Understanding Asthma

Asthma is a chronic inflammatory disease which affects the airways – the small tubes that carry air in and out of the lungs. When the airways come into contact with an asthma trigger, the muscles around the walls of the airways tighten and become narrower. The lining of the airways swells and produces a sticky mucus. As the airways narrow, it becomes difficult for air to move in and out.

What causes asthma?

It's difficult to say for sure what causes asthma. Factors include:

  • Family history
  • Lifestyle – e.g. hygiene and diet and environment
  • Smoking
  • Exposure to irritants in the workplace such as dust and chemicals
  • Environmental pollution can make asthma symptoms worse
  • Adult onset asthma may develop after a viral infection

What can trigger an Asthma attack?

A number of factors can trigger an Asthma attack; most of these air airborne irritants but other environmental or physical factors can cause or exacerbate the symptoms.

Knowing these factors can help you prevent a casualty from experiencing an attack or help relieve the symptoms by being aware of their environment or changing their behaviours.

Animals
Furry and feathery animals are a common trigger of asthma symptoms. The allergens are found in their saliva, flakes of skin, fur and urine.

Air pollutants
Air pollutants, like cigarette smoke and car exhaust fumes, release gases and particles into the atmosphere, which can irritate your airways.

Colds & viral infections
Colds and viral infections are very common triggers of asthma and can be almost impossible to avoid.

At your asthma review, you should talk to your doctor or asthma nurse about having the flu vaccination. These are normally available every autumn.

People who are regularly taking steroid tablets should also talk to their doctor about having the pneumococcal vaccination.

Emotions
Stress, depression, anxiety or even a fit of laughter can trigger asthma symptoms.

Exercise
Asthma should not prevent anyone from undertaking exercise; indeed, it is beneficial to everyone especially those with asthma. Exercise should be preceded with gentle warm-ups to gradually prepare the body, as well as appropriate management of medications.

Food
In some cases, certain foods, including cow’s milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives, can make symptoms worse.

Hormones
Some women find their asthma can be affected around puberty, before their periods, during pregnancy and during menopause.

House-dust mites
Many people with asthma are sensitive to the droppings of house-dust mites that live in the dust that builds up around the house, in carpets, bedding, soft furnishings and soft toys.

Medicines
Aspirin and non-steroidal anti-inflammatory tablets such as ibuprofen and voltarol can trigger attacks. Other medicines that can sometimes lead to asthma attacks include beta-blockers, used to treat heart disease and glaucoma, and some cold and flu remedies.

Moulds & fungi
Moulds release tiny seeds called spores into the air, which can trigger asthma symptoms in some people. Mould spores are found in any damp place – from piles of autumn leaves and woody areas, to bathrooms, kitchens and even piles of damp clothes.

Pollen
Pollen can trigger asthma symptoms in some people. Pollen is a powder-like substance produced by certain types of trees, grasses, weeds and flowers.

Smoking
Smoking not only increases one chance of developing asthma, it is also one of the most aggressive triggers.

Weather
Cold air, a sudden change in temperature, windy or hot, humid days and poor air quality are all known triggers for asthma.

Thunderstorms
Thunderstorms can release large amounts of pollen, in very small particles, into the air.


How is Asthma treated?

Asthma is commonly treated with an inhaled medication; a delivery route which is very fast acting.   It can also be controlled by parental (digested) medication.

A casualty suffering from an asthma attack needs their medication as quickly as possible – an inherent problem with breathing condition that relies on an inhaled medication for treatment is that the worse the condition becomes, the harder it can be for the casualty to medicate.

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Relievers

Everyone with asthma should have a bronchodilating reliever inhaler.  Reliever inhalers are usually blue and contain the beta-2 agonist salubutamol (Ventolin® ) or Terbutaline, another common bronchodilator which goes by the trade name Bricanyl®.  Terbutaline is often delivered in a blue Turbohaler

Relievers are medicines that are taken immediately to relieve asthma symptoms.   They quickly relax the muscles surrounding the narrowed airways allowing the airways to open wider, making it easier to breathe again.

A casualty should take a dose of reliever inhaler as soon as they feel symptoms of an Asthma attack.   A casualty who needs to use their reliever inhaler three or more times a week may not be well controlled and should have their medication reviewed.

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Preventer inhalers

Preventers control the swelling and inflammation in the airways, reducing their sensitivity and the risk of severe attacks.   The protective effect builds up over a period of time so they need to be taken every day (usually morning and evening) even when they are feeling well.

Preventers do not give immediate or quick relief when the casualty is breathless but instead they reduce long-term inflammation.  Preventer inhalers usually contain a low dose of chorticosteroid medicine.

Preventers are usually brown, red or orange inhalers.

Preventer inhalers will not relieve the symptoms of an Asthma attack and should never be offered to a casualty where a reliever inhaler is needed.


Using inhalers from Asthma UK.

Using an inhaler is the most common way of taking asthma medicines.  It is also a very effective way because inhaling the medicine takes it straight into the lungs.

It is important that the casualty takes the medicine properly.  Their doctor or asthma nurse should have explained how to use their inhaler so that every dose they take provides the most benefit.

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Spacers

Spacers are large plastic or metal chambers which have an aperture at one end for the reliever inhaler to fit. The space enables the medication to be aerated, making it easier to inhale.

