Asthma:

Asthma is a common lung condition that can cause breathing difficulties from time to time, ranging from very mild to severe symptoms. It affects people of all ages, often beginning in childhood, however, it may also develop in adulthood for the first time. It is particularly common in Ireland, where over 380,000 adults and children suffer from the condition.

Currently, there is no cure, but there are treatments that can control the symptoms so that they do not interfere with your daily life.

For a better understanding of asthma, we’ll look at what it is and the treatments that are available to help manage the symptoms.

What Is Asthma?

Asthma is a common condition in which the airways are hyper-reactive causing them to become narrowed. This results in the flow of air into the lungs being restricted, and can make breathing more difficult. The airways are more sensitive to triggers (even those that may not cause problems in others such as cold air and pollen). The body interprets these triggers as ‘an attack’ which initiates an immune response. This causes the smooth muscles around the airways to spasm/ squeeze, and inflammation to occur. The lining of the airways then swells and sticky mucus is formed (similar to a cold), clogging the breathing tubes. With so little space in the airways, airflow is reduced, and it becomes considerably harder to breathe.

Fortunately, the muscle spasm can be eased using a reliever inhaler (typically blue). However, the inflammation that causes this spasm as well as the swelling and mucus require a different treatment; a preventer inhaler. This is an essential part of the treatment as the cause of the symptoms must be treated, not just the symptoms.

The majority of asthma patients are given a daily preventer inhaler to use to control information and reduce the risk of an asthma attack and a reliever inhaler to use when acute symptoms arise. It is essential to take the preventer inhaler on a regular basis, as directed, and even when asthma symptoms are not persistent.

There are a number of resources available for more asthma information.

What Causes Asthma?

With Asthmatics, the airways are more sensitive to triggers/ allergens. When there is exposure to a trigger, an inflammatory reaction starts the airways become swollen, inflamed, and sensitive. They then begin narrow and become blocked with sticky mucus in reaction to certain triggers.

The exact cause of asthma is unknown but it involves an inflammatory response of the airway lining (this is what the steroid inhalers target and their regular daily use gives good asthma control).

Causes are believed to be related to:

• Genetics
  • Having asthmatic parents or siblings will increase the likelihood of your developing the condition
  • If you or a family member has atopic conditions (e.g., hay fever or eczema), you are more likely to develop asthma
• Air pollutants
• Modern hygiene standards
  • Modern changes in housing, food, and cleanliness may have contributed to the recent increase in asthma cases
• Illness
  • Adult-onset asthma can occur as a result of a respiratory tract infection (cold, flu, or chest infection)
• Lifestyle
  • Smoking during pregnancy or exposing a child to tobacco smoke increases the chance of asthma development
  • Overweight people are more likely to develop asthma

However, there are associations, there is insufficient evidence to determine if any of these actually cause asthma.

You should speak with a GP if you think you or a person in your care has asthma.

Asthma Triggers

Asthma symptoms occur after exposure to a trigger. Symptoms can start very suddenly, or they can gradually develop over several hours or days.

Avoiding things known to trigger asthma symptoms helps to reduce the frequency and severity of asthma symptoms and reduces the risk of an acute asthma attack.

This can be difficult to work out! Keeping a diary to record your asthma symptoms can help to determine what triggers an attack.

Asthma triggers can include:

• Allergies – pet hair, dust, pollen
• Illness – bacterial and viral
• Environment – pollution, damp/ mould, weather
• Lifestyle – smoking, certain foods, stress, exercise

By carefully using your preventer inhaler, you can lower your chances of having an asthma attack. You should always have your reliever inhaler with you just in case.

What Are The Symptoms Of Asthma?

Symptoms can range from mild to severe, and last for an hour, days or until treated.

In very rare cases asthma can be fatal, but this can be prevented, which is why it is so important to use your treatment regularly and as advised by your doctor.

The following are the most common asthma symptoms:

• Wheezing (whistling sound when breathing)
• Breathlessness
• Chest tightness (constricting feeling)
• Coughing

If you notice the following issues or your symptoms are not settling as usual with the advised treatment, you should speak with a doctor so that your asthma management plan can be reviewed:

• Increased frequency or severity of symptoms
• Symptoms are worse at night or early in the morning
• Seems to occur as a result of an asthma trigger e.g., allergies

What Treatments Are Available For Asthma?

Although there is no cure for asthma, treatments are available that can help reduce symptoms and allow you to live a normal, active life.

