How to stay well and avoid asthma attacks
Every year, 40% of people who have
have at least 1 asthma attack.
These attacks can be a period of time where your symptoms get worse, and you need to manage them with extra medication from your doctor. But for some people, an attack can be a life-threatening medical emergency, needing an ambulance, paramedics or even hospitalization. (Read more about
However, the good news is that evidence shows there are very effective ways you can cut your risk of an asthma attack.
“Nearly all asthma attacks can be prevented or made less severe,” says Dr Ann Nainan, family doctor and Healthily expert. “Evidence shows that if you get and use an asthma action plan that’s tailored for you, take your asthma medicines as prescribed, have effective regular check-ins with your doctor, and use some good lifestyle and self-care measures, you can significantly cut your risk.”
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3 key things you can do to prevent asthma attacks
Work with your doctor
- go for regular asthma reviews – and prepare for them
- get and use an asthma action plan
- take your regularly, as prescribed
Help yourself with self-care
- learn your triggers and avoid them if possible
- get into good habits and routines with your medicines
- follow other healthy
Know the signs your asthma is getting worse – and what to do
Prevention is also about realizing when your symptoms are getting worse. It’s easy to get used to a level of symptoms that are actually early signs of an asthma attack, such as:
- a lot of coughing
- needing to use your quick-relief inhaler 3 times a week or more
If your asthma symptoms aren’t under control and your coughing and wheezing are affecting your daily life, talk to your doctor.
“It’s important to get medical help early if this happens,” says Dr Ann. “Asthma symptoms that aren’t under control can be exhausting to deal with in the longer term, and can cause anxiety or depression. So it’s important to keep going back to your doctor for review if your meds aren’t controlling your symptoms.”
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Asthma action plan – get and use yours
The first step to managing your asthma is getting an
from your doctor. This has personalized information on your asthma medicines and how to take them, how to recognise when your symptoms get worse, and what to do in an emergency.
Getting the best from your asthma action plan
“It’s so important to have a personal asthma action plan,” says Dr Ann. “But it can be easy to put it in a drawer and forget about it. You need to use it to get your asthma symptoms under control and cut your risk of an asthma attack.”
To help ensure you get the best from your plan, you could:
- put your paper plan where you’ll see it often – such as on your fridge or with your asthma medications
- keep a photo of your plan on your cell phone – consider having it as your home screen image, so you’ve always got it with you and could easily show it to someone in an emergency (when you might be too breathless to speak)
- share a photo of your with friends, family and colleagues – as Dr Ann says: “They can sometimes notice if you have symptoms before you do, and will know how to help you if they can see this information”
- organize a diary reminder every month – to prompt you to read your plan again, to check in about how you’re doing with taking your asthma medications
Self-care to prevent asthma symptoms and asthma attacks
How to deal with your asthma triggers
When you have asthma, your airways get swollen (inflamed) and irritable. And coming into contact with an asthma trigger can irritate them even more.
This can cause your airways to tighten up, and the linings become inflamed and make more mucus. All this can lead to asthma symptoms, such as breathlessness and coughing.
“There are 3 key ways to reduce the effect your asthma triggers have on your symptoms and lower your risk of an asthma attack,” says Dr Ann.
1. Get to know your triggers
Identify your triggers by keeping a note of what you were doing when your symptoms started – for example, stroking a dog, walking in high-pollen conditions, or eating certain foods.
Your doctor may refer you for allergy testing to confirm this, and may suggest allergy treatments.
2. Take your preventer medications as prescribed
Whatever your triggers, if you keep your airways soothed and stop them getting inflamed in the first place, they’ll be less likely to react.
“As so many common asthma triggers are hard to avoid (such as hormonal triggers, colds or flu, or extreme emotion/stress), taking your preventer asthma medications as directed will help cut your risk of symptoms or an asthma attack,” says Dr Ann.
Ask your doctor or asthma nurse for advice about adjusting your medication to deal with coming into contact with triggers.
