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Frequently Asked Questions
What is asthma?
Asthma is a condition that affects the airways - the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an asthma trigger, the muscle around the walls of the airways tightens so that the airway becomes narrower. The lining of the airways becomes inflamed and starts to swell. Often sticky mucus or phlegm is produced. All these reactions cause the airways to become narrower and irritated - leading to the symptoms of asthma.
How do you get it?
Asthma can start at any age. It is difficult to know what causes asthma, but we know it tends to run in families. People whose parents have asthma are more likely to develop asthma. The interaction between genetics, the environment and many aspects of our modern lifestyle have contributed to the rise in asthma:
- smoking during pregnancy increases the chance of a child developing asthma
- second-hand smoke increases the chance of developing asthma
- irritants in the workplace may lead to a person developing asthma
- environmental pollution can make asthma symptoms worse, and has been proven to cause asthma.
- indoor environment - centrally heated and poorly ventilated homes have led to an increased exposure to house-dust mites and mould spores, both asthma triggers
- poor diet and an increase in obesity have been linked to asthma
- more hygienic environment has been suggested as a cause of asthma (hygiene hypothesis). International rates of asthma suggest that it is a disease of the developed world. UK has one of the highest incidences of asthma along with other developed countries such as NZ, Australia and Ireland
Lots of people seem to be getting it - children and adults - why does it seem to be getting more prevalent?
There was a dramatic increase in asthma prevalence in the 1980s and 1990s, increasing by 400% over 25 years. There is some recent research that now suggests that prevalence may have levelled off, although the reasons for these trends are still unclear.
How do you recognise an asthma attack? Will there be any warning?
If your symptoms are getting worse you may recognise some or all of the following:
- needing more and more reliever treatment
- waking at night with coughing, wheezing, shortness of breath or a tight chest
- having to take time off work because of your asthma
- feeling that you cannot keep up with your normal level of activity or exercise
If you experience any of the above you should visit your doctor or nurse to get your asthma back under control. You can also carry an Asthma Attack card from Asthma UK, which tells people what to do in an attack:
- Take two puffs of your reliever (blue) inhaler
- Sit up and loosen tight clothing
- If no immediate improvement during an attack, continue to take one puff of reliever inhaler every minute for five minutes or until symptoms improve
- If your symptoms do not improve in five minutes - or if you are in doubt - call 999 or a doctor urgently, especially if:
- You are too breathless or exhausted to talk
- Your lips are blue
Can you be cured?
There is currently no cure for asthma. However, there are some excellent treatments available to help you to control your asthma. The most effective way of taking most asthma treatments is to inhale the medicine so it gets straight into your lungs. There are a variety of inhalers available and it is important that you use a device that you are comfortable with and can use properly. Your doctor or nurse will advise you on the most appropriate device and should demonstrate how to use it correctly.
Will it get worse?
Some people may have to change parts of their lifestyle because of worsening asthma symptoms. It can be difficult to identify exactly what triggers your asthma. Sometimes the link is obvious, for example when your symptoms start within minutes of coming into contact with a cat or pollen. Some people have a delayed reaction. By avoiding the triggers that make your asthma symptoms worse, and by taking your asthma medicines correctly, you can reduce unnecessary symptoms and continue to enjoy your usual lifestyle.
What is the difference between reliever and preventer inhalers? What side effects do they cause
Relievers are medicines that you take immediately to relieve asthma symptoms. They quickly relax the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. They are essential in treating asthma attacks.
You should take a dose of reliever inhaler when you experience asthma symptoms. If you are using your reliever inhaler on a daily basis, you should go back to your doctor and have your symptoms reviewed so that they can be kept under control. You may need to use a preventer inhaler as well.
Relievers are a safe and effective medicine and have very few side effects. Some relievers can temporarily increase your heartbeat or give you mild muscle shakes. These effects are more common when taking high doses. They generally wear off within a few minutes or a few hours at most.
Preventers control the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks. They build up over a period of time so they need to be taken every day, usually morning and evening, even when you are feeling well. You will be started on an appropriate level of treatment to get your symptoms under control; once this has been achieved the treatment will be reduced to the lowest possible dose.
