Mother of three Rosemary Matthews first experienced asthma in her teenage years. 

“My first asthma attack happened when I was a teenager. I was outside chatting with my brother and my mother, enjoying the sunshine, when quite suddenly, I began to wheeze.

“I was really frightened, but none of us had any idea what was causing it. I was given a drink of water and, after I went indoors, it went away.

“Some time later, it happened again when I was with a boyfriend. I began wheezing and struggling for breath. He drove me straight to hospital, where they told me it was asthma. I was quite relieved to know what it was. I thought, ‘now I can do something about it’. 

“I had to learn to live with it, to live life in a different way. There would be things I couldn’t do. I learned what my triggers were and began to control my asthma quite well. My triggers are pollen, house dust mites, cold air, aerosol sprays, the fumes from bleach and cigarette smoke.

“I still have asthma today, and I probably have about two attacks a year. I have to be very careful about going out. If the pollen count is high or if it’s cool outside, that’s enough to set it off. Cigarette smoke is another trigger, so the smoking ban has been a good thing.

“The first thing you need to learn when you’re diagnosed with asthma is how to use an inhaler correctly. It isn’t that easy. You need to learn your triggers and keep away from those things. If you can’t keep away from them, take as many precautions as you can. Wearing a scarf over your face if the outside air is cold is a good example.

“My asthma is under control now. I self-manage it, but I have had to make lifestyle changes in recent years. The things I miss most are going for walks with my husband and gardening. It was my one favourite hobby. I can do very little in the garden now because of the pollen or the cold. You have to be careful of what’s in the air. 

“In the last three years, I’ve found I have to stay inside with the windows shut most of the time. In the hot weather, I have to use fans to keep cool.

“I’ve been advised to stay as fit as I can, and I have an indoor exercise regime.

“I feel I am doing quite well. It’s more than a year since I’ve had to go to the Accident and Emergency Department.

“It’s very scary, especially when you’re put on BiPAP [bilevel positive airway pressure]. It’s a non-invasive ventilation system to help you get more air into your lungs. You know then that you’re being kept alive only by this machine.”

For Shamim Arshad, a retired civil servant from Newcastle, walking has been a lifesaver.

“Six years ago, a big asthma attack put me in hospital for two weeks. When I went home, I was put on steroids, which made me overweight and depressed. I got breathless just walking upstairs, and I never went out because I was frightened I might have another asthma attack.

“A friend persuaded me to walk just to the end of the road with her. She’d had treatment for breast cancer and I went thinking I was doing her a favour. I gradually increased my walks and now regularly walk two or three miles around my housing estate or local park. Walking makes me feel fresh and takes stress away.

“My confidence has increased and I’ve reduced the number of inhalers I need from four to one. On cold or damp days, when doctors have told me I shouldn’t walk outside, I do indoor walks around the nearby shopping centre with a friend. And I lead walks around the local area for groups of older people. I want them to enjoy it as much as I do.

“It does give you an incentive to take care of yourself. You know you don’t want to be in hospital in the high-dependency unit on BiPAP [bilevel positive airway pressure].

“It makes you think more about your triggers because that’s the one way you can help yourself. The other thing I’ve learned and would like to pass on to others is that you should never panic. It will only make things worse. Try to relax. You will get help.”

Olwen Fish, from Waterhead, Oldham, has had asthma since 1950. She feels lucky to have survived to see the huge increase in effective medication and now lives life to the full. 

“I was only 13 when I first experienced asthma in 1950. It was terrible because not many people had heard of it in those days. All I knew about asthma was that my aunt had died from it three years earlier at the age of 42.

“It came on in the middle of the night. I woke up and I couldn’t breathe. I was really frightened. I’d been out in the pouring rain the day before and I had a hole in my shoe. My parents always stressed that we weren’t to let our shoes get ruined because it wouldn’t be possible to mend them. I was frightened to death because I thought not being able to breathe was my fault.

“I didn’t dare mention it and I tried to cover it up, but my mother saw that I was unable to breath and took me to the doctor. He said it was asthma and he gave me an injection, which helped.

