Worldwide, asthma affects more than 300 million people. According to the National Institute for Health and Care Excellence (NICE), more than eight million people – approximately 12 per cent of the population – have been diagnosed with asthma in the UK, though only 5.4 million are receiving asthma treatment (some, NICE explains, may have grown out of the condition) (i).
The health charity Asthma UK says of this 5.4 million, 1.1 million are children and 4.3 million are adults (ii). And while the condition can be controlled effectively in most people most of the time, around 200,000 people have severe asthma that doesn’t respond to usual treatments (ii).
What is asthma?
Asthma affects the airways that carry air in and out of the lungs. If you have asthma, coming into contact with something that irritates your airways – called an asthma trigger – sets off a chain of events. Your immune system starts to release a chemical called histamine, which, together with other chemicals, make the smooth muscle in your airways contract. This means your airways become narrower and irritated, causing wheezing, coughing, shortness of breath and tightness in the chest.
This irritation can be caused by triggers such as cigarette smoke, dust mites, mould, animal fur, feathers, pollen, certain foods, breathing cold air or taking exercise. If you have a respiratory tract infection – such as a cold or flu – it could trigger asthma symptoms. Even changes in temperature and other weather conditions, such as heat and humidity, can affect someone who suffers from the condition.
Some medicines, including aspirin and ibuprofen, can trigger asthma, as can certain foods that contain substances called sulphites, such as fruit juice, processed meals, prawns and jam. Some people who work in an environment where there is a lot of dust and/or fumes can suffer from work-aggravated asthma or occupational asthma. Stress may also be an asthma trigger.
What causes it?
Despite the fact that asthma is a relatively common health problem, nobody really knows what causes it. What we do know however, is that if you have asthma your child is much more likely to have it too, particularly if both parents are affected (though according to Asthma UK there’s slightly more chance of asthma being passed on by mothers than fathers) (iii). Also if there are allergies in your family such as eczema or hay fever, it means you’re more likely to have asthma. Understanding the link between asthma and eczema might be the key to managing your condition.
Smoking can also increase your risk – there’s even evidence that babies born to mothers who smoke while they’re pregnant have a higher risk of developing asthma (iii). Being obese may increase your risk too.
Many experts also believe that modern lifestyles, including more hygienic environments, could play a part in the way asthma has affected more people during the past few decades (iii).
Avoiding asthma triggers
If you have asthma, it’s likely that you’re aware of what triggers your symptoms. And by minimising your exposure to those triggers – wherever possible – you can do a lot to keep your symptoms under control. At home, this might mean taking measures to reduce dust mites, mould and pet fur.
Here are some of the things you could do that might help:
Wash your bedding at 60º degrees once a week to kill any house dust mites (if possible, use dust mite covers on your bed)
Cut down on carpets and soft furnishings
Wipe surfaces weekly with a damp cloth to prevent the build-up of dust
Wash your pets regularly and only groom them outdoors (also try to keep pets out of your bedroom)
Remove mould from surfaces in the kitchen and/or bathroom
Clean mould from window frames and tackle condensation
Cleaning products and air fresheners can also trigger asthma symptoms in some people, as they release chemicals that may cause breathing difficulties. If you have to use cleaning products, make sure your windows are open while you’re cleaning and use as little of the product as possible (use liquid or solid products rather than those that come in spray form).
Also try to make sure nobody smokes in your home, as inhaling cigarette smoke can irritate your airways and trigger asthma symptoms (if you’re a smoker, it goes without saying that giving up could help greatly relieve your symptoms).
Summer can be a difficult time for many people with asthma, since according to Asthma UK, around 80 per cent of asthmatics also have hay fever (iv).
Hay fever is caused by an allergy to pollen and affects people throughout the summer months – mostly between May and August when grass pollen is at its highest level. If you’re allergic to tree or weed pollens, or other allergens, the hay fever season can last from February to October. But by reducing your exposure to pollen, you may be able to control your asthma – and hay fever – symptoms. Here are some measures that may give you some relief during the spring and summer months:
Keep your windows closed at night (pollen begins to cool and fall in the evenings, and is released early in the mornings)
Take a shower and change your clothes when you get home if you’ve been outdoors during the pollen season (especially when the pollen count is high)
If you have pets that go outside, wash them regularly to rinse any pollen out of their fur, and wash their bedding and any soft furnishings they lie on frequently, ideally at 60ºC
When you’re outdoors, wear wrap-around sunglasses to protect your eyes
Avoid putting washing outside to dry when there’s pollen in the air, as pollen can get caught in fabric
When driving, keep your car windows shut (if possible, put a pollen filter in your car’s air vents)
Check the weather forecast every day to find out how high the pollen count is, and if possible, avoid going outside if the pollen count is very high
Discover more methods of coping with hay fever here.
