Asthma

Asthma is a chronic condition that makes the sufferer’s airways sensitive, experiencing reactions if they come into contact with any irritating substances known as triggers.

Each person’s asthma can be triggered differently depending on the type of asthma they suffer from. Triggers can cause breathlessness, a tight chest, wheezing, and coughing.

In the UK there are 5.4 million people receiving treatment for asthma as of 2014. Of that number 1.1 million are children. Globally there may be as many as 300 million sufferers.

Asthma is one of the top 10 most chronic conditions in the world. It is the most common chronic condition in children.

Three people die every day due to asthma attacks. Two thirds of these deaths are preventable.

How do you get asthma?

The main cause of asthma, and why some people do and others don’t have it remains unknown. It tends to run in families, especially if there is a history of allergies present or conditions like eczema. However, researchers are still unable to pinpoint a definitive cause.

As well as being partly genetic, developing asthma can also be down to your environment or lifestyle choices. Pollution like traffic fumes could cause asthma, or make symptoms worse.

You pose the highest risk of developing asthma when there is a history of atopic conditions. However, you are also more likely to get it if:

  • You were born prematurely, especially if you needed a ventilator to help you breathe after birth.
  • You didn’t grow at a normal rate in the womb resulting in a low birth weight.
  • You had bronchiolitis as a child.
  • Your mother smoked while pregnant with you.
  • Your parents smoke or smoked while you were a child.
  • You are regularly exposed to second-hand cigarette smoke.

Some researchers think that with modern day improved hygiene conditions; fewer children are being exposed to infections. This results in a lower immune system as it isn’t given a chance to build immunity to more commonplace illnesses. A lowered immunity can increase the risk of asthma.

What age groups are most likely to develop it?

Asthma can start at any age, with 1 in 11 children living with it and 1 in 12 adults. That being said, symptoms usually start during childhood.

It appears to be more common in boys than girls, but more common in women than men. This is because adult females can develop asthma due to hormones, especially before or after the menopause.

Where in the world has the highest prevalence?

A 2004 study showed that Scotland ranked the highest prevalence of clinical asthma at 18.4% of the population, with England coming in second at 15.3%, closely followed by Australia at 14.7%.

The World Health Organisation estimates that worldwide there are 300 million individuals living with asthma and that this number could reach 400 million by 2025.

Asthma symptoms and triggers

Asthma exclusively affects your airways making them overly sensitive and easily irritated. Airway symptoms caused by any of a person’s specific triggers - of which they may have one, or many - can present themselves in a few different ways.

Airway obstruction. The muscle bands that surround the airways are normally relaxed, allowing you to breathe freely. However, if a person with asthma comes into contact with, or experiences one of their triggers, these bands of muscle tighten, making the airways narrower so that air cannot move freely.

Airway inflammation. The lining of the airways can become inflamed and start to swell up making breathing difficult. The inflammation can also have long-term damaging effects on the bronchial tubes, making treatment of the swelling vital to managing asthma in the long run.

Airway irritability. Asthma sufferer’s airways are overly sensitive and can overreact when even the smallest trigger is present, such as pollen or animal dander. This overreaction causes the airways to narrow, restricting airflow.

Mucus build up. The airways are naturally lubricated with mucus to help humidify the inspired air, and to keep the airways functioning normally. However mucus - or phlegm - can build up causing the airways to narrow even more.

Either one or a combination of the above airway symptoms can create the asthma symptoms we recognise, including:

  • Wheezing (a whistling sound made by air moving through tightened airways)
  • Shortness of breath
  • A tight chest
  • Coughing

Asthma attacks

An asthma attack is when a person’s asthma gets drastically worse for a short period. This can either happen suddenly or over a few days.

A combination of some or all of the airway symptoms previously mentioned are responsible for causing an asthma attack, as when put together they can make breathing very difficult.

