Asthma

Asthma

Asthma is a common long-term condition that can cause a cough, wheezing, and breathlessness. The severity of the symptoms varies from person to person. Asthma can be controlled well in most people most of the time.

Schematic diagram showing how the airways change during asthma.

What is asthma?

Asthma is caused by inflammation of the airways. These are the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal.

When you come into contact with something that irritates your lungs, known as a trigger (see below), your airways become narrow, the muscles around them tighten and there is an increase in the production of sticky mucus (phlegm). This leads to symptoms including:

• difficulty breathing
• wheezing and coughing
• a tight chest.

A severe onset of symptoms is known as an asthma attack or an 'acute asthma exacerbation'. Asthma attacks may require hospital treatment and can sometimes be life-threatening, although this is rare. For some people with chronic (long-lasting) asthma, long-term inflammation of the airways may lead to more permanent narrowing.

Schematic diagram illustrating why asthma makes it hard to breathe. 

If you are diagnosed with asthma as a child, the symptoms may disappear during your teenage years. However, asthma can return in adulthood. Moderate to severe childhood symptoms are more likely to persist or return later in life. Although asthma does not only start in young people and can develop at any age. 

What causes asthma? 

The cause of asthma is not fully understood, although it is known to run in families. You are more likely to have asthma if one or both of your parents has the condition.

Common triggers

A trigger is anything that irritates the airways and brings on the symptoms of asthma. These differ from person to person and people with asthma may have several triggers. Common triggers include house dust mites, animal fur, pollen, tobacco smoke, exercise, cold air and chest infections.

Diagram showing some of the most common triggers of an asthma attack. 

Asthma can also be made worse by certain activities, such as work. For example, some nurses develop asthma symptoms after exposure to latex. This is often referred to as work-related asthma or occupational asthma.  

Treating asthma

While there is no cure for asthma, there are a number of treatments that can help effectively control the condition. Treatment is based on two important goals:

• relieving symptoms 
• preventing future symptoms and attacks from developing.

Treatment and prevention involves a combination of medicines, lifestyle advice, and identifying and then avoiding potential asthma triggers.

Who is affected?

In the UK, 5.4 million people are currently receiving treatment for asthma. That is 1 in every 12 adults and 1 in every 11 children. Asthma in adults is more common in women than men.

Map showing the prevalence of asthma amongst adults in the USA.

Causes of asthma 

There is no single cause of asthma, but certain things may increase the likelihood of developing it. These include genetics and the environment.

Who is at risk of developing asthma?

Things known to increase the likelihood of developing asthma include:

• a family history of asthma or other related allergic conditions (known as atopic conditions), such as eczema, food allergy or hay fever 
• developing another atopic condition, such as a food allergy
• having bronchiolitis as a child (a common lung infection among children)
• being exposed to tobacco smoke as a child, particularly if your mother smoked during pregnancy 
• being born prematurely (especially if you needed a ventilator) 
• a low birth weight (less than 2kg or 4.5lb).

Diagram showing the prevalence of asthma amongst children in the USA. 

Asthma triggers

The symptoms of asthma can have a range of triggers, but they do not affect everyone in the same way. Once you know your asthma triggers, you can try to avoid them. Triggers include:

• Airway and chest infections – Upper respiratory infections, which affect the upper airways, are often caused by cold and flu viruses and are a common trigger of asthma. 
• Allergens – Pollen, dust mites, animal fur or feathers, for example, can trigger asthma.
• Airborne irritants – Cigarette smoke, chemical fumes and atmospheric pollution may trigger asthma.
• Medicines – The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma for some people, although are fine for most. Children under 16 years of age should not be given aspirin. 
• Emotional factors – Asthma can be triggered by emotional factors, such as stress or laughing.
• Foods containing sulphites – Sulphites are naturally occurring substances found in some food and drink. They are also sometimes used as a food preservative. Food and drinks high in sulphites include concentrated fruit juice, jam, prawns and many processed or pre-cooked meals. Most people with asthma do not have this trigger, but some may. Certain wines can also trigger asthma in susceptible people.
• Weather conditions – A sudden change in temperature, cold air, windy days, poor air quality and hot, humid days are all known triggers for asthma.
• Indoor conditions – Mould or damp, house dust mites and chemicals in carpets and flooring materials may trigger asthma.
• Exercise – Sometimes, people with asthma find their symptoms are worse when they exercise.
• Food allergies – Although uncommon, some people may have allergies to nuts or other food items, known as an anaphylactic reaction. If so, these can trigger severe asthma attacks.