Asthma and exercise
You know you’re exercising properly when you’re slightly out of breath. But for many people with asthma, exercise can trigger their symptoms or even an asthma attack. Indeed, many people with asthma may not be doing enough exercise because they fear it could make their symptoms worse. Some also have a form of asthma called exercise-induced asthma, which means they only get symptoms when they are physically active.
However, exercise is important if you have asthma, because it could help you manage your symptoms better by boosting your lung capacity. It also improves your fitness and stamina, which can make everyday activities a lot easier. If you haven’t done much exercise recently, make sure you start slowly – just five minutes to begin with – and build up gradually. You should expect to breathe harder and faster when you’re exercising, but if you start coughing or wheezing, if you feel very short of breath or your chest feels tight and you have difficulty speaking, stop straight away and wait at least five minutes before resuming your activity. Also avoid exercising outdoors during a cold snap, as breathing cold air could trigger your symptoms. Instead, think about exercising indoors, at home or at your local gym or leisure centre.
Like everyone else, if you have asthma you should aim to be active every day and do at least 150 minutes of moderate activity every week (in other words, exercise that leaves you slightly out of breath and raises your heart rate). Suggested activities include:
It’s also a good idea to do some strengthening exercises a couple of times a week. Yoga, Pilates and even heavy gardening count as muscle-strengthening activities, or you could try doing exercises such as push-ups, squats, lunges and sit-ups, which use your own body weight as resistance.
Always speak to your GP or asthma nurse before starting any kind of exercise. You may be advised to take a puff or two of your reliever inhaler before you start working out (even if you’re not, make sure you keep your inhaler with you at all times, including when you exercise). If you have to keep stopping because you’ve been experiencing symptoms while exercising, see your GP or asthma nurse, as it may mean your symptoms aren’t being controlled effectively enough.
Asthma medicines Q&A
What medicines are usually used to treat asthma?
Asthma medicines come in the form of inhalers that are described as 'relievers' and 'preventers'. Reliever inhalers contain bronchodilator medicines that relax and widen the airways, offering quick relief. You can use them if you’re feeling breathless, tight-chested or wheezy.
If you need to use a reliever inhaler three times a week or more, your GP may also give you a preventer inhaler. These contain a low-dose steroid medicine that you inhale every day to prevent your symptoms from developing and stop you having an asthma attack.
Steroid tablets are also used, but only if your asthma isn’t under control and if taking high doses of your preventer inhaler doesn’t provide enough relief. Other types of tablets may also be used by people whose asthma symptoms aren’t properly controlled by using their inhalers.
Do asthma medicines have side effects?
Medical experts claim asthma medicines are generally safe to use (v), and while some people may experience mild side effects, most asthma sufferers will find the benefits of taking asthma medicines far outweigh the side effect risks.
Some of the side effects of preventer medicine – mostly only when taken in higher doses – include a sore tongue and throat, a hoarse voice and an increased risk of oral thrush. You can, however, help prevent these side effects by brushing your teeth or rinsing your mouth out after using your inhaler. Using a spacer device – which some people find helps them use their inhaler correctly – can also reduce the risk of these side effects.
If you use a reliever inhaler, there is a chance you could experience temporary side effects, such as an increased heartbeat, headache and slight muscle tremors. But this usually only happens when you need to take a few puffs of your inhaler, rather than just one or two. Thankfully, these side effects tend to pass quickly and you should feel normal again after a few minutes or a few hours at most.
Asthma medicine in tablet form may cause headaches, insomnia, vomiting or irritability, but these can usually be controlled by reducing the dose.
What medicine do you need if you’re having an asthma attack?
If your asthma symptoms aren’t under control, you could be at risk of having an attack. If that happens, here’s what you should do:
Sit down – don’t lie down – as calmly as possible and take one puff of your reliever inhaler every 30-60 seconds (don’t have more than 10 puffs altogether)
Loosen tight clothing and try to take slow, steady breaths
If your symptoms don’t improve after taking 10 puffs, or if you start feeling worse or worried, call 999 for an ambulance
If the ambulance takes longer than 15 minutes to arrive, repeat the first step
Please note: these instructions don’t apply to people on the Symbicort SMART or Fostair MART regime – ask your GP or asthma nurse to tell you what you should do in case of an asthma attack if you’re using one of these inhalers.
Natural treatments to compliment asthma medication
Conventional asthma medicines are highly effective, but there are some natural remedies you could use alongside them that may also be helpful.
Several studies suggest taking vitamin D may help improve asthma control when used alongside conventional treatments. One study involving people aged 65 and older found those with uncontrolled asthma symptoms had lower levels of vitamin D compared with the volunteers with well-controlled symptoms (vi). After taking vitamin D supplements for 12 weeks, those with uncontrolled asthma said their symptoms had decreased significantly. The effect may be linked to the role vitamin D plays in modulating the immune system, the researchers claim. Another study suggests that vitamin D deficiency may have an effect on the inflammatory response in the airways (vii). Meanwhile a review of seven clinical studies with a total of almost 1,000 participants has also found that taking vitamin D supplements may reduce the need for taking steroid tablets for worsening asthma symptoms (viii).