When having an asthma attack, you may experience:

  • Severe wheezing
  • Very rapid breathing
  • Coughing that won’t stop
  • Being too breathless to eat or speak
  • Difficulty performing normal daily activities
  • Quickened heartbeat
  • Blue lips or fingertips
  • Feeling anxious or panicky
  • Severe chest tightness

If you suffer an asthma attack, it is more likely to be mild rather than severe. The airways will usually open back up within a few minutes to hours after treatment. In the less likely event of a severe attack, the effects will last longer and need immediate medical help.

Learn the warning signs of an asthma attack so symptoms can be treated quickly to prevent a severe episode.

If you experience any of the symptoms and suspect you are having an asthma attack, and your symptoms do not quickly improve after following your action plan, call your appropriate emergency services for assistance immediately.

If you are ever unsure, take this asthma attack risk checker from Asthma UK in less than 3 minutes.

What are asthma triggers?

An asthma trigger is something that irritates your sensitive airways and sets off your asthma.

Common triggers include:

  • Pollen (grass, trees, weeds)
  • Pets (pet dander)
  • Dust Mites
  • Mould and fungi
  • Smoke (open fire/second-hand)
  • Cigarettes /smoking
  • Alcohol
  • Weather (cold air, extremely dry wet or windy weather)
  • Exercise
  • Colds, flu, other illnesses
  • Chemical fumes (e.g. chlorine, ammonia, etc.)

It is possible to have multiple triggers, as each person living with asthma has their own personal mix. One person’s triggers may be completely different to another’s, and one person may only have one specific trigger, whereas another person may have many.

You may also notice that sometimes your triggers don’t cause symptoms. This is because your airway sensitivity can vary from day to day, month to month, or even year to year. If you manage your asthma well, your triggers are less likely to cause symptoms.

Sometimes your symptoms can be caused by more than one trigger at the same time resulting in a stronger reaction, for example, if you have a cold and you are around people smoking cigarettes. The next time you are around cigarette smoke but don’t have a cold, your reaction might not be as strong.

Working out your triggers

Learning what your specific triggers are is a vital component to managing your asthma. Once you know what they are, you can deal with them appropriately to minimise the symptoms you experience.

Sometimes triggers are more obvious than others, so it is a good idea to keep track of when your symptoms occur.

For example, if you start to experience your symptoms after coming into contact with a cat or dog, animal dander will be an easy to spot trigger.

However, some triggers are invisible like pollen, pollution, or dust mites. It may be the case that you must first rule out the more obvious triggers before narrowing down to the less obvious ones.

It is also possible for you to have a delayed reaction to your triggers, making spotting them more challenging.

Once you know what your triggers are, you can work towards entirely avoiding or minimising contact with them. Some triggers are unavoidable - like pollen or dust mites - but if you know what they are you can take precautions to manage your symptoms.

Different types of asthma

Asthma is a condition that can be broken down into various subcategories, mainly differentiated by the time/situation in which you experience your symptoms.

There are 6 different types you could experience; it is possible to have a combination of the different types, or just one.

Your asthma flare-ups can appear in many situations and at various times. They could appear during spring and summer when pollen counts are at their highest, implying you have seasonal asthma. However, this could also be combined with symptoms that don’t respond to normal asthma medication, meaning you may have a combination of severe and seasonal asthma.

Here are the 6 types of asthma in more detail:

Occupational and Work-Aggravated Asthma

This form of asthma is directly caused by, or aggravated by the work that you do. This can be down to the environment you work in, or the substances you work with.

The two types vary slightly.

  • Work-aggravated asthma is when you already suffer from asthma, but it is made worse by the work you do.
  • Occupational asthma is asthma directly caused by the work you do.

1 in 10 instances of adult asthma is brought on by work-related factors, and occupational asthma is the most common cause of adult onset asthma, making up 9 to 15% of cases in people of working age.

Occupational asthma also has its own two subtypes:

  • Allergic occupational asthma
  • Irritant-induced occupational asthma

Allergic occupational asthma

Allergic occupational asthma is more common than its irritant-induced counterpart.

This type is developed when the sufferer comes into contact with substances they are allergic to exclusively in their workplace. These could include flour dust, car fumes, or animal dander.

People who develop allergic occupational asthma may have found that they can carry out their work for weeks, months, or even years without experiencing any symptoms. However, it can take a while for your immune system to become sensitive to an allergen.