What happens during an asthma attack?

During an asthma attack:

• the bands of muscles around the airways tighten
• there is increased inflammation in the linings of the airways, which swell
• the airways produce sticky mucus or phlegm, which can cause them to narrow further.

The passages of the airways narrow, making it more difficult for the air to pass through and therefore more difficult to breathe. This can cause the characteristic wheezy noise, although not everyone with asthma will wheeze. In a life-threatening attack, there may not be a wheezy sound.

Schematic diagram showing what happens during an asthma attack.

An asthma attack can happen at any time. However there are usually warning signs for a couple of days before. These include symptoms getting worse, especially during the night, and needing to use the reliever inhaler more and more. If you or someone else is having a severe asthma attack and cannot breathe, dial 999 immediately for emergency medical treatment.

Symptoms of asthma 

The symptoms of asthma can range from mild to severe. When asthma symptoms get significantly worse, it is known as an asthma attack. The symptoms of asthma include:

• feeling breathless (you may gasp for breath)
• a tight chest, like a band tightening around it 
• wheezing, which makes a whistling sound when you breathe
• coughing, particularly at night and early morning
• attacks triggered by exercise, exposure to allergens and other triggers.

Symptoms of asthma in adults.

You may experience one or more of these symptoms. Symptoms that are worse during the night or with exercise can mean your asthma is getting worse or is poorly controlled. Talk to your doctor or asthma nurse about this.

Asthma attack

A severe asthma attack usually develops slowly, taking 6 to 48 hours to become serious. However, for some people, asthma symptoms can get worse quickly. As well as symptoms getting worse, signs of an asthma attack include:

• you get more wheezy, tight-chested or breathless
• the reliever inhaler is not helping as much as usual
• there is a drop in your peak expiratory flow.

Diagram showing how the airways are affected by asthma.

If you notice these signs, do not ignore them. You must contact your family doctor or asthma clinic or consult your asthma action plan, if you have one. Signs of a severe asthma attack include:

• the reliever inhaler, which is usually blue, does not help symptoms at all
• the symptoms of wheezing, coughing and tight chest are severe and constant
• you are too breathless to speak
• your pulse is racing
• you feel agitated or restless
• your lips or fingernails look blue.

Call 999 to seek immediate help if you or someone else has severe symptoms of asthma.

Diagnosing asthma 

If you have typical asthma symptoms, your doctor is likely to be able to make a diagnosis. Your doctor will want to know when your symptoms happen and how often, and if you have noticed anything that might trigger them. A number of tests can be carried out to confirm the diagnosis:

Spirometry

A breathing test called spirometry is carried out to assess how well your lungs work. You will be asked to breathe into a machine called a spirometer. The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV1) and the total amount of air you breathe out (called the forced vital capacity or FVC).

Table showing some of the most common tests used to diagnose and monitor asthma.

You may be asked to breathe out a few times to get a consistent reading. The readings are compared with average measurements for people your age, which can show if your airways are obstructed. Sometimes an initial set of measurements is taken, then you are given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing. Another reading is then taken and, if it is much higher after taking the medicine, it can support the diagnosis.

Peak expiratory flow rate test

A small hand-held device known as a peak flow meter can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow rate (PEFR), and the test is usually called a peak flow test. 

You may be given a peak flow meter to take home and a diary to record measurements of your peak flow. Your diary may also have a space to record your symptoms. This will help you recognise when your asthma is getting worse.

Other tests

Some people, but not all, may need more tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor plan your treatment.

Airway responsiveness tests

This test is used to see how your airways react when they come into contact with a trigger. You will be asked to take a mannitol challenge test which involves breathing in increasing amounts of a dry powder. This deliberately triggers asthma symptoms and causes the airways to narrow. In children, exercise is sometimes used as a trigger.

You then blow into the spriometer to measure how much your FEV1 and FVC have changed in response to breathing in the trigger. If there is a significant decrease in these measurements, you may have asthma.

Testing airway inflammation

• Phlegm sample. The doctor may take a sample of phlegm to check whether you have inflammation in the lungs.
• Nitric oxide concentration. As you breathe out, the level of nitric oxide in your breath is measured. A high level of nitric oxide can be a sign of airway inflammation.

