Asthma Treatment: Everything You Need to Know

Asthma symptoms often include:

• wheezing (a whistling sound when you breathe)
• coughing
• difficulty breathing and a feeling of tightness in the chest

Symptoms can vary in severity and may get worse at night, disrupting sleep. If you notice your asthma symptoms becoming more frequent or severe, especially at night, it’s important to speak to your doctor. This could indicate that your condition is getting worse or that your current asthma treatment may need to be adjusted for better management.

Managing asthma effectively requires a combination of approaches to maintain healthy lung function and prevent symptoms. Treatment of asthma varies based on individual needs, and understanding these can help you manage your condition better.

Common types of asthma treatments include:

Inhalers

1. Reliever inhalers (like salbutamol), which provide quick relief during asthma symptoms or attacks by relaxing airway muscles.
2. Preventer inhalers (steroid-based), which reduce airway inflammation and sensitivity, lowering the risk of asthma attacks.
3. Combination inhalers, which contain both reliever and preventer medications for more comprehensive management.

Oral medications

Tablets can help control asthma symptoms and prevent attacks. For example, leukotriene receptor antagonists (LTRAs) can reduce inflammation and improve lung function. LTRAs are also available in a liquid or powder form.

Medications like theophylline or oral steroids can be prescribed if you’re not responding to other treatment types.

Biologic therapies

Injections of medications called ‘biologic therapies’ can be administered every few weeks. However, these are only offered as a treatment for severe asthma when other treatments have not been effective.

Bronchial thermoplasty

Bronchial thermoplasty is a new asthma treatment for severe cases not controlled by medication. It uses heat to reduce excess muscle around the airways, helping to prevent tightness. The procedure is performed under general anaesthetic and can help to reduce the frequency of attacks.

Allergy management

For allergic asthma, treatments may include antihistamines or immunotherapy. Minimising exposure to allergens like pollen, pet dander, or dust is also important.

Lifestyle adjustments

Regular physical activity and maintaining a healthy weight can improve lung capacity and overall respiratory health. Taking the steps to a healthier lifestyle is one of the most important things you can do to reduce the risk of additional complications.

Long-term goals of asthma treatment

The primary aim of asthma treatment is to:

• reduce lung inflammation
• keep airways relaxed and open
• prevent asthma attacks or reduce their frequency and severity

Most individuals benefit from using a regular preventer inhaler to avoid relying solely on relievers during symptoms. With the right treatment pathway, asthma can be effectively managed, allowing for a healthier and more active lifestyle.

An asthma attack occurs when symptoms get significantly worse. Severe attacks may build over 6 to 48 hours or develop rapidly without warning. Asthma attack symptoms include:

• difficulty breathing
• wheezing
• coughing
• chest tightness
• rapid breathing

Effective acute asthma treatment is essential for opening the airways and relieving symptoms quickly. The first step is to use a reliever inhaler, such as salbutamol (commonly branded as Ventolin), to relax airway muscles and ease breathing.

Steps to take if you’re having an asthma attack:

1. Sit up straight and try your best to stay calm.
2. Take a puff from your blue reliever inhaler every 30 to 60 seconds up to 10 puffs total.
3. If you don’t feel better after 10 puffs or you start feeling worse, call 999 for an ambulance.
4. If it’s been 10 minutes and you’re still waiting for an ambulance, repeat step 2.
5. If you still don’t feel better after another 10 puffs and you’re still waiting for an ambulance, call 999 again.

Additional options for severe asthma treatment include:

• nebulised salbutamol – delivered through a mask and nebuliser to provide rapid symptom relief
• steroids – administered in tablet, liquid, or intravenous forms to reduce airway inflammation

For long-term management, it’s important to follow asthma treatment guidelines and work with your doctor to adjust your treatment plan. This ensures the best asthma treatment is in place to minimise attacks and improve lung health.

Asthma flare-ups are often triggered by specific factors, known as asthmatic triggers, which can include dust, pollen, cigarette smoke, and animal fur. However, asthma is sometimes less predictable, with attacks triggered by anxiety, stress, exercise, or even laughter. Other common triggers include:

• airway and chest infections
• certain medicines, such as ibuprofen, aspirin, or other non-steroidal anti-inflammatory drugs (NSAIDs)
• weather conditions, including sudden temperature changes, cold air, windy days, poor air quality, or thunderstorms
• foods containing sulphites, a preservative found in processed or pre-cooked foods, jam, concentrated fruit juice, and prawns
• chemicals in carpets, house dust mites, mould, and damp environments
• food allergies, such as nut allergies

Why do some people get asthma?

The likelihood of developing asthma can depend on several factors, including genetics and the environment. You may be at a higher risk if you:

• have a family history of asthma or other allergic conditions like hay fever, eczema, or food allergies
• had bronchiolitis as a child
• develop an allergic condition (also known as an atopic condition) like a food allergy
• were exposed to tobacco smoke as a child, or if your parent smoked while pregnant
• were born prematurely and required ventilation
• had a low birth weight (under 2kg/4.5lb)

What is occupational asthma?

