Asthma is a 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.

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.

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

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

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, your airways become narrow, the muscles around them tighten and there is an increase in the production of sticky mucus (phlegm). This makes it difficult to breathe and causes wheezing and coughing. It may also make your chest feel tight.

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.

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.

Other types of asthma

There are other types of asthma that can be made worse by certain activities:

• Work-aggravated asthma is pre-existing asthma that is made worse by dust and fumes at work. 
• Occupational asthma is caused by exposure to specific substances at work. For example, some nurses develop occupational asthma after exposure to latex, and some workers in the food-processing industry develop occupational asthma as a response of exposure to flour.

Outlook

While there is no cure for asthma, symptoms can come and go throughout your life. A number of treatments can help control the condition very effectively. Treatment is based on two important goals:

• relief of symptoms 
• preventing future symptoms and attacks from developing

For more information, see Asthma - treatment.

Successful prevention can be achieved through a combination of medicines, lifestyle advice and identifying and then avoiding potential asthma triggers.

Wheezing

Wheezing is the whistling sound made during breathing when the airways are blocked or compressed.

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

Who is at risk of developing asthma?

Factors that are 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) 
• being born with a low birth weight (less than 2kg or 4.5 pounds)

Want to know more?

• Asthma UK: What causes asthma?

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.

• Infections of the airways and chest. 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 that are 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 that 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.

Want to know more?

• Asthma UK: Asthma triggers A-Z.
• Food Standards Agency: Intolerance to additives.

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 further narrow the airways.

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.

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.

Asthma can be life threatening. See Asthma - treatment to find out more about how to manage your asthma. Speak to your doctor or asthma nurse for further advice.

If you or someone else is having a severe asthma attack and cannot breathe, dial 999 immediately for emergency medical treatment.

There is no simple test to diagnose asthma. Your GP can normally diagnose asthma by asking you about your symptoms and doing tests in the surgery. They will want to know when symptoms happen and how often, and if you have noticed anything that might trigger them.

Your GP will want to know if you have been taking any medicines, what your occupation is, whether you smoke or are exposed to passive smoking, and details about your work and home environment. This could help identify the possible triggers of your asthma.

If your GP suspects you may have asthma, a number of tests can be carried out to confirm the diagnosis.

Spirometry

To assess how well your lungs work, a breathing test called spirometry is carried out. 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).

You may be asked to breathe out a few times to get a consistent reading.

The readings are compared with normal measurements for 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 taken and, if it is much higher after taking the medicine, this 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 breathe in histamine or methacholine, which will deliberately trigger asthma symptoms and cause 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.

Tests of 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.

Tests of allergy

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

Want to know more?

• British Lung Foundation: Breathing tests.
• British Lung Foundation: Asthma – how to get the correct diagnosis.

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 GP may ask you to take measurements of your peak expiratory flow both at work and when you are away from work or on leave.

Your GP 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.

Want to know more?

• Health and Safety Executive: Asthma.
• Asthma UK: Occupational asthma.

Allergic

An allergen is a substance that reacts with the body's immune system and causes an allergic reaction.

Bronchodilator

Bronchodilator medicines are used to widen the airways of the lungs to help with breathing difficulties. An example is salbutamol.

Chronic

Chronic usually means a condition that continues for a long time or keeps coming back.

Lungs

Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

Personal asthma action plan

As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP 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 GP 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.

Want to know more?

• Your health, your way: What is self care?
• Asthma UK: Personal asthma action plan.

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 GP 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 reduce 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 large 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 it is 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.

Want to know more?

• Asthma UK: Using your inhalers.

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 they are 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.

Want to know more?

• Asthma UK: Relievers.

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. For more information on side effects, see below.

Want to know more?

• Asthma UK: Preventer inhalers.

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. Or 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 severe persistent allergic asthma who meet certain criteria.

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.

Want to know more?

• Asthma UK: Other treatments and ‘add on’ therapies.
• Asthma UK: Steroid tablets.
• NICE: Omalizumab for severe persistent allergic asthma (PDF, 76Kb).

Side effects of treatments

Side effects of relievers and preventers

Relievers are a safe and effective medicine and have very 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 the control of your asthma with the risk of side effects, and how to keep the 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. Some studies have suggested that there may be a small increased risk of serious side effects, including severe asthma attacks and death, when using long-acting relievers with corticosteroids. Your GP 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 not drink more than the recommended daily amount of alcohol (three to four units a day for men, and two to three units for women). A unit of alcohol is equal to about half a pint of normal strength lager, a glass of wine or a single measure (25ml) of spirits. 
• Do regular exercise.