3. Avoid your triggers where possible
Try to avoid your known triggers, or find ways to come into contact with them less often. For example:
- avoid smoking and smoky environments – this can reduce the frequency of asthma attacks and severity of symptoms
- if air pollution affects you, check the forecast, and stay indoors on high-pollution days if you can. And consider finding alternatives to barbecues, bonfires and wood burners
- if cold air is a trigger, cover your mouth with a scarf, and breathe through your nose rather than your mouth – that way, the air that reaches your lungs will be warmer (read more about and )
- if hot air is a trigger, use a fan or air conditioning indoors to keep your room cool
- if you’re allergic to dust mites, an allergen-proof mattress will reduce your exposure
- if something at work is a trigger, talk to your boss or occupational health department about a risk assessment and any adjustments that can be made
- if exercise is a trigger, try using your preventer medication beforehand and
- doing a 5- to 10-minute warm-up first
Lifestyle tips for reducing asthma symptoms and attacks
- get enough sleep – there’s some evidence that lack of sleep may make symptoms worse, so talk to your doctor if your shuteye is disrupted (and check out our )
- eat healthily – including lots of fruit and vegetables. These contain antioxidants such as beta-carotene and the vitamins C and E, which may reduce lung swelling and irritation
- keep to a healthy weight – being overweight can make symptoms worse (read about )
- keep up with your vaccinations – you should have the annual and the pneumococcal vaccine against , as well as the . These illnesses are common triggers
- check with your doctor before taking other medication – especially painkillers. Some medicines trigger symptoms in some people, including and non-steroidal anti-inflammatory drugs (NSAIDs), such as
How your doctor can help treat your asthma
Your doctor will work with you to help you manage your asthma. They can:
- prescribe asthma medications
- create and update your personalized asthma action plan
- ask you to keep track of your symptoms, perhaps using a or a symptom diary
- offer regular check-ups to see if your asthma is under control
- help you if your symptoms change by adjusting your asthma medications
- refer you to specialist to help with managing your condition
The aim of treatment is to control your asthma so you:
- don’t need to use your quick-relief inhaler more than 2 or 3 times a week
- don’t wake up in the night with asthma symptoms
- can do your daily activities, including exercise, with few or no symptoms
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“Using your inhaler properly is key, to get the medicine down into your lungs where it can do the most good,” says Dr Ann. “There are a few different types of inhalers, so ask your doctor or pharmacist to show you how to use yours and check your technique.”
The way inhalers work can vary, as follows:
- metered dose inhalers – these squirt out the medicine in a spray. You can make it easier to get the medicine into your lungs (instead of your mouth or throat) by using a spacer device. This will cut the risk of side effects that can happen if you get the medicine in your mouth, such as oral thrush
- breath-activated inhalers – these release a spray when you begin breathing in
- dry powder inhalers – these release asthma medications that come as a powder
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There are 2 main types of inhaler for managing asthma.
Quick-relief – or reliever – inhalers are for on-the-spot relief of symptoms, including coughing, wheezing and a tight chest.
Here’s what you need to know:
- it’s your emergency back-up. If you use your preventer inhaler as prescribed, your airways should be less irritable, and less likely to react to any triggers to make you need your quick-relief inhaler
- you should use it if you feel your asthma symptoms starting
- when used as directed by your doctor, it should quickly bring your symptoms under control, by relaxing the muscles around your airways to let in more air
- it’s for short-term relief – it doesn’t tackle underlying inflammation
- if you need to use it 3 or more times a week, see your doctor or asthma nurse – this is a sign that your asthma isn’t controlled, and you might be at higher risk of an asthma attack
Your doctor may recommend you use a preventer inhaler if you’re getting asthma symptoms 3 or more times a week.
A preventer inhaler soothes and prevents inflammation in your airways. This makes your airways less irritable, and less likely to react and cause symptoms when you come into contact with triggers, such as cold weather or dust.
It’s the key to keeping your asthma symptoms under control, so you can sleep well and enjoy life.
