Asthma

Asthma is a chronic condition centralised around the airway system; these are the tubes that carry air in and out of your lungs. The term "chronic condition" sounds far more severe than the reality, and simply means that it is "long-term". Whilst asthma is "chronic", it is known for an adult to 'grow out' of the condition as they get older, and it is certainly well manageable for the vast majority of asthmatics.

Depending on the intensity of the condition, the amount of triggers, the symptoms and the severity can vary massively. This results in many levels of asthma and many inhalers to help combat the condition.

With the broad spectrum, this can produce a misunderstanding surrounding asthma and the best way of managing the condition correctly, which is all detailed on this page.

These varying triggers and causes of asthma can provoke the airways leading to inflammation that can be categorised into three types listed below. The symptoms produced - such as wheezing and breathlessness - are a result of the body reacting to the trigger. To put simply, asthmatics have highly sensitive lungs and airways. The airway sensitivity can differ between asthmatics, and it's this that will determine which inhaler is right for you:

• Inflammation – the airways become swollen, making it difficult for the air to pass through without soreness and enough air to reach and leave the lungs.
• Muscle tightening – the airways tense resulting in them becoming narrower and reducing the amount of air that can be inhaled and exhaled.
• Mucus build-up – Mucus, or phlegm, is produced as the body looks to unnecessarily prevent a "threat" (aka the trigger) that narrows the airways.

Asthma is generally split into non-allergic and allergic, and it is possible to have one or all of these issues with both types. For example, if a cold virus has triggered your asthma, you may find your airways have become inflamed and there is a mucus build-up.

There could be a number of reasons that provoke symptoms from person-to-person. Luckily, there is an abundance of effective inhalers available in the UK and self-help tactics that can help you manage the condition. Some asthma causes include:

• A family history of asthma, allergies and eczema
• A past lung infection such as bronchiolitis (especially when you were a child)
• If you were born prematurely or your birth weight was below average
• If you required the use of an inhaler at a young age
• If your mother smoked whilst she was pregnant with you
• If you were subjected to secondhand smoke (so your parents or other relatives smoked whilst you were a child)
• If you are subjected to secondhand smoke now (with friends and family)
• If your work environment includes harmful chemicals or smoke that could damage the airways
• If you are a woman (asthma affects slightly more women than men due to hormone imbalance, especially around the time of the menopause)

What's the difference between a cause and a trigger?

The cause of your particular condition differs from a trigger, as it is the catalyst. Whilst a trigger can provoke this long-term condition, a cause is underlining factor and creates a knock-on effect that prompts the particular trigger(s).

Depending on what your particular cause(s) is, will conclude the type of asthma you have. Many asthmatics have had asthma since they were a child and have therefore had the time and experience to establish a foolproof manageable plan.

Childhood asthma

More children are diagnosed with asthma in the UK than adults. If you're an adult with asthma, it's most likely that you experienced the condition in your childhood at some point.

Those children with mild to severe symptoms are more likely to have the condition long-term and well into adulthood, although many find symptoms improving over time. For some children, asthma disappears completely and others may find it disappears then reappears in later life if a trigger occurs or health declines.

Adult onset asthma

Also referred to as ' late onset asthma', if you develop asthma in adulthood, you fall into this category. It is easier to establish asthma in children as there are fewer lifestyle factors or illnesses to take into account. For example, smoking, pollution, exercise and hormonal changes can all provoke symptoms of asthma in adulthood. It is also possible that allergies develop over time and mental health factors such as depression and anxiety can result in asthma. Furthermore, in adulthood, asthma can be trickier to diagnose, as there are other conditions such as COPD, heart disease and bronchitis that could be the cause.

Seasonal asthma

The main cause of seasonal asthma is hay fever. If you are allergic to pollen and this is tightening your airways, your doctor may offer you a reliever inhaler for the spring and summer months to alleviate pressure.

Whilst this is uncommon, you may only experience symptoms in the cold weather and many asthmatics find this can increase the severity of symptoms. Alternatively, hot weather, damp weather and even thunderstorms can trigger symptoms, which just goes to show the vast nature of the condition.

