Asthma Uncovered: Understanding the Causes, Symptoms, and Treatment Options

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2 May

Asthma Care for All - World Asthma Day 2023 Logo

It’s world asthma day on 2nd May 2023

“World Asthma Day (WAD)… is organized by the Global Initiative for Asthma, (GINA)…a World Health Organization collaborative organization founded in 1993. WAD is held each May to raise awareness of Asthma worldwide.”

— (Global Initiative for Asthma - GINA, n.d.)

What is this years theme?

“Asthma care for all” is this year’s theme. The majority of asthma morbidity and mortality burden is present in low and middle-income countries. To alleviate this burden, GINA encourages healthcare leaders to ensure the availability of effective, quality-assured medications. The Asthma care for All message promotes the development and implementation of effective asthma management programs in all resource-limited countries.

GINA aims to increase and strengthen its collaboration with local and national guideline makers. Additionally, GINA is committed to ensuring specific recommendations for environmental sustainability by prioritising patient safety and addressing concerns about planetary health. GINA's efforts aim to improve the lives of people with asthma worldwide, and multi-faceted collaboration for improvement in all aspects of asthma care, for patients and the environment, is crucial. (Global Initiative for Asthma - GINA, n.d.).

What is asthma?

A respiratory physiotherapist explains what asthma is.

Key Facts about asthma

Asthma is a significant non-communicable disease (NCD) that affects both adults and children. It is the most prevalent chronic disease among children.
The inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which may include coughing, wheezing, chest tightness, and shortness of breath.
In 2019, an estimated 262 million people were affected by asthma, resulting in 455,000 deaths.
Asthma symptoms can be controlled with inhaled medication, enabling individuals with asthma to live a typical, active life.
Reducing exposure to asthma triggers can also aid in the management of asthma symptoms.
The majority of asthma-related deaths occur in low- and lower-middle-income countries, where under-diagnosis and under-treatment are common challenges.

(World Health Organization, 2022).

The different types of asthma

Allergic asthma

Asthma triggered by allergens such as pollen, pets, and dust mites is known as allergic asthma or atopic asthma. Allergies are present in approximately 80% of people with asthma.

‘Seasonal’ asthma

Certain individuals experience asthma symptoms only during specific periods of the year, such as during hay fever season or in cold weather. Although asthma is typically a long-term condition, being free of symptoms is achievable when triggers are absent. It remains essential to continue following your asthma action plan and taking your prescribed preventer inhaler.

Occupational asthma

Asthma that is directly caused by one's occupation is known as occupational asthma. If your asthma symptoms emerged as an adult and improve on days when you're not at work, you may have occupational asthma. Various factors can cause occupational asthma, such as flour dust in a bakery or latex in healthcare settings.

Non-allergic asthma

Non-allergic asthma, also referred to as non-atopic asthma, is a type of asthma that is not triggered by allergens such as pollen or dust. It is less common than allergic asthma and frequently appears in later stages of life.

‘Exercise-induced’ asthma

Approximately 90% of individuals with asthma experience tightening of the airways triggered by physical activity. However, this symptom can also manifest in individuals without asthma. If you're experiencing tightness in the chest, breathlessness, coughing, or fatigue during or after exercise, but you haven't been diagnosed with asthma, it's crucial to see your GP. They can perform a spirometry test to determine if you have asthma and conduct exercise challenge tests to evaluate how your airways respond to physical activity. Furthermore, they can provide treatments to alleviate your symptoms and enable safe exercise, such as prescribing reliever medication to take before exercising.

Difficult asthma

Roughly 17% of individuals with asthma suffer from challenging asthma, also known as difficult-to-control asthma. Difficult asthma may be indicated by:

Experiencing symptoms three or more times every week

Using your reliever inhaler three or more times each week

Awakening during the night due to asthma one or more times per week

Severe asthma AKA ‘Brittle’ asthma

Severe asthma is a type of difficult asthma that does not respond to typical treatments. However, even if your asthma is described as 'difficult' and you're having many asthma attacks, it does not necessarily mean you have severe asthma.

Your GP may refer you for further assessment and tests if:

Your prescribed treatments are not controlling your asthma symptoms effectively.

You have had two or more asthma attacks requiring oral steroids in a year.

You have had one or more asthma attacks requiring hospital treatment in a year.

You use your reliever inhaler three or more times a week.

You take long-term steroids for your asthma.

Your asthma is affecting your daily life or activity levels.

You are waking up at night due to asthma.

If you have severe asthma, you may require different asthma medications, such as long-term steroid tablets to decrease airway inflammation.

Some individuals with severe asthma may be treated with biologics, which can help manage asthma symptoms and reduce asthma attacks. Top of Form

Childhood asthma

In the UK, approximately 1.1 million children are affected by asthma.

Childhood asthma refers to the condition where some children with asthma experience an improvement in their symptoms or complete resolution of their asthma as they grow older. Nonetheless, it can occasionally resurface in later life.

Adult-onset asthma

Asthma can begin during childhood, but some people may receive an asthma diagnosis for the first time as an adult, which is referred to as adult-onset or late-onset asthma.

There are several potential causes of adult-onset asthma, including:

Occupational asthma: approximately one in ten cases of adult-onset asthma are related to the workplace.

Smoking and exposure to second-hand smoke

Obesity

Female hormones: this may be a factor in why women are more prone to developing asthma as adults than men.

Stressful life events.

(www.asthmaandlung.org.uk, n.d.)

Asthma Attacks

If you experience the following, you may be having an asthma attack:

Your blue reliever inhaler does not provide relief, or you need to use it more than every four hours.