“The doctor also gave me some medicine, but it tasted like poison. I just wasn’t able to take it unless I really couldn’t breathe at all.

“When we were leaving school, all my friends wanted to go and work in the cotton mill, but I couldn’t because of the dust. I had to work in the sewing factory. 

“I was having asthma attacks that lasted three days. It was horrible, not being able to breathe. I was really ashamed and tried to cover it up. I don’t know why I felt that way, but it was such an unknown thing in those days.

“Not being able to breathe is awful. If I was walking up a hill, I couldn’t talk. And there was no medicine I could take then. 

“I often had attacks in the night when I was sleeping in the same bed as my two sisters. I would be wheezing and they would get mad at me. They thought I could stop it. They didn’t understand it. Nobody understood it.

“Later, I got married and had four children. When I was pregnant, I never had any asthma. I’ve been told it was because the body makes its own steroids when you’re pregnant.

“When I had a really long attack, my husband had to take time off work and it was sometimes difficult for me to take the children to school. I had to give up work when I was 53, and now it has become chronic asthma. I have it all the time, but I’m very grateful that we have such good medication.

“Asthma runs in my family. My father’s sister died of asthma when she was 41. My son started with it when he was two and my daughter developed it when she was 13, like me. My eldest grandson had childhood asthma, but has not got it now, and I have another grandson who was diagnosed with asthma at two and still has it. My sister was diagnosed with asthma at 50, my niece was diagnosed when she was 12, and I have cousins who also have it. 

“I began using an inhaler when I was about 40, and in my 50s I began using a nebuliser.

“I first realised my asthma could kill me when I was 62 and I collapsed in the street. I knew I needed help. It was a very hot day, which is always difficult for me, and I couldn’t breathe. I couldn’t use my inhaler because I couldn’t breathe in. They’re no use unless you can breathe in. I’d forgotten my mobile, but I managed to get to a phone box to phone my husband. I was holding on to the door handle when I began to slip down to the ground.

“There were some young men in their early 20s nearby drinking outside a pub. I heard one of them say: ‘Leave her, she’s just drunk.’ Luckily, two of them brought me into the pub and laid me on the floor in the games room.

“The landlady, who later told me she had had a few brandies, couldn’t find a pulse. She saved my life by giving me mouth-to-mouth resuscitation. Everyone cheered when I came around. Later, when the ambulance took me to the hospital, I had a respiratory arrest and actually died for some time.

“I’ve taken it very seriously since then. I go for regular check-ups and use all the latest medications. I’m thrilled to bits that I have all these things. It’s a luxury to me to know that when I get really short of breath, I have all the inhalers and medications I need. I’ve found going to the Breathe Easy support group meetings very helpful.

“My asthma is now well under control. The Chest Clinic allows me to manage my own steroids, and I’m on maintenance doses of several drugs and use the nebuliser every morning and night. I also have inhalers that I can use when I need them. With all these medications, I really have had a new lease of life.”

Tashaurn, his mother and his nurse talk about living with childhood asthma.

It’s not clear exactly what causes asthma, although it is likely to be a combination of factors.

Some of these may be genetic. However, a number of environmental factors are thought to play a role in the development of asthma. These include air pollution, chlorine in swimming pools and modern hygiene standards (known as the “hygiene hypothesis“).

There is currently not enough evidence to be certain whether any of these can cause asthma, although a variety of environmental irritants, such as dust, cold air and smoke, may make it worse.

Who is at risk?

Although the cause of asthma is unknown, a number of things that can increase your chances of developing the condition have been identified. These include:

• a family history of asthma or other related allergic conditions (known as atopic conditions) such as eczema, food allergy or hay fever
• having another atopic condition
• having bronchiolitis (a common childhood lung infection) as a child
• childhood exposure to tobacco smoke, particularly if your mother also smoked during pregnancy 
• being born prematurely, especially if you needed a ventilator to support your breathing after birth
• having a low birth weight as a result of restricted growth within the womb

Some people may also be at risk of developing asthma through their job.

