Asthma management

Asthma affects the airways, the breathing tubes that carry air to and from the lungs. During asthma, the muscles around the airways tighten, the airway lining becomes swollen and inflamed, and sticky mucus is produced. These changes narrow the airways and make it hard to breathe, causing typical symptoms such as coughing, wheezing, chest tightness and shortness of breath.

A flare-up can come on slowly over hours, days or even weeks, or quickly over minutes.

Asthma is common, affecting around 1 in 10 adults and children. The exact cause is not always known, but allergy often plays a large part, and symptoms can be triggered by many things in everyday life.

Why good asthma management matters#

Medication is essential to manage asthma well. Good care also means treating other conditions that can affect asthma, such as hay fever (allergic rhinitis). A healthy lifestyle helps you stay in control of your symptoms and feel well. With good management, you can lead a normal, active life.

The main aims of asthma treatment are to:

• keep symptoms under control
• prevent flare-ups or attacks
• keep your lungs as healthy as possible
• stop asthma from interfering with school, work, leisure or sport
• help you or your child enjoy a full and active life

Your asthma action plan#

Following a personal written asthma action plan, developed with your doctor, is the best way to keep your asthma under control. It gives simple instructions for managing your asthma day to day, plus advice on what to do if your symptoms flare up.

There is no “standard” plan, because everyone’s asthma is different. Your plan needs to deal with your own triggers, signs and symptoms, and medication. Plans can also be generated using your doctor’s medical software or provided by a hospital after an admission for asthma.

Have your asthma reviewed with a doctor every 6 months for children and every year for adults, and update the plan if needed.

Common asthma triggers#

Triggers vary from person to person, and you may have more than one. Common triggers include:

• viral infections, such as colds and flu
• cigarette smoke and e-cigarettes
• allergens, such as house dust mites and their droppings, cockroaches, pollens, mold and pets
• irritants in the environment, such as dust, pollution, gas cooking and heaters, and wood or fire smoke
• weather, such as changes in air temperature or thunderstorms
• workplace exposures, such as wood dust, chemicals or metal salts
• chemicals and strong smells, such as perfumes, incense and household cleaners
• some foods, food preservatives, additives, flavorings or colorings, and cold food and drinks
• certain medications (in rare cases), including aspirin and anti-inflammatories, echinacea and some blood pressure medicines
• strong emotions, including laughter or crying
• stress

Physical activity can also be a trigger, but having asthma should not stop you from playing sport or exercising, which is important for your overall health and wellbeing. On your doctor’s advice, exercise-related symptoms can often be managed with extra medication or warm-up exercises before you begin.

The two main types of asthma medication#

Everyone who has asthma needs a reliever to use when they have symptoms. Some children and most adults also need a preventer, which makes the airways less sensitive to triggers and reduces inflammation.

Reliever medication#

A reliever opens the airways quickly and is taken as needed for immediate relief during a flare-up or emergency.

Relievers are sometimes overused. Using too much, or too often, can cause side effects such as tremor (shaking or trembling) and a rapid heart rate. These effects are unlikely to cause harm, but frequent use may be a sign that your asthma is not well controlled. If you need a reliever more than twice a week for symptoms (apart from before exercise), see your doctor to review your asthma and medication.

Preventer medication#

A preventer makes the airways less sensitive and reduces inflammation and swelling. It needs to be taken as prescribed, regularly and over the long term, to reduce the risk and severity of flare-ups.

Most preventers are inhaled corticosteroids. Because the medication goes straight to the lungs, the risk of side effects is very low. Most adults achieve good control with a low dose. Some children also need a regular preventer, which can be an inhaled corticosteroid or a non-steroid medication, including a tablet. Talk to your doctor about the best type for your child, as this usually depends on their symptoms and age and on how easy it will be to give.

People who use a regular preventer but still get regular symptoms may need to step up their medication. These stronger “combination” preventers include a second medicine alongside the inhaled corticosteroid. Preventers should always be prescribed at the lowest strength that works for you or your child, as there is no extra benefit in taking more than you need.

Some people need additional therapies for more severe asthma. Your doctor may prescribe these or refer you to a respiratory specialist.

