Asthma
Diagnosis and control of bronchial asthma: spirometry, identifying triggers, inhaled treatment and reviewing your inhaler technique.
What asthma is
It's chronic inflammation of the airways that makes them reactive: certain triggers make them narrow, causing breathlessness, coughing, wheezing and chest tightness. It comes in flare-ups, with good spells in between, which is why many people live for years with poorly controlled asthma thinking «this is just how it is».
Signs it isn't well controlled
- Symptoms more than twice a week.
- Waking up at night with coughing or breathlessness.
- Needing your rescue inhaler often.
- Having to give up sport or certain activities.
- Having had a flare-up that needed A&E or oral steroids.
Any of these is reason for a review: the goal of current treatment is for you to live a completely normal life.
How we investigate it
With your medical history, spirometry with a bronchodilator test and, when allergic asthma is suspected, an allergy workup — because identifying the allergen changes the plan and can even open the door to immunotherapy.
Treatment and the detail that most often goes wrong
Background treatment is an inhaled anti-inflammatory taken every day, even when you feel fine; the rescue inhaler is for symptoms. Mixing the two up is the most common mistake. The second most common mistake is technique: a significant number of inhalers are used incorrectly and the medication never reaches the airways. At the appointment your technique is checked with your own device, the plan is adjusted, and you're given a written plan for what to do if you get worse.
Frequently asked questions
How do I know if my asthma is well controlled?
If you have symptoms more than twice a week, if you wake at night with a cough or breathlessness, if you use your reliever inhaler often or if you have given up sport because of your asthma, it is not. The aim of current treatment is for you to lead a completely normal life.
Do I have to use the preventer inhaler even if I feel well?
Yes, that is precisely the point: the preventer is an anti-inflammatory and is taken every day, including when you are well, because it keeps the airway calm. The reliever is only for symptoms. Confusing the two is the most frequent mistake and the usual cause of attacks.
Can I play sport if I have asthma?
Yes, and you should. With asthma well controlled you can train and compete; there are elite athletes with asthma. If exertion triggers symptoms, the treatment is adjusted and you are given a plan for what to do before training rather than giving up the activity.
What should you avoid doing if you have asthma?
Stopping your preventer inhaler when you feel well —the most common mistake—, overusing the reliever without asking, smoking or being exposed to fumes, and self-medicating with anti-inflammatories if you have had reactions to them. Nor should you give up sport: with asthma under control you can train.
Is it possible to get rid of asthma?
Asthma is not cured, it is controlled, and many people go long spells without symptoms. In childhood there are cases that resolve with growth. With maintenance treatment, good inhaler technique and, if it is allergic, considering immunotherapy, the realistic goal is to lead a completely normal life.