Asthma triggers

In people with asthma, the small tubes (bronchi) that carry air in and out of the lungs become inflamed and more sensitive than normal.

This means that when you come into contact with something that irritates your lungs (a trigger), your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).

Asthma symptoms can have a range of triggers, such as:

• respiratory tract infections – particularly infections affecting the upper airways, such as colds and the flu
• allergens – including pollen, dust mites, animal fur or feathers
• airborne irritants – including cigarette smoke, chemical fumes and atmospheric pollution
• medicines – particularly the class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), which includes aspirin and ibuprofen, and beta-blockers sometimes given for high blood pressure or some types of heart disease
• emotions – including stress or laughing
• foods containing sulphites – naturally occurring substances found in some food and drinks, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals
• weather conditions – including a sudden change in temperature, cold air, windy days, thunderstorms, poor air quality and hot, humid days
• indoor conditions – including mould or damp, house dust mites and chemicals in carpets and flooring materials
• exercise
• food allergies – including allergies to nuts or other food items

Once you know your asthma triggers, you may be able to help control your condition by trying to avoid them.

Want to know more?

• Asthma UK: asthma triggers A-Z

Occupational asthma

In some cases, asthma is associated with substances you may be exposed to at work. This is known as “occupational asthma”.

Some of the most commonly reported causes of occupational asthma include exposure to:

• isocyanates (chemicals often found in spray paint)
• flour and grain dust
• colophony (a substance often found in solder fumes)
• latex
• animals
• wood dust

You may be at an increased risk of developing occupational asthma if you are regularly exposed to substances such as these through your work.

Occupations that are commonly associated with the condition include paint sprayers, bakers and pastry makers, nurses, chemical workers, animal handlers, welders, food processing workers and timber workers.

Want to know more?

• Asthma UK: occupational asthma
• Health and Safety Executive: asthma

If you have typical asthma symptoms, your GP will often be able to make a diagnosis.

They will want to know when the symptoms happen and how often, and if you have noticed anything that might trigger them.

Your GP may also ask whether you have any allergic (atopic) conditions such as eczema and hay fever, which often occur alongside asthma.

A number of tests can be carried out to confirm the diagnosis. These are described below.

In children, asthma can be difficult to diagnose because many other conditions can cause similar symptoms in infants. The tests outlined below are also not always suitable for children.

Your GP therefore may sometimes suggest that your child uses an asthma inhaler as a trial treatment. If this helps improve your child’s symptoms, it is likely they have asthma.

Spirometry

A breathing test called spirometry will often be carried out to assess how well your lungs work. This involves taking a deep breath and exhaling as fast as you can through a mouthpiece attached to a machine called a spirometer.

The spirometer takes two measurements – the volume of air you can breathe out in the first second of exhalation (the forced expiratory volume in one second, or FEV1) and the total amount of air you breathe out (the forced vital capacity or FVC).

You may be asked to breathe into the spirometer a few times to get an accurate reading.

The readings are then compared with average measurements for people your age, sex and height, which can show if your airways are obstructed.

Sometimes an initial set of measurements is taken, and you are then given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing when another reading is taken.

This is known as reversibility testing, and it can be useful in distinguishing asthma from other lung conditions, such as chronic obstructive pulmonary disease (COPD).

Peak expiratory flow test

A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test.

This test requires a bit of practise to get it right, so your GP or nurse will show you how to do it and may suggest you take the best of two or three readings.

You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day.

Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take.

To help diagnose asthma that may be related to your work (occupational asthma), your GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work. Your GP may then refer you to a specialist to confirm the diagnosis.

Other tests

Some people may also need a number of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment.

Airways responsiveness

This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger.

You will be asked to breathe in a medication that deliberately irritates or constricts your airways slightly if you have asthma, causing a small decrease in your FEV1 measured using spirometry and possibly triggering mild asthma symptoms. If you do not have asthma, your airways will not respond to this stimulus.