Inhaler devices#

Work with your doctor to decide which device is best for you. Inhalers are the most common devices for asthma medication, and there are four main types:

• Metered-dose inhaler (puffer): an aerosol canister that produces a fine mist of medication. Always shake the canister before use, and use a spacer (and a mask for young children).
• Breath-activated inhaler: a spring-loaded aerosol canister that automatically releases the medication as a mist when you start to breathe in through the mouthpiece. These suit children and people who find it hard to coordinate a puffer.
• Dry-powder inhaler: delivers medication as a dry powder rather than a liquid mist. Deep, fast breathing is needed to draw the medication into the lungs, so young children and anyone short of breath may find these difficult to use.
• Soft mist inhaler: releases the medication as a fine mist.

Ask your doctor or pharmacist to show you the correct technique for your device.

Using a spacer#

A spacer makes it easier to inhale your medicine. Using a spacer with a puffer lets more medication reach your lungs and reduces possible side effects. It is a clear tube that attaches to a metered-dose inhaler.

After shaking the puffer, fire one puff only into the spacer, breathe in slowly and deeply, then hold your breath for about 5 seconds or as long as is comfortable. If a second dose is needed, repeat the same steps.

Young children should breathe in and out normally for 4 breaths before the next puff is fired into the spacer. This 4-breath technique may also be preferred during a flare-up.

Clean spacers at least once a month in warm soapy water and allow them to air dry.

Nebulizers#

Nebulizers were once commonly used for asthma, but research suggests a puffer with a spacer works just as well. A puffer and spacer are also easier and cheaper to use and reduce the risk of side effects. If you still use a nebulizer, whether day to day or only during a flare-up, talk to your doctor about making the switch.

Taking your medication well#

Taking medication regularly can be difficult. It is easy to forget, and many people dislike taking medication, especially when they feel well and have no symptoms. Even so, it is important to take your medication correctly and follow medical advice.

Tips that can help include:

• Ask for written instructions on how, when and how much to take, and what to do if symptoms get worse.
• Know the side effects of your medication so you understand what is and is not normal.
• Ask your doctor whether your medication can be simplified, such as using one device for all your medicines.
• Ask for a device you feel comfortable with. Special aids are available for people who have trouble coordinating inhalers.
• Make sure you know how to use your devices correctly, and ask your doctor or pharmacist to check your technique whenever you can.
• Create memory aids, such as taking your medication before brushing your teeth in the morning and evening.

If you have any concerns, talk to your doctor, asthma educator or pharmacist.

Helping children with their medication#

These tips also apply to children. In addition:

• Generally, your child can take their preventer before or after school.
• As your child gets older, involve them in decisions about their asthma medications and management.
• Linking asthma medication to your child’s own goals can help. For example, a child who loves sport may take their medication more readily knowing it helps them take part.

Other medications and asthma#

Some medications for other health conditions can make asthma worse and trigger a flare-up. Always tell your doctor and pharmacist that you have asthma when a new medicine is prescribed, or when you are buying over-the-counter or complementary products (for example, echinacea, propolis and royal jelly). If you feel a particular medicine is making your asthma worse, treat your symptoms and contact your doctor.

Medicines known to trigger asthma symptoms in some people include:

• ACE inhibitors, often used to control high blood pressure
• aspirin, contained in some pain relievers
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
• beta-blocker tablets, often used to control high blood pressure
• beta-blocker eye drops, used to treat glaucoma

Asthma first aid#

An asthma attack can take anything from a few minutes to a few days to develop, and it can be a very frightening experience. The 4 steps of asthma first aid are:

1. Sit the person upright. Keep them comfortable, stay calm and reassure them.
2. Give 4 puffs of reliever. Without delay, give 4 separate puffs of their blue/grey reliever inhaler. Use a spacer if available, giving one puff at a time and asking the person to take 4 breaths in and out of the spacer after each puff. Then wait 4 minutes.
3. Stay with the person, watch them carefully and reassure them. Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance at any time if you need to, and say that someone is having an asthma attack.
4. Reassess after 4 minutes. If they are getting worse or have severe breathing problems, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance now and keep giving 4 puffs every 4 minutes (4 separate puffs, 4 breaths with each puff) until it arrives. If they are still struggling to breathe, give 4 more puffs; if they still cannot breathe normally within a few minutes, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) . If they feel better and are breathing normally, take them to a doctor for a check-up.

Key Points#

• Medication is essential to manage asthma well.
• A healthy lifestyle helps you stay in control of your symptoms and feel well.
• The main aims of treatment are to keep symptoms under control and help you or your child enjoy a full and active life.
• The goal of an asthma action plan is to prevent and control asthma symptoms.
• Your plan needs to be developed around your own triggers, signs and symptoms, and medication.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).