What is asthma
Asthma is a condition that effects your airways. The airway can become inflamed and irritated to external triggers.
Pollen, weather changes, dust, animal hair, stress and hormones can be a trigger which can affect the airways. This can cause them to become narrower, inflamed and irritated – in turn this can increase asthma symptoms.
Symptoms of asthma:
- Chest tightness
Asthma is a long-term condition and cannot be cured but the effects are reversible. Changes in lifestyle, age and health can affect how well controlled asthma symptoms are. Asthma can be controlled through medication and support.
Around 4% of asthmatic patients have severe or difficult to control asthma. They struggle to control their symptoms. Their GP will refer them to secondary care to be seen by a specialist consultant and nurse to help manage their condition.
Asthma patients’ airways can become inflamed when in contact with triggers, this results in inflammation which in turn leads to asthma symptoms. To prevent asthma symptoms worsening, it is important for you to take your preventer inhaler every day as prescribed. This will help to reduce the inflammation and irritation.
House dust mite allergen avoidance
One of the biggest causes of allergies are dust mites, which are tiny insects found in household dust. You can limit the number of mites in your home by:
- Choosing wood or hard vinyl floor coverings instead of a carpet
- Fitting roller blinds that can be easily wiped clean
- Choosing leather, plastic or vinyl furniture instead of upholstered furniture
- Cleaning cushions, soft toys, curtains and upholstered furniture regularly, either by washing (at a high temperature) or vacuuming
- Using tested allergy-proof covers on mattresses, duvets and pillows
- Using a vacuum cleaner fitted with a HEPA (high efficiency particulate air) filter, as it can trap more dust mites than ordinary vacuum cleaners
- Regularly wiping surfaces with a damp, clean cloth – avoid dry dusting, as this can spread dust into the air
- Concentrate your efforts of controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room
You can find more information on allergies in the home on the Allergy UK website.
This is the ideal therapy, which will reduce the need for long-term medication:
- Stay indoors until after midday (if possible) to reduce your exposure to pollen, particularly in the pollen season and on windy days
- Try to avoid going out on windy days or after thunderstorms
- Wear sunglasses to protect your eyes
- Do not mow the grass and make sure to stay inside when it is being mown. If mowing is unavoidable, wear a mask or consider taking a non-drowsy antihistamine if your doctor has suggested this
- Consider planting a low allergen garden around the home
- Keep windows closed both at home and particularly when in your car (and where possible use recirculating air conditioning in your car)
- Do not picnic in parks or in the country during the pollen season.
- Try to plan your holidays out of the pollen season or holiday at the seaside
- If you are sensitive to particular weeds or trees that are outside your bedroom window, have them removed
- If landscaping at home, research plants less likely to trigger allergic rhinitis or asthma
- Shower when you arrive home and rinse your eyes frequently with water
Carry a supply of tissues
Pet allergen avoidance
It’s not pet fur that causes an allergic reaction. Instead, it’s flakes of their dead skin, saliva, and dried urine. If you can’t permanently remove a pet from the house, you could try:
Keeping pets outside as much as possible or limiting them to a particular area of the house, preferably an area without carpet and not allowing pets in bedrooms
Washing pets at least once a week
Regularly grooming pets outside
Regularly washing all bedding and soft furnishings pets lie on
Using an air filter in rooms where you spend most of your time
Increasing ventilation with fans or air conditioning, or by opening windows
If you’re visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you’re visiting, as this will stir up the allergens into the air
Taking an antihistamine medicine about an hour before entering a pet-inhabited house can also help reduce your symptoms
Other triggers that can affect asthma symptoms are colds and viruses, these can cause inflammation in the airways and can worsen asthma symptoms. We recommended that you have your flu vaccine yearly.
Smoking can cause inflammation of the airways due to the toxins and chemicals in cigarettes. Smoking can lead to increased asthma symptoms and a need for higher doses of your preventer inhaler to control symptoms. Patients with asthma, who smoke have a high chance of developing Chronic Obstructive Pulmonary Disease (COPD) as well as a higher Asthma attack rate therefore it is important that you stop smoking.
Stress can be a big factor in worsening asthma symptoms, it is important to identify the cause of stress and seek support before it affects your health.
There are support networks available online, speaking to someone can help. Making time for yourself is important to help alleviate stress.
Asthma treatment varies depending on the severity of your asthma and personal choice with regard to inhalers.
The aim of treatment is to be symptom free during the daytime and not to awaken overnight due to your asthma symptoms. Asthma should not limit daily life.
All asthma patients will be given inhalers, they are the first line of treatment for asthma. A preventer and a reliever inhaler should be prescribed by the GP.
The preventor inhaler contains a steroid, this should be taken every day even when you are well. It helps to reduce the inflammation in the airways and reduce asthma symptoms. Inflammation is the main cause for Asthma symptoms.
The reliever inhaler is fast acting. It is used to relieve asthma symptoms by relaxing the smooth muscle around the airways allowing them to open and reducing symptoms in the short term.
There are many types of inhaler devices, patients may prefer one to another.
A Metred Dose Inhaler (MDI) is the most commonly prescribed, it is used in conjunction with a spacer device to allow more of the drug to reach the lungs. Your asthma nurse, GP or pharmacist should demonstrate how to take this effectively.
Asthma UK also has demonstration videos on how to use different devices. You can view these by visiting https://www.asthmaandlung.org.uk/living-with/inhaler-videos
Dry power devices require good technique to breathe in the medication, this can be difficult to do if the patient is breathless.
There are other medications that can be prescribed to help with asthma symptoms.
Montelukast can be used to treat nocturnal asthma symptoms. It is used to reduce inflammation; it is used in conduction with preventor inhaler.
Uniphylline can also be used in the form of tablets which are taken twice a day. This medication belongs to a family called Bronchodilators and they help to open the airways. It is important that blood levels are done to check that the correct dose is given.
Peak flows are an important indicator to show how stable a person’s asthma is, keeping a record of them is important to see certain trends in symptoms. A diary should be kept when you are initially diagnosed or when you have an exacerbation
(symptomatic) to monitor your peak flow readings.
Once you know what your best peak flow reading is, it is easier to monitor. If peak flows reduce you can seek help earlier. Your peak flow may start to reduce before you become symptomatic. It can be an early indicator that you are going to have an Asthma attack, therefore you are able to seek advice and help before becoming unwell or requiring an admission to hospital.
To monitor peak flows, take three readings on a morning and three at night. Document the best result, from the three, on a graph like the one here.
Documenting how many inhalations of your reliever inhaler you have used each day is useful when your doctor or nurse is reviewing you.
Asthma action plan
An asthma action plan can be a useful tool to use as a guide for your asthma. It works on a traffic light system.
Green suggests asthma is controlled, amber suggests a person may be symptomatic and red suggests urgent medical attention is required.
- Green will have details of preventor and reliever inhalers and your normal peak flow,
- Amber will show 80% of your normal peak flow and what to step up your medication too. There will also be advice to follow.
- Red will show 60% of your normal peak flow and to seek medical advice.
Asthma UK – www.asthmaandlung.org.uk
For most patients with asthma, if they take their medications each day and attend their appointments with the asthma nurse whilst also removing or reducing their known triggers, they will likely be symptom free.
It is important to be active, it helps to increase lung function and has other health benefits such as improving mood and increasing your general fitness.
Keep your reliever inhaler with you when exercising and always consult your doctor or nurse if you are becoming symptomatic as this could indicate that your asthma is not under control.
A healthy diet can manage weight and can promote wellbeing.
Doing things you enjoy can reduce stress levels and therefore reduce asthma symptoms.
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.