Once you have become sensitive, you only need to come into contact with a small amount of the allergen to trigger your asthma symptoms.

The most common substances that cause allergic occupational asthma in the UK are isocyanates, and additives called amylase. These are usually found in things like vehicle spray paint and in places such as bakeries.

Certain jobs have the highest rates of allergic occupational asthma, including:

  • Vehicle spray painting
  • Baking
  • Woodworking
  • Soldering and welding
  • Working with animals
  • Working in agriculture

The Health and Safety Executive has put together tips for you to follow if you work in these industries and want to avoid allergic occupational asthma.

Irritant-induced occupational asthma

This form of occupational asthma is far less common as it doesn’t involve any allergens and only occurs if you breathe in a chemical in the workplace. Breathing in chemicals can irritate your airways and can cause asthma symptoms.

You are only likely to breathe in irritating chemicals if there is a chemical spillage in your workplace. If this occurs and you start to experience asthma symptoms like wheezing, breathlessness or coughing within a day of the spillage, seek advice from your GP.

Some irritating chemicals include chlorine and ammonia.

If you are worried about whether your work may cause or aggravate your asthma, find out what your employer can do to help.

Difficult to Control and Severe Asthma

Among asthma sufferers, around 17% have difficulty breathing nearly all the time and have frequent, sometimes potentially life-threatening asthma attacks.

Out of this 17%, they can be divided into two different groups:

  • Difficult to control asthma
  • Medically diagnosed severe asthma

Differentiating between these two types can be challenging as the line that sets them apart is very fine.

Difficult to Control Asthma

12% fall under the ‘difficult to control’ category. Sufferers often have difficulty breathing and experience varying degrees of asthma attacks regularly, despite being on high doses of medication.

There are many reasons why you may have difficult to control asthma, including:

  • Struggling to get into a good routine of taking your medication or inhalers, preventing you from getting the right dosage.
  • Smoking, which inhibits medication from working properly and worsens asthma symptoms.
  • Some long-term conditions can make it harder to manage your asthma, such as diabetes or a heart condition.

Despite this, it is still possible to bring difficult to control asthma under control with normal asthma medicines, and the correct support and care to understand what is needed to achieve this.

Knowing how to correctly take your medication to continually get the correct dosage is of utmost importance, as well as taking them exactly as prescribed.

Sufferers can often believe that their difficult to control asthma is instead severe asthma. However, it is normally the former. Having ‘severe asthma symptoms’ is not the same as having a severe asthma diagnosis, which can make deciphering between the two types difficult.

Even if you have to keep taking your reliever inhaler, it still doesn’t always mean that you have severe asthma. It does, however, confirm that your asthma is not under control, and you should speak to your GP or asthma nurse about the steps you can take to get it well controlled.

Severe Asthma

5% of sufferers will be diagnosed with severe asthma. They are normally referred for specialist ongoing asthma care as they don’t respond to usual asthma medication even if it is taken regularly and correctly. Severe asthma needs different support and treatments to other types as the nature of the asthma is complex.

Organisations such as Asthma UK are supporting lots of research into severe asthma and its causes, as little is still known about this type and why some sufferers have it, and others don’t.

Some current theories include:

  • The inflammation is caused by chemicals that the currently available medications aren’t designed to block or control.
  • The sufferer’s airways might be too inflamed for normal medication to have enough of an effect.
  • The sufferer’s asthma may not be caused by allergens or irritants, so medication combating these won’t work. They could have 'eosinophilic asthma' which is triggered by a higher level of white blood cells called an eosinophil.

Severe asthma can develop at any age, but sufferers are likely to already have some form of asthma diagnosis. Their condition could become severe, triggered by things like hormonal changes or pneumonia. Or it could be that it was severe asthma for some time before the correct diagnosis was given.

There are some medications to help with severe asthma, including Xolair which targets severe allergic asthma, and Mepolizumab and Reslizumab which target eosinophilic asthma.

However, there is no set medication combination that works for everyone. Each sufferer is different, so it can take time to find the right form of treatment for an individual’s severe asthma.