If you’re thinking of taking a vitamin D supplement, vitamin D3 – or cholecalciferol – is the recommended for, as it’s the natural form of the vitamin that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.
Omega-3 fatty acids found in fish oils are thought to have an anti-inflammatory effect, and may be helpful in asthma cases where there’s bronchial inflammation, particularly among those whose diets are low in omega-3s. One study suggests the anti-inflammatory effects of omega-3 fatty acids may be linked to a change in cell membrane composition, and that supplementing with omega-3s is an attractive non-pharmacological intervention that may benefit people with asthma (ix).There’s also some evidence that fish oils may be helpful for people with exercise-induced asthma (x).
If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish.
This mineral is a well-known muscle relaxant, which may help to expand the airways. Studies of inhaled and injected magnesium sulfate as an emergency treatment for asthma also suggest it may be beneficial and that it may even reduce the risk of being admitted to hospital (xi).
A plant pigment (flavonoid) found in onions, apples and black tea, quercetin is thought to help block or reduce the production and release of histamine, the chemical your body produces in response to an allergen that makes your airways narrower and irritated (xii).
High-strength multivitamin and mineral
It may also be worth considering taking a multivitamin supplement that provides vitamin C, a nutrient that may provide general antioxidant support for the lungs. There are also a few promising studies that support the use of vitamin C in asthma, but experts agree there needs to be more research in this area (xiii).
Meanwhile, try practicing this abdominal relaxation breathing technique a few times each day:
Sit or lie down, and make yourself comfortable.
Put one hand over your heart or chest, and the other over your belly button.
Breathe in through your nose and try to make your lower hand go up (imagine you’re filling a balloon) without letting the upper hand on the chest move.
Breathe out with puckered lips and let the lower hand go down again.
Take three deep breaths, and with each, tell yourself to relax.
As you’ve discovered, asthma is linked to a number of allergies and conditions. For more information on a range of other common health conditions, visit our health library.
Available online: https://cks.nice.org.uk/asthma#!backgroundSub:1
Available online: https://www.asthma.org.uk/about/media/facts-and-statistics/
Available online: https://www.asthma.org.uk/advice/understanding-asthma/causes/
Available online: https://www.asthma.org.uk/about/media/news/hay-fever-survey/
Available online: https://www.webmd.com/asthma/asthma-medications#2
Columbo. M, Panettieri. RA, Rohr. AS. Asthma in the elderly: a study of the role of vitamin D. Allergy, Asthma & Clinical Immmunolog 2014, 10:48.
Hall SD, Agrawal DK. Vitamin D and Bronchial Asthama: An Overview of DAte From the Past 5 Years. Clin Ther. 2017 May;39(5):917-929.Available online: https://www.ncbi.nlm.nih.gov/pubmed/28449868
Jolliffe DA et al., Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data. Lancet Respir Med. 2017 Nov;5(11):881-890.Available online: https://www.ncbi.nlm.nih.gov/pubmed/28986128
Kumar. A., Mastana SS, Lindley MR, et al. n-3Fatty acids and asthma. Nutr Res Rev. 2016 Jun;29(1):1-16. Available online: https://www.ncbi.nlm.nih.gov/pubmed/26809946
Mickleborough. TD, Murray. RL, Ionescu. AA, et al. Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med. 2003 Aug 6.
Mickleborough. TD, Lindley. MR, Ionescu. AA, Fly. AD. Protective effect of fish oil supplementation on exercise-induced bronchoconstriction in asthma. Chest. 2006;129;39-49.
Hughes. R, Goldkorn. A, Masoli. M, et al. Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial. Lancet. 2003;361:2114-2117.
Irazuzta. JE., Chiriboga N., Magnesium sulphate infusion for acute asthma in the emergency department. J Pediatr (Rio J). 2017 Nov - Dec;93 Suppl 1: 19-25. Available online: https://www.ncbi.nlm.nih.gov/pubmed/28754601
Ogasawara H., Middleton E Jr., Effect of selected flavonoids on histamine release (HR) and hydrogen peroxide (H2O2) generation by human leukocytes [abstract]. J Allergy Clin Immunol. 1985;75(suppl):184.
Middleton E Jr., Effect of flavonoids on basophil histamine release and other secretory systems. Prog Clin Biol Res. 1986;213:493-506.
Bielory. L, Gandhi. R. Asthma and vitamin C. Ann Allergy. 1994 Aug;73:89-99.
Kaur. B., Rowe BH, Fam FS. Vitamin C supplementation for asthma. Cochrane Database Syst Rev. 2001;(4): CD000993. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11687089
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.