The test often involves inhaling progressively increasing amounts of the medication at intervals, with spirometry measurement of FEV1 in between to see if it falls below a certain threshold. In some cases, however, exercise may be used as a trigger.

Testing airway inflammation

It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways:

• a mucus sample – the doctor may take a sample of mucus (phlegm) so it can be tested for signs of inflammation in the airways
• nitric oxide concentration – as you breathe out, the level of nitric oxide in your breath is measured using a special machine; a high level of nitric oxide can be a sign of airway inflammation

Allergy tests

Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies, such as dust mites, pollen or foods.

Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma.

Read more about diagnosing allergies.

Want to know more?

• British Lung Foundation: diagnosing asthma

Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness.

The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems.

Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an “asthma attack”, although doctors sometimes use the term “exacerbation”.

Severe attacks may require hospital treatment and can be life threatening, although this is unusual.

Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control your symptoms.

Read more about the symptoms of asthma and diagnosing asthma.

What causes asthma?

Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal.

When you come into contact with something that irritates your lungs – known as a trigger – your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).

Common asthma triggers include:

• house dust mites
• animal fur
• pollen
• cigarette smoke
• exercise
• viral infections

Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday.

The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition.

Asthma can develop at any age, including in young children and elderly people.

Read more about the causes of asthma.  

Who is affected?

In the UK, around 5.4 million people are currently receiving treatment for asthma.

That’s the equivalent of 1 in every 12 adults and 1 in every 11 children. Asthma in adults is more common in women than men.

How asthma is treated

While there is no cure for asthma, there are a number of treatments that can help control the condition.

Treatment is based on two important goals, which are:

• relieving symptoms 
• preventing future symptoms and attacks

For most people, this will involve the occasional – or, more commonly, daily – use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important.

You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so.

Read more about treating asthma and living with asthma.

Outlook

For many people, asthma is a long-term condition – particularly if it first develops in adulthood.

Asthma symptoms are usually controllable and reversible with treatment, although some people with long-lasting asthma may develop permanent narrowing of their airways and more persistent problems.  

For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on.

Daily life

With the right treatment and management, asthma shouldn’t restrict your daily life (including your sleep) in any way. You should work with your healthcare professionals and strive to achieve this goal.

You should also be confident about how to recognise when your asthma is getting out of control, and what to do if it does.

Sleeping

Asthma symptoms are often worse at night. This means you might wake up some nights coughing or with a tight chest.

If your child has asthma, poor sleep can affect their behaviour and concentration, as well as their ability to learn.

Effectively controlling asthma with the treatment your doctor or nurse recommends will reduce the symptoms, so you or your child should sleep better.

Read about living with insomnia for more tips on getting better sleep.

Exercise

Very occasionally, people with asthma develop symptoms only during exercise. However, usually this is a sign that your asthma could be better controlled generally.

If you or your child have asthma symptoms during or after exercise, speak to your doctor or asthma nurse. It is likely they will review your general symptoms and personal asthma plan to make sure the condition is under control.

Your doctor or asthma nurse may also advise that:

• you make sure the people you are exercising with know you have asthma
• you increase your fitness levels gradually
• you always have your reliever inhaler (usually blue) with you when you exercise
• you use your reliever inhaler immediately before you warm up
• you ensure that you always warm up and down thoroughly
• if you have symptoms while you are exercising, stop what you’re doing, take your reliever inhaler and wait until you feel better before starting again

Read about health and fitness for more information on simple ways to exercise.

Diet

Most people with asthma can eat a normal, healthy diet. Occasionally, people with asthma may have food-based allergic triggers and will need to avoid foods such as cows’ milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives. However, this is uncommon.

Read more about good food and a healthy diet.

Want to know more?

• Asthma UK: exercise
• Asthma UK: diet and food
• 10 tips on getting active with your kids

Know your triggers

It’s important to identify possible asthma triggers by making a note of any worsening symptoms or by using your peak flow meter during exposure to certain situations.

Read our page on the causes of asthma for more information about potential triggers. 

