Asthma treatment

Asthma symptoms may be mild or severe. Some people experience symptoms occasionally, while others have them most of the time. Asthma symptoms are often triggered by exercise, or an allergy to a substance such as dust mites, pet dander or grass pollen.

Symptoms of asthma include:

• Chest tightness or pain
• Wheezing (noisy breathing)
• Shortness of breath
• Coughing

What is an asthma attack?

An asthma attack is a sudden worsening of your asthma symptoms. Asthma attacks can be life-threatening and need immediate treatment.

Symptoms of an asthma attack include:

• Severe, continued wheezing, coughing, and chest tightness
• Severe shortness of breath making it difficult or impossible to speak, eat or sleep
• Rapid breathing
• Rapid heartbeat
• Severe fatigue
• Cyanosis (blue lips or fingertips)
• Confusion
• Dizziness
• Drowsiness
• Collapse

It isn’t fully understood what causes asthma, but it is probably due to a combination of genetic and environmental factors. Asthma often runs in families and is strongly linked to other allergic conditions such as eczema (atopic dermatitis) and hay fever (allergic rhinitis).

Asthma symptoms commonly start after exposure to substances or external factors in the environment. These are known as triggers.

Some common asthma triggers include:

• Allergens such as pollen, dust mites, pet dander or mould spores
• Physical activity
• Breathing in cold air
• Strong emotions or stress
• Air pollutants and irritants, such as cigarette smoke, cleaning products, or aerosols
• Respiratory infections
• Some medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), beta-blockers, and aspirin
• Sulphites and some food preservatives
• Gastroesophageal reflux disease (GERD)

At your first consultation, you will be seen by a consultant respiratory physician, a doctor specialising in conditions affecting the respiratory system.

Your consultant will ask you about your symptoms and medical history. They will perform a physical examination. If asthma is suspected, your consultant will order some tests to check the health of your lungs and confirm your diagnosis.

Tests to diagnose asthma include:

Peak flow

During a peak flow test, you take a full breath in and blow out as hard as you can into a handheld device called a peak flow meter. The test measures how fast you can breathe out. Peak flow is used both to diagnose asthma and also to monitor your condition to see if your peak flow changes over time.

Spirometry tests

Spirometry tests use a machine called a spirometer to assess how well your lungs are working. It measures how much air moves in and out of your lungs when you breathe. During the test, you breathe into a mouthpiece connected to a computerised machine that measures your airflow.

FeNO (fractional exhaled nitric oxide)

This is a relatively new technology that measures the amount of nitric oxide in your breath. It is used to determine the type of asthma you have and the level of inflammation in your lungs. It can be used to diagnose and monitor asthma and to assess whether your treatment is working effectively.

Chest X-ray

Although asthma isn’t usually diagnosed with a chest X-ray, your consultant may request one to rule out other conditions that could be causing your symptoms

Allergy testing

If you are diagnosed with asthma, your consultant may recommend allergy testing, either as a blood or skin prick test to help identify any triggers

How is a diagnosis made?

Your consultant will make a diagnosis based on your symptoms, physical examination, and the results of any tests.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where your consultant will ask you about your symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you and encourage you to ask any questions you may have about your condition and treatment options. It is important to us that you are well-informed and comfortable at all stages of your treatment, so please discuss any questions and concerns with your consultant at your appointment.

At the end of your appointment, your consultant will discuss possible treatment options with you and decide on the best treatment for you, based on your symptoms and diagnosis.

There is currently no cure for asthma, but a range of treatments are available to help you manage your condition. Your consultant will work with you to find the best treatment, or combination of treatments for you.

Inhalers

The main treatment for asthma is inhalers. These are handheld devices that you use to breathe medication straight into your lungs.

There are two main types of inhalers; reliever inhalers and preventer inhalers.

Reliever inhalers

These are normally blue and are used when needed to relieve symptoms of asthma. They work by relaxing the muscles surrounding your airways, allowing them to open and making it easier to breathe. Common reliever inhalers include salbutamol and terbutaline.