Allergy tests

Skin testing or a blood test can be helpful to confirm whether your asthma is associated with specific allergies, for example dust mites, pollen, or foods.

Occupational asthma

If you report that your symptoms are better on days you do not work or when you are on leave, you may have occupational asthma. Occupational asthma may also be diagnosed if you work in an industry where there is a high risk of getting the condition, such as:

• paint sprayers 
• bakers and pastry makers 
• nurses 
• chemical workers 
• animal handlers 
• welders
• food processing workers 
• timber workers.

To help diagnose occupational asthma, your family doctor may ask you to take measurements of your peak expiratory flow both at work and when you are away from work.

Your doctor may then refer you to a specialist in occupational medicine to confirm the diagnosis. Tests can also be carried out to see if you are allergic or sensitive to certain substances known to cause occupational asthma.

Treating asthma 

The aim of treatment is to get your asthma under control and keep it that way. Everyone with asthma should be able to lead a full and unrestricted life. The treatments available for asthma are effective in most people and should enable you to be free from symptoms.

What is good asthma care?

Your doctor or nurse will tailor your asthma treatment to your symptoms. Sometimes, you may need to be on higher levels of medication than at other times.

You should be offered:

• care at your doctor's surgery provided by doctors and nurses trained in asthma management
• full information about your condition and how to control it
• involvement in making decisions about your treatment
• regular checks to ensure your asthma is under good control and your treatment is right for you (which should be at least once a year)
• a written personal asthma action plan agreed with your doctor or asthma specialist nurse.

There is a variety of inhalers, nebulisers and other medication used in the treatment and prevention of asthma.

It is also important that your doctor or pharmacist teaches you how to properly use your inhaler as this is an important part of good asthma care.

Personal asthma action plan

As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your doctor or asthma nurse. If you have been admitted to hospital because of an asthma attack, you should be offered an action plan (or the opportunity to review an existing action plan) before you go home.

The action plan should include information about your asthma medicines and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack. Your personal asthma action plan should be reviewed with your doctor or asthma nurse at least once a year, or more frequently if your symptoms are severe.

As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms.

Taking asthma medicines

Inhalers

Asthma medicines are usually given by inhalers, which are devices that deliver the drug directly into the airways through your mouth when you breathe in. Inhaling a drug is an effective way of taking an asthma medicine as it goes straight to the lungs, with very little ending up elsewhere in the body. However, each inhaler works in a slightly different way. You should have training from your doctor or nurse in how to use your device. This should be checked at least once a year.

Spacers

Some inhalers emit an aerosol jet when pressed. These work better if given through a spacer, which can increase the amount of medication that reaches the lungs and reduces the side effects. Some people find using inhalers difficult, and spacers can help them. However, spacers are often advised even for people who use inhalers well as they improve the distribution of medication in the lungs. 

Spacers are plastic or metal containers with a mouthpiece at one end and a hole for the inhaler at the other. The medicine is ‘puffed’ into the spacer by the inhaler and then breathed in through the spacer mouthpiece. Spacers are also good for reducing the risk of thrush in the mouth or throat, which can be a side effect of inhaled asthma medicines.

Asthma: inhaler techniques

Reliever inhalers

Reliever inhalers are taken to relieve asthma symptoms quickly. The inhaler usually contains a medicine called a short-acting beta2-agonist. It works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. 

Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless over used. However, they should rarely be necessary if asthma is well controlled, and anyone needing to use them three or more times a week should have their treatment reviewed. Everyone with asthma should be given a reliever inhaler, also known simply as a reliever. It is often blue.

Preventer inhalers

Preventer inhalers work over time to reduce the amount of inflammation and ‘twitchiness’ in the airways and prevent asthma attacks occurring. You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the reliever inhaler (usually blue) to relieve symptoms, but if you continue to need them often, your treatment should be reviewed.

The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include beclometasone, budesonide, fluticasone and mometasone. Preventer inhalers are often brown, red or orange. Preventer treatment is normally recommended if you:

• have asthma symptoms more than twice a week
• wake up once a week due to asthma symptoms
• have to use a reliever inhaler more than twice a week.

Smoking can reduce the effects of preventer inhalers. Inhaled corticosteroids can occasionally cause a mild fungal infection (oral thrush) in the mouth and throat, so rinse your mouth thoroughly after inhaling a dose.

