Asthma
What asthma is, the difference between preventer and reliever inhalers, and the warning signs of poor control.
Last revised
A long-term condition in which the airways are inflamed and narrow in response to triggers, causing wheeze, cough, chest tightness and breathlessness. It varies over time and between people, and good control means having essentially no symptoms.
Preventer and reliever
Reliever inhalers, usually blue, contain a short-acting bronchodilator that opens the airways within minutes. Preventer inhalers contain an inhaled corticosteroid that reduces the underlying inflammation and must be taken regularly whether or not you have symptoms. The common and dangerous pattern is over-reliance on the reliever while skipping the preventer, which treats the symptom and leaves the disease progressing.
What good control looks like
No daytime symptoms, no night waking, no limitation on activity, and little or no need for the reliever. Needing a reliever three or more times a week is a marker of inadequate control and a reason to review treatment rather than to request more relievers. Getting through more than a small number of reliever inhalers a year is a recognised risk signal.
Inhaler technique and reviews
A large proportion of people use their inhaler incorrectly, which means the dose never reaches the airway. Technique should be checked at every review, and a spacer improves delivery substantially with a metered dose inhaler. Everyone with asthma should have a written personalised asthma action plan and an annual review.
Triggers
Common ones include respiratory infections, exercise, cold air, pollen, house dust mite, animal dander, mould, smoke and air pollution. Some medicines, particularly beta blockers and NSAIDs including ibuprofen and aspirin, can trigger attacks in susceptible people. Identifying personal triggers is useful; avoiding all of them is usually neither possible nor necessary.
At a glance
| Term | Detail |
|---|---|
| Reliever inhaler | short-acting bronchodilator, usually blue, works in minutes |
| Preventer inhaler | inhaled corticosteroid, taken regularly regardless of symptoms |
| Marker of poor control | needing a reliever 3 or more times a week |
| Everyone should have | a written personalised asthma action plan |
| Review frequency | at least annually, and after any attack |
| Improves inhaler delivery | a spacer device |
| Medicines that can trigger attacks | beta blockers, NSAIDs including ibuprofen and aspirin |
When to get help
Call 999 if the reliever inhaler is not helping, if you are too breathless to speak in full sentences, if your lips or fingers look blue, or if you are struggling to breathe. Contact a GP urgently if you are using your reliever more than usual, waking at night with symptoms, or your peak flow is falling. Always seek review after an asthma attack, even if you recovered; attacks predict further attacks.
Where to go next
Where this comes from
- NICE - Asthma: diagnosis, monitoring and chronic asthma management
- NHS - Asthma
- Asthma + Lung UK - inhalers and action plans
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