You are coughing excessively, have a very tight chest, or are wheezing heavily.

You feel breathless and find it challenging to talk or walk.

Your breathing is becoming more rapid, and it feels as if you can't get enough air into your lungs.

You may exhibit all or just some of these signs and symptoms. For instance, you may not wheeze.

If you are in any doubt if you or someone you know is having as asthma attack, you must call 999 immediately. Asthma attacks can become fatal if left untreated.

The NHS state that

“Never be frightened of calling for help in an emergency.

Try to take the details of your medicines (or your personal asthma action plan) with you to hospital if possible.

If your symptoms improve and you do not need to call 999, get an urgent same-day appointment to see a GP or asthma nurse.

This advice is not for people on SMART or MART treatment. If this applies to you, ask a GP or asthma nurse what to do if you have an asthma attack.”

(NHS, 2019)

Who can be and who is affected by asthma? Stats and figures in the UK.

What are the treatments for asthma?

While there is no cure for asthma, proper treatment and support can help people lead symptom-free lives. The goal of asthma treatment is to manage symptoms, improve lung function, and prevent asthma attacks. Doctors and asthma nurses work to achieve this by prescribing the lowest effective dose of medication and developing an individualized treatment plan. If your medications are effective, you should experience no symptoms during the day, better sleep because you are not being woken up by symptoms at night, less need for your reliever inhaler, no asthma attacks, good lung function, and the ability to engage in daily activities, including exercise, without asthma symptoms interfering.

Inhalers are the most common type of treatment for asthma and are usually the most effective for most people. Inhalers are preferred because they help deliver the medicine directly to the airways where it's needed.

Most people with asthma use two types of inhalers: a preventer inhaler and a reliever inhaler.

Regular use of preventer inhalers can help to reduce inflammation and swelling in the airways, making it less likely for symptoms to occur when exposed to asthma triggers. Using preventer medicine regularly can also decrease the risk of having asthma attacks. Therefore, it is recommended that all individuals with asthma use a preventer inhaler.

Reliever inhalers are designed to alleviate asthma symptoms such as coughing, wheezing, breathlessness, and chest tightness.

You should only use your reliever inhaler when you experience symptoms or have an asthma attack.

If your asthma is well-managed, you may not need to use your reliever inhaler frequently, or not at all. Nonetheless, you should always carry it with you in case of symptom flare-ups.

In rare cases, individuals with infrequent, mild symptoms may only need a reliever inhaler for symptom relief.

Nonetheless, studies suggest that it is advisable for everyone with asthma to have a preventer inhaler to minimize the risk of asthma attacks.

Although most people with asthma manage well with a regular preventer inhaler and a reliever inhaler as needed, some may require additional treatments. These are called "add-on" treatments because they are taken in addition to the regular preventer inhaler.

Your doctor may consider add-on treatments if you are following your prescribed preventer inhaler regime but still experience symptoms. Before starting any additional medications, your doctor will assess whether other factors may be contributing to your difficulty managing your asthma, such as difficulty adhering to your treatment plan, improper inhaler technique, or exposure to triggers. Smoking can also hinder the effectiveness of the preventer inhaler medication.

If you may benefit from additional medications to better manage your asthma, your doctor may suggest trying one of these add-on treatments:

Long-acting bronchodilators are a type of medication that can help open up your airways and contain reliever medicines that last up to 12 hours, thus reducing the likelihood of asthma attacks. However, it's important to note that long-acting bronchodilators cannot treat the inflammation in your airways, so it's crucial to continue using your preventer inhaler as prescribed.

Your GP may prescribe a combination inhaler that contains both the long-acting bronchodilator and your preventer medication. While a certain type of long-acting bronchodilator medication found in MART inhalers (Maintenance and Reliever Therapy) can provide quick relief for asthma symptoms, not all combination inhalers can be used as a reliever, so it's important to confirm this with your GP.

It's also important to have a blue reliever inhaler on hand in case symptoms do occur. Make sure to discuss with your GP or asthma nurse the limitations of your long-acting bronchodilator and what it can and cannot do.

Montelukast, also known as Singulair, is a tablet used as a preventer medicine for asthma. It belongs to a class of drugs called leukotriene receptor antagonists (LTRAs) which help reduce inflammation in the airways.

Montelukast does not contain steroids like your preventer inhaler, so it is taken in addition to your regular steroid preventer inhaler.

Your GP may recommend oral steroids, typically prednisolone, to supplement your regular asthma medication.

Steroids work by reducing inflammation in your airways and can help bring your symptoms under control in the short term, or after an asthma attack.

However, if you require oral steroids frequently or for an extended period, it is advisable to consult an asthma specialist to explore alternative methods for managing your asthma.

If you continue to experience asthma symptoms despite taking your preventer and add-on medicines as prescribed, your GP may refer you to a specialist.

The specialist can conduct tests to determine if you have severe asthma. They can explore treatment options such as monoclonal antibody therapy or bronchial thermoplasty.

(www.asthmaandlung.org.uk, n.d.)

Links to relevant sites and further information

Have a look at the asthma and lung UK website for news about the amazing work they do and what you can do to help. Their website also contains a wealth of information on all things asthma and lung related.

https://www.asthmaandlung.org.uk/about-us/what-we-stand-for/our-latest-work

Another great resource for information is the global initiative for asthma. You can read all about their work here –

https://ginasthma.org/

The NHS site is also a great resource for up to date patient focussed information on any and all health conditions, including asthma. You can find their information page on asthma here –

https://www.nhs.uk/conditions/asthma/