Other treatments and ‘add on’ therapy

Long-acting reliever inhaler

If your asthma does not respond to treatment, the dose of preventer inhaler can be increased in discussion with your healthcare team. If this does not control your asthma symptoms, you may be given an inhaler containing a medicine called a long-acting reliever (long-acting bronchodilator/long acting beta2-agonist or LABA) to take as well. 

Alternatively, you may be given an inhaler combining an inhaled steroid and a long-acting bronchodilator in the one device, called a ‘combination’ inhaler. These work in the same way as short-acting relievers, but they take longer to work and can last up to 12 hours. Examples of long-acting reliever inhalers include formoterol and salmeterol.

Only use your long-acting reliever inhaler in combination with the preventer inhaler and never by itself. Studies have shown that using only a long-acting reliever can increase the chance of an asthma attack and can even increase the risk of death. Examples of combination inhalers include Seretide, Symbicort and Fostair. These are usually purple, red and white, or maroon.

Preventer medicines

If treatment of your asthma is still not successful, additional preventer medicines will be tried. Two possible alternatives include:

• leukotriene receptor antagonists (montelukast): tablets that block part of the chemical reaction involved in inflammation of the airways
• theophyllines: tablets that help widen the airways by relaxing the muscles around them.

If your asthma is still not under control, you may be prescribed regular oral steroids (steroid tablets). This treatment is usually monitored by a respiratory specialist (a specialist in asthma). Long-term use of oral steroids has possible serious side effects, so they are only used once other treatment options have been tried. See below for more information on the side effects of steroid tablets.

Occasional use of oral steroids

Most people only need to take a course of oral steroids for one or two weeks. Once your asthma is under control, you can be 'stepped-down' to your previous treatment.

Omalizumab (Xolair)

Omalizumab, also known as Xolair, is the first of a new category of drugs. It binds to one of the proteins involved in the immune response and reduces its level in the blood. This reduces the chance of an immune reaction happening. The National Institute for Heath and Clinical Excellence (NICE) recommends that omalizumab can be used in people with frequent severe asthma attacks which require visits to A&E or hospital admission.

Omalizumab is given as an injection every two to four weeks. It should only be prescribed in a specialist centre. If omalizumab does not control asthma symptoms within 16 weeks, the treatment should be stopped.

Bronchial thermoplasty

Bronchial thermoplasty is a relatively new procedure not yet widely available. In some cases it may be used to treat severe asthma by reducing airway narrowing. The procedure is carried out either with sedation or under general anaesthetic. A bronchoscope (a type of hollow tube) containing a probe is inserted through the mouth or nose into the airway and expanded so it touches the airway wall, it then heats up. Three treatment sessions are usually needed with at least three weeks between each session.

There is some evidence to show this procedure may reduce asthma attacks and improve the quality of life of someone with severe asthma. However, the long-term risks and benefits are not yet fully understood. You should discuss this procedure fully with your clinician if the treatment is offered.

Side effects of treatments

Side effects of relievers and preventers

Relievers are a safe and effective medicine and have few side effects, as long as they are not used too much. The main side effects include a mild shaking of the hands, headache and muscle cramps. These usually only happen with high doses of reliever inhaler and usually only last for a few minutes.

Preventers are very safe at usual doses, although they can cause a range of side effects at high doses, especially over long-term use. The main side effect of preventer inhalers is a fungal infection (oral candidiasis) of the mouth or throat. You may also develop a hoarse voice. Using a spacer can help prevent these side effects. Also, rinse your mouth or clean your teeth after taking your preventer inhaler.

Your doctor or nurse will discuss with you the need to balance control of your asthma with the risk of side effects, and how to keep side effects to a minimum.

Side effects of add on therapy

Long-acting relievers may cause similar side effects to short-acting relievers, including a mild shaking of the hands, headache and muscle cramps. Your doctor can discuss the risks and benefits of this drug with you. You should be monitored at the beginning of your treatment and reviewed regularly. If you find there is no benefit to using the long-acting reliever, it should be stopped.

Theophylline tablets have been known to cause side effects in some people, including headaches, nausea, insomnia, vomiting, irritability and stomach upsets. These can usually be avoided by adjusting the dose. Leukotriene receptor agonists do not generally cause side effects, although there have been reports of stomach upsets, feeling thirsty and headache.