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

Want to know more?

• Asthma UK: side effects of asthma medicines.

Occupational asthma

If it is possible that 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 that is 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.

Want to know more?

• Asthma UK: Occupational asthma.
• Asthma UK: Workplace charter – aimed at employers, employees and health professionals.
• DirectGov: Industrial Injuries Disablement Benefit.

Asthma attacks

Your personal asthma action plan will help you recognise the initial symptoms of an asthma attack and 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 that the reasons for your asthma attack can be identified and avoided in future.

Want to know more?

• Asthma UK: What to do in an asthma attack.

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 uses 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.

Want to know more?

• Asthma UK: Complementary therapies.

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 that 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.

Want to know more?

• Asthma UK: Healthy lifestyles.
• Asthma UK: Exercise and asthma.

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.

Want to know more?

• Asthma UK: Asthma triggers A-Z.

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 that your asthma is seriously affecting your quality of life, contact your GP 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 the levels of oxygen in the blood become dangerously low, or the levels of carbon dioxide become dangerously high)
• status asthmaticus (severe asthma attacks that do not respond to treatment)

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

Death

In the UK in 2006, there were 1,200 deaths from asthma, 40 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 that the medicines you use for asthma will cause any problems for the developing baby in the womb. Due to the changes that take place in the body during pregnancy, many women find that their asthma symptoms change when they are pregnant. Some women’s asthma improves during pregnancy, some women’s asthma worsens and for others asthma 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. While there is no evidence that it can harm babies during pregnancy and breastfeeding, there is not enough evidence about its safety compared with other asthma medications.

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

Want to know more?

• Asthma UK: Pregnancy FAQs.

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 or
• 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.

Want to know more?

• Prescription costs.

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.

Want to know more?

• Directgov: Industrial Injuries Disablement Benefit (diseases and deafness).
• Money Advice Service.

Get in touch with others

1. 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 GP. They will be able to give you advice and support. Alternatively, you can find depression support services in your area.

Want to know more?

• Chat about asthma online at Asthma UK’s forum.

Olwen Fish, 69 from Waterhead, Oldham, has had asthma since 1950. She feels lucky to have survived to see the huge increase in effective medication and now lives life to the full. 

“I was only 13 when I first experienced asthma in 1950. It was terrible because not many people had heard of it in those days. All I knew about asthma was that my aunt had died from it three years earlier at the age of 42.

“It came on in the middle of the night. I woke up and I couldn’t breathe. I was really frightened. I'd been out in the pouring rain the day before and I had a hole in my shoe. My parents always stressed that we weren’t to let our shoes get ruined because it wouldn’t be possible to mend them. I was frightened to death because I thought not being able to breathe was my fault.

“I didn't dare mention it and I tried to cover it up, but my mother saw that I was unable to breath and took me to the doctor. He said it was asthma and he gave me an injection, which helped.

“The doctor also gave me some medicine, but it tasted like poison. I just wasn’t able to take it unless I really couldn’t breathe at all.

“When we were leaving school, all my friends wanted to go and work in the cotton mill, but I couldn’t because of the dust. I had to work in the sewing factory. 

“I was having asthma attacks that lasted three days. It was horrible, not being able to breathe. I was really ashamed and tried to cover it up. I don’t know why I felt that way, but it was such an unknown thing in those days.
 
“Not being able to breathe is awful. If I was walking up a hill, I couldn’t talk. And there was no medicine I could take then. 

“I often had attacks in the night when I was sleeping in the same bed as my two sisters. I would be wheezing and they would get mad at me. They thought I could stop it. They didn’t understand it. Nobody understood it.    

“Later, I got married and had four children. When I was pregnant, I never had any asthma. I've been told it was because the body makes its own steroids when you're pregnant.

“When I had a really long attack, my husband had to take time off work and it was sometimes difficult for me to take the children to school. I had to give up work when I was 53 and now it has become chronic asthma. I have it all the time but I'm very grateful that we have such good medication.

“Asthma runs in my family. My father’s sister died of asthma when she was 41. My son started with it when he was two and my daughter developed it when she was 13, like me. My eldest grandson had childhood asthma, but has not got it now, and I have another grandson who was diagnosed with asthma at two and still has it. My sister was diagnosed with asthma at 50, my niece was diagnosed when she was 12, and I have cousins who also have it. 

“I began using an inhaler when I was about 40, and in my 50s I began using a nebuliser.

