Myths and Facts on Asthma

It is important for those living with asthma to have the knowledge they need to control their asthma effectively. Understanding triggers, managing symptoms and recognising the signs that require medical attention are all vital skills that can transform lives.

Asthma myths

• Asthma only affects children

Asthma does often start in childhood. Some grow out of it. However, a significant proportion develop asthma as an adult. This can potentially be linked to their work, i.e. occupational asthma, but not always.

• You have to have a wheeze to be asthmatic

A wheeze (musical/whistling sound when breathing out) is one of the core symptoms of asthma. The other symptoms are a cough and a tight chest – all three do not have to be present, particularly at any one time. If an asthma attack is severe, a person may not sound wheezy. This is because so little air is moving through their airways.

• You can’t die from asthma in this day and age

Sadly, there are still four deaths every day in the UK from asthma. Studies have found that two-thirds of these deaths are preventable, and a large number happen outside hospital – often because medical help hasn’t been sought. 

• There are no treatments other than inhalers or steroid tablets 

If asthma is severe, there are several new biologic treatments that are potentially available. Lifestyle factors, such as stopping smoking, exercise and having a healthy weight can make a big difference to symptoms, too. 

How to manage an asthma attack 

One of the most important things is for everyone with asthma to have a personal asthma action plan, which helps to recognise when symptoms may be getting worse and what to do about it. These can also be shared with friends and workplace managers or first aiders. 

What to do in an asthma attack

1. Sit up straight - try to keep calm.
2. Take one puff of your reliever inhaler (usually blue) every 30-60 seconds up to 10 puffs.
3. If you feel worse at any point or you don't feel better after 10 puffs, call 999 for an ambulance.
4. If the ambulance has not arrived after 10 minutes and your symptoms are not improving, repeat step 2.
5. If your symptoms are no better after repeating step 2, and the ambulance has still not arrived, contact 999 again immediately.

*This asthma attack advice does not apply to you if you use a MART inhaler. 

It can be lifesaving to know what to do if someone is having an asthma attack. It may not look like what you might expect it to. Always take a ‘better safe than sorry’ approach and call 999 if you’re not sure or if the person appears to be getting worse. 

Severe Asthma

Severe asthma is not the same as ‘bad’ or ‘difficult to control’ asthma. 

It is the most serious and life-threatening type of asthma; some 200,000 people in the UK have the diagnosis. Whilst asthma is common, severe asthma only affects around 4% of those with the disease. Severe asthma is where symptoms are harder to control, even with high doses of medication. 

‘Difficult to control’ asthma is also not the same – in these cases, people need some extra support for managing the condition or other medical problems that may contribute to making the symptoms worse, e.g. reflux.

People with severe asthma will almost certainly be covered under the disability provisions of the Equality Act 2010. 

Severe asthma could be considered a possibility if:

• You need 12 of more reliever (blue) inhalers in a year;
• You’ve needed two or more courses of oral steroids or take steroids all the time;
• You’ve had an asthma attack or been in hospital for asthma in the last year.

You should ask for a referral from your GP to a specialist asthma clinic at the hospital if one of these applies.

More specialist treatments are needed to then try and control the asthma symptoms. 

Steroids for asthma

People with asthma may have to take steroid tablets (such as Prednisolone) to control their asthma, particularly if they are having an exacerbation. One of the reasons why the newer biologic treatments have become so important is because steroids can cause a massive range of side effects. However, they do still remain lifesaving and should obviously be taken if necessary:

• A lot of people need to be told that they’re not the same as anabolic steroids and they’re not going to end up looking like a ’90s bodybuilder!
• One of the most frequently under-explained effects of steroids is on mood. They can make people feel ‘wired’, cause insomnia and even psychosis. They can affect concentration and cause ‘brain fog’. Often when they’re stopped or decreased, people can feel low in mood. It’s important to consider these affects on decisions about work;
• They can cause weight gain, affect the body’s metabolism and glucose control and cause diabetes, high cholesterol and high blood pressure;
• They can cause osteoporosis;
• People who’ve had a number of courses/longer term steroids can get secondary adrenal insufficiency – where the body’s adrenal glands struggle to produce enough cortisol. These patients will then need a steroid tablet three times a day to manage this. 

Written by Dr Lizzie Butler-Meadows MBChB, Remote Case Manager, Health Partners Group