Asthma: Triggers, Inhalers and How to Keep It Under Control
Asthma is a long-term condition in which the airways become inflamed and over-sensitive, narrowing in response to triggers and making breathing difficult. It affects people of all ages, often begins in childhood and can also appear for the first time in adulthood. With the right treatment most people lead fully active lives, yet poorly controlled asthma still causes thousands of emergency admissions and avoidable deaths each year.
What happens in the airways
In asthma, the lining of the airways is chronically swollen. When a trigger arrives, the muscle around the airways tightens, the lining swells further and sticky mucus is produced. Air flows through the narrowed passages with difficulty, causing the typical symptoms.
Typical symptoms
- Wheezing, a whistling sound on breathing out
- Cough, often worse at night or early morning
- Chest tightness
- Shortness of breath
- Symptoms that vary over time and are triggered by exercise, cold air, infection or allergens
Symptoms that come and go and are worse at night strongly suggest asthma rather than other lung conditions.
Common triggers
Triggers differ between people, but frequent ones include:
- Viral colds and flu
- Pollen, house dust mites, mould and pet dander
- Cigarette smoke and air pollution
- Cold air and exercise
- Strong smells, cleaning products and workplace chemicals
- Anti-inflammatory painkillers such as aspirin and ibuprofen in some people
- Stress and strong emotion
- Gastro-oesophageal reflux
Identifying and, where possible, reducing your triggers is half the battle.
How asthma is diagnosed
Doctors combine your history with breathing tests. Spirometry measures how much air you blow out and how fast, and whether it improves after a reliever inhaler. Peak flow diaries, exhaled nitric oxide tests and allergy testing can add useful information. In children, diagnosis is often based on symptom pattern and response to treatment.
Reliever and preventer inhalers
Understanding the two basic types is the foundation of good control.
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Reliever (rescue) inhalers contain a fast-acting bronchodilator such as salbutamol (albuterol). They relax airway muscle within minutes and are used when symptoms occur. Needing a reliever more than twice a week, or at night, means asthma is not well controlled.
Preventer inhalers contain a low dose of inhaled corticosteroid. They are used every day, even when you feel well, to calm the inflammation and cut the risk of attacks. They work slowly over days and weeks, so they cannot be used for sudden symptoms. Many people stop them when they feel better, which is a common reason for relapse.
Current guidelines increasingly recommend a combined inhaler that contains both a steroid and a fast-acting bronchodilator (formoterol) for use both regularly and as needed, because relying on a reliever alone leaves inflammation untreated. Others may need add-on treatments such as long-acting bronchodilators, leukotriene tablets or, for severe allergic asthma, biologic injections.
Using your inhaler properly
Poor technique is extremely common. A spacer device used with a pressurised inhaler delivers far more medicine to the lungs, especially in children. Ask your nurse, doctor or pharmacist to watch you use your inhaler at least once a year. Rinse your mouth after steroid inhalers to prevent thrush.
Your asthma action plan
A written plan, agreed with your clinician, tells you what to do day by day: your usual medicines, how to recognise worsening symptoms, when to increase treatment, and when to seek urgent help. People with a plan have fewer hospital admissions.
Recognising an asthma attack
Seek emergency help straight away if:
- Your reliever is not helping or is needed more often than every four hours
- You are too breathless to speak a full sentence
- Your lips or fingertips look blue
- Your breathing is fast and laboured, or your peak flow has fallen sharply
While waiting, sit upright, take your reliever through a spacer (one puff at a time, up to ten), and call emergency services if there is no improvement.
Everyday steps that help
- Do not smoke and avoid second-hand smoke
- Get your annual flu vaccine and recommended pneumonia and COVID-19 vaccinations
- Manage hay fever, since uncontrolled nasal allergy worsens asthma
- Use allergen-proof covers and wash bedding hot if you are dust-mite sensitive
- Warm up before exercise, which should be encouraged rather than avoided
- Maintain a healthy weight
Outlook
Asthma cannot be cured, but it can be controlled. Regular preventer use, correct inhaler technique, trigger awareness and an action plan allow most people to sleep through the night, exercise freely and stay out of hospital.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.