Asthma is a common respiratory condition which affects the air passages or breathing tubes that carry air in and out of your lungs. Asthma causes wheeze and cough, and can make breathing difficult. New Zealand has one of the highest rates of asthma in the world, affecting up to 1 in 4 children and 1 in 6 adults.
Learning about asthma, what causes it and how it is treated can help you avoid triggers and keep your symptoms under control.
If you have asthma, your airways are very sensitive and react to certain triggers such as allergens (substances that cause an allergic reaction), viruses, cold or humid weather, exercise and air pollutants such as cigarette smoke.
These triggers cause your air passages to tighten up, swell on the inside (become inflammed) and produce more mucus.
As a result, the airways become narrower, making it difficult for air to move into the lungs, and even more difficult for air to move out.
Avoiding your triggers and knowing what to do when you have asthma is key to managing your asthma well.
Seek urgent medical help if you have severe asthma symptoms.
What causes asthma?
Asthma is thought to be caused by a combination of genetic and environmental factors.
Asthma and allergies are closely linked. About 70 to 80% of asthma in New Zealand is associated with allergies. Often people with asthma also have eczema or hay fever, or have close family members who have asthma, eczema or hay fever.
The tendency for these three condition to occur together is known as 'atopy'.
If you are atopic, allergies, especially to dust mite, can be a trigger for your asthma.
Factors in our environment thought to have a role in causing asthma include:
allergens air pollution (such as second hand smoke)
Triggers – things that can cause asthma symptoms
Learning what triggers your asthma and finding ways to avoid or reduce the impact is an important part of managing your asthma.
Common asthma triggers include:
house dust mite
infections of the airways such as colds and flu
pollen or mould
weather such as change in temperature, cold weather or humid weather
stress and high emotion
chemicals that irritate the airways such as sprays, perfumes, cleaning fluids
What are the symptoms of asthma?
Common symptoms of asthma include:
difficulty breathing, feeling out of breath, can't get enough air out of the lungs
a tight feeling in your chest like something is squeezing or sitting on your chest
wheezing (a whistling, musical or squeaky noise in the chest)
a cough which can be worse at night or in the morning.
If you have any of these symptoms, see your doctor so they can assess if this is due to asthma or something else.
Severe asthma symptoms
From time to time, your symptoms may get gradually or suddenly worse. Seek urgent medical help if you have any of these severe symptoms:
it is difficult to talk
your lips and/or fingernails have a bluish tinge
your nostrils flare when you breathe
the skin around your neck and/or ribs pulls in when you breathe
your heart is racing
it is hard to walk.
For severe asthma symptoms, you should use your reliever inhaler immediately and call an ambulance 111 or go to your nearest Accident & Emergency clinic.
How is asthma diagnosed?
In most cases, asthma can be diagnosed from:
your history (describing your asthma symptoms now and in the past)
listening to your breathing with a stethoscope
checking how your lungs are working with a device called a peak flow meter.
In some cases, more detailed testing may be required, such as a spirometry (lung function) test, a skin-prick test to test for allergens or rarely, a chest x-ray to rule out other conditions.
Once a diagnosis is made, your doctor will prescribe the type of medicines you need to take and will also set up an asthma action plan. This plan will remind you how to manage your asthma on a daily basis and how to recognise and handle worsening symptoms.
Asthma is ongoing and your symptoms may come and go. In some children, the symptoms may disappear as they get older.
How is asthma treated?
While asthma cannot be cured, the correct use of medication combined with other self-care measures means that symptoms can be well controlled in most people.
The main aims of asthma treatment are to:
keep symptoms under control
prevent 'asthma attacks' or 'exacerbations' (sudden worsening of symptoms)
keep lungs healthy as possible
stop asthma from interfering with school or work
help you enjoy a full and active life.
There are many different types of asthma medicines and sometimes you will have to take more than one. These are usually puffers or inhalers but may also be tablets. They fall into the main categories of:
The main groups of asthma medicines are:
These provide short-term relief by relaxing the muscles around your airways, and open up your airways and makes it easier to breathe.
Common relievers include salbutamol and terbutaline.
These are taken every day to prevent symptoms from developing.
They do not provide quick relief of asthma symptoms.
The two main types of preventers commonly used are:
long-acting bronchodilator preventers.
prednisone (steroid tablets)
These are usually taken for very severe episodes of asthma and works more intensely to reverse the swelling of the airways.
Keep an eye on your symptoms. If you are getting wheezy more than two times a week, it may mean your asthma is not well controlled. See your doctor for a check up.
If you have symptoms of allergic rhinitis (such as nasal congestion, hayfever, runny nose) talk to your doctor about medication to treat these symptoms such as antihistamines or nasal steroids (steroid nasal sprays). Treating allergic rhinitis can improve your asthma symptoms.
There are many things you can do to improve how well your asthma is controlled. By working with your doctor or nurse to create an asthma action plan, you can reduce the severity of your asthma symptoms and how often they occur.
Here's what you can do:
Understand your asthma, recognise your symptoms and your triggers.
