Understanding Asthma

Written by Susi Rogol 18 January 2013

Asthma is an illness that affects many lives in Britain today. All of us know someone with asthma, and most will have seen at first hand the symptoms and the effects on people's quality of life it can cause, says Dr Mike Thomas, Asthma UK Chief Medical Advisor and GP in Minchinhampton, Gloucester.

"The symptoms of asthma (wheeze, breathlessness, chest tightness and coughing) can be frightening and distressing, and can result in sudden 'asthma attacks' or more insidious long-term effects. This chronic illness affects over five million people in the UK. Asthma is a ‘disease of affluence', and like other allergy-associated conditions is far more common in wealthy Westernised countries, particularly the UK.

The fundamental problem in asthma is inflammation in the airways. If we look inside the asthmatic lungs, the lining of the bronchi (the air conducting tubes) are reddened and swollen, with the tubes 'twitchy' so that they tighten up when exposed to irritant triggers. In severe asthma, the narrowing of the tubes can be so bad that sufficient oxygen doesn't get into the body, resulting in a life-threatening situation which sees three people die every day from asthma in the UK. In less severe asthma, the difficulty in breathing can be distressing, and can interfere with normal everyday activities and sleep.

Many people with asthma have allergies, usually to 'aero-allergens' – small particles that are inhaled in the air which trigger an increase in the inflammation in the airways resulting in asthma symptoms. The most common aero-allergens are house-dust mites (tiny creatures that live in beds, sofas and carpets), pet dander (particularly cat and dog), pollen from grasses and trees and fungal moulds.

Food allergies can act as a trigger for sudden severe asthma attacks in some, but are relatively uncommon. Other triggers for asthma include viral infections, irritants such as tobacco smoke (from active and passive smoking), traffic fumes and air pollution.

Current treatments

Facts and figures
  • Asthma is a serious condition affecting 5.4 million people in the UK and 1 in 5 households.
  • Asthma is serious. There are around 1,200 deaths each year from asthma, including the equivalent of a classroom full of children.
  • In the UK, a person with asthma is admitted to hospital every 7 minutes.
  • 1 in 8 children under 15 with asthma symptoms experience attacks so severe they can't speak.
Although we have effective treatments to control asthma, at the current time there is no cure, and the medicine only works while people continue to use it. Asthma deaths have reduced in recent years, although many people continue to suffer avoidable symptoms, impaired quality of life and reduced productivity. The most effective asthma treatments are with inhaled anti-inflammatory medicines that control symptoms and reduce the risk of asthma attacks. Inhaled steroids have a very good safety and efficacy record, (these are a different type than those used by bodybuilders) and the doses used are usually low and do not result in absorption into the body or in well-known steroid side effects. People are understandably wary of steroids, but except at the very highest doses, they are very safe through inhalers, even in young children.

Most people will also have a 'bronchodilator' reliever inhaler, to be taken as needed, which opens the constricted airways in the short-term by relaxing muscles. They do not however lessen the inflammation that is behind the constriction, so are a symptomatic treatment only. Ideally it should not be necessary to use them more than twice a week.

There are also ‘long-acting bronchodilators' that are used regularly in addition to the inhaled steroids to improve asthma control; these inhalers should never be used without inhaled steroids, and are now usually given in the form of a 'combination' inhaler with both inhaled drugs in a single device.

New treatments

Newer asthma treatments also exist as 'add-ons', including non-steroid anti-inflammatory tablets ('leukotriene antagonists'). Several new treatments have recently been launched or are under development for those few patients with very severe asthma, currently up to half a million people in the UK, and particularly those with severe allergic asthma. These treatments generally involve regular injections with monoclonal antibodies that target specific parts of the inflammatory pathway in asthma. This treatment needs to be supervised by specialist 'difficult asthma' clinics after a careful assessment.

For most people with asthma, high levels of control and a normal unimpeded life should be possible, yet evidence suggests that many (indeed most) people are failing to achieve the best results. Often a better partnership between the person with asthma and the health professional (usually a doctor or a trained asthma nurse) can result in better outcomes.

Many people with asthma are interested in non-drug treatments. Allergen avoidance can be successful for some, but is often difficult to achieve practically. There is some promise that some herbal treatments may help, although the evidence is not conclusive. Breathing exercises may help some people with asthma, although they are not a 'cure'. Unfortunately, there is little evidence that strict diets or acupuncture can make much difference.

The future

Asthma is a long-term condition, and long-term treatment is needed. A good 'partnership' between the patient and the healthcare professional is key to best outcomes; where it exists, results are good but where it doesn't, people suffer. People with asthma often don't feel they have been given enough information about their condition; high-quality care involves two-way communication, in which the patient is provided with the information and tools they need to make decisions about their own health.

Information is the key to empowerment, and patient organisations such as Asthma UK have a vital role in providing accessible information, lobbying for change and supporting research. Asthma is far from being 'sorted out' in the UK in 2010; we still don't understand the causes and still don't have a cure, and there is a need for prioritisation of research. In addition, there is a need to provide national standards of care for asthma - currently standards vary considerably around the UK (for example in England, there is a large difference in asthma hospital admission rates for children between Primary Care Trusts), and people with asthma deserve the best care we can give.

For more information please visit the Asthma UK website on or call our specialist asthma nurses on 0800 121 62 44.

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