Anyone can develop asthma. Asthma is a very common; in fact it is the most common chronic disease in Ireland. Asthma can start at any time of life, although it usually starts in childhood. Asthma can sometimes run in families and is linked to other conditions such as eczema and hay fever.
It is a chronic medical condition, which for many patients begins in childhood and is thus life-long. Many of these patients live and work without being free of asthma symptoms, due to having uncontrolled disease, despite the availability of well constructed international evidenced-based guidelines and excellent, accessible and safe medicines.
Uncontrolled asthma leads to poor quality of life for many of these patients with asthma as well as their families. It is often associated with increased cost due to increased out of hours GP visits, emergency department visits, hospitalisation for acute asthma and loss of time from work and school.
In the Republic of Ireland:
- We have the 4th highest prevalence of asthma worldwide and it is the most common chronic respiratory disease for children and young adults. It affects people of all ages and all socioeconomic groups
- It is estimated there are in the region of 450,000 patients with asthma, most of which are managed solely in primary care
- Asthma has been estimated to account for over 40,000 lost working days per annum (INHALE 2008)
- Over 11,000 hospital bed days are utilised by patients with acute asthma
- In recent years, approximately 1 death per week occurs due to asthma.
For some facts and figures on asthma http://www.asthma.ie/get-help/resources/facts-figures-asthma
What is Asthma?
Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. The airways become over-sensitive, which means that they react to things that would normally not cause a problem, such as cold air or dust.
This reaction means that muscles around the wall of the airway tighten up, making it narrow and difficult for the air to flow in and out. The lining of the airways then gets swollen (just like your nose during a cold) and sticky mucus is produced, clogging up the breathing passages.
With the airways narrowed like this, you can see why it becomes difficult for air to move in and out and why the chest has to work so much. Tightening of muscle around the airways can happen quickly and is the most common cause of mild asthma.
Thankfully, this tightness can be relieved quickly with the right inhaler. However, the swelling and mucus happen more slowly and need a different treatment. They take longer to clear up and are a particular problem in more severe asthmatic cases.
Other types of asthma:
There are other types of asthma that can be made worse by certain activities:
Work-aggravated asthma is pre-existing asthma that is made worse by dust and fumes at work.
Occupational asthma is caused by exposure to specific substances at work. For example, some nurses develop occupational asthma after exposure to latex, and some workers in the food-processing industry develop occupational asthma as a response of exposure to flour.
For more on occupational asthma, visit http://www.asthma.ie/get-help/learn-about-asthma/asthma-triggers-a-z/occupations-and-asthma
While there is no cure for asthma, symptoms can come and go throughout your life. A number of treatments can help control the condition very effectively. Treatment is based on two important goals:
- relief of symptoms
- preventing future symptoms and attacks from developing
Successful prevention can be achieved through a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers.
www.asthma.ie The Asthma Society of Ireland
The symptoms of asthma are one or any combination of:
- Shortness of breath
- Regular wheezing
- Chest tightness
Asthma symptoms can vary fromperson to person.You may have one symptom or a combination of symptoms. Below are somesigns that you may have asthma:
- You have one or more of the symptoms listed above
- You cough at night
- You cough or wheeze after exercise
- You have wheeze, chest tightness or a cough after comingin contact with an asthma trigger such as cold air, dust or pollen
- When you have a cold it goes down to your chest or takes more than ten days to clear.
If you answer yes to any of these questions you should visit your doctor who will assess your symptoms.
We still don’t know exactly what causes asthma, but what we do know is that:
- Anyone can develop asthma. It is particularly common in Ireland, where over 470,000 adults and children have the condition.
- It can start at any time of life, although it most often begins in childhood.
- Sometimes it affects several family members e.g. if you have parents or brothers and sisters with asthma or allergies such as eczema or hay fever, you are more likely to have it yourself.
- Conditions like hay-fever, eczema, or hives, which are usually the result of allergy, may occur along with asthma.
- Adult onset asthma may develop after a respiratory tract infection.
- Many aspects of modern lifestyles such as changes in housing, diet and a more sterile home environment may have contributed to the rise in asthma over the last few decades.
- Most people can think of several things that make their asthma worse. These are known as ‘triggers’, and a variety of triggers can contribute to your asthma, including, allergens, viral infections, pollutants and drugs.
