Asthma FAQs

Asthma is characterised by airway inflammation and bronchoconstriction. The airways become obstructed, limiting airflow and causing breathing difficulties. In severe cases, poorly controlled asthma can lead to hospitalisation and even death.1

 

1. Asthma UK. https://www.asthma.org.uk/advice/understanding-asthma/what-is-asthma/ (Accessed April 2016).

There is no single definitive causal factor for asthma, but genetic, environmental and individual factors all contribute. These either cause development of asthma and or trigger asthma symptoms.1

Genetic factors

Asthma has a genetic component, but it is not straightforward. Multiple genes may be involved in the pathogenesis and approximately a third of the genetic predisposition to asthma has been discovered.2 A family history of asthma, eczema or allergies can also influence the development of asthma.1

Environmental factors

Allergens, pollution and occupational irritants may all have a role in asthma development. Exposure to indoor and outdoor allergens in children may be a causal factor, particularly in urban environments.2 Outbreaks of asthma exacerbations have also been linked to increased levels of air pollution, but the role this plays in developing asthma is not clearly defined.3

Individual factors

Asthma is more frequently observed in obese patients, possibly due to a combined effect of a lower lung function, altered pattern of breathing and higher incidence of co-morbidities compared with those of a normal weight.4 In addition, pre- or post-natal exposure to tobacco smoke results in a greater risk of developing asthma and is also associated with an accelerated decline of lung function and increased asthma severity.1,5

 

1. Asthma UK. https://www.asthma.org.uk/advice/understanding-asthma/causes/ (Accessed April 2016).
2. WHO – Genetics and Asthma. http://www.who.int/genomics/about/Asthma.pdf (Accessed April 2016).
3. Asthma UK. https://www.asthma.org.uk/advice/triggers/pollution/ (Accessed April 2016).
4. Asthma UK. https://www.asthma.org.uk/advice/living-with-asthma/weight-loss/ (Accessed April 2016).
5. Asthma UK. https://www.asthma.org.uk/advice/triggers/smoking/ (Accessed April 2016).

Asthma is a common disease that affects as many as 334 million people of all ages in all parts of the world.1 It is a cause of substantial burden to people, often causing a reduced quality of life, not only due to its physical effects, but also its psychological and social effects.1

The various estimates of its economic burden, mostly due to productivity loss, are all significant. Avoidable asthma deaths are still occurring due to inappropriate management of asthma, including over-reliance on reliever medication rather than preventer medication.1

Asthma is a particularly serious burden in low- and middle-income countries least able to afford the costs.1

 

1. Global Asthma Report 2014. http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf (Accessed April 2016).

There are varying triggers for asthma attacks and in some instances, these may lead to a full exacerbation.* Triggers include:1

  • allergens like dust mites, pet dander and pollen
  • fear, anxiety or anger
  • viral infection
  • physical exertion

Allergic asthma is the most common form of asthma and can be triggered by many different allergens. Tobacco smoke poses a particular risk for people with asthma as the smoke can irritate and inflame their airways.People with asthma should try to limit their exposure to their known allergens and those who smoke should see their doctor or pharmacist for support in quitting.

*Exacerbations are clinically characterised as episodes resulting in a change from the patient's previous status, either severe and requires urgent medical intervention, or moderate that prompt a change in treatment.1

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).
2. Asthma UK. https://www.asthma.org.uk/advice/triggers/smoking/ (Accessed April 2016).

The diagnosis of asthma is often prompted by a patient’s symptoms.

Common symptoms include coughing, wheezing, shortness of breath, trouble breathing and tightness in the chest. Not all symptoms may be present at the same time.1

Asthma symptoms are recurrent and vary widely from patient to patient, and day to day. They may be more common or severe at night, or early in the morning.1

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).

Spirometry and peak flow measurement are routinely used to diagnose asthma as they detect airflow obstruction:

Spirometry - measures the forced expiratory volume (FEV1), which is the volume of air that a person can forcibly breathe out in one second. The total volume of air that can be forcibly breathed out (forced vital capacity, FVC) is also measured.1,2

It can be used in conjunction with a bronchodilator to check for reversibility of the airflow obstruction. Reversibility refers to improvement in airflow limitation that occurs in response to treatment and is a key indicator of asthma.1,2

Peak expiratory flow (PEF) monitoring - monitors response to treatment and management.1,2

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).
2. Asthma UK. https://www.asthma.org.uk/advice/diagnosis/tests/ (Accessed April 2016).