Severe asthma

Severe asthma affects around 4% of asthmatics and asthma classed as 'difficult to control' affects a further 13% according to asthma.org.uk. For those in the 'difficult to control' category, you can control asthma but you require specific medication taken at the correct times on a daily basis. You will also need to attend frequent check-ups. As long as your condition is correctly managed, you can live a symptomless life.

For the 4% with severe asthma, you will have had no success with any medication for the condition. You will need on-going care, often provided by the hospital and may even require weekly visits. In the past, severe asthma has been called 'brittle asthma' and 'refractory asthma', however, the much clearer term 'severe asthma' is now used.

Occupational asthma

Occupational asthma is triggered by your occupation, or your work/job. The majority of asthmatics in this category will also fall under 'adult onset asthma'. Workplaces that can trigger asthma include those with manual labour such as a builder, but also professions involving chemicals and contained areas with a lack of fresh air. This could also encourage 'childhood asthma' to return.

There are many asthma triggers, which can vary depending on the cause, the type of asthma and even the weather. Over time, you will gain a greater understanding of what can provoke any symptom(s) of asthma, and learn to avoid or minimise these in your daily life. For example, if you have seasonal asthma caused by hay fever, taking the precautions advised for avoiding pollen will have a positive effect. This could include keeping the windows closed and avoiding large green areas. Quite often, a trigger isn't something you can completely avoid so understanding them and reacting swiftly is advised.

• Feeling ill (cold or flu viruses)
• Pollution
• Smoking or secondhand smoke
• Depression or anxiety
• Stress
• Hay fever (pollen)
• Animals and pets (pet dander)
• The weather
• Dust mites
• Chemicals
• Enclosed environments
• Certain foods and drinks (i.e. alcohol)
• Mould and fungi
• Drugs
• Hormones (i.e. the menopause)
• Sex
• Exercise

All asthmatics are shown how to use their inhaler and advised to carry a reliever at all times; this can offer protection and relief if any symptoms have caught you off-guard. It is also recommended that you keep a couple of inhalers spare and check the dates, as they do expire. You can also limit some triggers such as chemicals, pollution and exercise by being responsible such as wearing masks to avoid inhalation, or not pushing yourself too hard at the gym. There are also self-help techniques. For example, for stress and anxiety, medication apps and breathing techniques can calm nerves as well as help this condition.

Whilst causes and triggers can vary, the symptoms for most are very similar and these all revolve around your airways and chest:

• Breathlessness
• Wheezing
• Coughing
• Lightheadedness
• A tight chest

Many asthmatics manage their symptoms with the use of inhalers. This becomes easier over time as you become familiar with your particular strain of the condition. For example, a mild asthmatic and avid gym-goer may use the reliever inhaler Ventolin 10 minutes before a cardio session to help open his or her airways quickly. In comparison, an asthmatic with more persistent symptoms may need to use a Qvar preventer inhaler twice a day as they know sprinting for the bus could prompt an asthma attack.

Whilst asthma can be triggered by lifestyle choices such as smoking, it is often hereditary. It is also more likely for a child to develop asthma than an adult with one in 11 children in the UK currently diagnosed with the chronic condition in comparison to one in 12 adults.

It is important to be vocal and book an appointment with your doctor if you or your child has been experiencing any of the symptoms associated with asthma. It's also important to remember that a diagnosis can take some time as symptoms and triggers vary. This is especially true in adults as we pick up habits such as smoking or work in unhealthy environments. Before visiting your GP, make a note of any information that can help with your diagnosis:

• Make a list of your symptoms
• Note the days and times of which these symptoms are prevalent
• Can you pinpoint any possible triggers?

Whilst asthma is common, there are other conditions associated with the airways and the lungs such as chronic obstructive pulmonary disease (COPD) and bronchitis. This makes booking an appointment even more necessary so you can receive the best possible treatment and advice. Even certain inhalers can have an adverse effect if you are not using the right one for your particular strain of the condition.

By arriving at your doctor's appointment with an abundance of information, your doctor or nurse will be able to analyse your particular scenario more effectively.

