Asthma is a chronic condition in which the airways in the lungs are inflamed, causing obstruction due to inflammation, airway muscles are tightened and irritated. Excess mucus production in the airways is also implicated by clogging up the airways.

This makes it difficult to breathe and interferes with the distribution of oxygen that is needed by the body. It can occur at any age. If treated inadequately, a permanent narrowing of the tubes in the airways can occur.

Asthma is a lifelong condition, but having asthma does not mean you will have symptoms all the time. They usually occur when your lungs are irritated. An asthma flare up or attack may develop gradually or suddenly, and may last for a few minutes to a few days.

The severity of asthma in individuals ranges from mild to very severe, which can interfere with daily life activities. It can be classified in a number of ways but in this article we will focus on the classification below:

• Intermittent: Asthma comes and goes, and you can feel normal in between asthma attacks.
• Persistent: Asthma symptoms are there most of the time and the symptoms may be mild, moderate, or severe.

Asthma must be diagnosed by your doctor usually by performing a thorough physical examination, conducting lung function, allergy and other tests, chest x-rays, getting a full family history and more.

Causes and triggers

It may be caused by genetic, occupational, or environmental factors and triggered by one or more the following:

• Exercise
• Allergens like mold, pollen, food, animal dander, dust mites, etc.
• Pets – Usually due to their hair, fur, or dander
• Viral respiratory infections like RSV, flu, colds
• Gastroesophageal reflux disease (GERD)
• Chemical irritants like disinfectants
• Strong Emotions – Crying, excessive laughter, stress, and anxiety
• Environmental factors like cigarette smoke, weather changes especially cold air, occupational chemicals, poor air quality, etc.
• Certain drugs like aspirin, non-steroidal anti-inflammatory drugs like ibuprofen, naproxen, beta blockers.
• Food preservatives e.g., sulfites

Triggers may be different in each person and may change over time.

Risk Factors

• Having a relative that has asthma
• Smokers
• Having allergies like hay fever or eczema
• Being Overweight
• Exposure to chemicals, fumes or secondhand smoke
• Having a lot of respiratory infections e.g. RSV

Symptoms

• Wheezing
• Tightness in the chest because the muscles around the airways tighten.
• Coughing
• Shortness of breath due to narrow airways restricting the flow of air.
• Excess mucus production in the airways adds to the shortness of breath due to airway obstruction.
• Difficulty talking
• Trouble sleeping

Symptoms vary from person to person and change with time.

Prevention & Treatment of Asthma

The goal of treatment is to help the patient breathe better, resume as close to normal daily activities, and to reduce the number of attacks with lifestyle changes, trigger avoidance and medication.

Since triggers and symptoms may vary from person to person, it is important to work with your doctor to track and treat your asthma with an ‘Asthma Action Plan’. An Asthma Action Plan is a personalized plan that helps to prevent and control your asthma. See an example here.

The plan takes into account the severity of your symptoms and your triggers and gives guidance on what actions and medicines you need to take depending on your symptoms. The plan may be updated depending on your outcomes.

Looking at the action plan, in general:

The GREEN zone indicates no coughing, wheezing, chest tightness, or shortness of breath, and can do usual activities. This means you are doing well.

The YELLOW zone indicates one or more of these symptoms: coughing, wheezing, chest tightness, breathing trouble, waking up at night due to asthma, or, if you can only do some, but not all, usual activities.

The RED zone indicates an EMERGENCY. You are very short of breath, or quick-relief medicines have not helped, or symptoms are the same or worse after 24 hours in the Yellow Zone or if you cannot do any of your usual activities.

Lifestyle modification

• Asthma cannot be cured but can be controlled by learning what triggers your attack and avoiding them. Like managing stress, quitting smoking, managing your weight, etc.
• Lead a healthy lifestyle by exercising safely (speak with your doctor about what is safe for you), having a healthy diet and getting good quality sleep.
• By recognizing an oncoming attack and taking actions directed by your doctor to prevent it from getting severe.
• Monitor your breathing with a peak flow meter which measures how fast the air comes out of your lungs when you blow with force. Follow the directions of your doctor according to your results. Here is a video showing how to use a peak flow meter. When using a peak flow meter:
  • Your green zone is 80% to 100% of your best score.
  • Your yellow zone is 50% to 80% of your best score.
  • Your red zone is 50% of your best score or lower.
• Take your medicine and follow your treatment plan as directed by your doctor.
• Keep up to date on your flu and pneumonia immunizations in order to prevent attacks.