Side effects of steroid tablets

Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently (three or four courses of steroids a year). Side effects can include:

• osteoporosis (fragile bones)  
• high blood pressure (hypertension)  
• diabetes 
• weight gain  
• cataracts and glaucoma (eye disorders)  
• thinning of the skin  
• easy bruising  
• muscle weakness.

To minimise the risk of taking oral steroids:

• eat a healthy, balanced diet with plenty of calcium 
• maintain a healthy body weight 
• stop smoking (if you smoke)
• do regular exercise.

You will also need regular appointments to check for high blood pressure, diabetes and osteoporosis.

Occupational asthma

If it is possible you have occupational asthma, you will be referred to a respiratory specialist to confirm the diagnosis. If your employer has an occupational health service, they should also be informed, along with your health and safety officer.

Your employer has a responsibility to protect you from the causes of occupational asthma and it may sometimes be possible to substitute or remove the substance triggering your occupational asthma from your workplace. A number of steps can be taken to minimise the impact of occupational triggers. 

However, you may need to consider changing your job or relocating away from your work environment as soon as possible, ideally within 12 months of your symptoms becoming apparent. Some people with occupational asthma may be entitled to Industrial Injuries Disablement Benefit.

Asthma attacks

Your personal asthma action plan will help you recognise the initial symptoms of an asthma attack, know how to respond and when to seek medical attention. Treatment of asthma attacks usually involves taking one or more doses of your reliever medicine. If the symptoms of the asthma attack progress and worsen, you may require hospital treatment. 

If you are admitted to hospital, you will be given a combination of oxygen, reliever and preventer medicines to bring your asthma under control. Your personal asthma action plan will then need to be reviewed, so reasons for your asthma attack can be identified and avoided in future.

Complementary therapies

A number of complementary therapies have been suggested for the treatment of asthma, including:

• breathing exercises 
• traditional Chinese medicine  
• acupuncture  
• ionizers, which are devices that use an electric current to charge (ionize) molecules of air  
• the Alexander technique, a training programme designed to change the way you move your body  
• homoeopathy
• dietary supplements.

There is little evidence that any of these treatments, other than breathing exercises, are effective. There is good evidence that breathing exercises, including breathing exercises taught by a physiotherapist, yoga and the Buteyko method (a technique involving shallow breathing) can improve symptoms and reduce the need for reliever medicines in some people.

Living with asthma 

Your asthma may get better or worse at different times. There may be periods when you have asthma symptoms, but in between you may be generally well, even for many years. Here are some things you can do to help keep your asthma under control.

Self care

Self care is an integral part of daily life. It involves taking responsibility for your own health and wellbeing with support from those involved in your care. Self care includes what you do every day to stay fit and maintain good physical and mental health, prevent illness or accidents and care more effectively for minor ailments and long-term conditions. 

People living with long-term conditions can benefit enormously from being supported to self care. They can live longer, experience less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.

Take your medication

It is important to take your medication as prescribed, even if you start to feel better. Taking your preventer medication every day will help keep your asthma under control and can help prevent asthma attacks. If you have any questions or concerns about medication you're taking or side effects, talk to your doctor or nurse.

Regular reviews

Because asthma is a long-term condition, you'll be in contact with your healthcare team regularly. A good relationship with the team means you can easily discuss your symptoms or concerns. The more the team knows, the more it can help you.

Keeping well

Everyone with a long-term condition such as asthma is encouraged to get a yearly flu jab each autumn to protect against flu. They are also recommended to get a pneumoccocal vaccination, a one-off injection that protects against a specific serious chest infection called pneumococcal pneumonia.

Stop smoking

If you are a smoker and have asthma, you should stop smoking. This will significantly reduce the severity and frequency of your symptoms. Smoking can also reduce the effectiveness of asthma medication. If you do not smoke and you have asthma, avoid being exposed to tobacco smoke. Research has shown you are up to four times more likely to quit smoking if you use the support of the NHS in addition to stop-smoking medicines, such as patches or gum.

Daily life

With the right treatment and management, asthma shouldn’t restrict your daily life.

Sleeping

Asthma symptoms are often worse at night. This means you might wake up some nights coughing or with a tight chest. Effectively controlling your asthma with the treatment your doctor or nurse recommends will reduce your symptoms, so you should sleep better.