Preventer inhalers usually contain a steroid medication. There are several kinds of inhaled steroids, but they all work in the same way. Some people worry about the side effects of steroids. There is a small risk of a sore throat, hoarseness of voice and a mouth infection called thrush. Using your inhaler before brushing your teeth, and rinsing your mouth and spitting out afterwards will help you avoid this. Using a spacer will also help reduce the possibility of thrush.
Some points to remember:
- The steroids used to treat asthma are corticosteroids - a copy of the steroids produced naturally in your body
- They are completely different to the anabolic steroids used by bodybuilders and athletes Inhaled steroids go straight down to the airways, so very little is absorbed into the rest of the body
- Your doctor will prescribe the lowest possible dose Children should be monitored closely, especially for growth
What do you do if you get it?
To help you to control your asthma symptoms, your doctor or nurse should discuss with you the best way you can control your symptoms and as part of this should give you a written record of your asthma medicines and what to do if your symptoms get worse. At your review, ask them for an asthma medicine card and a personal asthma action plan.
Who is most likely to get asthma?
Allergies and asthma tend to run in families. If one parent has asthma, the chance of their child developing asthma is approximately double that of children whose parents don't have asthma. A child is 35% more likely to develop asthma if the mother smokes during pregnancy. If a child is exposed to second hand smoke because both parents smoke, they are 1.5 times more likely to develop asthma.
How does pregnancy affect a woman's asthma? Why would a woman's asthma be worse during pregnancy?
Like pregnancy itself, asthma varies enormously from woman to woman.
Around one third of women find their asthma symptoms improve in pregnancy, one third stay the same and one third find their asthma gets worse.
Some women, particularly those carrying a baby high up under the rib cage, report a feeling of finding it more difficult to breathe. Some women who continued to work right into the late stages of their pregnancy reported feelings of stress, which can be a trigger for asthma symptoms.
Asthma treatment guidelines emphasise the importance of women with asthma continuing to take their inhaled steroids throughout their pregnancies. Inhaled steroids go straight down to the airways where they are needed, so very little is absorbed into the bloodstream. This means the medicine is highly unlikely to reach the baby. If high doses of inhaled steroids are used, it is sensible to use a spacer device to reduce the risk of absorption.
Research shows that smoking during pregnancy leads to a 35% increased risk of your baby being wheezy or having breathing difficulties.
Why do some people develop asthma later in life?
People can develop asthma at any point during their lives. Some people are diagnosed with asthma for the first time later in life. They have what is called 'late-onset asthma.'
70% of late-onset asthma does not have an allergic basis. This is different from many other people whose asthma symptoms can be triggered by allergies to things like the house-dust mite and pollen. In older people, the symptoms of asthma are more likely to be triggered by catching a cold or irritants such as cigarette smoke, household chemical sprays and fragrances.
Asthma can be difficult to detect in older people as some of the symptoms - cough, wheeze and shortness of breath - are shared with other conditions such as chronic bronchitis, emphysema, chronic obstructive pulmonary disease (also known as COPD) and heart disease, which are more common among older people.
The main message is that if you have had asthma in the past and become breathless or wheezy again later in life, or you develop breathlessness or wheeze for the first time, however old you are, there is a significant chance you have asthma and need treatment. You will need to see your GP who can take a full history of your symptoms.
The number one trigger for asthma symptoms is the common cold. Older people are particularly at risk from severe chest problems so it's very important to get an annual flu vaccination from a doctor or practice nurse. If you start coughing and wheezing with your cold you should increase your asthma treatment according to your personal asthma plan. If this does not improve your symptoms you should arrange to see your doctor.
What should people do if they see someone having an asthma attack?
Someone having an asthma attack should immediately take a puff of their blue (reliever) inhaler, help them to sit (but not lie down) and loosen any tight clothing. If there is no immediate improvement encourage them to take one puff on the reliever every minute for five minutes or until symptoms improve. If symptoms do not improve in 5 minutes or if you are in any doubt - call 999 or a doctor urgently. They should continue to take one puff of their reliever inhaler every minute until help arrives or symptoms improve.