Some triggers, such as air pollution, illnesses and certain weather conditions, can be hard to avoid. However, it may be possible to avoid other triggers, such as dust mites, fungal spores, pet fur and certain medications that trigger your symptoms.

Make sure your healthcare team knows about and investigates triggers for your symptoms that you may have noticed yourself.

Want to know more?

• Allergy prevention
• Asthma UK: asthma triggers A-Z

Complications of asthma

Quality of life

Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in:

• fatigue (extreme tiredness)
• underperformance or absence from work or school
• psychological problems – including stress, anxiety and depression
• disruption of your work and leisure because of unexpected visits to your GP or hospital
• in children, delays in growth or puberty

Children may also feel excluded from their school friends if they cannot take part in games, sports and social activities.

If you feel your asthma is seriously affecting your quality of life, contact your GP or asthma clinic. Your personal asthma action plan may need to be reviewed to better control the condition.

Respiratory complications

In rare cases, asthma can lead to a number of serious respiratory complications, including:

• pneumonia
• the collapse of part or all of the lung
• respiratory failure – where levels of oxygen in the blood become dangerously low, or levels of carbon dioxide become dangerously high
• status asthmaticus (severe asthma attacks that do not respond to normal treatment)

All these complications are life threatening and will need medical treatment.

Death

Although most people are able to effectively control their symptoms, asthma can be a life-threatening condition.

Often, people who die from asthma do so at home because they do not recognise when their condition is getting worse or leave it too long to take action.

Do not let this happen to you. Be confident in recognising deterioration of your asthma and what action to take. Take action promptly – never ignore severe asthma.

Asthma and pregnancy

As a result of changes that take place in the body during pregnancy, many women find their asthma symptoms change when they are pregnant. Some women find their asthma improves during pregnancy, while others see it worsen. For others, it stays the same.

The most severe asthma symptoms experienced by pregnant women tend to occur between the 24th and 36th week of pregnancy. Symptoms then decrease significantly during the last month of pregnancy.

Only 10% of women experience asthma symptoms during labour and delivery, and these symptoms can normally be controlled through the use of reliever medicine.

It’s important to ensure your condition is well controlled during pregnancy, because poorly controlled asthma can lead to complications such as pre-eclampsia, premature birth and restricted growth of the baby in the womb. Good asthma control also minimises the chance of problems during labour and delivery.

You should manage your asthma in the same way you did before you were pregnant. The medicines used for asthma – particularly those that are inhaled – are generally considered to be safe to take during pregnancy and when breastfeeding your child.

The one exception is leukotriene receptor antagonists. These are not known to be harmful, but there is insufficient experience of their use in pregnancy to be absolutely certain.

If, however, you do need to take leukotriene receptor antagonists to control your asthma, you may decide (in discussion with your GP or asthma clinic and obstetrician) that you should carry on taking them and that the potential risks to you and your child from uncontrolled asthma are likely to be far higher than any potential risk from this medicine.

Read more about asthma in pregnancy.

Want to know more?

• Asthma UK: pregnancy

Asthma at school

Most children with well-controlled asthma can learn and participate in school activities completely unaffected by their condition.

However, it is important to ensure the school has up-to-date written information about your child’s asthma medicines, 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 your child to use if they experience 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 should have an asthma policy in place, which you can ask to see.

Want to know more?

• Asthma UK: your child at school
• Asthma UK: nursery and childcare

Financial support

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

• Employment and Support Allowance (ESA) – a benefit paid to people who are not able to work because of ill health or disability
• Disability Living Allowance (DLA) – a benefit for disabled children and adults under 65 to help with the extra costs you may have because you have a disability
• 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 are on a low income, you may also be entitled to some help with healthcare costs.

Want to know more?

• Asthma UK: financial help
• GOV.UK: benefits

Occupational 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 from the Benefits Agency.

This is a weekly amount paid to people with asthma caused by exposure to a specific substance through their work and is known to be associated with asthma (a complete list 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 three years of diagnosis.

Want to know more?

• Asthma UK: occupational asthma
• GOV.UK: Industrial Injuries Disablement Benefit
• Money Advice Service

Get in touch with others

Many people with a long-term health condition experience feelings of stress, anxiety and depression.