Asthma can be effectively managed with controllers/preventers (i.e. maintenance therapy) and relievers.1

As a maintenance therapy, controllers are used regularly to target inflammation, control asthma symptoms and reduce the frequency and severity of exacerbations.1

Relievers are taken immediately to alleviate asthma symptoms. They quickly relax the muscles surrounding the narrowed airways, allowing the airways to open wider so it’s easier to breathe.1

 

1. Asthma UK – Living well with asthma booklet. https://www.asthma.org.uk/globalassets/health-advice/resources/adults/asthma-and-me-booklet.pdf (Accessed April 2016).

The extent to which the effects of asthma can be seen – or have been reduced or removed by treatment – is referred to as asthma control.1

A number of tools are available for assessing asthma control in clinical practice. An example of a categorical tool is the consensus-based Global Initiative for Asthma (GINA). This can be used to help guide treatment decisions.1,2

With GINA, asthma control has two domains:1

  • Symptom control (previously called ‘current clinical control’)
  • Risk factors for future outcomes. These are factors that increase the patient’s future risk of exacerbations (flare-ups), loss of lung function or medical side effects.

 

GINA defines well controlled asthma as the following in the preceding four weeks:1,2

  • Daytime symptoms less than twice a week
  • No limitation of activities
  • No night waking due to asthma
  • Reliever/rescue treatment (excludes reliever taken before exercise) less than twice a week

 

Other tools are also available that provide scores and cut-off points to distinguish different levels of control. Examples include the Asthma Control Questionnaire (ACQ) and the Asthma Control Test (ACT). For example, an ACT score of 20 or more is classified as well-controlled asthma, while 15 or less is considered very poorly controlled.2,3

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).
2. GINA. Global strategy for asthma management and prevention. 2016. http://ginasthma.org/2016-gina-report-global-strategy-for-asthma-management-and-prevention/ (Accessed July 2016).
3. Thomas M et al. Prim Care Respir J. 2009; 18(1):41–49.

Global Initiative for Asthma (GINA) recommends an inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination in patients whose asthma symptoms remain uncontrolled with regular doses of low dose ICS, plus a reliever as-needed.1

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).

Uncontrolled asthma refers to the worsening of symptoms and an increased risk of exacerbations or a decline in lung function. The Global Initiative for Asthma (GINA) classifies uncontrolled asthma as three or four of the following in the past four weeks:1,2

  • Daytime asthma symptoms more than twice per week
  • Any night waking due to asthma
  • Reliever needed for symptoms* more than twice per week
  • Any activity limitation due to asthma

During an exacerbation, the reliever may not be effective and patients find that their symptoms continue to worsen. This can lead to difficulty in speaking, eating and sleeping.3 In severe cases it can require hospitalisation and may even be fatal.

* Excludes reliever taken before exercise.2

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).
2. GINA Global strategy for asthma management and prevention. 2016. http://ginasthma.org/gina-report-global-strategy-for-asthma-management-and-prevention/ (Accessed April 2016).
3. Asthma UK. https://www.asthma.org.uk/advice/asthma-attacks/ (Accessed April 2016).

Patient education is a key factor in preventing asthma exacerbations. It is an integral part of the partnership between healthcare professional and patient, and should include:

  • Importance of patients complying with medication
  • Difference between reliever medication and maintenance treatment
  • Proper use of inhalers
  • Signs that suggest asthma is worsening and actions to take
  • Monitoring control of asthma

 

Creating a personal Asthma Action Plan for each patient can reduce the impact of asthma exacerbations.1,2 This can be further achieved by identifying and reducing exposure to triggers for asthma. Triggers include:

  • Dust mites, pet dander and pollen
  • Fear, anxiety or anger
  • Viral infection
  • Physical exertion

Several examples of personalised Asthma Action Plans can be found online by searching for ‘Asthma Action Plan’.

 

1. GINA Pocket Guide for Asthma Management and Prevention. 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/ (Accessed April 2016).
2. Asthma UK – Living well with asthma booklet. https://www.asthma.org.uk/globalassets/health-advice/resources/adults/asthma-and-me-booklet.pdf (Accessed April 2016).

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