Allergic asthma: triggers, testing and treatment

Asthma and Lung UK defines allergic asthma as asthma triggered by allergens such as pollen, pets and dust mites, and says it is sometimes called atopic asthma. About 4 in 5 people with asthma have allergies. Non-allergic asthma, which accounts for roughly 1 in 5, often starts later in life and is triggered by things such as air pollution, damp and mould, infections, stress and smoke.

The NHS explains that in asthma the airways become swollen, which makes them narrower and causes breathing problems. You may be more likely to have asthma if you also have eczema, hay fever or food allergies, or if relatives have asthma or allergies.

The NHS lists wheezing, coughing, shortness of breath and a tight chest. Symptoms are usually intermittent and can be worse at night and early in the morning. Triggers named include exercise, high levels of air pollution, cold air, and contact with things you are allergic to such as pollen, dust, mould or animals.

• Seasonal patterns, such as symptoms during hay fever season, are sometimes called seasonal asthma; you still need your preventer treatment as prescribed.

• Many people have both allergic and non-allergic triggers, for example cold weather and smoke alongside pollen.

• The NHS says some medicines, including aspirin, ibuprofen and beta blockers, can trigger asthma in some people.

Asthma and Lung UK says people diagnosed with asthma may have a skin prick test or blood test to see if they are allergic to common allergens, which helps in understanding triggers. Asthma itself is diagnosed in the NHS by questions, a chest examination and often a simple breathing test; a peak flow meter may be lent for a few weeks, and the NHS says diagnosis can take time because symptoms vary.

A positive allergy test shows sensitisation but does not by itself prove that an allergen is driving your asthma, so results are best interpreted by a clinician alongside your symptoms and when they occur.

The NHS says the main treatment is inhaled medicine. Depending on severity you may be offered an anti-inflammatory reliever (AIR) inhaler used only when symptoms occur; a maintenance and reliever therapy (MART) inhaler used daily and when needed; or two separate inhalers, a daily preventer and a blue reliever, and you should not be given a blue reliever to use on its own. If inhalers are not enough, a stronger inhaler or tablets such as montelukast may be added, and people with severe asthma that remains uncontrolled may be offered injected biological therapies.

Asthma and Lung UK describes about 1 in 5 adults with asthma as having difficult asthma and about 1 in 25 as having severe asthma, usually managed in specialist clinics. Signs that you may need specialist review include two or more attacks needing oral steroids in a year, an attack needing hospital treatment, or symptoms disturbing sleep.

The NHS says to sit up straight, stay calm and use your reliever. With a blue reliever, take 1 puff every 30 to 60 seconds until you feel better, up to a maximum of 10 puffs, ideally with a spacer. With an AIR or MART inhaler, take 1 puff every 1 to 3 minutes up to a maximum of 6 puffs. Follow your personal asthma action plan if it states a different maximum.

Call 999 if you feel worse at any time, do not feel better after the maximum dose, or do not have an inhaler. If no better after 10 minutes and the ambulance has not arrived, use the inhaler again up to the same maximum. After recovering from an attack, see a GP within 2 days.

The NHS advises always carrying your inhaler, using inhalers as recommended, avoiding triggers such as air pollution, smoke, pollen or animals where possible, exercising regularly, keeping to a healthy weight, having the flu vaccine, and not smoking. You should have an asthma review at least once a year to check inhaler technique and your action plan. Pets, hay fever and indoor allergens each have their own guidance on the Asthma and Lung UK site.

Asthma is managed by your GP surgery or practice nurse with hospital specialists for severe disease. Private allergy tests are widely sold; remember that a positive result does not prove allergy-driven asthma, and a clinician who knows your history should interpret it. Ask whether the service connects to your GP, so your inhaler plan stays consistent.