Asthma: symptoms, causes, treatment and what to do in an attack

The NHS says the main symptoms of asthma are problems with breathing: wheezing, coughing, shortness of breath and your chest feeling tight. Asthma symptoms can be mild or severe. They usually come and go, and may be worse at night and early in the morning.

Symptoms can be triggered by different things including exercise, high levels of air pollution, cold air, or contact with something you are allergic to, such as pollen, dust, mould or animals. Asthma + Lung UK adds that some people with asthma may not have symptoms for weeks or months at a time, and that everyone with asthma has their own set of triggers.

The NHS says to see a GP if you or your child have asthma symptoms, if you have asthma and treatments are not helping or you are needing your inhaler more often, or if your symptoms are stopping you doing your usual activities or waking you up at night.

• Wheezing.

• Coughing, often worse at night or early in the morning.

• Shortness of breath.

• A tight chest.

• Symptoms that come and go and are set off by triggers such as exercise, cold air or allergens.

Asthma + Lung UK describes asthma as a long-term lung condition that affects the airways (breathing tubes) that carry air in and out of the lungs, causing them to become swollen (inflamed). The airways of someone with asthma are more sensitive. When they meet a trigger, they get narrow and tight and the lining swells, and some people also produce sticky mucus, which makes breathing harder.

The NHS explains that asthma symptoms happen when your airways become swollen, making them narrower and causing breathing problems. In the UK 7.2 million people have asthma, about 8 in every 100 people, according to Asthma + Lung UK.

The NHS says the main treatment for asthma is medicines you breathe in using an inhaler, and that for most people they work well to reduce or prevent symptoms. Depending on how severe your symptoms are, you may be offered an anti-inflammatory reliever (AIR) inhaler used only when you get symptoms, a maintenance and reliever therapy (MART) inhaler used every day and when you get symptoms, or 2 separate inhalers: a daily preventer inhaler and a blue reliever inhaler. The NHS says you should not be given a blue reliever inhaler to use on its own.

Asthma + Lung UK explains that a reliever inhaler, which is usually blue, opens the airways but cannot treat the inflammation, so it is very important to use your preventer inhaler every day as prescribed even if you feel well.

If inhalers are not enough, the NHS says your care team may recommend a stronger inhaler or tablets that make breathing easier, such as montelukast, and that people with severe asthma not controlled by inhalers and tablets may be offered biological therapies, which are injected. It is important to use your inhaler correctly, and a doctor, nurse or pharmacist will show you how.

The NHS says that if you or your child have symptoms of asthma, a GP or nurse will ask you some questions and listen to your chest. You may need a simple breathing test to check for signs of asthma, and sometimes a blood test. You may also be given a handheld peak flow meter to use at home for a few weeks to check how well your lungs are working.

The NHS says asthma can take some time to diagnose because the symptoms often vary over time and breathing problems can have different causes. If it is likely you have asthma, you may be offered asthma medicines to see if they help your symptoms.

The NHS says it is not fully understood what causes asthma. Asthma + Lung UK distinguishes causes from triggers: causes are the underlying reasons someone gets asthma, while triggers, such as dust mites or pollen, make symptoms worse.

The NHS lists things that make asthma more likely: having allergies such as eczema, hay fever or food allergies, a family history of asthma, hay fever, eczema or allergies, being born prematurely or at a low birth weight, exposure to high levels of air pollution or cigarette smoke as a child, childhood illnesses that affected breathing such as bronchiolitis or croup, and being overweight. It can also be caused by breathing in certain substances, such as chemicals, at work.

The NHS says an asthma attack is when you have severe symptoms and it is difficult to breathe, and that it can be life-threatening. Asthma + Lung UK says you may be having an attack if your symptoms are quickly getting worse, your reliever is not helping as much as usual, you are finding it difficult to walk or talk, or your peak flow score is much lower than usual.

If you are having an asthma attack, the NHS says to sit up straight and try to stay calm, and use your reliever inhaler if you have one. If you have a blue reliever inhaler, take 1 puff every 30 to 60 seconds until you feel better, up to a maximum of 10 puffs, using a spacer if you have one. If you have an AIR or MART inhaler, take 1 puff every 1 to 3 minutes until you feel better, up to a maximum of 6 puffs. Follow the maximum dose in your personal asthma action plan if it differs.

Call 999 if you start to feel worse at any time, do not feel better after taking the maximum dose, or do not have an inhaler. If symptoms are no better after 10 minutes and an ambulance has not arrived, use the inhaler again up to the same maximum dose. Do not drive yourself to A&E.

After an attack, even if you feel better, the NHS says to see a GP within 2 days to discuss your treatment and how to prevent another one. Asthma + Lung UK says you need a follow-up appointment no later than two working days after hospital or paramedic treatment, and an urgent same-day appointment if you managed it yourself.

The NHS says asthma usually starts in children, but it can happen at any age, and that asthma in young children sometimes goes away by the time they are teenagers or adults. Asthma + Lung UK says some children find their symptoms go away by their mid-teens, but they can return later in life, set off by an illness, stress, a workplace substance, pollution or hormonal changes such as menopause.

Asthma + Lung UK says children with an allergy or allergy-related condition such as eczema or hay fever are more likely to develop asthma, and children who are exposed to tobacco smoke, whose mothers smoked in pregnancy, or who were born prematurely are at higher risk. The NHS says to see a GP if your child has asthma symptoms, and notes the Beat Asthma website for children and young people.

The NHS says your care team will explain how and when to use your medicines, how to monitor your asthma, ways to avoid triggers and what to do if symptoms get worse, and that this is recorded in your asthma action plan. You should have check-ups at least once a year, which include checking that you are using your inhalers correctly and your plan is up to date.

The NHS suggests always having your inhaler with you, avoiding triggers such as air pollution, smoke, pollen or animals, exercising regularly with advice if exercise triggers symptoms, keeping to a healthy weight and having vaccinations such as the flu vaccine. It says not to smoke, and to check with a pharmacist or doctor before taking medicines such as aspirin, ibuprofen and beta blockers, which can trigger asthma in some people.

Asthma + Lung UK says most people can keep their asthma under control when they take their medicines as prescribed, that asthma can get worse over time if it is poorly controlled, and that four people die every day in the UK because of asthma attacks, with 2 out of 3 deaths preventable.

The NHS says that if you are pregnant, you should tell your doctor or midwife about your asthma, because it is important to manage asthma in pregnancy to keep you and your baby well.

On the NHS, asthma is usually diagnosed and managed in general practice by a GP or nurse, sometimes with a specialist hospital doctor if it is severe or hard to control. The NHS says that if you have severe asthma not controlled by inhalers and tablets, you may be offered biological therapies.

Some people choose a private respiratory consultant for assessment or a second opinion. Whichever route you take, make sure you have a written asthma action plan, an annual review, and that the team looking after you can see your inhaler history.