Asthma: spotting your triggers and using inhalers properly

In asthma, the airways are sensitive and become inflamed and narrowed in response to triggers. That causes wheezing, coughing, chest tightness and breathlessness, often worse at night or early morning.

Common triggers

• Dust and dust mites in bedding and carpets
• Smoke from cigarettes, cooking fires or burning rubbish
• Cold air, or sudden weather changes
• Pollen and grass, particularly in certain seasons
• Animal fur
• Strong smells, including perfumes and cleaning products
• Respiratory infections such as colds
• Exercise, in some people
• Stress and strong emotion

Keeping a short note of when symptoms occur usually reveals a pattern within a few weeks.

Knowing your two inhalers apart

A reliever inhaler opens the airways quickly during symptoms. A preventer inhaler, usually containing a steroid, reduces the underlying inflammation and is taken regularly even when you feel well. Many flare-ups happen because the preventer is skipped once symptoms settle. Some people are now prescribed a combination inhaler used differently again, so follow the plan you were given.

Technique matters as much as the medicine

Poor technique means the medicine lands in the mouth rather than the lungs. Ask a clinician or pharmacist to watch you use your inhaler at least once a year. A spacer device improves delivery considerably, particularly for children, and reduces throat irritation. Rinse your mouth after a steroid inhaler.

Reducing triggers at home

• Wash bedding regularly in hot water and air mattresses and pillows.
• Damp-dust rather than sweeping, which throws dust into the air.
• Keep cooking areas ventilated, and avoid smoking anywhere indoors.
• Deal with damp and mould promptly.
• Keep pets out of bedrooms if animal fur is a trigger.

Have a written asthma action plan

A good plan states which inhaler to use daily, what to do when symptoms worsen, when to start additional treatment, and when to seek urgent help. Review it with your clinician at least yearly, and after any flare-up.

Emergency signs

• Breathlessness that makes it hard to speak in full sentences
• The reliever inhaler not helping, or being needed again within hours
• Lips or fingertips turning blue
• Drowsiness, confusion or exhaustion from the effort of breathing
• In children: flaring nostrils, the chest pulling in with each breath, or inability to feed

These need emergency care immediately. While waiting for help, sit upright and keep taking the reliever as instructed in your plan.