The doctor will ask you questions regarding your family's health history as well as your own personal medical records. You will also be asked about your particular symptoms, whether these have corresponded to anything in particular, your working and living environment and lifestyle choices.

Peak flow reading

The doctor will take a peak flow meter reading, also known as a peak expiratory flow test or PEF. This is a tube with numbers up the side. You will be asked to take a large inhale then exhale sharply into the tube. The doctor may ask you to do this a couple of times to create a realistic average. The result depends on your age, gender and height and is a good indication of how well your lungs are functioning. A peak flow reading is generally taken by all asthmatics, in particular, those who require a reliever inhaler, aka an inhaler used on a needs-be basis.

Spirometry

Also referred to as the reversibility test, you will be given a mouthpiece, which is attached to a spirometer machine. The doctor will ask you to inhale as much as you can then exhale quickly, similar to the peak flow meter process. The doctor can analyse how inflamed your airways if there is a struggle when breathing out. Spirometry is usually connected to asthmatics that requires a preventer inhaler, so continual daily asthma medication.

Airways responsiveness test

If the spirometry test or peak flow reading didn't provide sufficient evidence - and the doctor isn't certain that the condition isn't asthma - they may refer you to the hospital for an airways responsiveness test. This involves provoking asthmatic symptoms by breathing in an irritant such as histamine. The doctor will examine the effects in a controlled environment.

Allergy tests

Asthma can often be linked to allergies such as hay fever or dust mites. To determine whether you have a particular allergy that provokes asthmatic symptoms, the doctor will complete a blood test or a skin-prick test. Asthma medications can be supplied to individuals who suffer from particular allergies. For example, those with bad hay fever symptoms can order an inhaler around the spring and summer months.

FeNO testing

The FeNO test stands for a fractional exhaled nitric oxide test. This is a machine that monitors the level of nitric oxide that is expelled from your body as you breathe out, which can signify the condition.

As mentioned, asthma can differ tremendously between each individual. Whilst most asthmatics handle their condition very effectively and are seldom bothered by the condition, 4% of the UK asthmatics are classed as 'severe asthma'. This includes having frequent attacks and daily symptoms. Having severe asthma can have you feeling a lack of control, however, help is always on-hand in the form of NHS services, helplines from asthma charities and stronger medication.

Take your medication

Up to one in three asthmatics use their inhaler incorrectly. Therefore, it is advised to always take your medication as prescribed and ask your doctor to review the way you use your inhaler. For some, this will mean taking a preventer inhaler twice a day whilst others may only need additional support in the form of a reliever inhaler before partaking in any strenuous activities.

Using a spacer

Inhalers can also come with what is called a "spacer", or "bubble" for individuals who find directly ingesting the medication can irritate their throat. This is particularly handy for the young or the elderly. It is a plastic hollow ball device where the inhaler is placed on one end and you breathe through the opposite end. It's a similar process to using an inhaler, which is detailed below, but the bubble acts as a buffer to reduce the intensity of the medication. It also lessens the likelihood that the medication will aggravate the back of the throat.

Attend your asthma reviews

Like the dentist, your GP will arrange reviews to access your symptoms and whether the medication is working as effectively as possible. Some surgeries have specific asthma nurses who are highly knowledgeable. Depending on your type of asthma and the level of symptoms will determine how many asthma reviews you have, all of which will be arranged by your doctor surgery. Many doctor's surgeries now offer a reminder service as well. Your asthma review is the perfect opportunity to voice any concerns you may have about the condition, or to try a new inhaler.

Asthma reviews are important as the medical professional can assess if the current medication and dosage are right for you. This is particularly important as, in recent years, it has been reported that many asthmatics are not only using their inhalers incorrectly, but they have a wrong dose or type.

Get support

If at any point you feel that your symptoms are out of your control, you can book an appointment with your doctor or asthma nurse without needing to wait for the review. There are also asthma helplines; for asthma.org.uk, this is 0300 222 5800 Monday to Friday 9am-5pm. There is also the British Lung Foundation who can be reached at 0300 0030 555 or through online chat. Do be aware that if you or a loved one is going through an asthma attack and requires assistance, you should be contacting 999 for emergencies or 111 for minor emergencies.