“I first realised my asthma could kill me when I was 62 and I collapsed in the street. I knew I needed help. It was a very hot day, which is always difficult for me, and I couldn't breathe. I couldn’t use my inhaler because I couldn’t breathe in. They're no use unless you can breathe in. I'd forgotten my mobile, but I managed to get to a phone box to phone my husband. I was holding on to the door handle when I began to slip down to the ground.

“There were some young men in their early 20s nearby drinking outside a pub. I heard one of them say: ‘Leave her, she’s just drunk.’ Luckily, two of them brought me into the pub and laid me on the floor in the games room. The landlady, who later told me she had had a few brandies, couldn’t find a pulse. She saved my life by giving me mouth-to-mouth resuscitation. Everyone cheered when I came around. Later, when the ambulance took me to the hospital, I had a respiratory arrest and actually died for some time.

“I've taken it very seriously since then. I go for regular check-ups and use all the latest medications. I'm thrilled to bits that I have all these things. It’s a luxury to me to know that when I get really short of breath, I have all the inhalers and medications I need. I've found going to the Breathe Easy support group meetings very helpful.

“My asthma is now well under control. The Chest Clinic allows me to manage my own steroids and I'm on maintenance doses of several drugs and use the nebuliser every morning and night. I also have inhalers that I can use when I need them. With all these medications, I really have had a new lease of life.”

Fifty-six-year-old mother of three Rosemary Matthews first experienced asthma in her teenage years

“My first asthma attack happened when I was a teenager. I was outside chatting with my brother and my mother, enjoying the sunshine, when quite suddenly, I began to wheeze.

“I was really frightened, but none of us had any idea what was causing it. I was given a drink of water and, after I went indoors, it went away.

“Some time later, it happened again when I was with a boyfriend. I began wheezing and struggling for breath. He drove me straight to hospital where they told me it was asthma. I was quite relieved to know what it was. I thought, 'now I can do something about it.'

“I had to learn to live with it, to live life in a different way. There would be things I couldn’t do. I learned what my triggers were and began to control my asthma quite well. My triggers are pollen, house dust mites, cold air, aerosol sprays, the fumes from bleach and cigarette smoke.

"I still have asthma today and I probably have about two attacks a year. I have to be very careful about going out. If the pollen count is high or if it is cool outside, that's enough to set it off. Cigarette smoke is another trigger, so the smoking ban has been a good thing.

“The first thing you need to learn when you're diagnosed with asthma is how to use an inhaler correctly. It isn’t that easy. You need to learn your triggers and keep away from those things. If you can’t keep away from them, take as many precautions as you can. Wearing a scarf over your face if the outside air is cold is a good example.

“My asthma is under control now. I self-manage it, but I have had to make changes in my lifestyle in recent years. The things I miss most are going for walks with my husband and gardening. It was my one favourite hobby. I can do very little in the garden because of the pollen or the cold. You have to be careful of what’s in the air. 

“In the last three years, I've found I have to stay inside with the windows shut most of the time. In the hot weather, I have to use fans to keep cool.

“I've been advised to stay as fit as I can and I have an indoor exercise regime.

“I feel I am doing quite well. It's more than a year since I've had to go to the Accident and Emergency Department.

“It's very scary, especially when you're put on BiPAP [bilevel positive airway pressure]. It's a non-invasive ventilation system to help you get more air into your lungs. You know then that you're being kept alive only by this machine.”

For 49-year-old Shamim Arshad, a retired civil servant from Newcastle, walking has been a lifesaver

“Six years ago, a big asthma attack put me in hospital for two weeks. When I went home, I was put on steroids, which made me overweight and depressed. I got breathless just walking upstairs and I never went out because I was frightened I might have another asthma attack.  

“A friend persuaded me to walk just to the end of the road with her. She’d had treatment for breast cancer and I went thinking I was doing her a favour. I gradually increased my walks and now regularly walk two or three miles around my housing estate or local park. Walking makes me feel fresh and takes stress away.

“My confidence has increased and I’ve reduced the number of inhalers I need from four to one. On cold or damp days, when doctors have told me I shouldn’t walk outside, I do indoor walks around the nearby shopping centre with a friend. And I lead walks around the local area for groups of older people. I want them to enjoy it as much as I do.

“It does give you an incentive to take care of yourself. You know you don’t want to be in hospital in the high-dependency unit on BiPAP [bilevel positive airway pressure].

“It makes you think more about your triggers because that's the one way you can help yourself. The other thing I've learned and would like to pass on to others is that you should never panic. It will only make things worse. Try to relax. You will get help.”