The primary treatment is inhalers, which are devices that require you to breathe in the medication so that it gets into your lungs. If your asthma is severe, you may additionally require tablets and other treatments. There are a number of resources available for more asthma information.

Asthma inhalers are classified into three types:

1. Preventer inhalers

• Usually brown, red or purple in colour
• Contain steroid medication to control airway inflammation
• First-line treatment for asthma – all patients with a diagnosis of asthma should use a steroid inhaler, either regularly or as required, depending on their symptoms
• Good practice to use for robust asthma management

2. Reliever inhalers

• Act quickly to reduce/ relieve acute asthma symptoms
• Contain a bronchodilator medication such as salbutamol
• If asthma symptoms are appropriately controlled, these should not be needed more than once weekly. If they are needed more often than this, then your asthma management plan needs to be reviewed by your doctor!

3. Combination inhalers

• Contain both reliever and preventer medication to improve symptom control

A personal asthma action plan is usually developed in collaboration with a doctor or asthma nurse. You can book an online GP appointment to discuss this with a GP. The action plan would contain details about your medications, how to monitor your condition, and what to do if you experience an asthma attack.

Some patients will require additional treatments from time to time e.g., oral steroids, steroid nasal sprays, anti-histamines, or ongoing e.g., montelukast.

If symptoms are not controlled with these medications, then other treatments are sometimes considered under the care of a respiratory specialist team.

Can I Use A Reliever Inhaler Only To Manage My Asthma?

It is very important to be aware that asthma is a dynamic condition, and even those with apparently mild asthma are at risk of serious adverse events:

• 30-37% of patients with acute asthma had symptoms less than once a week in the previous 3 months
• 16% of patients with near-fatal asthma had symptoms less than once a week in the previous 3 months
• 15-20% of adults dying of asthma had symptoms less than once a week in the previous 3 months

Unfortunately, every year in Ireland, 50-70 persons die from poorly controlled asthma.

Inhaled Ventolin/ Bricanyl was the first drug of choice for the last 50 years when asthma was thought to be due to a simple airway narrowing (bronchoconstriction).

The treatment of asthma has changed fundamentally in the last several years. The updated (since 2019) version of the GINA asthma guidelines recommend that rescue inhalers such as Ventolin/Bricanyl should not need to be used more than once weekly when asthma is well controlled by regular daily use of the steroid preventer Inhaler, which controls bronchial inflammation (the cause of the asthma symptoms).

So be watchful for any coughing fits/ wheezes/ breathlessness/ increased use of the Ventolin/ Bricanyl as it can mean your control of the asthma is slipping and you need to use your steroid inhaler or even seek urgent medical review if this occurs.

Is It Possible To ‘Outgrow’ Asthma?

Some children outgrow their symptoms as they get into their teens, however, approximately half of these children will experience a return of their asthma symptoms in later life. Asthma is considered a chronic disease.

How Do I Know If I Am Having An Asthma Attack?

Asthma symptoms can become severe, often quite suddenly. This is referred to as an asthma attack.

The following are symptoms of a severe asthma attack:

• Wheezing
• Coughing
• Chest tightness
• Breathlessness (often so much so that it can affect sleeping, eating, or speaking)
• Fast, short breathing
• Fast heartbeat
• Drowsiness, confusion or dizziness
• Fatigue
• Blue lips and/ or fingers
• Fainting

Here is more information on asthma attacks.

What To Do If I’m Having An Asthma Attack

If you believe you are having an asthma attack, follow these steps:

1. Stay calm and do not panic as this will make things worse
2. Sit up straight – do not lie down!
3. Take slow, even breaths
4. Take one puff of your reliever inhaler every 30 to 60 seconds (maximum 10 puffs)
5. Call 999 or 112 if you do not have an inhaler to hand, or if your symptoms do not improve despite using your inhaler
6. If the ambulance is not there within 15 minutes, repeat steps one to four again

If possible, bring the information of your medications and your personal asthma action plan with you to the hospital.

How Can I Get A Prescription For Asthma Treatment

You can easily request a prescription for Asthma Treatment via Webdoctor.ie’s online prescription service.

To request a prescription, you just need to fill in a short and secure questionnaire. Then, one of our Irish-registered doctors will review your request to make sure it is safe and suitable for you. Once approved, we’ll send your prescription to an Irish pharmacy of your choice.

There’s no need to make an appointment with a GP unless it is your first time seeking a prescription for asthma. If this is the case, you can book an online video consultation with one of our experienced GPs. There, we can help you find the treatment for you.