Take your prescribed medication – especially your preventer – every day.
Don't smoke and keep clear of anyone else who smokes and of any other fumes.
See an allergy specialist about managing allergies if these are a known trigger for you.
Use a peak flow meter to take and record regular readings.
Keep active – physical activity improves how well your lungs work, and people who are fit usually find they have less asthma and cope better when they do have it.
Visit your asthma team (your GP, your practice nurse and your pharmacist) regularly. They will review the medications you are taking and can teach you how to use your inhaler properly, for maximum benefit.
Get a seasonal flu jab – see your doctor about a free flu vaccination each autumn to reduce your risk of flu, which in turn will reduce the risk of serious asthma.
Most asthma medication is available as a puffer (pump) or inhaler and may often be used with a spacer.
What they do
These are used to relieve asthma symptoms once they have started. They are fast-acting (start working in 5 to 20 minutes) and improve your breathing immediately.
They are used for quick relief when you are experiencing difficulty breathing.
Relievers should only be used now and again. Using them too often means that your asthma is not well controlled. If you find you are using your reliever more than 3 times per week, tell your doctor – you will need your asthma medication to be reviewed.
These are available as puffers or inhalers such as:
You may hear these described as ‘combination’ inhalers
Prednisone (steroid tablets)
Prednisone is a tablet form of steroid that works very well to reduce inflammation in your airways. If your asthma symptoms become severe or you have an asthma attack, your GP or asthma nurse may give you a short course of prednisone tablets for 3 to 6 days to help your asthma settle.
Short courses of prednisone are safe and have no lasting side effects. If you need prednisone more than 2 times a year then your asthma is not well controlled and you need to review your self-management plan with your doctor.
If your asthma is more difficult to control, you may need to take prednisone long term but this would be under the care of a specialist.
Important points to remember about prednisone
Long-term treatment with steroid tablets is only needed in a small number of people with asthma.
Good asthma care will reduce the need for steroid tablets.
If you need steroid tablets your doctor must supervise this treatment. You should see them regularly.
A medic-alert bracelet for steroids is only needed if you take steroid tablets for months or years.
It's dangerous to suddenly stop taking steroid tablets if they have been taken continuously for months or years.
What is an inhaler?
An inhaler is a device used to deliver medicine to the lungs and airways. By getting medicine directly to the lungs, smaller doses of medicine are needed and it can start working more quickly.The main types of inhaler devices are metered dose inhalers and dry powder inhalers such as Turbuhalers, Accuhalers, and Handihalers.
Read more about the different inhaler devices, and the points to consider when deciding on the right inhaler for you.
What is a spacer?
A spacer is a long plastic tube into which your inhaler fits. It makes using an MDI inhaler much easier to use. Your doctor or nurse can show you how to use a spacer properly. Spacers are not just for children, adults can make use of them, too.
TIP: You can often get a spacer for free from your doctor – just ask them for one.
If you are an athlete and need to take medication to keep your asthma under control, then you need to be familiar with which inhalers and medications are permitted in sport.
Many asthma medications contain Beta2-Agonists, which are prohibited (not allowed) in competitive sport. If you need to take one of these inhalers, then you will need to apply for a Therapeutic Use Exemption. Visit the DrugFree Sports NZ website for details.
An asthma action plan or asthma self-management plan is a written document designed to help you remember what you need to do to manage your asthma well.
Many of us have difficulty remembering directions or instructions that are given by our health care provider. An asthma action plan or asthma self-management plan is a written document that will provide you with instructions and information on how to:
manage your asthma daily, including taking medications correctly
identify and avoid exposure to allergens and irritants that can bring about asthma symptoms
recognise and handle worsening asthma symptoms, and when, how, and who to contact in an emergency.
You can develop your asthma management plan with your health care provider and fit the plan to suit the severity of your asthma and your preferences. At each visit with your health care provider you can review the plan and make adjustments as needed.
What are the benefits of an asthma action plan?
The use of asthma action plans, tailored to individual patient needs has been found to:
reduce absences from work or school
reduce hospital admissions
reduce emergency visits to general practice
reduce reliever medication use
improve lung function.
Asthma action plans & symptom diaries
Note: Some of these resources are from other countries so make sure you know the emergency numbers for New Zealand. Ring 111 for emergencies, or Healthline 0800 611 116.
Designed for young people and teenagers, My Asthma Toolkit is a simple guide that gives you some handy tips and skills to help you understand and manage asthma better! Developed by the team of patients and health professionals at Pain toolkit. from the UK.
COPD & Asthma Fundamentals "The most up-to-date Asthma & COPD Fundamentals course available in New Zealand. The course aligns the latest research with specific information for the New Zealand context, such as recently funded medications, treating Māori and Pacific peoples, and best practice health literacy. The course aligns with the latest NZ asthma guidelines." It includes two half day workshops covering the key aspects of COPD and asthma pathophysiology, management and practice. Delivered by The Asthma & Respiratory Foundation (NZ).