Adult Onset Asthma

Many may believe that once they hit adulthood, they’ve passed an age where they could develop asthma. However, this isn’t the case.

Adult onset asthma is a type of asthma first diagnosed in adulthood and tends to be more common in women than men.

As with all types of asthma, the exact cause is unknown. However, research has shown that 9 to 15% of cases are caused by the work the individual does. There are certain occupations that are more likely to cause a person to develop asthma.

It should go without saying that smoking will increase your risk of developing asthma at any age, as well as having regular contact with secondhand smoke.

It is also believed that female hormones can have a part to play in adult onset asthma, which could be why women are more likely to develop it than men.

Stress, along with other atopic conditions, is also another big cause. Some research has found that those with highly stressful jobs see a massive 50% increase in their likelihood of developing adult onset asthma.

Symptoms are less likely to be triggered by allergies in adult onset asthma, but instead by:

  • Flu, colds, or other related viral infections
  • Hormonal changes (especially in women)
  • Some medicines
  • Irritants, such as chemicals
  • Depression or anxiety
  • Exercise

In adults, these symptoms can sometimes be confused with other conditions like bronchitis, heart disease and chronic obstructive pulmonary disease (COPD). Because of this, diagnosis can take longer.

Childhood Asthma

Childhood asthma is simply asthma that develops during childhood. Sometimes it can improve - or even disappear - as the child gets older. However, there is always the chance of it returning when in adulthood.

There is a higher chance it will carry on or reappear when they are older if their childhood asthma was moderate or severe. Children suffering from mild childhood asthma are less likely to have prevailing symptoms, or for it to reappear in later life.

Triggers are more likely to be allergy related than adult onset asthma, although environmental triggers are just as likely.

Seasonal Asthma

As the name would imply, seasonal asthma is a type that only affects the sufferer at certain times of the year when their triggers are present. This means that they can have extended periods when they do not experience asthma symptoms, but despite this, it is still considered a long-term condition.

Some common triggers are pollen - present between late March and September, depending on the type of pollen - and cold weather.

Seasonal asthma is usually combined with Hay Fever when the sufferer’s trigger is pollen.

Exercise-induced Asthma

Exercise-induced asthma is when symptoms are experienced as a result of physical exercise, either during or shortly after the activity.

This type is normally referred to as exercise-induced bronchoconstriction, as the exercise causes constriction of the airways, in turn causing common asthma symptoms.

Exercise-induced asthma is more commonly experienced in conjunction with another type of asthma, although it is possible to only have symptoms when you exercise.

Along with the common asthma symptoms, sufferers of exercise-induced asthma may also experience:

  • Poorer than expected athletic performance.
  • Fatigue during exercise.
  • Feeling out of shape, even when you're in good physical shape.

An additional sign among children of this condition is activity avoidance.

Luckily for most people with exercise-induced asthma, the condition can be managed with medication and preventative measures to ensure they can continue to exercise.

Asthma management and solutions

Learning how to manage your asthma is a key part of living as healthy and normal a life as possible. There is no known cure for the condition, so rather than being ‘treated’, asthma is ‘controlled’.

There are various things you can do to manage your asthma.

Work out your triggers

The first and most important step to managing your asthma is working out what triggers it. If you know that certain things or environments will cause your asthma symptoms, you can take precautions to avoid them or minimise your exposure.

Working out your triggers can be tough as there is a long list of possibilities, from obscure chemicals to cats. The most effective way to work out your triggers is to keep a diary detailing when you experience symptoms, and what you had been doing prior.

Initially, you will want to track a wide range of things, like whether you experience symptoms more during working hours, any products you have been using, and even what time of year it is.

Being meticulous to begin with will mean you can narrow down your list of possible triggers quicker.

Switching to natural flooring like coir carpet or sisal carpet can help with chemical fume sensitivity.

Get your asthma under control

Once you know what your triggers are, the next step to managing your asthma will be to get it under control. This is easier said than done and will be a process. Some people may find it much easier than others.

