local pharmacy for safe disposal and understand how inhalers impact the environment.

Visit Inhaler choices | Asthma + Lung UK (asthmaandlung.org.uk) to find out more about these four simple steps and talk to your healthcare professional at your next appointment and ask about your inhaler choices. (Gwefan annibynnol, heb fod dan gyfrifoldeb LlC/Independent website, not under WG responsibility)

Tablets

You may also need to take tablets if using an inhaler alone is not helping control your symptoms.

Leukotriene receptor antagonists (LTRAs)

LTRAs are the main tablets used for asthma. They also come in syrup and powder form.

You take them every day to help stop your symptoms occurring.

Possible side effects include tummy aches and headaches.

Theophylline

Theophylline may also be recommended if other treatments are not helping to control your symptoms.

It's taken every day to stop your symptoms occurring.

Possible side effects include headaches and feeling sick.

Asthma + Lung UK has more information on theophylline.

Steroid tablets

Steroid tablets may be recommended if other treatments are not helping to control your symptoms.

They can be taken either:

• as an immediate treatment when you have an asthma attack
• every day as a long-term treatment to prevent symptoms – this is usually only necessary if you have very severe asthma and inhalers do not control your symptoms

Long-term or frequent use of steroid tablets can occasionally cause side effects such as:

• increased appetite, leading to weight gain
• easy bruising
• mood changes
• fragile bones (osteoporosis)
• high blood pressure

You'll be monitored regularly while taking steroid tablets to check for signs of any problems.

Asthma + Lung UK has more information on steroid tablets.

Other treatments

Other treatments, such as injections or surgery, are rarely needed but may be recommended if all other treatments are not helping.

Injections

For some people with severe asthma, injections given every few weeks can help control the symptoms.

The main injections for asthma are:

• benralizumab (Fasenra)
• omalizumab (Xolair)
• mepolizumab (Nucala)
• reslizumab (Cinqaero)

These medicines are not suitable for everyone with asthma and can only be prescribed by an asthma specialist.

The main side effect is discomfort where the injection is given.

Surgery

A procedure called bronchial thermoplasty may be offered as a treatment for severe asthma. It works well and there are no serious concerns about its safety.

You will be sedated or put to sleep using a general anaesthetic during a bronchial thermoplasty. It involves passing a thin, flexible tube down your throat and into your lungs. Heat is then used on the muscles around the airways to help stop them narrowing and causing asthma symptoms.

Asthma + Lung UK has more information on bronchial thermoplasty.

Complementary therapies

Several complementary therapies have been suggested as possible treatment for asthma, including:

• breathing exercises - such as techniques called the Papworth method and the Buteyko method
• traditional Chinese herbal medicine
• acupuncture
• ionisers - devices that use an electric current to charge molecules of air
• manual therapies - such as chiropractic
• homeopathy
• dietary supplements

There's little evidence to suggest many of these treatments help.

There's some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some people, but they should not be used instead of your medicine.

Asthma + Lung UK has more information on complementary therapies for asthma.

Work-related asthma

If you seem to have occupational asthma, where your asthma is linked to your job, you'll be referred to a specialist to confirm the diagnosis.

If your employer has an occupational health service, they should also be informed, along with your health and safety officer.

Your employer has a responsibility to protect you from the causes of occupational asthma. It may sometimes be possible to:

• substitute or remove the substance that's triggering your asthma from your workplace
• redeploy you to another role within the company
• provide you with protective breathing equipment

Want to know more?

• Asthma +Lung UK: occupational asthma
• Health and Safety Executive: asthma at work

Living with

Identify and avoid your triggers

It's important to identify possible asthma triggers by making a note of where you are and what you're doing when your symptoms get worse.

Some triggers can be hard to avoid, but it may be possible to avoid some, such as dust mites, pet fur and some medicines. See allergy prevention for more information.

Speak to your doctor or asthma nurse for advice if you think you've identified a trigger for your symptoms.

Asthma + Lung UK has more information about asthma triggers.