- A trigger is anything that irritates the airways and causes the symptoms of asthma to appear. Everyone's asthma is different and you will probably have several triggers. It can be difficult to identify exactly what triggers your asthma, as the effects can take up to 4-6 hours before you notice them – or even longer.
- Reducing your exposure to some of these risk factors improves your control of asthma and reduces the need for drugs. For example, you can avoid tobacco smoke or foods and additives known to cause symptoms of asthma.
- In the case of other know triggers (e.g. allergens, viral infections and pollutants) measures should be taken to avoid these as far as possible. Many patients react to multiple factors that are common in the environment. Avoiding these factors is usually impractical and very limiting for people with asthma and allergies.
Medications to maintain asthma control have an important role because patients are often less sensitive to risk factors when their asthma is under proper control.
Often it's not just one trigger that sets off an episode of asthma but a mixture of several triggers at about the same time.
The following is an incomplete list of triggers:
- Cigarette smoke
- Foods, especially nuts
- Occupational sensitisers
- Viral respiratory infections
- Emotions e.g. anxiety, stress and laughter
- Exposure to known allergens e.g. dust mites, pollens, animal dander and moulds
- Drugs e.g. aspirin, non steroidal anti inflammatory drugs (NSAIDs), beta blockers and some
- Complementary medicines
- Food additives e.g. colourings, metabisulfite and monosodium glutamate
- Gastro-oesophageal reflux, allergic rhinitis or sinusitis
- Exposure to irritants e.g. industrial chemicals, cleaning agents and pressure pack products
Before you can be treated for asthma you must be diagnosed by a doctor. Your doctor will check if you have asthma by asking you questions, examining your chest and performing some tests.
Questions Your Doctor Might Ask You:
- How long have you had asthma-like symptoms?
- How often do you have symptoms?
- How do your symptoms affect your day to day life?
- Have you had an attack or regular attacks of wheezing, coughing or shortness of breath?
- Do you cough at night and does it disturb your sleep?
- Do you wheeze or cough after exercise?
- Do you wheeze or cough after you come in contact with triggers such as pollen, smoke, cold air etc.?
- Do your colds go down to your chest or take more than ten days to clear?
- Are your symptoms improved by taking asthma treatments?
- Is there a history of asthma in your family?
If you suspect that you or your child may have asthma, your G.P. will be able to give you a diagnosis based on:
- Whether there’s a family history of asthma;
- The pattern of the symptoms;
- A physical chest examination;
- Peak flow/lung function test (child must be over 5 years old);
- A trial of asthma treatment.
Before confirming or ruling out asthma, your doctor may also ask if there are any conditions, such as eczema or hay fever. You may also be asked to keep a diary of which symptoms you or your child has - and when you have them. The following tests may be performed by your doctor to confirm the correct diagnosis.
Spirometry; a simple breathing test that gives measurements of lung function including a reversibility test that measures lung function before and after a dose of reliever to see if it has improved your lung function. This can be helpful with asthma diagnosis.
Peak Expiratory flow rate measurements (PEFR); another simple breathing test which may be measured over a period of time, when one has symptoms or even when symptom free, performed in a GP surgery, hospital or even at home.
An exercise test to check if exercise worsens the symptoms
Children under 2
Asthma is difficult to diagnose in children under the age of two. This is because wheezing and respiratory infections, such as bronchiolitis, are common in young children and the symptoms are often very similar to asthma.
If your child is under two and the symptoms are bad or persistent, your doctor may decide to give them a trial of asthma medication to help make a diagnosis.
Around 60% of asthma sufferers in Ireland do not have their asthma under control. With the right treatment you can control your asthma and keep your symptoms at bay.
There are a variety of different treatments and medications for asthma. Some, called relievers, work to relieve your symptoms when they happen, while others, called controllers, help to control your symptoms and stop them happening.
It is important to take your medication as prescribed.
When you breathe in reliever medication it relaxes the muscles around the airways, allowing them to widen and making it easier for you to breathe. You should use your reliever inhaler whenever you get asthma symptoms or if you are having an asthma attack. Everyone with asthma should have a reliever inhaler and you should always carry your reliever inhaler with you.
