long lasting asthma

Overview

Long lasting asthma, also called persistent asthma, is a condition where your airways (the tubes that carry air in and out of your lungs) are often swollen and tight. This makes it harder to breathe and can cause coughing, wheezing, and chest tightness. Unlike mild asthma that only bothers you once in a while, long lasting asthma needs daily care to keep symptoms under control.

Yes, asthma is very common. According to the NHS, about 5.4 million people in the UK have asthma, and many of them have the long lasting type. It affects people worldwide.

Long lasting asthma can affect anyone, but it often starts in childhood. It is more common in boys during childhood, but in adults it is more common in women. People with a family history of asthma, allergies, or eczema are more likely to have it.

Symptoms

Common symptoms

• Frequent coughing, especially at night or early morning
• Wheezing (a whistling sound when you breathe out)
• Shortness of breath
• Chest tightness or pain
• Trouble sleeping because of breathing problems
• Needing to use a quick-relief inhaler (like a blue inhaler) more than twice a week

Symptoms in children

• Frequent coughing that may be worse when they play, laugh, or cry
• Tiring quickly during exercise or play
• Complaining of a 'tummy ache' – sometimes children feel chest tightness as pain in the belly
• Breathing faster than usual or using extra muscles around the neck to breathe

Symptoms in older adults

• Shortness of breath during mild activity, which may be mistaken as just 'getting older'
• Feeling very tired because of poor sleep due to breathing problems
• More frequent chest infections
• Reduced ability to do daily tasks like housework or climbing stairs

Causes

Main causes

• The exact cause of asthma is not known, but it involves both genes and the environment.
• Your airways become overly sensitive to certain triggers, causing them to swell and tighten.
• Common triggers include allergens like pollen, dust mites, pet dander, and mould.
• Other triggers include respiratory infections, cold air, exercise, smoke, and stress.

Risk factors

• Having a family history of asthma, allergies, or eczema
• Having other allergic conditions, like hay fever or food allergies
• Exposure to tobacco smoke during pregnancy or early childhood
• Living in areas with poor air quality
• Being born prematurely or having a low birth weight

When to see a doctor

See a doctor urgently if:

• If you have difficulty breathing and your usual medication is not working
• If you are using your quick-relief inhaler more than every 4 hours
• If you wake up at night with coughing, wheezing, or shortness of breath more than once a week

Book a routine appointment if:

• If you have any symptoms of asthma, even if they are mild
• If you need to use your quick-relief inhaler more than twice a week
• If you have a persistent cough, especially at night or after exercise

Diagnosis

Your doctor will ask about your symptoms, examine you, and do breathing tests to see how well your lungs work. They may also ask about your family history and possible triggers. Diagnosis is based on a pattern of symptoms and test results.

Tests that may be done

• Spirometry – you take a deep breath and blow out hard into a tube to measure how fast and how much air you can exhale.
• Peak flow test – you blow into a small handheld device to measure how fast you can blow air out. You may do this at home for a few weeks.
• Allergy tests – skin or blood tests to see if allergies are triggering your asthma.
• FeNO test – you breathe into a machine that measures inflammation in your airways.

What to expect at your appointment

Diagnosis may take a few visits. You will likely be asked to keep a diary of your symptoms and peak flow readings. Your doctor will use all this information to create a treatment plan tailored to you. They will also check your inhaler technique to make sure you are using it correctly.

Treatment

Treatment for long lasting asthma aims to control symptoms, prevent severe attacks, and help you live without limits. It usually involves a combination of daily controller medications and quick-relief medications for when symptoms happen. Your doctor will work with you to find the right plan.

Self-care at home

• Identify and avoid your asthma triggers, such as dust, pet hair, smoke, or strong smells.
• Take your daily controller medication exactly as prescribed, even when you feel well.
• Use your quick-relief inhaler only when needed – if you need it often, tell your doctor.
• Keep a written asthma action plan that tells you what to do when symptoms worsen.
• Get the flu vaccine every year to protect against infections that can worsen asthma.

Medical treatments

Doctors typically prescribe two types of inhalers: a 'preventer' inhaler (usually taken every day to reduce airway inflammation) and a 'reliever' inhaler (used as needed for quick relief of symptoms). Some people may need additional medications like inhalers that combine two medicines or tablets to help control inflammation. For very severe asthma, there are injectable treatments called biologics that target specific pathways in the immune system. All treatments should be prescribed and monitored by a healthcare professional.

When is surgery considered?

Surgery is not usually needed for asthma. In rare, very severe cases, a procedure called bronchial thermoplasty may be considered. This uses heat to reduce the muscle in the airways and is only done in specialist centres for people who do not respond to other treatments. Your doctor will discuss all options with you.

Living with this condition

Living with long lasting asthma means paying attention to your breathing and taking your medications as prescribed. Most people with asthma can do everything they enjoy, including sports, work, and travel. The key is having a good asthma action plan and knowing how to adjust your treatment if symptoms change.

Lifestyle tips

• Avoid smoking and second-hand smoke – this is the most important thing you can do for your lungs.
• Keep your home clean and free of dust, mould, and pet dander. Use dust-mite covers on pillows and mattresses.
• Check air quality forecasts and avoid outdoor activities when pollution or pollen is high.
• Manage stress with relaxation techniques like deep breathing, meditation, or gentle exercise.

Diet and exercise

A healthy, balanced diet can help your overall health, but no specific diet cures asthma. Regular exercise is good for your lungs and heart, but some people have exercise-induced symptoms. If you do, talk to your doctor – using your reliever inhaler before exercise can often prevent symptoms. Swimming, walking, and yoga are often well tolerated.

Mental health and emotional wellbeing

Living with a long-term condition like asthma can cause anxiety, especially if you have had a severe attack. It is normal to worry. If you feel overwhelmed, speak to your doctor or a mental health professional. Support groups can also help you connect with others who understand.

Prevention

There is no proven way to prevent long lasting asthma, but you can reduce the risk of it developing in children by avoiding smoking during pregnancy and keeping the home smoke-free. For people who already have asthma, the goal is to prevent flare-ups by taking medications regularly and avoiding triggers.

Vaccines

It is highly recommended to get the annual flu vaccine and the pneumococcal vaccine (which protects against pneumonia). These vaccines help prevent infections that can trigger severe asthma attacks. Ask your doctor or pharmacist about them.

Screening programmes

There is no routine screening test for asthma in the general population. However, if you have a family history of asthma or allergies, and you have symptoms like a persistent cough or wheeze, it is important to see a doctor for evaluation.

Complications

If left untreated

• Frequent asthma attacks that may require emergency care or hospital stays
• Permanent narrowing of the airways, making breathing harder over time
• Reduced ability to work, exercise, or take part in daily activities
• Increased risk of pneumonia and other lung infections
• In severe cases, life-threatening asthma attacks

Long-term outlook

With proper treatment and self-care, most people with long lasting asthma can control their symptoms and lead a full, active life. Asthma does not have to stop you from doing what you love. Working closely with your healthcare team and following your action plan can keep your asthma in check for years to come.

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