Asthma Medication

• A bronchodilator which relaxes the muscle around the airways making air flow easier and making it easier to breathe. This is usually taken as needed and must be taken as soon as symptoms begin. They are also used to prevent asthma triggered by exercising when used before exercising.
  • Short Acting: Work quickly after administration and help to relieve symptoms like coughing, wheezing, difficulty breathing and chest tightness quickly.
    • Albuterol (Salbutamol in some other countries)
    • Levalbuterol
  • Long Acting: Their effects last a long time. These should not be used when quick or immediate relief is needed.
    • Salmeterol
    • Formoterol
  • Theophylline: relaxes the muscles around the airways and blood vessels in the airways helping to keep the airways open. It is used when other bronchodilators do not work.
• An anti-inflammatory which reduces mucus production and swelling in the airways preventing future asthma attacks. This is usually taking daily even when you feel okay, to prevent symptoms. When using an inhaled form of anti-inflammatory, it is important to rinse your mouth after use to prevent getting a yeast infection in your mouth.
  • Some inhaled examples are:
    • budesonide
    • beclomethasone
    • ciclesonide
    • fluticasone
    • mometasone
  • Some oral examples are:
    • methylprednisolone
    • prednisolone
    • prednisone.
• Anticholinergics help to open up the airways. They are usually used with an inhaled anti-inflammatory daily for long term prevention and control.
  • Ipratropium
  • Tiotropium bromide
• Leukotriene modifiers are used to reduce swelling and keep the airways open.
  • Montelukast
  • Zafirlukast.
• Antibodies are used when standard therapy does not work and in severe asthma.
  • benralizumab
  • dupilumab
  • mepolizumab
  • omalizumab
  • reslizumab
• Mast cell stabilizers help to prevent swelling in the airways in the presence of allergens.
  • Nedocromil
  • Cromolyn Sodium
• Allergy medications are used to treat allergies if asthma is triggered by allergies.

Medicines are given in the form of an inhaler, nebulization solution, oral tablets or injected depending on the needs of the patient.

NOTE: There are some medications that combine both bronchodilators and anti-inflammatories that are used to increase drug compliance and treatment outcomes.

Examples:

• Budesonide and formoterol (Symbicort)
• Fluticasone and vilanterol (Breo)
• Fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta)
• Fluticasone and salmeterol (Advair Diskus, AirDuo Respiclick)
• Mometasone and formoterol (Dulera)

Inhalers and nebulizers deliver the medicine directly to the lungs. The use of an inhaler may be difficult for children, or for people during an attack. In these situations, it is helpful to use a spacer device which is a plastic container with a mouth piece on one end and an opening for an inhaler at the other end. A mask could be attached to mouth piece area if needed.

For a video of how to use an inhaler with a spacer click here. For a PDF click here.

For a video of how to use an inhaler without a spacer click here. For a PDF click here.

When to call your doctor

• If you have symptoms more often
• If symptoms are not getting better after taking medication as directed by your doctorand you need to use an inhaler more often
• If you have shortness of breath when you talk
• If it is getting harder and harder to breathe

When to go to the Emergency Room

• If you have severe difficulty breathing
• If you are turning greyish or pale blue
• If your heart is beating very fast
• If you are having difficulty talking or walking
• Excessive coughing
• If you have severe chest pressure or pain
• If you confused or disoriented
• If symptoms are not getting better after taking medication as directed by your doctor

Conclusion

Although asthma is a lifelong condition, it can be managed and treated and there are a lot of resources and medications to help lead a healthy life.

All the resources discussed in this article can be accessed on our ‘Guides and Resources’ page here.

Disclaimer: This is not an exhaustive list and is for information only. This is not medical advice. Please consult your doctor or pharmacist if you need personal treatment options or have any questions that affect you directly.