Asthma affects millions of people in the UK and, with the right treatment, most patients can manage their symptoms. However, it remains a serious condition leading to around 1,500 deaths and 60,000 emergency hospital admissions every year. Many of these could be prevented through better treatment and the correct day-to-day management, according to Dr Azeem Majeed, a GP and Express health columnist.
What is asthma?
Asthma occurs when the airways that carry air into and out of the lungs become inflamed. This makes the airways swollen and sensitive, so they react more strongly to triggers such as viral infections, pollen, house dust mites, cigarette smoke and air pollution. During an asthma attack, the muscles around the airways tighten, the lining of the airways swells further and extra mucus may be produced. These changes make breathing difficult and can lead to wheezing, coughing and breathlessness.
Reliever inhalers are only part of the answer
For many years, the treatment that most people associated with asthma was the blue reliever inhaler, usually containing salbutamol. These inhalers, available by prescription only, work quickly by relaxing the muscles surrounding the airways, allowing them to open within minutes. They provide rapid relief and remain an important treatment for asthma. However, reliever inhalers treat only one part of the problem. They do not reduce the underlying inflammation that causes asthma. If inflammation is left untreated, the airways remain swollen and sensitive, making future attacks more likely. While symptoms may improve temporarily, the underlying disease may actually be worsening.
Modern asthma treatment focuses on inflammation
Our understanding of asthma has changed significantly and so has the recommended treatment. Current NHS guidance recommends inhalers that not only relieve symptoms but also treat the underlying inflammation. These inhalers contain both a reliever medicine and an inhaled corticosteroid which reduces inflammation inside the airways. For people with mild asthma, this approach is known as anti-inflammatory reliever (AIR) therapy. The inhaler is used only when symptoms occur but every dose provides both immediate symptom relief and treatment of the inflammation. People whose asthma is more severe may be advised to use maintenance and reliever therapy (MART). With MART, the same inhaler is used every day to keep asthma under control and also whenever symptoms develop. This simplifies treatment while ensuring that inflammation is treated consistently. Increasing numbers of people are now being prescribed AIR and MART inhalers rather than relying solely on reliever inhalers. This reduces the risk of severe asthma attacks and emergency hospital admissions while providing good day-to-day symptom control.
An important message for anyone with asthma is that frequent use of a reliever inhaler should not be seen as normal. If you find yourself needing your reliever inhaler several times a week, waking at night because of symptoms, or limiting your activities due to breathlessness, your asthma may not be well controlled. Rather than simply using your inhaler more often, you should arrange a review with your GP practice or asthma nurse to discuss whether your treatment needs adjusting.
Taking control of your asthma
Taking asthma medicines correctly is just as important as having the right prescription. Many people do not use their inhalers properly, meaning that much of the medicine never reaches the lungs. Your GP practice or asthma nurse can check your technique and make sure you are getting the maximum benefit. Even small improvements can improve asthma control. Every person with asthma should also have a personalised asthma action plan. This written plan explains which medicines to take every day, how to recognise when asthma is becoming worse, what changes to make to treatment if symptoms increase, and when to seek urgent medical help. Asthma action plans are available through your GP practice. Templates can also be downloaded from the Asthma + Lung UK website.
There are also lifestyle measures that can help reduce the risk of asthma attacks. Avoiding smoking is one of the most important. Maintaining a healthy weight, exercising regularly, keeping vaccinations such as the annual flu vaccine up to date, and attending regular asthma reviews all contribute to better asthma control. It is important to recognise when urgent medical attention is needed. If you are becoming increasingly breathless, struggling to speak in full sentences, your reliever inhaler is not providing relief, or your symptoms are rapidly worsening, seek emergency medical help.
Living well with asthma
Modern treatments have transformed the outlook for most people with asthma. Today’s inhalers also treat the inflammation that lies at the heart of asthma, helping to prevent severe attacks. By using the right inhaler recommended by a clinician, checking your technique, attending reviews and following a personalised asthma action plan, you can greatly improve your asthma control and enjoy an active, healthy life.