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

If you experience feelings of depression, talk to your GP. They will be able to give advice and support. Alternatively, find depression support services in your area.

Read more about living with long-term conditions.

Want to know more?

• Chat about asthma online at Asthma UK’s forum
• HealthUnlocked: asthma community

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: asthma in adults

The symptoms of asthma can range from mild to severe. Most people will only experience occasional symptoms, although a few people will have problems most of the time.

The main symptoms of asthma are:

• wheezing (a whistling sound when you breathe)
• shortness of breath
• a tight chest – which may feel like a band is tightening around it 
• coughing

These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen.

Read our page on the causes of asthma for more information about potential triggers.

Speak to your GP if you think you or your child may have asthma. You should also talk to your doctor or asthma nurse if you have been diagnosed with asthma and you are finding it difficult to control the symptoms.

Asthma attacks

When asthma symptoms get significantly worse, it is known as an asthma attack or “acute asthma exacerbation”.

Asthma attacks often develop slowly, sometimes taking a couple of days or more to become serious, although some people with asthma are prone to sudden, unexpected severe attacks. It is important to recognise attacks early and take appropriate action.

During an asthma attack, the symptoms described above may get worse and – if you’re already on treatment – your inhaler medication may not work as well as it normally does.

You might be monitoring your asthma using a device called a peak flow meter, and there may be a drop in your peak expiratory flow. Read about diagnosing asthma for more information.

If you think you or your child are having an asthma attack, don’t ignore it. Contact your GP or asthma clinic as soon as possible, or consult and use your asthma action plan if you have one.

Signs of a particularly severe asthma attack can include:

• your reliever inhaler (which is usually blue) is not helping symptoms as much as usual, or at all
• wheezing, coughing and chest tightness becoming severe and constant
• being too breathless to eat, speak or sleep
• breathing faster
• a rapid heartbeat
• feeling drowsy, exhausted or dizzy
• your lips or fingers turning blue (cyanosis)

Call 999 to seek immediate help if you or someone else has symptoms of a severe asthma attack.

Reliever inhalers

Reliever inhalers – usually blue – are taken to relieve asthma symptoms quickly.

The inhaler usually contains a medicine called a short-acting beta2-agonist, which works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again.

Reliever inhalers do not reduce the inflammation in the airways, so they do not make asthma better in the long term – they are intended only for the relief of symptoms.

Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless overused.

However, they should rarely, if ever, be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed.

Everyone with asthma should be given a reliever inhaler, also known simply as a "reliever".

Want to know more?

• Asthma UK: relievers

Preventer inhalers

Preventer inhalers – usually brown, red or orange – work over time to reduce the amount of inflammation and sensitivity of the airways, and reduce the chances of asthma attacks occurring.

They must be used regularly (typically twice or occasionally once daily) and indefinitely to keep asthma under control.

You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the blue reliever inhaler to relieve your symptoms, but your treatment should be reviewed if you continue to need them often.

The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone, ciclesonide and mometasone.

Preventer treatment should be taken regularly if you have anything more than occasional symptoms from your asthma, and certainly if you feel the need to use a reliever inhaler more than twice a week.

Some inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so make sure you rinse your mouth thoroughly after inhaling a dose. The use of a spacer device also reduces this risk. For more information on side effects, see below.

Smoking can reduce the effects of preventer inhalers.

Want to know more?

• Asthma UK: preventer inhalers

Other treatments and ‘add-on’ therapy

Long-acting reliever inhalers

If your asthma does not respond to initial treatment, the dose of preventer inhaler you take may be increased in agreement with your healthcare team.

If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long-acting beta2-agonist, or LABA) to take as well.

These work in the same way as short-acting relievers. Although they take slightly longer to work, their effects can last for up to 12 hours. This means that taking them regularly twice a day provides 24-hour cover.

Regular use of long-acting relievers can also help reduce the dosage of preventer medication needed to control asthma. Examples of long-acting relievers include formoterol and salmeterol, and recently vilanterol, which may last up to 24 hours.