Self-help

As well as inhalers and prescription medication, you can alter and improve your lifestyle to avoid triggering symptoms:

• Quit smoking
• Alter your commute to work
• Cover your mouth on your commute or in the workplace
• Follow best practises in terms of controlling hay fever
• Act quickly when experiencing symptoms
• Medication and calming apps to reduce stress and anxiety

Be aware

Keep a mental note of when triggers will arise and address these when they occur. This could be incorporating a thorough weather review whilst eating breakfast in the morning, or making sure you're not rushing to and from work.

If stress, anxiety or any other mental ailment provokes asthmatic symptoms, you can try exercising, soothing music, yoga or Pilates. There are also great apps for any device that encourage breathing techniques that will not only help your mind but your asthma as well. Headspace is free and a popular app as it focuses on embracing the little noises, rather than attempting to block them out completely.

Many asthmatics will have mild asthma all of their life and will not experience an asthma attack. When you are effectively treating your condition with self-help, additional support and medication in the form of inhalers, any symptoms can lay dormant the vast majority of the time. If symptoms do occur, this will mean they never escalate to the point of an attack. It is possible to recognise an impending attack and take action before it escalates:

• You've had symptoms for a prolonged amount of time
• If these symptoms aren't improving
• If your usual medication (reliever inhaler) isn't working
• If you can't control the speed of your breathing
• If you're having difficulty speaking, sleeping or eating

There are slight differences between an adult experiencing an attack and a child. These guidelines are to aid an adult asthma attack:

• Sit up straight (do not lie down or slouch)
• Inform your partner or housemate if you feel symptoms are out of your control
• Take one puff of your reliever inhaler between 30-60 seconds
• You should do this a maximum of 10 times
• Really concentrate on regulating and slowing down the breathing

By the tenth puff over the course of five to ten minutes, your breathing should have returned to normal or become far more manageable. If it hasn't, or the symptoms have gotten worse, please contact - or get a loved one/colleague to contact - 999. Waiting for an ambulance can be daunting with every minute seeming five times as long, however, if after ten-fifteen minutes you are still struggling, you can repeat the process again.

The leading asthma charity in the UK, asthma.org.uk, has an asthma attack risk checker that takes minutes to complete and can highlight issues in your asthma plan that you or other support may have overlooked.

It is feasible to reduce the possibility of an asthma attack and many of these techniques are under the 'managing asthma effectively' section above. This includes using preventer and reliever inhalers as prescribed and instructed as well as attending all your asthma reviews to make sure you're using the medication correctly. Not only is it good to review the technique you are using for ingesting – we can all fall into bad habits – but to check the frequency and dosages you have been prescribed too. The dosages and type of inhaler are important as an inhaler you use in your childhood or teen years can alter throughout the rest of your life. Other prevention includes monitoring and minimising your exposure to your particular triggers.

If you have seasonal asthma, avoiding the weather can be impossible, but minimising symptoms using your medication and reducing the time spent in that environment can help tremendously. The same goes if allergy-based asthma; avoid the trigger as much as possible.

Inhalers can be split into two categories; reliever and preventers. Preventers are used on a daily basis for those needing continual treatment. A reliever inhaler should only be used when needed (before sport or if you feel short of breath for any reason).

When many people – non-asthmatics and asthmatics - think "asthma treatment", they conclude with the reliever inhaler 'Ventolin' and this is a very effective medication for the chronic condition. However, there are ten times as many medications with different benefits stretching across the entire spectrum of 'asthma'. These include:

• Turbohalers
• Easyhalers
• Accuhalers
• Autohalers
• EasiBreathe Inhalers
• Metered Dose Inhalers

These inhalers all differ in how they are taken. The typical inhaler we're used to seeing works by pressing a button at the top, however, some of these inhalers work by simply opening the device and inhaling, which is a great option if you have arthritis, for example.

• An Accuhaler is a dry powder inhaler also referred to as (DPIs).
• Metered dose inhalers (or MDIs) are aerosols. Spray aerosol inhalers include Ventolin for example. These may also be referred to as puffers.
• The EasiBreathe and Autohalers are activated when you inhaled and can also be referred to as Breath-actuated inhalers (BAIs).

