Asthma and respiratory allergy
Asthma is a long-term disease of the airways that shows itself as cough, wheezing, shortness of breath and chest tightness. This page explains in plain language what asthma is, how it is assessed, what treatment aims for, what you can do yourself and when to get urgent help.
What is asthma?
Asthma is a long-term disease of the airways. The ATS names two main problems: inflammation, meaning swelling and extra mucus in the lining, and tightening of the muscle around the airway. Both make it harder for air to pass. The NHS lists the symptoms as wheezing, cough, shortness of breath and chest tightness. These symptoms come and go and are usually worse at night and in the early morning.
What sets off an attack differs from person to person. The ATS groups triggers into several categories:
- Allergens: pollen, mould, cats and dogs, dust mites and cockroaches.
- Irritants: dust, weather changes, air pollution, cleaning products and insect sprays, strong smells, and smoke or vapour from cigarettes, e-cigarettes and similar products.
- Respiratory infections: the ATS considers these the most important cause of asthma-related hospital admissions.
- Other things: stress, exercise and some medicines such as aspirin and beta-blockers.
If you also have an allergy, controlling it is part of controlling asthma. The NHS lists allergic conditions such as eczema and hay fever among the risk factors for asthma.
Who should be seen?
According to the NHS, make an appointment if any of these apply:
- You have asthma symptoms and have not yet been diagnosed.
- Your current treatment is not helping, or you need your reliever inhaler more than before.
- Symptoms limit your daily activities or wake you at night.
- You want to learn or review how to use your inhaler.
The ATS adds that if you are not getting better despite asthma treatment, seeing an asthma specialist is appropriate. The NHLBI describes signs of worsening like this: symptoms are more frequent or more severe than usual, you need your reliever inhaler more, you wake at night coughing, and usual activities, including exercise, have become harder. The NHS writes that after recovering from an asthma attack you should see a doctor within two days.
How is it assessed?
The NHS writes that diagnosing asthma can sometimes take time. It usually involves these steps:
- A doctor or nurse asks about your symptoms and examines your chest.
- A simple breathing test may be needed, and sometimes a blood test.
- Sometimes you are given a small device called a peak flow meter, to record at home over several weeks how your lungs are working.
- If asthma is likely, you may be given medicine for a while to see whether it works.
The ATS says the doctor usually suspects asthma from the pattern of symptoms and the response to a bronchodilator medicine, and that for people older than five, spirometry helps confirm it. A normal spirometry result does not rule out asthma. If asthma is hard to control, other causes may also be checked: allergy, sinus disease, vocal cord dysfunction, reflux and heart problems. See the “Lung tests” guide for an explanation of each test.
What does treatment look like overall?
The NHS describes the aim of treatment as reducing or preventing symptoms and lowering the risk of attacks. The main treatment is inhaled medicine:
- A reliever inhaler is used when symptoms occur and relaxes the muscle around the airway.
- A controller inhaler is used every day and keeps inflammation calm over the long term. Controller inhalers are usually inhaled steroids.
- Some plans include a combination inhaler that is used both daily and when symptoms occur. The choice of plan is up to the doctor.
The doctor writes an asthma action plan with you. The NHS and ATS say it states when and how to take your medicines, how to assess your own condition, and what to do if symptoms get worse. The NHS says you should have a routine review at least once a year, and that your inhaler technique should be checked at it.
If inhalers are not enough, the doctor may add tablets such as montelukast. The ATS stresses that these tablets do not replace inhalers. For severe asthma that is not under control there are also injectable medicines, which a specialist doctor chooses based on tests. Oral steroids are usually used to settle an attack.
What can you do yourself?
- Do not stop your controller medicine just because you feel better. GINA says stopping an inhaled steroid inhaler often makes asthma dangerously worse. Talk to your doctor or nurse before stopping or reducing any medicine.
- Do not stop oral steroids on your own. The doctor tells you how long to take them and how to reduce them.
- An inhaler is a medicine and is not addictive. If you are worried about dependence, ask your doctor.
- Rinse your mouth after a steroid inhaler: swish water in your mouth, gargle and spit it out (ATS).
- Always carry your reliever inhaler (ATS). If you need it more than before, that is itself a warning sign and you should see a doctor.
- Show your doctor or pharmacist how you use your inhaler. The “Inhalers and spacers” guide sets out the steps.
- Learn your own triggers. The ATS says a daily diary of activities and symptoms helps find patterns. Give up cigarette smoke and e-cigarette vapour.
- Exercise regularly and talk to your doctor about how to do it safely. Have a flu vaccine every year and ask about the pneumococcal vaccine (ATS).
- Before taking aspirin, ibuprofen or a beta-blocker, ask a pharmacist or doctor, because the NHS says they can trigger asthma symptoms in some people.
For any medicine, supplement or product you want to take alongside your treatment, ask your doctor before starting.
When to get urgent help
Call 115 (Iran’s emergency number) right now or go to the emergency department if:
- Your condition gets worse during an asthma attack, or you do not improve after using your reliever inhaler as your doctor’s plan says, or you do not have your inhaler with you (NHS).
- You are gasping for breath and cannot finish a sentence (NHS).
- Your lips or skin have turned pale, blue or grey. On dark skin, the color change is easier to see on the palms (NHS).
- You have suddenly become confused.
The NHS stresses that you should not drive yourself. Ask someone to take you or call an ambulance, and take your medicines with you.
See a doctor the same day if: your symptoms have got worse, you need your reliever inhaler more than before, or symptoms wake you at night. If you cannot reach a doctor, go to the nearest emergency department. See the “When should I call urgently?” guide for the full list.
Frequently asked questions
Are asthma and allergy the same thing?
No, but they are often seen together. The NHS writes that a person with an allergic condition, such as eczema or hay fever, is more likely to develop asthma, and the ATS lists pollen, mould, pets and dust mites among asthma triggers. Asthma is a disease of the airways, while allergy is the body's reaction to a substance. The doctor works out what part your allergy plays in your symptoms from your history and, if needed, tests.
Is the inhaler addictive?
Asthma inhalers are medicines and are not addictive. We did not find this stated so explicitly in the sources we read for this page, and a doctor must confirm it. What the sources say is that a daily controller medicine keeps airway inflammation calm, while a reliever inhaler is used when symptoms occur (ATS). Worry about addiction is not a reason to give up your inhaler; if you are worried, talk to your doctor.
I feel well. Can I stop my controller inhaler?
Not without talking to your doctor. GINA writes that stopping an inhaled steroid inhaler often leads to a dangerous worsening of asthma, and that you should consult a doctor or nurse before stopping any asthma medicine. Feeling well is usually a sign that this medicine is working. Whether the medicine can be reduced is the doctor's decision.
Can I stop steroid tablets myself once I feel better?
No. GINA says that not taking oral steroids during a severe asthma attack can have serious consequences, and that stopping them suddenly is dangerous for people who have taken them for a long time. The doctor tells you how long to take them and how to reduce them.
How many times a week can I use my reliever inhaler before I should be worried?
We did not find an exact number in our sources, but the sign is clear. The NHS and NHLBI both say that if you need your reliever inhaler more than before, your symptoms wake you at night, or daily activities have become harder, you should see a doctor. Heavy use of the reliever inhaler shows that asthma is not under control and the treatment plan needs to be reviewed.
Can asthma be cured?
The NHS writes that there is currently no cure that completely removes asthma, but with the right treatment symptoms should not disrupt your life. Some children improve by their teens or adulthood, but in many people asthma is lifelong. The aim of treatment is to control symptoms and reduce attacks.