However, like short-acting relievers, long-acting relievers do not reduce the inflammation in the airways. If they are taken without a preventer, this may allow the condition to get worse while masking the symptoms, increasing the chance of a sudden and potentially life-threatening severe asthma attack.

You should therefore always use a long-acting reliever inhaler in combination with a preventer inhaler, and never by itself.

In view of this, most long-acting relievers are prescribed in a "combination" inhaler, which contains both an inhaled steroid (as a preventer) and a long-acting bronchodilator in the one device.

Examples of combination inhalers include Seretide, Symbicort, Fostair, Flutiform and Relvar. These are usually (but not always) purple, red and white, or maroon.

Other preventer medicines

If regular efficient administration of treatment with a preventer and a long-acting reliever still fails to control asthma symptoms, additional medicines may be tried. Two possible alternatives include:

• leukotriene receptor antagonists – tablets that block part of the chemical reaction involved in the swelling (inflammation) of the airways
• theophyllines – tablets that help widen the airways by relaxing the muscles around them, and are also relatively weak anti-inflammatory agents

Oral steroids

If your asthma is still not under control, you may be prescribed regular steroid tablets. This treatment is usually monitored by a respiratory specialist (an asthma specialist).

Oral steroids are powerful anti-inflammatory preventers, which are generally used in two ways:

• to regain control of asthma when it is temporarily upset – for example, by a lapse in regular medication or an unexpected chest infection; in these cases, they are typically given for one or two weeks, then stopped
• when long-term control of asthma remains a problem, despite maximal dosages of inhaled and other medications – in these cases, oral steroids may be given for prolonged periods, or even indefinitely, while maintaining maximum treatment with inhalers as this maximises the chance of being able to stop the oral steroids again in the future

Long-term use of oral steroids has serious possible side effects, so they are only used once other treatment options have been tried, and after discussing the risks and benefits with your healthcare team.

See below for more information on the side effects of steroid tablets.

Omalizumab (Xolair)

Omalizumab, also known as Xolair, is the first of a new category of medication that binds to one of the proteins involved in the immune response and reduces its level in the blood. This lowers the chance of an immune reaction happening and causing an asthma attack.

It is licensed for use in adults and children over six years of age with asthma.

The National Institute for Heath and Care Excellence (NICE) recommends that omalizumab can be used in people with allergy-related asthma who need continuous or frequent treatment with oral corticosteroids.

Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped.

Want to know more?

• Asthma UK: other treatments and "add-on" therapies
• Asthma UK: steroid tablets
• NICE: omalizumab for severe persistent allergic asthma

Bronchial thermoplasty

Bronchial thermoplasty is a relatively new procedure that can be used in some cases of severe asthma. It works by destroying some of the muscles surrounding the airways in the lungs, which can reduce their ability to narrow the airways.

The procedure is carried out either with sedation or under general anaesthetic. A bronchoscope (a long, flexible tube) containing a probe is inserted into the lungs through the mouth or nose so it touches the airways.

The probe then uses controlled heat to damage the muscles around the airways. Three treatment sessions are usually needed, with at least three weeks between each session.

There is some evidence to show this procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma.

However, the long-term risks and benefits are not yet fully understood. There is a small risk it will trigger an asthma attack, which sometimes requires hospital admission.

You should discuss this procedure fully with your clinician if the treatment is offered.

Want to know more?

• NICE: bronchial thermoplasty for severe asthma

Side effects of treatments

Side effects of relievers and preventers

Relievers are a safe and effective medicine, and have few side effects as long as they are not used too much. The main side effects include a mild shaking of the hands (tremors), headaches and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes.

Preventers are very safe at usual doses, although they can cause a range of side effects at high doses, especially with long-term use.

The main side effect of preventer inhalers is a fungal infection of the mouth or throat (oral candidiasis). You may also develop a hoarse voice and sore throat.

Using a spacer can help prevent these side effects, as can rinsing your mouth or cleaning your teeth after using your preventer inhaler.

Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keep side effects to a minimum.

Side effects of add-on therapy

Long-acting relievers may cause similar side effects to short-acting relievers. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped.

Theophylline tablets have been known to cause side effects in some people, including nausea, vomiting, tremors and noticeable heartbeats (palpitations). These can usually be avoided by adjusting the dose according to periodic measurement of the theophylline concentration in the blood.

Side effects of leukotriene receptor agonists can include tummy (abdominal) pain and headaches.

Side effects of steroid tablets

Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (more than three or four courses of steroids a year). Side effects can include:

• osteoporosis (fragile bones)  
• high blood pressure (hypertension) 
• diabetes 
• increased appetite, leading to weight gain
• cataracts and glaucoma (eye disorders)  
• thinning of the skin  
• easy bruising  
• muscle weakness

With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon.

However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma.

You will need regular appointments to check for these.

Want to know more?

• Asthma UK: side effects of asthma medicines

Asthma attacks

A personal asthma action plan (see below) will help you recognise the initial symptoms of an asthma attack, know how to respond, and when to seek medical attention.

In most cases, the following actions will be recommended:

1. Take one to two puffs of your reliever inhaler (usually blue) immediately.
2. Sit down and try to take slow, steady breaths.
3. If you do not start to feel better, take two puffs of your reliever inhaler (one puff at a time) every two minutes (you can take up to 10 puffs) – this is easier using a spacer, if you have one.
4. If you do not feel better after taking your inhaler as above or if you are worried at any time, call 999.
5. If an ambulance does not arrive within 10 minutes and you are still feeling unwell, repeat step three.

If your symptoms improve and you do not need to call 999, you still need to see a doctor or asthma nurse within 24 hours.

If you are admitted to hospital, you will be given a combination of oxygen, reliever and preventer medicines to bring your asthma under control.

Your personal asthma action plan will need to be reviewed after an asthma attack, so reasons for the attack can be identified and avoided in future.

Want to know more?

• Asthma UK: what to do in an asthma attack

Personal asthma action plan

As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse.

If you’ve been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home.

The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.

Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.

As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps.

Want to know more?

• Asthma UK: personal asthma action plan
• Your health, your way: what is self care?

What is good asthma care?

Your doctor or nurse will tailor your asthma treatment to your symptoms. Sometimes you may need to be on higher levels of medication than at others.

You should be offered:

• care at your GP surgery provided by doctors and nurses trained in asthma management
• full information about your condition and how to control it
• involvement in making decisions about your treatment
• regular checks to ensure your asthma is under control and your treatment is right for you (this should be at least once a year)
• a written personal asthma action plan agreed with your doctor or nurse

It is also important that your GP or pharmacist teaches you how to properly use your inhaler, as this is an important part of good asthma care.

Occupational asthma

If it is possible you have asthma associated with your job (occupational asthma), you will be referred to a respiratory 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 triggering your occupational asthma from your workplace, to redeploy you to another role within the company, or to wear protective breathing equipment.

However, you may need to consider changing your job or relocating away from your work environment, ideally within 12 months of your symptoms developing.

Some people with occupational asthma may be entitled to Industrial Injuries Disablement Benefit.

Want to know more?

• Asthma UK: occupational asthma
• GOV.UK: Industrial Injuries Disablement Benefit
• Health and Safety Executive: asthma

Complementary therapies

A number of complementary therapies have been suggested for the treatment of asthma, including:

• breathing exercises
• traditional Chinese herbal medicine
• acupuncture
• ionisers – devices that use an electric current to charge (ionise) molecules of air
• manual therapies – such as chiropractic
• hypnosis
• homoeopathy
• dietary supplements

However, there is little evidence that any of these treatments, other than breathing exercises, are effective.

There is some evidence that breathing exercises can improve symptoms and reduce the need for reliever medicines in some people. These include breathing exercises taught by a physiotherapist, yoga and the Buteyko method (a technique involving slowed, controlled breathing).

Want to know more?

• Asthma UK: complementary therapies