Spacers are very important because:

  • they make aerosol inhalers easier to use and more effective
  • they get more medicine into your lungs than when using the inhaler on its own
  • they are convenient and compact and work at least as well as nebulisers at treating most asthma attacks in children and adults
  • they help to reduce the possibility of side effects from the higher doses of preventer medicines by reducing the amount of medicine that is swallowed and absorbed into the body

Hints on how to use a spacer and mask with young children

  1. Fit the mask on to the spacer if necessary.
  2. Shake the inhaler well.
  3. Fit the inhaler into the opening at the end of the spacer.
  4. Place the mask over your child's face so it seals around the nose and mouth.
  5. Press the inhaler once and allow your child to take five slow breaths in and out of the spacer. This is called tidal breathing.
  6. Remove the inhaler and shake again.
  7. Repeat steps 2 to 5 for each dose of medicine.  Their doctor or asthma nurse will tell them how many puffs are needed.  Always check with them if you are not sure and ask them to write this down on a personal asthma action plan for your child. 

Remember:

Only put one puff of medicine into the spacer at a time.  If you put in more than one puff, the droplets of spray stick together and coat the sides of the spacer so your child actually gets less medicine.

What to do in an asthma attack

The casualty is having difficulty breathing – this is incredibly distressing and, remembering that emotions can trigger an Asthma attack it can by psychosomatic; the more anxious the casualty becomes, the worse their symptoms become, the harder it is to breathe, the more anxious they become...

  • Remember that asthma attack are often caused by triggers so attempt to remove the causalty form the trigger.
  • Sit the casualty down, on a chair or on a floor against a wall. Do not attempt to lie them down. The chest has weight and casualties with chest pain or breathing conditions often find lying down exacerbates their conditions.
  • Sit the casualty forward slightly.
  • Loosen anything around the casualty's neck; the first couple of shirt buttons or an inch or two of zip.
  • Look into the casualty's eyes and hold their attention.
  • Ask them; “Do you have Asthma?” , “Do you have your medication?”
  • Ask “Yes” or “No” questions which they are able to respond to without talking.
  • Enable the casualty to take one to two puffs of their reliever inhaler (usually blue), immediately.
  • Encourage, gently, calmly and supportively, the casualty to take a few gentle breaths.
  • If they do not start to feel better, take two puffs of the reliever inhaler (one puff at a time) every two minutes.  They can take up to ten puffs.
  • If the casualty does not feel better after taking their inhaler as above, or if you are worried at any time, call 999.
  • If an ambulance does not arrive within 10 minutes and there is no improvement, repeat the medication.
  • If the symptoms improve and you do not need to call 999, the casualty should still see a doctor or asthma nurse within 24 hours.

A casualty is having an asthma attack if any of the following happens:

  • Their reliever inhaler does not help.
  • Their symptoms are getting worse (cough, breathlessness, wheeze or tight chest).
  • They are too breathless to speak, eat or sleep.
  • Do not be afraid of causing a fuss, even at night; If the casualty needs to go to A&E or is admitted to hospital, take details of their medicines with you if possible.

What to do if there is no inhaler?

It is tempting to ask if anyone else has an inhaler that the casualty can use.   We have to take a legal and responsible stance and say that it is not appropriate to give the casualty anyone else's inhaler, for a number of reasons:

The Law:

Inhaled medications are prescription medicines.  It is illegal to administer such a medicine without the prescription of a doctor.   Read this article on the control of medicines.

In some case you may be in a position or responsibility of handling the casualty's medication.   Read this article to for further guidance on the handling of medicines.

Type of Inhaler:

There are several types of inhaler, each with their own mechanism of use.  The type of inhaler represents part of the prescription and will have been prescribed to the casualty for a reason.  The casualty may not be familiar a different typr of inhaler or know how to effectively use it.

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Drug type and dose:

While all blue inhalers tend to be for relieving asthma symptoms, they do not all contain the same drug, nor the same dosage.  Don't assume all inhalers are the same.

If there is no inhaler present continue to rest and calm the casualty - do not underestimate the power of emotional support.   Give positive statements such as "Stay calm" as opposed to "Don't panic".  The brain hears the verb first and has to process the fact that the instruction is a negative.   What does someone climbing a ladder do immediately after you shout "Don't look down!" ?

If there is no sign of improvement after 5 minutes, the casualty's breathing becomes undetectable or they loose consciousness, call 999 immediately.

After an emergency asthma attack:

Encourage the casualty to make an appointment with their doctor or asthma nurse for an asthma review, within 48 hours of your attack.

Asthma attacks are the result of gradual worsening of symptoms over a few days that you may not have noticed.

Occupational Asthma

Some substances that you might come across at work can actually cause asthma.  The condition can take weeks, months or even years to develop, depending on the person and the substance.

If you think your asthma has been caused by something at work, look out for these clues:

  • your asthma symptoms are worse during the working week, at work or after work
  • your symptoms may get worse after work, or you may find your sleep is disturbed during the night
  • your symptoms improve when you have been away from work for several days (for example when you are on holiday).

Which substances cause occupational asthma?

Substances that can cause asthma are called respiratory sensitisers.  Below is a list of some of the main ones and the jobs where you are most likely to come across them.

  • Chemicals called isocyanates are the most common cause of occupational asthma in the UK. There are many jobs in which you might be exposed to these chemicals, particularly spray painting, foam moulding using adhesives, and making foundry cores and surface coatings.
  • Dust from flour and grain. Industrial baking, farm work and grain transport
  • Wood dust, particularly from hard wood dusts and western red cedar.  Carpentry, joinery and saw-milling.
  • Colophony – this is widely present in soldering fumes but also in glues and some floor cleaners. Electronics industry
  • Dust from latex rubber.  Any job involving latex gloves, such as nursing or dentistry
  • Dust from insects and animals, and from products containing them. Laboratory work, farm work or work with shellfish

For a more complete list of Industrial Diseases and their causes, read about our RIDDOR information.

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