A key part of this process will be to regularly visit your GP or asthma nurse for preventative checkups and to discuss what has and hasn’t been working for you. Attending these appointments means you’ll be able to regularly assess if your medication is working for you, if the dosage needs to be changed, or if you should try a different medication.

Once your asthma is under control, your appointment frequency can be reduced.

Your asthma will be considered ‘under control’ if:

  • symptoms such as coughing and shortness of breath are prevented and occur no more than 2 days per week.
  • You hardly need your quick-relief medication, or it is needed less than 2 days per week.
  • Your sleep is unaffected, and symptoms don’t wake you up more than 2 nights per month.
  • Your peak flow - determined by your GP or asthma nurse - stays above 80% of your personal best.
  • You maintain good lung function.
  • Your level of activity is normal.
  • You do not need emergency medical treatment.

By working together with your GP or asthma nurse, you can use these benchmarks to determine if your asthma is - or is on the way to being - controlled.

Long-term control medication

A big part of keeping your asthma under control is to take your medication regularly and correctly.

Long-term medication is taken every day to help prevent symptoms, prevent inflammation, and keep your airways healthy and open.

Inhaled corticosteroids are the best at relieving airway inflammation and swelling, and are not habit-forming even if taken every day.

Inhaling corticosteroids can cause thrush if taken incorrectly and the corticosteroids land in your throat or mouth. You can avoid this by using spacers or holding chambers, or rinsing your mouth after taking them.

Corticosteroids can increase the risk of cataracts and osteoporosis if taken for long periods of time.

Quick-relief medication

Quick-relief medication relieves asthma symptoms when they occur. They are fast acting medications, such as bronchodilators, that quickly relax tightened muscles surrounding the airways. This allows air to flow freely through them again, aiding in steady breathing.

Quick-relief medication should not replace long-term medications as they don’t calm inflammation and should not be used more than twice a week.

Instead, they should be treated as a back up to your long-term, daily medication, and used only when necessary.

Ideally, well controlled asthma should only prompt the need for quick-relief medication very rarely, if at all.

Create an asthma action plan

Work together with your GP or asthma nurse to build your own personal asthma action plan.

This will be your way of measuring the state of your asthma at any given time, and your guide to what you should be doing to maintain good health, or what to do when it gets worse.

Sufferers who use their action plans are 4 times less likely to be admitted to hospital because of their asthma, meaning creating your own will help you stay as well as possible.

You can use this action plan template from Asthma UK to build your plan with your GP or asthma nurse.

Manage dust

Dust mites are one of the many triggers of asthma symptoms, but keeping dust at bay in the home can be a tricky task.

The process of dusting can move dust around and send particles flying into the air, irritating your airways. Instead, try dusting with a damp microfiber cloth to effectively catch all dust.

When doing a deep clean of your home, start dusting from top to bottom, and finish by vacuuming to ensure as much dust as possible is removed.

Also, make sure to keep your windows closed. Opening them will allow dirt in the air, pollen, bugs, and more dust into your home. If there is a breeze, this will kick dust up into the air throughout the house.

Seek support

Living with asthma can be challenging, especially if you suffer from severe asthma, or are constantly changing medication to try and find the right one for you. It can be a long process, but you don’t have to go through it alone. Finding a support group to talk about both good days and bad can be a powerful tool in making life with asthma easier.

There are many online communities you can join to share your experiences with others. Facebook is home to the Asthma Support Group which has over 7,500 members from all over the world with varying degrees of asthma. There is also a group for those with severe asthma in the UK, and parents of children with asthma.

Whatever group you choose to become a part of, sharing experiences and getting advice from people who know exactly what you’re going through will help you feel supported.

Products to help with asthma

Taking your prescribed medication is an important part of managing your asthma, and you should always take them regularly to ensure it remains controlled.

There are, however, additional products you can use in conjunction with your medication to help ease or prevent your symptoms.

Turmeric

Many studies have been carried out on turmeric, and curcumin which is found in turmeric, and it is thought to affect histamines. More research needs to be done on just how effective it can be, however, turmeric remains a popular anti-inflammatory among people wishing to take a more natural management route.