If you find your asthma symptoms improve on days when you’re not at work, you may have occupational asthma. This condition is commonly seen in people working as:

• paint sprayers
• bakers or pastry makers
• nurses
• chemical workers
• animal handlers
• welders
• food processing workers
• timber workers

Your doctor may recommend taking peak flow tests at work and outside of work to compare the results. If occupational asthma is suspected, you may be referred to a specialist or asked to take tests for common allergens to determine the best asthma treatment for you.

Diagnosing asthma involves understanding your symptoms and identifying triggers that may cause or worsen them. Your GP will usually perform a series of tests to confirm the diagnosis.

Other tests for diagnosing asthma

If further testing is required, your GP might recommend:

Airway responsiveness tests

This involves inhaling a dry powder in increasing amounts while measuring changes in your FEV1 and FVC. A significant decrease indicates asthma.

Tests for airway inflammation

Your doctor may:

• examine your phlegm for signs of inflammation
• measure the levels of nitric oxide in your breath – high levels suggest airway inflammation

Allergy tests

Blood or skin tests can identify allergens that may trigger your asthma symptoms.

The type of asthma treatment you need depends on your symptoms and triggers. Your doctor may ask you to create an asthma action plan to help monitor your symptoms, recognise when your condition is worsening, and understand how to prevent asthma attacks.

Do all asthmatics need inhalers?

Not all people with asthma need a preventer inhaler, but everyone with asthma will need a reliever inhaler in case of asthma attacks. Some people with mild asthma that does affect them very often won’t need regular medication and will only need to keep a reliever inhaler around in case they have an attack of asthma symptoms.

Inhalers are recommended as the primary asthma treatment, but other devices or medication types (like tablets), may be required if you’re unable to use an inhaler for any reason. There are a few different types of inhalers, so it’s important to ask your doctor how to use yours correctly.

When do you need to use a spacer?

You may need a spacer when you find normal inhalers difficult to use.

Some inhalers, particularly those with aerosol jets, work more effectively when used with a spacer. A spacer is a plastic or metal device that attaches to the inhaler. It helps distribute medication evenly across the lungs, making it especially helpful for people who find standard inhalers difficult to use, including children.

Using a spacer also reduces the risk of side effects like oral thrush, which can occur with preventer inhalers.

What are long-term bronchodilators?

Long-term bronchodilators are highly effective for keeping the airways open, while corticosteroids (such as cortisone) treat airway inflammation. For those with allergic asthma, immunotherapy or anti-inflammatory medications like cromolyn may be recommended. Your doctor will work with you to find the best asthma treatment tailored to your needs.

What additional preventer medications are available if inhalers aren’t enough?

If inhalers do not fully control symptoms, your doctor may recommend an advanced asthma treatment pathway, which can include:

• leukotriene receptor antagonists (like montelukast) – tablets that reduce airway inflammation
• theophyllines – relax airway muscles, helping to open the airways further
• oral steroids – a short-term solution for severe cases with long-term use closely monitored due to potential side effects
• biologic therapy injections – injectable treatments administered every few weeks

What to tell your doctor before starting asthma treatment

When considering a new asthma treatment, inform your doctor if you:

• are pregnant or breastfeeding
• have allergies or sensitivities to ingredients in the medication
• have conditions like diabetes, heart problems, or kidney issues

Always read the patient information leaflet to understand specific cautions for each medication.

What to expect after treatment

Your asthma may get better and worse throughout your life. Quitting smoking, living a healthy lifestyle and taking your medication in line with your doctor’s instructions will all help you to manage your asthma. We also recommend getting a flu jab every autumn. Keep in regular contact with your healthcare team, and review your symptoms and medication on at least an annual basis.

If you have any concerns or want to reduce your risk of asthma flare-ups as much as possible, you might like to talk to your doctor about other ways that you can look after yourself.

When do I need to see a GP?

If you’re not having problems managing your asthma, you should review your treatment with your doctor once a year. However, you should speak to your doctor if:

• your asthma symptoms worsen during the night
• you need to use your reliever inhaler more than 3 times a week
• the frequency or severity of your symptoms increases

These could be signs that your condition is worsening or that your current treatment for asthma needs to be adjusted.

Do all asthma treatments need a prescription?

Yes, you’ll need a prescription to access most asthma treatments. Your GP can provide one, or you can complete a short questionnaire or consultation to get a prescription online. No matter what type of treatment you need, you should always follow the guidelines of a healthcare professional.

Most asthma medications are safe and effective, with minimal risk of long-term side effects. Because inhalers deliver medication directly to the airways, very little of the medication enters the rest of the body. However, some medications may cause mild or temporary side effects.

Effective asthma management starts with finding the right asthma treatment for your needs, understanding your symptoms, and following a personalised treatment plan. Whether it’s using a reliever inhaler for immediate symptom relief, incorporating preventer medications into your daily routine, or exploring advanced options like combination inhalers, taking control of your treatment is key to improving your quality of life.

Asthma may be a lifelong condition, but with the right medication, tools, and professional guidance, it’s possible to live confidently and minimise the impact of symptoms. If you’re ready to take the next step in managing your asthma, ZAVA can help you access trusted treatments and advice. Get started today by consulting our online doctors.