Asthma and respiratory allergy

What is asthma?

Asthma is a long-term condition of the airways. The airways become inflamed, swollen and narrow, and air has a harder time passing through. The NHS says symptoms come and go and can be mild or severe. The exact cause is not fully known.

Asthma can occur at any age. It mostly starts in childhood but can appear in adulthood too. According to WHO it is the most common long-term disease of children, and in 2023 about 363 million people worldwide had it.

Respiratory allergy (such as hay fever or sensitivity to dust) is when the body reacts to something that is harmless in itself. Sometimes this sensitivity involves the airways and sets off asthma.

Symptoms

• Wheezing, a whistling sound when breathing out.
• Cough, especially at night or early in the morning.
• Breathlessness.
• A feeling of heaviness or pressure in the chest.

WHO and the NHS both say symptoms are often worse at night or during exercise. Common triggers are exercise, cold air, air pollution, cigarette smoke, pollen, dust, mould, pets, viral infections and sometimes certain medicines. The NHS says medicines such as aspirin and ibuprofen can set off asthma symptoms in some people, so tell your doctor about every painkiller you take.

Who should be seen?

Make an appointment if:

• You have wheezing, cough or breathlessness that keeps coming back, especially at night, with exercise or in cold air.
• Even with an inhaler, your symptoms stop you from being active or sleeping.
• You need your reliever inhaler more than before, or you are not sure you are using it correctly.
• You have had an asthma attack. The NHS says that after an attack, even if you feel better, a doctor should see you within two days to help prevent the next one.

The NHS says asthma can take time to diagnose because symptoms vary over time.

How is it assessed?

The doctor first asks about your symptoms, when they happen, triggers, and your family and allergy history, and listens to your chest. Then they may:

• Ask for a simple breathing test. In general, in these tests you blow into a device that measures how much air you breathe out and how fast. See the guide “Lung tests and imaging”.
• Use a peak flow meter, a small handheld device that the NHS says you may be given to use at home for a few weeks to monitor your lung function.
• Ask for a blood test or an allergy test, if allergy is suspected. In general, allergy testing can be a skin prick test or a blood sample (NHS). These tests show what your body is sensitive to; they do not always confirm asthma.
• Suggest a trial of treatment and see how your symptoms change.

What does treatment generally look like?

The aim of treatment is to control symptoms and reduce attacks. WHO says the main treatment is inhalers, and attacks are prevented with a steroid inhaler. The type and schedule are set by your doctor. The main parts are:

• Controller (preventer) inhaler: calms inflammation in the airways and must be used on schedule, even when you have no symptoms. The NHS says it does not work immediately.
• Reliever inhaler: for when symptoms appear. The NHS says a blue reliever inhaler (such as salbutamol) should not be prescribed on its own. If you need it often, your asthma is not under control.
• Combination inhaler, which some patients have and which does both jobs, as your doctor decides.
• Tablets or injected medicines (biologics) when inhalers are not enough and asthma is severe (NHS).
• A written asthma action plan: the NHS says your doctor or nurse writes down in a plan how to take your medicines, how to monitor your symptoms, how to avoid triggers and what to do when things get worse. Bring it to every appointment.
• A review at least once a year, which also checks your inhaler technique and that your plan is up to date (NHS).
• Allergy treatment if needed: avoiding the allergen, antihistamines and nasal sprays; in special cases immunotherapy, which the NHS says should only be done by a medical professional.

Do not stop your controller medicine because you feel better. Do not reduce or stop steroid tablets on your own either, since the NHS warns that stopping suddenly has side effects. Inhalers are not addictive; do not stop yours out of fear of dependence.

What can you do yourself?

• Use your inhalers correctly and regularly, and ask your doctor, nurse or pharmacist to watch your technique. See the guide “Asthma and COPD inhalers”.
• Learn your triggers and reduce them as far as you can. For the home, the CDC recommends: nobody smokes near you, wash bedding and pillows and dry them completely, deal with damp and mould quickly, and avoid insect sprays and foggers, which can themselves cause an attack. See the guide “Asthma triggers at home”.
• Do not smoke cigarettes or hookah, and stay away from other people’s smoke. Hookah is not a safe alternative to cigarettes.
• Follow your written plan and keep a note of how often you use your reliever.
• The NHS recommends regular physical activity. If exercise brings on symptoms, ask your doctor how to do it safely.
• Ask your doctor about recommended vaccines, such as flu. The NHS says viruses such as influenza can make asthma symptoms worse.

When to get urgent help

The NHS describes an asthma attack as severe symptoms with difficulty breathing, which can be life-threatening.

• During an attack: sit upright, stay calm and use your reliever inhaler as set out in your written plan (with a spacer if you have one).
• Call 115 now (Iran’s emergency number) if you are getting worse, you have not improved after the maximum amount of inhaler your plan allows, you have no written plan and the reliever has not helped, your inhaler is not with you, you cannot finish a sentence, or your lips or nails have turned blue. Do not drive yourself.
• If ten minutes have passed, help has not arrived and you are still not better, the NHS says to use the inhaler again, in the amount your plan gives.
• After an attack, even if you feel better, see a doctor within two days.

See the full list in the guide “When to call urgently”. If you cannot reach your doctor, go to the emergency department of the nearest hospital.