Asthma

Diagnosis

If your doctor suspects you could have asthma, they’ll ask about your symptoms and suggest tests to diagnose it. They’ll look at your nose, throat, and upper airways, listen to your breathing using a stethoscope, and take a general medical history.

Lung function tests will be carried out to see how well your lungs work. Common tests used include:

• Spirometry [25] – where you blow into a machine that measures how fast you can breathe out and how much air you can hold in your lungs.
• Peak flow test [26] – where you blow into a small handheld device, and it measures how quickly you can breathe out.
• FeNO test [27] – where you breathe into a machine that measures the level of nitric oxide in your breath (this can highlight some types of inflammation in the lungs or elsewhere) Learn more in GAAPP’s FeNO educational flyer!

Sometimes, you may have a chest x-ray to rule out other causes of your symptoms.

Asthma Severity

Asthma severity [4] is measured by how difficult asthma is to treat.

Mild asthma: This is sometimes defined by doctors as asthma that is well-controlled with low-dose corticosteroid medication, but the term “mild asthma” is more commonly used for people who don’t have frequent or severe asthma symptoms. Even if you think your asthma is mild, you can still have severe attacks, so it is important to take a preventer or controller inhaler.

Moderate asthma: Asthma that is well-controlled with low-dose combination of corticosteroids with long-acting beta-agonist medications.

Difficult-to-treat: Asthma that is uncontrolled despite treatment with medium or high doses of corticosteroids plus long-acting beta-agonist medications. This form of asthma is difficult to treat due to several reasons:

• Treatment that isn’t working due to strength or action of medications
• Continual issues with following a treatment plan
• Not taking your inhaler correctly or regularly
• Additional health issues, including chronic rhinosinusitis or obesity

Severe asthma: Some people have asthma that is uncontrolled despite regularly taking high doses of corticosteroids plus long-acting beta-agonist medications, and having other problems addressed where possible. This is often due to a different type of asthma that doesn’t respond as well to normal asthma inhalers, and may benefit from additional treatment. 

Treatment and Medicines

Asthma treatment and medicines help to control symptoms, so you can live an active and normal life. As everyone experiences asthma differently, your doctor will put together an asthma treatment plan designed specifically for you.

The two ways that inhalers for people with asthma can be used are:

• Reliever or rescue inhaler – this is used to treat your symptoms when they occur and usually provides relief within minutes. It can also be used before exercise. In the past, rescue inhalers contained only a bronchodilator such as albuterol. Although these inhalers will relax your lung muscles making it easier to breathe, they do not treat your asthma or prevent you from having severe attacks.  In many countries, people with asthma can be prescribed an anti-inflammatory reliever (AIR). This contains an inhaled corticosteroid as well as a bronchodilator, which as well as relaxing your lung muscles making it easier for you to breathe, also treats the inflammation in your airways that is causing your asthma symptoms and attacks. 
• Daily preventer or controller inhaler – this contains an anti-inflammatory corticosteroid, sometimes combined with a long-acting beta-agonist medicine and is used daily, as prescribed, to reduce the amount of inflammation and sensitivity in your airways. People with moderate or severe asthma need to use a daily preventer or controller inhaler to help control asthma symptoms, stop them from occurring, and reduce the risk of asthma attacks.

International asthma guidelines recommend that every person with asthma aged 6 years and older should be taking an inhaler containing a corticosteroid, to reduce the risk of having a severe attack. Many people with asthma need only a low dose of inhaled corticosteroid, either as an anti-inflammatory reliever inhaler or as a daily anti-inflammatory inhaler. These low dose inhalers are very safe to use, and as well as controlling your symptoms, they protect you from having severe attacks. 

People whose asthma symptoms or attacks are not well-controlled with a low-dose corticosteroid inhaler should be taking a corticosteroid inhaler or combination corticosteroid plus beta-agonist inhaler every day, as well as a reliever inhaler. 

There is also a reliever-preventer combination option in many countries for adults and adolescents (and in some countries also for children 4 or 6 years of age and older) who have moderate to severe asthma. You may hear this referred to as MART or SMART therapy, which stands for Single Maintenance and Reliever Therapy. With this treatment, you use the same anti-inflammatory reliever inhaler for relieving symptoms (and before exercise if needed) and for your regular daily preventer or controller treatment.

Make sure that you learn the correct way to use your inhaler or inhalers. For example, if you have a “puffer” that contains an aerosol to deliver the medication to your airways, you should breathe in the medication slowly. If you have a dry powder inhaler, you should breathe in the medication strongly. 

Depending on your symptoms, other medications and treatments may also be prescribed. Complementary therapies [28], such as special breathing exercises, may be recommended to help you learn to breathe better with asthma and increase your overall lung capacity, strength and health. It is essential for you to avoid exposure to tobacco smoke or vape products, because these cause serious lung problems in people with asthma. If you smoke or vape, ask your doctor or pharmacist for advice to help you quit. Where possible, avoid indoor and outdoor air pollution. For example, if possible, exercise away from main roads. Regular physical exercise and a healthy diet are recommended for all people with asthma.