Regular check-ups

You'll have regular contact with your doctor or asthma nurse to monitor your condition.

These appointments may involve:

• talking about your symptoms – for example if they're affecting your normal activities or are getting worse
• a discussion about your medicines – including if you think you might be experiencing any side effects and if you need to be reminded how to use your inhaler
• breathing tests

It's also a good chance to ask any questions you have or raise any other issues you want to discuss

You may be asked to help monitor your condition between appointments. For example, you may be advised to check your peak flow if you think your symptoms may be getting worse.

Your personal action plan should say what to do if your symptoms get gradually or suddenly worse. Contact your doctor or asthma nurse if you're not sure what to do.

Cold weather and asthma

Cold weather is a common trigger for asthma symptoms. Asthma UK advises the following to help you control your symptoms in the cold:

• carry your reliever inhaler with you at all times and keep taking your regular preventer inhaler as prescribed
• if you need to use your inhaler more than usual, speak to your doctor about reviewing your treatment
• keep warm and dry – wear gloves, a scarf and a hat, and carry an umbrella.
• wrap a scarf loosely over your nose and mouth – this will help warm up the air before you breathe in
• try breathing in through your nose instead of your mouth - your nose warms the air as you breathe

Asthma + Lung UK has more about weather and asthma

Travelling with asthma

Asthma should not stop you from travelling, but you'll  need to take extra precautions when going on holidays and long trips.

Make sure you have enough medicine with you, and keep your reliever inhaler easily accessible.

If you've not seen your doctor or asthma nurse for a while, it's a good idea to see them before you travel to review your personal action plan and make sure it's up-to-date.

Your doctor or asthma nurse can also advise you about travelling with asthma.

Asthma + Lung UK has more about asthma and travel.

Pregnancy and asthma

Asthma does not affect your chances of having children, and the vast majority of women with asthma will have a normal pregnancy.

Generally, treatment stays the same during pregnancy. Most asthma medicines, particularly inhalers, are considered safe while pregnant or breastfeeding.

But you should speak to your doctor or asthma nurse for advice if you become pregnant or are planning a pregnancy, because:

• your symptoms may get worse during pregnancy - although some women find they improve - so your treatment may need to be reviewed regularly
• poorly controlled asthma in pregnancy can increase the risk of complications such as pre-eclampsia and premature birth
• extra precautions may need to be taken during labour to avoid an asthma attack, although attacks during labour are rare

Want to know more?

• Asthma in pregnancy
• Asthma + Lung UK: asthma and pregnancy

Asthma at school

Most children with well-controlled asthma can learn and participate in school activities without being affected by their condition.

But it's important to ensure the school has up-to-date written information about your child's asthma medicines, including what they are, how much they take and when they need to take them.

You may also need to supply the school with a spare reliever inhaler for use if your child experiences symptoms during the school day.

Staff at the school should be able to recognise worsening asthma symptoms and know what to do in the event of an attack, particularly staff supervising sport or physical education.

Your child's school may have an asthma policy in place, which you can ask to see.

Asthma + Lung UK has more about asthma at school and nursery.

Talking to others

Many people with long-term health conditions such as asthma experience feelings of stress, anxiety and depression.

You may find it helpful to talk about your experience of asthma with others. Patient organisations have local groups where you can meet people who have been diagnosed with asthma and have undergone treatment.

If you feel you're struggling to cope, talk to your GP. They will be able to give advice and support. Alternatively, you can find depression support services in your area.

Want to know more?

• Health Unlocked: asthma community

Financial issues and help

Benefits

Depending on how severely asthma affects you on a daily basis, you may be entitled to some benefits, such as:

• Employment and Support Allowance – a benefit paid to people who are not able to work because of ill health or disability
• Personal Independence Payment – a benefit that helps with some of the extra costs caused by long-term ill health or a disability if you're aged 16 to 64
• Attendance Allowance – a benefit for help with the extra costs you may have if you're 65 or over and have a physical or mental disability, and need someone to help look after you

If you're on a low income, you may also be entitled to some help with healthcare costs.

