Asthma can’t be cured, but its symptoms can be controlled. Around 1200 people die every year in the UK as a result of asthma. In this article, we will explain asthma, how to recognise its signs and symptoms, and how it can be treated in a first-aid setting.

What is Asthma?

Asthma is a condition in which your airways narrow due to swelling and produce extra mucus, causing coughing, wheezing and shortness of breath.

Most people have specific triggers that set off their asthma, for some asthma is a minor nuisance. For other people, it can be a major problem that gets in the way of daily activities and may lead to life-threatening asthma attacks.

How do asthma triggers bring on an attack?

Asthma sufferers have sensitive airways that react to a trigger. When they encounter a trigger, the airways react in three ways:

1. The muscles around the walls of the airways tighten so that the airways become narrower.

2. The lining of the airways becomes inflamed and starts to swell.

3. Sticky mucus can sometimes build up, which can narrow the airways around the lungs. The tiny airways in the lungs are also blocked by this mucus making the lungs very inefficient and the casualty struggles to get them to work properly.

These reactions in the airways make it difficult to breathe and can lead to an asthma attack. 

Examples of Asthma Triggers:

• Heavy exercise or physical exertion

• Cold, damp, dusty or smoky environments

• Stress or anxiety, especially for prolonged periods

• Airborne substances, such as pollen, dust mites, mould spores, pet hairs

• Respiratory infections, such as the common cold or flu

• Work-specific triggers may include chemicals in spray paint, fumes from soldering, flour or grain dust and damp environments.

What are the signs and symptoms of an asthma attack?

Many people with asthma self-manage by using their inhalers. However, their triggers may overwhelm their ability to manage the condition or a new trigger may impact them leading to what we call an asthma attack.

The signs and symptoms of an asthma attack are:

• Their blue reliever inhaler isn’t working – or they need to use it much more over 4 hours

• They wheeze or cough a lot or have a very tight chest

• They are breathless and find it difficult to walk or talk, often not able to finish a sentence without taking a breath

• Their breathing rate increases and they feel like they can’t get a breath into their lungs properly

What is the best thing to do when someone is having an asthma attack?

If someone is having an asthma attack, you should get them to:

1. Get them away from the trigger 

2. Sit upright

3. Stay calm 

4. Use their inhaler

5. Take long, deep breaths. This helps to slow down their breathing and prevent hyperventilation (Hyperventilation makes the condition worsen more quickly)

6. Seek emergency medical help if their inhalers do not help

The duration of an asthma attack can vary, depending on what caused it and how long the airways have been inflamed. Mild episodes may last only a few minutes and can resolve spontaneously or may require the use of the blue quick-acting reliever inhaler. More severe episodes can last for hours but should be recognised early and medical help sought quickly.

This asthma attack information is not for people on a SMART or MART regime, who will have their action plan.

How do you tell if an asthma attack is severe or not?

Most asthmatics monitor their asthma using a peak flow meter. This lets them judge the function of their lungs as it measures the amount of air they can forcefully blow and push out of their lungs. The numbers on the meter are usually correlated to their Asthma Action Plan. For example, if their ‘normal’ peak flow is 400 on the meter, they may have 300 as ‘time to see your GP’ and 200 as ‘go to hospital / seek urgent medical attention’.

Peak flow is assessed at their annual review and a ‘best’ figure is marked in their asthma action plan. By comparing this to their peak flow rate during an episode or attack, we can determine how mild or severe the asthma attack is along with oxygen levels and other signs.

Some asthmatics and Outdoor First Aiders carry a Pulse oximeter This is a small device that fits onto the finger and measures heart rate but also oxygen level in the blood. (It is also a feature on some smartwatches.) A decreasing oxygen level in the blood is a good indicator of the worsening of an asthmatic episode or attack. Smart watches and pulse oximeters vary in their accuracy though and are best used to show a change in oxygen levels rather than an accurate record of it.

How to manage asthma:

There are several steps people can take to cut their risk of asthma triggers causing an asthma attack:

1. Be alert to the potential triggers at different times of the year (pollen etc) or in different situations such as moving from warm indoor spaces to very cold outdoor spaces.

2. Use a preventer inhaler regularly – A preventer inhaler is a “non-blue” inhaler that works away in the background to help inflammation and sensitivity in your airways. Taking it every day means there’s less chance of a reaction if they come into contact with any triggers. 

3. Write an Asthma action plan with a GP or Nurse – You can download an asthma action plan here. This will help identify triggers and know what to do during an attack.

4. Go an Asthma review each year – An ‘asthma review’ gives them and their GP or asthma nurse a chance to make sure their written asthma action plan is up to date. It also allows them to ask more questions and learn how to spot the early signs of an attack or potential triggers at different times of the year.

5. Check their doses – Make sure their medicine is at the right dose and that their inhalers are in date.

6. Check their inhaler technique – A change of inhaler technique could help them manage their asthma better. They can discuss this at any time with their doctor or at their annual review. Different inhalers work better for different people. Sometimes, spacers or masks may help to take the dosage more effectively as well as slow down their breathing rate.

Is asthma the same as COPD?

COPD is Chronic Obstructive Pulmonary Disease. It is progressive and irreversible and caused by damage to the lungs, most often by smoking or work-related causes such as dust. It may manifest as Chronic Bronchitis or Emphysema. With both of these, gas exchange in the lungs is impaired and often a daily wheezy cough is a typical sign along with an increased breathing rate. Breathing may also be difficult or laboured. First aid treatment is similar to asthma with the use of inhalers but there is often the need to get further medical help as the casualty may need additional medication or different treatment methods through nebulisers or oxygen masks to aid their breathing. People with COPD need to manage their breathing every day whereas asthmatics, although they take inhalers every day, only need to use their emergency inhalers when a trigger sets off an attack.