The curcumin content in turmeric isn’t very high, around 3%. What’s more, your body isn’t very efficient at absorbing curcumin. However, if consumed with black pepper, which contains piperine, the absorption of curcumin is increased by 2000%. This is why many turmeric and curcumin supplements also contain black pepper.

There are many ways to take turmeric and curcumin, one of the easiest being via a capsule. You can try these capsules from Holland and Barrett, or try one of the many other methods of consumption.

Chemical Free Carpet

Standard carpets are riddled with chemicals which can be massive triggers for asthma. This is due to VOCs (volatile organic compounds) off gassing, when chemical fumes are released from the carpet that irritate sensitive airways.

If you want to have carpet in your home, finding one free from these chemicals is imperative! Natural flooring company Sisal and Seagrass designed a chemical free, pure wool range that combats chemical sensitivity, and has already helped many people across the UK manage their symptoms.

Shop their full range of chemical free pure wool carpets.

HEPA Filter Vacuums

If your asthma is triggered by things like dust mites or pet dander, investing in a vacuum with a true high-efficiency particulate air (HEPA) filter could positively affect your symptoms. A HEPA filter picks up tiny particles like allergens that regular vacuums would recirculate back into the air. When choosing a vacuum, check that it is fitted with a true HEPA filter that has been proven to trap a minimum of 99.97% of particles of 0.3 microns.

One such vacuum is the Shark Rotator Lift-Away NV340UKT. However, there are many on the market. Do your research, and look out for models that trap the minimum amount of particles of 0.3 microns and bigger.

Asthma Stories

Millions of people live with asthma every day in the UK alone. On top of that, a large number of people are hospitalised every day across the world due to their asthma. Every person living with the condition has their own story to tell about their journey with asthma, and most of the time it is neither simple nor easy.

Many people want to share their stories of dealing with asthma, whether personally or with a family member, in the hopes that they could help others going through similar situations.

Abby S
Buckinghamshire

I suffer from a sensitivity to chemicals that can really agitate my airways, making it very difficult to breathe. This means I have to be very conscious of any purchases I make, to ensure I avoid irritant chemicals.

I was excited to have new carpets installed by a leading retailer who claimed they were chemical free. Once they were fitted in my home, I had to move out for six months! My reaction to the pesticides in the carpet agitated my chemical sensitivity symptoms very severely. I hoped that, given time, the carpet would stop off-gassing these chemical fumes, but it never did.

Desperate to move back into my home, I learnt that pure wool carpets could be my answer. I went on the hunt for the perfect carpet from the right retailer and discovered Sisal and Seagrass chemical free Pure Wool range. They removed my chemical-laden carpet and replaced it with their chemical free Pure Wool.

I moved back into my home that night, and haven’t had any symptoms since!

Harriet B
Kent

I suffer with a very bad chemical sensitivity to the point that all the windows, plastic, and paints in my home had to be changed for me to live comfortably.

I longed to have carpet and rugs in the house, but I didn’t think it was possible as they’re made with chemicals that trigger my symptoms.

Healthy Home recommended a natural flooring company to me, and I discovered chemical free pure wool carpets. I now have various different styles from their pure wool range on my hall, stairs and landing, in the bedrooms and bathroom, and a big pure wool rug in the lounge.

I’m thrilled that the carpet has lived up to my expectations, as I haven’t suffered from any reactions in the 12 months the carpet has been fitted.

It’s crazy what simple items your allergies can deny you, but my life feels a little more normal now that I’m not confined to wood floors and cold feet!

Mark H
Essex

Our baby daughter is quite poorly and suffers from chemical sensitivity issues. Because of this sensitivity we have hardwood flooring in our home. However, our daughter also has issues with her balance, and we were concerned that she would end up injuring herself on the hard flooring.

We found a company online that made and fitted chemical free, pure wool carpet. We had the carpet fitted throughout the house, including a room-sized rug in our lounge.

We’re so glad we found this type of carpet, as now we don’t have to worry about our daughter hurting herself on hard flooring, and as it’s chemical free, she hasn’t had any issues with her chemical sensitivity.