Both relievers and preventers can come in any three of these modes. In terms of colour, reliever inhalers are usually blue and preventers are usually red or brown. There are additional brands of reliever and preventer inhalers available as well as the particular brands detailed below.

Reliever inhalers include:

• Ventolin Accuhaler
• Ventolin Evohaler
• Serevent Accuhaler
• Serevent Evohaler
• Bricanyl Turbohaler
• Easyhaler Salbutamol

Preventer inhalers include:

• Clenil Modulite
• Seretide Accuhaler
• Seretide Evohaler
• Symbicort Turbohaler
• Atrovent Inhaler
• Flixotide Evohaler
• Flixotide Accuhaler
• Qvar Inhaler

You can also have additional gadgets to accompany your condition and inhaler; peak flow meter used during your diagnosis and a spacer to help ingest correctly. You can get both of these by speaking to your doctor, especially as spacers (bubbles) come in various sizes. Spacer types depending on your age, whether you have a single breath or multiple breathes in a short space of time.

It's important to receive the correct inhaler in terms of the following:

• Is it a reliever or preventer?
• Is it the right dosage?
• Is it a DPIs, a MDIs or a BAIs?
• Do you need a peak flow meter and/or spacer?
• Is the spacer the correct shape and format for my inhaler and myself?

Once you have your inhaler, the doctor or asthma nurse can demonstrate the correct procedure. This means the treatment may be getting stuck at the back of your throat or on your tongue. The easiest way to recognise that you're using your inhaler wrong is if the symptoms don't improve if you develop oral thrush or if taking your medication provokes a sore throat. You can always ask again at your asthma reviews and here is a guide as well:

Metered Dose Inhalers (MDIs)

• Shake the inhaler well before use and remove the cap.
• MDIs can be used without a spacer, however, many asthma professionals advise this additional extra as it is easier to inhale the medication without breathing in as soon as you press the canister down.
• Place the inhaler to your mouth.
• Whilst pressing down on the canister, take a large breath in.
• Make sure you sit up straight and ensure you are digesting the spray. For example, avoid pointing the inhaler towards the back of your throat or tongue.
• Hold your breath for as long as you can (up to 10 seconds ideally).
• For most, this process is repeated twice. For relievers, it's only when it is needed and for preventers, it is twice a day.

Breath-Actuated MDIs (Autohalers and EasiBreathe)

• If you require a breath-actuated device, this could be for a specific reason such as arthritis or if you're elderly, or simply because you can trouble using the typical puffer.
• Give the inhaler a good shake and simply open the cap (these inhalers are often circular-shaped, like a fossil).
• Place on your lips and breathe in fully. The inhaler will automatically release a fine spray of medication.
• Breathe in for up to ten seconds.
• Repeat medication if required.

Dry powder inhalers DPIs (Accuhalers, Turbohalers and Easyhalers)

• Shake the inhaler well before use. This is even more important for dry powder inhalers.
• Remove the cap and breathe out fully.
• Breathing in with DPIs requires a stronger inhale than the other devices to ensure the medication.

With all inhalers, don't forget to check the expiry date and arrange new medication accordingly.

Common mistakes when using an inhaler

• Not shaking your inhaler before each use
• Not checking the expiry date
• Not exhaling fully before use.
• Not holding your breath for long enough
• Not waiting at least a minute between puffs
• Not storing your inhaler at the correct temperature

Buying treatment for asthma in the UK is simple, but will always require a prescription that is issued by a doctor or nurse qualified by UK medical standards. This can be obtained during your asthma review, during a check-up for another ailment (if you know you just need a repeat prescription or even online. Some surgeries have also started issuing repeat prescriptions over the phone if and when necessary.

In terms of online, there are many inhalers on order ranging from relievers to preventers, dry powdered formulas and sprays. To obtain this mandatory prescription online, you will have needed to be diagnosed with asthma beforehand, and used inhalers before.

The consultation will last approximately five minutes and involves detailing your medical history and any other personal information important to your symptoms in the same way that a doctor would ask you face-to-face. Our doctor will then list the appropriate inhalers for your condition that you can order.