Asthma
Asthma is a chronic inflammation of the airways that leaves them excessively touchy. In response to dust, cold air or an ordinary cold, the muscle in the…
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Medicines commonly prescribed for Asthma
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: PULMONARY INHALATION, 0.25 mg budesonide/mlActive substance: budesonideManufacturer: Astrazeneca Farmaceutica Spain S.A.Prescription requiredDosage form: PULMONARY INHALATION, 25 mcg salmeterol / 125 mcg fluticasone propionateActive substance: salmeterol and fluticasoneManufacturer: Glaxosmithkline S.A.Prescription requiredDosage form: PULMONARY INHALATION, 0.25 mg/mlActive substance: budesonideManufacturer: Laboratorio Aldo Union S.L.Prescription required
Asthma is a chronic inflammation of the airways that leaves them excessively touchy. In response to dust, cold air or an ordinary cold, the muscle in the wall of the airway tightens, the lining swells and the passage narrows, so breathing out stops being effortless. The condition does not disappear for good, but with well-chosen treatment most people live without restrictions: they work, play sport and have children. The key is to understand how the two inhalers differ from each other and what to do in the hour when things go wrong.
What it feels like
There are four classic complaints: wheezy or whistling breathing, cough, shortness of breath and a feeling of a band tightening around the chest. They rarely arrive all together and almost never stay constant, and that is the trap. Between attacks the person feels perfectly well and so does not regard what is happening as an illness.
Several features separate asthma from other causes of a cough:
- symptoms get worse at night and in the early morning, and often wake you;
- they come in waves: one bad week, two quiet ones;
- something specific sets them off, such as running, laughing, cold air outdoors, a cat or house cleaning;
- after a cold the cough drags on for six to eight weeks rather than ten days;
- it is breathing out that is difficult, and the out-breath becomes long and noisy.
Asthma most often begins in childhood, but it can appear for the first time at any age, including after forty and after fifty.
What irritates the airways
Everyone has their own set of triggers, and knowing yours is more useful than any general advice. The commonest are tree and grass pollen, house dust and the mites living in it, animal hair and saliva, and mould in damp rooms. Then come irritants that involve no allergy at all: tobacco smoke, including other people's, traffic fumes and smog, aerosols and bleach, frosty air and strong perfume.
A separate group consists of conditions and substances. A simple viral infection can unsettle asthma for several weeks. Acid reflux from the stomach, long-standing nasal congestion and nasal polyps, excess weight and severe stress all make it worse, and in women flare-ups may follow hormonal changes. Finally, certain medicines cause airway spasm in some people, including painkillers from the non-steroidal anti-inflammatory group and beta blockers, even as eye drops, which is why every doctor you see should know about your asthma.
An attack: what to do minute by minute
An attack is not merely finding it hard to breathe; it is a progressive narrowing of the airways that will not reverse on its own. Act straight away.
- Sit upright, do not lie down. Loosen tight clothing and try to keep your breathing steady.
- Take a puff of your reliever inhaler exactly as set out in your treatment plan, and repeat it at intervals of a few minutes. If you have a spacer, use it: the medicine reaches the airways far better through one.
- Keep track of the time. If you are no better after ten minutes, call for an ambulance.
Call the emergency number 112 immediately if:
- the inhaler has stopped working, or its effect lasts less than an hour;
- speaking has become difficult and only single words are possible;
- the lips or fingernails look blue, and the skin is pale and clammy;
- the person is drowsy, limp or confused, which with a shortage of oxygen is an ominous sign;
- the wheeze suddenly goes quiet without any relief, because almost no air is moving;
- there is no inhaler at all.
Do not drive yourself and do not ask anyone to take you to hospital: help is needed sooner than you could get there. Keep using the inhaler until the ambulance arrives. Even if the attack settles and you feel fine, see a doctor within the next couple of days, because after a severe flare the treatment plan almost always needs changing.
How the diagnosis is made
There is no single test for asthma; the diagnosis is assembled piece by piece. The doctor asks when and why the symptoms occur and listens to the chest. Then breathing is measured: spirometry shows how narrowed the airways are and whether they open up after medication. Sometimes you are asked to record your peak flow at home for two or three weeks, because the spread between morning and evening readings reveals what a single visit missed.
Measurement of nitric oxide in exhaled breath may be added as an indirect sign of allergic inflammation, along with a blood test for eosinophils and allergy testing. Where the picture stays unclear, a doctor may prescribe a trial of treatment and judge by the response. The process often stretches out, because between flare-ups breathing can be entirely normal.
Two inhalers and the difference between them
This is the single most important thing to understand about asthma treatment. One inhaler relieves a spasm that has already started, within minutes, but it leaves the inflammation untouched and does nothing to the course of the disease. The other contains an inhaled steroid, works slowly and imperceptibly, and puts out the inflammation itself, so it is the one that decides whether an attack happens at all.
From this comes a rule that inverts the usual logic: the more often you need the reliever, the worse your underlying treatment has been chosen. Using more than three or four doses a week is a signal to see a doctor, not to buy a second box. In many current regimens the steroid and the fast-acting component are combined in a single device, used both regularly and whenever symptoms appear.
If that is not enough, long-acting medicines and tablets that act on allergic inflammation are added. For severe asthma that inhalers cannot control, injected biological treatments matched to the particular type of inflammation are available. Steroid tablets are prescribed as short courses and only for flare-ups. Doses in every case are chosen by a doctor and reviewed at least once a year.
What is in your hands
- Master your inhaler technique and ask a doctor or pharmacist to watch you use it. Most inhalers that supposedly do not work are simply being used incorrectly.
- Carry your reliever inhaler at all times rather than leaving it at home for emergencies.
- Do not abandon the preventer inhaler once you feel well: feeling well is exactly what it achieved.
- Do not smoke or vape, and avoid other people's smoke; this affects the course of asthma more than any household measure.
- Get vaccinated against flu and other respiratory infections, since an ordinary virus is the commonest cause of a flare.
- Remove whatever irritates your own airways, and keep your weight within a sensible range.
- Keep moving. Sport is not forbidden in asthma but beneficial; if exertion brings on symptoms, discuss taking an inhaler beforehand and warming up for longer.
Children, pregnancy and older age
Asthma is harder to identify in small children: wheezing also occurs with ordinary viral chest infections, and breathing tests are not possible until about five or six. Some children grow out of it by adolescence, though the tendency can return later in life. Young children should always use an inhaler through a spacer, with a mask if needed.
Pregnancy is the situation in which treatment is continued rather than stopped. Poorly controlled asthma is more dangerous to the baby than inhaled medicines, because when the mother is short of oxygen the baby is short of it too. In older people breathlessness is often blamed on age or the heart, and chronic obstructive pulmonary disease looks very similar, so it matters particularly here to establish exactly what is being treated.
Online consultation: how it helps
Everything that does not require a stethoscope is convenient to sort out remotely. The doctor can go through a lingering cough or breathlessness at night and advise which tests to arrange. For those already diagnosed, an online appointment helps with everyday questions: checking inhaler technique, understanding why the reliever is running out faster, drawing up a plan for flare-ups, and preparing for a flight, for the pollen season or for pregnancy. An attack in progress is not handled this way: if breathing keeps getting harder, what you need is your inhaler and the number 112, not a message in a chat.
This material is for information only and does not replace medical advice.
Consult with a doctor about Asthma
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Asthma
Discuss your symptoms and possible next steps for Asthma with a doctor online.