Want to know more?

GOV.UK: benefits

Work-related asthma

If you develop asthma because of your work, and this is fully documented by your doctor and your employer, you can make a claim for Industrial Injuries Disablement Benefit.

This is a weekly amount paid to people with asthma caused by work-related exposure to a specific substance known to be associated with asthma. A list of asthma-causing substances is available from the Health and Safety Executive.

If you want to take legal action against your employer because of occupational asthma, your lawyer must act within 3 years of diagnosis.

Want to know more?

Asthma + Lung UK: occupational asthma
GOV.UK: Industrial Injuries Disablement Benefit
Money Advice Service: money issues if you're ill or disabled

Asthma attacks

Asthma attacks kill 3 people in the UK each day. But many of these deaths could be avoided.

Every 10 seconds someone has a potentially life-threatening asthma attack. Find out what your risk of having an attack is using Asthma UK's asthma attack risk checker.

If you're on the right asthma treatment, your chance of having an attack is greatly reduced. Visit your doctor or asthma nurse at least once a year for a check-up and to discuss your treatment.

Symptoms of an asthma attack

Signs that you may be having an asthma attack include:

• your symptoms are getting worse (cough, breathlessness, wheezing or tight chest)
• your reliever inhaler (usually blue) isn't helping
• you're too breathless to speak, eat or sleep
• your breathing is getting faster and it feels like you can't catch your breath
• your peak flow score is lower than normal
• children may also complain of a tummy or chest ache

The symptoms won't necessarily occur suddenly. In fact, they often come on slowly over a few hours or days.

What to do if you have an asthma attack

If you think you're having an asthma attack, you should:

1. Sit upright (do not lie down) and try to take slow, steady breaths. Try to remain calm, as panicking will make things worse.
2. Take 1 puff of your reliever inhaler (usually blue) every 30 to 60 seconds, up to a maximum of 10 puffs.
3. Call 999 for an ambulance if you do not have your inhaler with you, you feel worse despite using your inhaler, you do not feel better after taking 10 puffs or you're worried at any point.
4. If the ambulance has not arrived within 15 minutes, repeat step 2.

Never be frightened of calling for help in an emergency.

Try to take the details of your medicines (or your personal asthma action plan) with you to hospital if possible.

If your symptoms improve and you don't need to call 999, get an urgent same-day appointment to see your GP or asthma nurse.

This advice is not for people on SMART or MART treatment. If this applies to you, ask your GP or asthma nurse what to do if you have an asthma attack.

After an asthma attack

You should see a GP or asthma nurse within 48 hours of leaving hospital, or ideally on the same day if you did not need hospital treatment.

About 1 in 6 people treated in hospital for an asthma attack need hospital care again within 2 weeks, so it's important to discuss how you can reduce your risk of future attacks.

Talk to your doctor or nurse about any changes that may need to be made to manage your condition safely.

For example, the dose of your treatment may need to be adjusted or you may need to be shown how to use your inhaler correctly.

Preventing asthma attacks

The following steps can help you reduce your risk of having an asthma attack:

• follow your personal asthma action plan and take all of your medicines as prescribed
• have regular asthma reviews with a GP or asthma nurse – these should be done at least once a year
• check with a GP or asthma nurse that you're using your inhaler correctly
• avoid things that trigger your symptoms whenever possible

Do not ignore your symptoms if they're getting worse or you need to use your reliever inhaler more often than usual.

Follow your action plan and make an urgent appointment to see a GP or asthma nurse if your symptoms continue to get worse.

Advice for friends and family

It's important that your friends and family know how to help in an emergency.

It can be useful to make copies of your personal asthma action plan and share it with others who may need to know what to do when you have an attack.

You can photocopy your existing plan, or you could download a blank personal asthma action plan (PDF, 681kb) from Asthma UK and fill it in for anyone who might need a copy.

Alternatively, you could take a photo of your action plan on your phone, so you can show or send it to others easily.