What are the most recent developments in asthma research? Are there any new treatments in development?
See Where next in basic asthma research? (BARS), an Asthma UK consultation strategy on basic research
See Where next in clinical asthma research? (CARS)
Is asthma classed as a disability?
Yes. A disability is defined as a physical or mental impairment, which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities. The impairment must have lasted 12 months or be likely to last 12 months or be of a recurring nature where a recurrence is likely in a 12 month period.
If you or your child have care or mobility needs because of asthma, you may be entitled to benefits.
What is an allergy?
An allergy is a reaction by the body to something it comes in contact with - an allergen. Allergens are the things that can trigger an allergic reaction in susceptible people. Common allergens include house-dust mites, pollen and pets.
Do more women have asthma than men?
Asthma is more common among boys than girls and over the age of 14, the prevalence reverses and asthma is higher among women than men. This may be because boys can grow out of the condition and girls can develop asthma symptoms around puberty.
What is occupational asthma?
The Health & Safety Executive estimates that between 1,500 and 3,000 people in Great Britain develop occupational asthma every year. Some substances that people come across at work can actually cause asthma. The condition can take weeks, months or even years to develop, depending on the person and the substance. Substances that can cause asthma are called respiratory sensitisers.
Chemicals called isocyanates are the most common cause of occupational asthma in the UK. There are many jobs in which you might be exposed to these chemicals, particularly spray painting, foam moulding using adhesives, and making foundry cores and surface coatings.
Other common causes of occupational asthma are dust from flour and grain (baking, farm work and grain transport), wood dust (carpentry, joinery and sawmilling), dust from latex rubber (often from rubber gloves used in healthcare situations) and colophony - widely present in soldering.
There are over 200 other respiratory sensitisers and more are being identified all the time. Reports in the media suggest that cleaners and hairdressers, who are regularly exposed to chemicals, are susceptible to developing asthma.
Does what you do for work make any difference?
Some substances that you might come across at work can actually cause asthma. If you think your asthma has been caused by something at work, look out for these clues:
- your asthma is worse during the working week, though not necessarily at work itself. Your symptoms may get worse after work, or you may find your sleep is disturbed during the night.
- your symptoms improve when you have been away from work for several days or on holiday
Does where you live make any difference?
We know that there are interregional differences in less developed countries, with lower rates in rural areas, but in most developed countries, rates are pretty constant across all areas. The little previous work that there is on this suggests slightly higher rates rurally than in urban areas (eg Scotland). Any differences across the UK are more likely to reflect differences in how doctors diagnose asthma and lack of clarity of differentiation of asthma from COPD than a true difference in prevalence.
Are there particular foods that can help asthma?
Several studies have suggested that a balanced diet with lots of fresh fruit and vegetables protects against asthma. There is some evidence to illustrate that abundance of Vitamin E and antioxidants in the diet may prevent wheezing or asthma. Research into increasing intake of Vitamin C, magnesium and fish oils have all shown some benefits in some studies but no benefit in others.
Is there anything you can do to prevent getting it?
Because it is difficult to say what causes asthma, it is difficult to suggest how it might be prevented in the first place. However, we do know that for adults exposure to second hand smoke at work doubles your risk of developing asthma and exposure to second hand smoke at home increases the risk five fold.
Why does the UK have such a high number of people with asthma?
The UK has one of the highest rates of asthma along with USA, Australia and New Zealand, many studies are continuing into why this might be (see number 7. 'What are the causes of asthma?') and what might link these four countries and be different from others, but no one factor has yet been identified. It's probably a complex mix of factors, which appear in these countries more than others, but we'll know more when we know more about what causes asthma.
What is the 'Hygiene Hypothesis'?
The theory is that early exposure to certain bacteria may help children to develop effective immune systems and therefore be able to ward off allergies. Children living on farms and in close proximity with animals tend to have lower rates of asthma, as do third, fourth and fifth children in large families, where frequent infections caught from older siblings may stimulate the immune system on the infections side and reduce the risk of development of allergic conditions including asthma.
How many people with asthma also have allergic rhinitis?
Approximately 80% of people in the UK have allergic rhinitis.