Preventer inhalers

These are usually brown, orange, or red and are used regularly (normally once or twice a day) to prevent asthma symptoms from occurring. Preventer inhalers normally contain an inhaled corticosteroid such as beclometasone, fluticasone, budesonide, ciclesonide or mometasone. They work by reducing inflammation and sensitivity in your airways, making asthma symptoms less likely.

Other preventative treatments

Long-acting reliever inhalers

If reliever and preventer inhalers aren’t enough to manage your asthma effectively, your consultant may prescribe a long-acting reliever in addition to your current treatment.

These inhalers work in the same way as short-acting relievers, but their effects last much longer (up to 12 hours). However, like short-acting relievers, long-acting reliever inhalers do not reduce inflammation in the airways and must be taken with a preventer inhaler, to stop inflammation from getting worse. Most long-acting relievers are prescribed as a ‘combination’ inhaler, which contains both an inhaled steroid (preventer) and a long-acting bronchodilator (reliever) in the same device. Examples of combination inhalers include Seretide, Symbicort, Fostair, Flutiform and Relvar.

If the above treatments have not been successful in managing your asthma, your consultant may try other preventative treatments such as leukotriene receptor antagonists or theophyllines.

Leukotriene receptor antagonists (leukotriene modifiers)

These are tablets that block the effects of leukotrienes, (chemicals your body releases when exposed to an asthma trigger) or stop your body from producing them. Leukotriene receptor antagonists are taken every day as a preventative treatment. They do not help relieve symptoms during an asthma attack.

Theophylline

Theophylline is a bronchodilator that works by relaxing the muscles around your airways, allowing them to widen, and making it easier for you to breathe. It is taken as a tablet, usually every 12 hours.

Theophylline can build up in the blood and may be toxic if levels get too high. You’ll need to have regular blood tests to check the levels of theophylline in your blood while using this medication.

Oral steroids

If steroid inhalers aren’t effective in treating your asthma, your consultant may prescribe oral steroids (corticosteroids). These are tablets that work by reducing inflammation. Steroids may be prescribed temporarily to treat short-term worsening of your asthma due to a chest infection or other factors, or long-term when other medications are not effective.

Omalizumab (Xolair)

This medication works by reducing the levels of substances in your blood that cause allergy symptoms, lowering the chances of an allergic reaction and resulting asthma attack. It may be recommended for people with allergy-related asthma who need continuous or frequent treatment with oral corticosteroids.

Omalizumab is given by injection every two to four weeks. If no improvement is seen within 16 weeks, the treatment should be stopped.

Surgery

If your asthma is severe and not responding to other treatments, you may be a candidate for a relatively new surgical procedure called a bronchial thermoplasty.

During an asthma attack, the smooth muscle that lines your lungs swells, narrowing your airways and making breathing difficult. Bronchial thermoplasty uses heat to shrink the smooth muscle so it can’t swell and cause asthma symptoms.

Bronchial thermoplasty is performed under either general anaesthetic, which means you’ll be asleep during the procedure, or sedation which will make you feel relaxed and sleepy during the procedure.

During the procedure, your consultant passes a long flexible tube called a bronchoscope into your lungs through your mouth or nose and passes it to your airways. A probe at the end of the bronchoscope then uses controlled heat to damage the muscles around your airways.

Bronchial thermoplasty is normally performed as a day case, meaning you’ll go home the same day.

You’ll normally need three treatment sessions, each targeting different areas of your lungs, with at least three weeks between each session.

As a new treatment, the long-term risks, and benefits of bronchial thermoplasty are not yet fully understood. If you are a suitable candidate for this procedure, your consultant will discuss the risks and benefits with you fully, allowing you to make an informed decision.

Any potential risks, side effects, or complications of asthma treatment vary according to the type of treatment you have.

Your consultant will explain all the possible risks and complications of your treatment and give you instructions on how to use your medication correctly. Follow these instructions carefully and ask your consultant or pharmacist if you have any questions.

Being fully informed about your treatment will help to reduce the risk of side effects and complications and improve the likelihood of your treatment being as effective as possible.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about asthma treatment, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in March 2024. Next review due March 2027.

• Treatment. Asthma NHS
• Overview. Asthma NHS
• How is asthma treated? ASTHMA+LUNG UK
• Asthma. Treatment and Action Plan National Heart, Lung, and Blood Institute