Exercise

If you have asthma symptoms during or after exercise, speak to your doctor or asthma nurse. It is likely they will review your general symptoms and personal asthma plan to make sure your asthma is under control. Your doctor or asthma nurse may also tell you to:

• Use a reliever inhaler (usually blue) 10-15 minutes before you exercise and again after two hours of prolonged exercise, or when you finish. 
• Structure your exercise plan around short-burst activities and ensure you warm up properly. 
• Exercise in humid environments, such as swimming pools. 
• Breathe through your nose to avoid hyperventilation (excessively rapid and deep breathing).

Diet

Most people with asthma can eat a normal, healthy diet. Occasionally, people with asthma may have food-based allergic triggers and will need to avoid foods such as cows' milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives. However, this is rare.

Know your triggers

It is important to identify triggers where possible by making a note of any worsening symptoms or by using your peak flow meter during exposure to certain situations. Some triggers, such as air pollution, viral illness or certain weather conditions, can be hard to avoid. However, it may be possible to avoid other triggers, such as dust mites, fungal spores or pet fur.

Complications of asthma

Quality of life

Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in:

• fatigue
• underperformance or absence from work (in the UK, asthma accounts for at least 12.7 million work days lost each year)
• psychological problems including stress, anxiety and depression.

If you feel your asthma is seriously affecting your quality of life, contact your doctor or asthma clinic. Your personal asthma action plan may need to be reviewed to better control the condition.

Respiratory complications

In rare cases, asthma can lead to a number of serious respiratory complications, including:

• pneumonia (infection of the lungs)
• a collapse of part or all of the lung
• respiratory failure, where levels of oxygen in the blood become dangerously low, or levels of carbon dioxide become dangerously high)
• status asthmaticus (severe asthma attacks that do not respond to treatment).

All these complications are life threatening and will need medical treatment.

Death

In the UK in 2009, there were 1,131 deaths from asthma, 12 of which were in children aged 14 or under. On average, three people a day die from asthma.

Asthma and pregnancy

There is no danger medicines you use for asthma will cause any problems for the developing baby in the womb. Due to changes that take place in the body during pregnancy, many women find their asthma symptoms change when they are pregnant. Some women’s asthma improves during pregnancy, some women’s asthma worsens and for others it stays the same.

The most severe asthma symptoms experienced by pregnant women tend to occur between the 24th and 36th week of pregnancy. Symptoms then decrease significantly during the last month of pregnancy. Only 10% of women experience asthma symptoms during labour and delivery, and these symptoms can normally be controlled through the use of reliever medicine.

You should manage your asthma in the same way as you did before you were pregnant. The medicines used for asthma have been proven to be safe to take during pregnancy and when breastfeeding your child. The one exception is leukotriene receptor antagonists which do not yet have enough evidence about their safety compared with other asthma medications.

However, if you need to take leukotriene receptor antagonists to control your asthma, your doctor or asthma clinic may recommend you carry on taking them. This is because risks to you and your child from uncontrolled asthma are thought to be far higher than any potential risk from this medicine.

Financial support

Asthma is classed as a disability if it has a substantial and long-term adverse effect on your ability to carry out normal daily activities. This impairment must:

• have lasted for 12 months
• be likely to last 12 months
• be of a recurring nature where a recurrence is likely in a 12-month period.

If you or your child has care or mobility needs because of asthma, you may be entitled to benefits.

Occupational asthma

If you develop asthma because of your work and this is fully documented by your doctor and your employer, you can make a claim for Industrial Injuries Disablement Benefit from the Benefits Agency. This pays £20-100 a week to people with asthma that was caused by certain respiratory sensitisers. You can still claim even if your respiratory sensitiser is not on this list, as long as it is a 'known sensitiser' (a complete list is available from the Health and Safety Executive).

If you want to take legal action against your employer because of occupational asthma, your lawyer must act within three years of diagnosis.

Get in touch with others

Many people with a long-term health condition experience feelings of stress, anxiety and depression. You may find it helpful to talk about your experience of asthma with others in a similar position. Patient organisations have local groups where you can meet others who have been diagnosed with asthma and undergone treatment.

If you experience feelings of depression, talk to your doctor. They will be able to give advice and support. Alternatively, you can find depression support services in your area.

Source: NHS Choices.