Preventer treatment includes:
- – steroids medicines are used to reduce inflammation in your airways and prevent asthma symptoms. They contain corticosteroids – copies of hormones your body makes naturally. You’ll usually be prescribed the lowest dose needed to control your symptoms
- long-acting bronchodilators (LABAs) – these can be used as an add-on to a steroid inhaler. They relax the muscles around your airways to keep them open, and the effects last at least 12 hours. They include salmeterol, formoterol and olodaterol
- long-acting muscarinic antagonists (LAMAs) – if you can’t use a LABA as an add-on to a steroid inhaler, your doctor might recommend a LAMA inhaler, such as tiotropium. This also works by helping keep your airways open
Single maintenance and reliever therapy (SMART)
This is a newer way of taking asthma medications, which involves taking preventer and quick-relief medications through 1 inhaler.
In the US, SMART inhalers are recommended in the latest asthma clinical guidelines, but haven’t yet been approved by the Food and Drug Administration (FDA) for use in this way.
Asthma medications to add on if your symptoms won’t go
If your asthma symptoms aren’t controlled with inhalers and lifestyle tips, your doctor might prescribe other medicines.
If you have severe asthma, which doesn’t respond as well to the usual medicines, you might need to take them in higher doses.
Your doctor will work with you to prescribe the lowest doses of asthma medications to get the results you need.
Leukotriene receptor antagonists LTRAs
Leukotriene receptor antagonists (LTRAs) are tablets that help reduce inflammation and are sometimes used instead of preventer inhalers, or as an add-on treatment.
can also be used to treat asthma:
- you may be prescribed a short-course to treat flare-ups or an asthma attack
- in very severe cases, you might need to take them for longer
- you’ll be prescribed the lowest dose needed to control your symptoms, as they can have side effects (read more about )
Nebulizers turn liquid asthma medicine into a mist, which you then breathe in through a mask or a mouthpiece. They allow you to get a high dose of medication quickly.
They’re usually used to treat asthma flare ups or worsening of symptoms in a hospital, clinic or medical center.
In some cases of severe asthma, your specialist may advise using a nebuliser at home.
Other asthma drugs for severe or uncontrolled asthma
If your symptoms are severe and uncontrolled, your doctor might refer you to a specialist.
Treatments they may recommend include:
- theophylline – a type of LABA that you take as a tablet
- biologic drugs – given by injection or infusion, these target a protein or cell to prevent swelling in your airways
What is an asthma attack?
An asthma attack is when your symptoms get so bad that you find it difficult to breathe.
Usually, your airways have been getting more inflamed and irritable for a while. In an attack, it gets to the stage where other things happen alongside to cause coughing, wheezing and breathlessness.
The muscles around your airways contract, so your airways get narrower and less air can pass through. Your airways also make extra mucus, which makes it harder for air to flow.
How to treat an asthma attack
“People can start to panic when they can’t get their breath during an attack,” says Dr Ann. “So it’s important to learn what to do – and have your quick-relief inhaler with you at all times, so you can treat the early signs.”
If you have an asthma attack:
- Sit upright and try to remain calm.
- Take 1 puff of your quick-relief inhaler every 30 to 60 seconds, for up to 10 puffs.
- If you feel worse, or don’t feel better after 10 puffs, call for an ambulance.
- If the ambulance hasn’t arrived after 10 minutes and you’re not improving, do step 2 again.
- Call the ambulance again right away if it still hasn’t arrived and your symptoms haven’t improved.
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Your health questions answered by our medical team
Can asthma go away?
“Asthma is a long-term condition,” explains Dr Ann. “In children, it sometimes goes away or improves during their teenage years, but symptoms can return later.”
COVID-19 and asthma – am I at higher risk?
“If you have moderate to severe asthma, you’re more likely to be hospitalized with COVID-19,” says Dr Ann. “Current advice from the Centers for Disease Control and Prevention (CDC) is that you should take steps to protect yourself – which includes having the COVID-19 vaccine and any boosters. Keeping up to date with the vaccine significantly lowers your risk of being very sick, hospitalized or dying from COVID-19. It’s also important to have all your regular reviews and make sure your asthma is well controlled.”