Facts about Relievers
- Reliever inhalers are usually blue.
- Reliever inhalers are sometimes referred to as ‘rescue medication’.
- They work quickly to ease your symptoms.
- You can take your reliever in advance of coming in contact with an asthma trigger e.g. before you exercise or before you go out in cold air.
- Reliever medication is safe and has few side effects. Some relievers may slightly increase your heart rate, or cause mild tremors but these side effects are temporary and should not cause concern.
- If you use your reliever inhaler more than twice a week, it is a sign that your asthma is not controlled and you should speak to your doctor.
The key to controlling your asthma is to use your controller inhaler every day, even when you are well. Controller medication contains a steroid called corticosteroid. It does not relieve your symptoms immediately, but builds up over a period of time to reduce swelling in the airways and stop your symptoms developing.
At first, your doctor will prescribe the level of controller medication needed to get your asthma under control. Over time, once your asthma is better controlled, you may be ‘stepped down’ to a lower level of medication.
Facts about Controllers
- Controller inhalers vary in colour but are usually brown.
- Controller inhalers should be taken everyday, even when you are well.
- The steroids in controller inhalers are similar to those found naturally in the body and should not be confused with anabolic steroids, which are sometimes banned for use in sport.
- When you inhale controller medication it targets the airways directly so only a small amount is absorbed into the rest of your body.
- Sometimes using controller medication can cause hoarseness or a mouth infection called thrush. To reduce the chance of this happening use a spacer device and rinse your mouth after taking your controller inhaler.
Some people may be prescribed a combination inhaler. Combination inhalers give you a dose of a reliever medication and a dose of controller medication at the same time.
Leukotriene Receptor Antagonists
Leukotriene Receptor Antagonists or LTRAs help control your asthma by stopping the natural chemicals in your airways that can cause them to narrow and become inflammation. They are usually given as well as your reliever and controller inhalers, and taken as a tablet.
If you are taking your controller medication, but your asthma is still not well controlled your doctor may prescribe further treatment as well as your reliever and controller inhaler. Below is a list of other treatments which you might be prescribed.
Theophyline Tablets widen your airways and reduce inflammation. They may cause nausea and are best taken with food. Your doctor will check the levels of theophylline in your blood to make sure the tablets are working and that there is not too much theophyline in your system.
Controller or Steroid Tablets contain larger amounts of medication than a controller inhaler and may be prescribed for a short time, in addition to your controller inhaler, if your asthma gets worse. They work to reduce the inflammation in your airways.
For more information on medicines and treatments visit http://www.asthma.ie/get-help/learn-about-asthma/medicines-treatments
To help you with inhaler technique please visit http://www.asthma.ie/get-help/learn-about-asthma/medicines-treatments/video-gallery
Being diagnosed with any health condition can be upsetting and even frightening, but particularly so when it affects your breathing. You may have many questions you want answered, and the Asthma Society of Ireland is here to provide information and support as you come to terms with your condition, and set about bringing it under control. You’ll find lots of educational material on this website, but the key point that you should note is that asthma does not have to control your life. Instead, you can manage and control your condition by:
- Becoming educated about asthma
- Taking your medications as directed
- Avoiding your triggers
- Developing a personalized action plan
The goal of asthma management is to obtain asthma control and maintain it over time.
What does Control look like?
- No daytime symptoms
- No night-time symptoms
- Not needing your reliever therapy more than twice a week
- No school or work absenteeism due to asthma symptoms
- Good lung function
A management approach needs to recognise that patients need support to self-manage their own condition. This should include patients receiving a written asthma management plan which is discussed, developed and agreed with them via a process of supportive education. It should be tailored to their individual needs, in order that they can confidently manage their asthma and lead lives unconstrained by their condition. Self-management support is an ongoing process necessitating regular review in order to achieve long-term behavioural change.
To help with self-management, your doctor or nurse can help you develop an Asthma Management Plan. An Asthma Management Plan will have all the information you need to keep your asthma under control.
Your Asthma Management Plan will include the following information:
- A list of your medication and when to take it
- How to tell if your symptoms are getting worse
- What to do when your symptoms get worse
- A list of your triggers, vaccinations and the asthma education you have received
- A peak flow diary to help monitor how well your lungs are working
- What to do if you have an asthma attack
- Important contact information, such as your GP and emergency contacts.
