Managing asthma: a respiratory consultant’s guide

Asthma is a common long-term lung condition that affects the airways, causing symptoms that can range from mild to potentially life-threatening. With the right approach, asthma can be well controlled in most individuals, allowing them to live normal, active lives. This article by a consultant respiratory physician provides an overview of asthma and how to manage it successfully.

 

 

 

What is asthma?

Asthma is usually a long-term condition that affects the bronchial tubes (airways), causing them to become inflamed and narrowed. This inflammation leads to symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which are often worse at night or in the early morning. These symptoms can vary in severity and frequency, and they tend to come and go.

An asthma attack occurs when these symptoms suddenly worsen, often due to exposure to a specific trigger. In severe cases, asthma attacks can be life-threatening and require urgent medical attention.

 

What causes asthma?

The exact cause of asthma is not fully understood, but it is believed to be the result of a combination of genetic and environmental factors. People with a family history of asthma, eczema, or allergies (known collectively as atopic conditions) are more likely to develop asthma themselves.

Asthma can develop at any age, although it commonly begins in childhood. Certain environmental and lifestyle factors increase the risk, including:

• Exposure to allergens, such as pollen, dust mites, pet dander or mould
• Air pollution and cigarette smoke
• Occupational exposure to fumes, chemicals, or dust
• Respiratory infections, particularly in early childhood
• Obesity, which is associated with more severe asthma symptoms

It is important to recognise that asthma is not a one-size-fits-all condition. Triggers and symptom patterns differ significantly between individuals.

What are the risks of unmanaged asthma?

Uncontrolled asthma can have serious health implications. Frequent symptoms, disturbed sleep, and limited physical activity can significantly impact quality of life. More seriously, poorly managed asthma increases the risk of severe asthma attacks, which can be life-threatening if not treated promptly.

Long-term effects of poorly controlled asthma may include permanent airway damage (airway remodelling), which can make the condition harder to manage over time. Children with unmanaged asthma may also experience impaired growth and development due to restricted activity or repeated absences from school.

People with asthma are also at increased risk of complications from respiratory infections, such as influenza or pneumonia. For this reason, regular flu and COVID-19 vaccinations are recommended.

 

How to manage asthma effectively

Asthma management is centred on reducing symptoms, preventing attacks, and maintaining normal activity levels. This can include:

• Using asthma medication correctly: Most patients are prescribed a reliever inhaler (usually blue) for quick symptom relief , although recently the guidelines have changed in the UK and a combined inhaler may provide both immediate relief and also act as a preventer inhaler for daily use to reduce inflammation in the airways. Proper inhaler technique is crucial and patients should have their technique reviewed regularly by a healthcare professional.
• Understanding and avoiding triggers: Identifying specific asthma triggers, such as pollen, pets, or cold air—and minimising exposure can greatly reduce the frequency of symptoms.
• Regular asthma reviews: Patients should have an annual asthma review with their GP or asthma nurse. This provides an opportunity to assess symptom control, review medications, and update the personalised asthma action plan.
• Monitoring symptoms and peak flow: Keeping a record of symptoms and using a peak flow meter can help detect early signs of deterioration.
• Lifestyle considerations: Maintaining a healthy weight, staying physically active, and avoiding smoking (including vaping) can all contribute to better asthma control.

It is essential for patients to recognise when their asthma is not under control. Warning signs include increased use of the reliever inhaler, waking at night with symptoms, and limitations in daily activity. These should prompt a review with a physician or asthma nurse.