Everyone should have an Asthma Management Plan. You can get a free children’s or adult plan by calling the Asthma Society of Ireland on 01 8178886 or by emailing firstname.lastname@example.org. Or you can download some asthma management materials by visiting http://www.asthma.ie/get-help/resources/publications-documents/asthma-management-materials
There is also a mobile and web version of an Asthma Management Plan called Asthma Coach. Read about it at http://www.asthma.ie/get-help/resources/iphone-app/iphone-app You can download it for free from the App Store for iPhone or go to www.app.asthmasociety.ie
For information and advice on why flu vaccinations help manage your asthma visit http://www.asthma.ie/get-help/learn-about-asthma/managing-your-asthma/seasonal-flu-vaccine
A Structured Review
A structured review is required to achieve and maintain asthma control. An asthma review is simply an opportunity for you to discuss with your G.P. or asthma nurse how well controlled your asthma is. The following are the typical subjects covered at a review:
- How controlled your asthma is
- Allergy avoidance
- Inhaler technique
- Review of treatment
- Use of reliever therapy
- Lung Function Test and review
- Vaccination update
- Quitting smoking (if you’re a smoker)
- Any other issues you may have regarding your asthma.
How often should you have a review?
After commencing asthma treatment, your doctor will usually see you after a month to review your symptoms.
When your asthma is under control, a 6-monthly review would normally be suggested.
If control is poor, you will need to be reviewed more regularly until your symptoms have reduced and the doctor is satisfied that you have gained control of your asthma. The frequency of reviews will depend on the patient and how they are responding to treatment.
What you should bring to an asthma review:
Inhalers - to ensure your inhaler technique is correct.
Peak flow meter and diary - for your doctor to examine any important changes.
A list of any questions you may have - this may be very helpful as you don't always remember everything you should ask your doctor while you are there.
Questions to ask at a review:
Complete a self-management plan with your HCP if you don’t have one.
Any issues regarding the compliance of treatment.
Side effects of treatments if experiencing them and how to manage them
Any other conditions worsening your asthma control, such as Hay fever
The ASTHMA CONTROL TEST is a way to help you and your healthcare provider determine if your asthma symptoms are well controlled. You can take the asthma control test which you will find on http://www.asthma.ie/get-help/learn-about-asthma/managing-your-asthma/asthma-control-test
An Asthma Attack
Occasionally an asthma attack may occur no matter how careful you are about taking your asthma treatment and avoiding triggers. An asthma attack normally doesn't occur suddenly; most people find that asthma attacks are the result of a gradual worsening of symptoms over a few days. If your symptoms are getting worse, do not ignore them. Quite often using your reliever may be all that is needed to get your asthma under control again. At other times symptoms are more severe and more urgent action is required.
The Five Step Rule
During an Asthma Attack - Follow the Five Step Rule
- Take two puffs of reliever inhaler (usually blue) immediately
- Sit upright and stay calm
- Take slow steady breaths
- If there is no immediate improvement take one puff of reliever inhaler every minute (You can take up to 10 puffs in ten minutes - Children under 6 years can take up to 6 puffs in ten minutes)
- Call 999 or 112 if symptoms do not improve after following steps 1 -4 OR if you are in worried
- If an ambulance does not arrive within 10 minutes repeat Step 4.
Don't put your arm around me or lie me down - this will restrict my breathing.
Don't worry about giving me too much reliever - during an asthma attack extra puffs of reliever medication are safe.
Do use a spacer device if one is available.
Do listen to what I am saying - I have had attacks before.
If you are admitted to hospital or an accident and emergency department because of your asthma, take details of your treatment with you. Bring your asthma management plan if you have one to the hospital.
You should also make an appointment with your doctor or nurse after you are discharged from hospital, so that you can review your asthma treatment to avoid the situation rising again.
Severe asthma is difficult to define. It is made more confusing because there are several other words people use to describe it (difficult, brittle) and people use the term severe asthma in different ways.
There is a widespread popular misconception that asthma is a mild disease that only affects children. Not many people are aware of the severe consequences it can have on a person’s quality of life.