Asthma: Causes, Symptoms & NHS Treatment
Asthma is a common long-term condition affecting over 5.4 million people in the UK. It causes the airways to become inflamed and narrowed, making breathing difficult. This guide explains NHS diagnosis, treatment options, and how to manage asthma effectively.
⚡ KEY FACTS
- Prevalence: 5.4 million people in the UK have asthma
- Diagnosis: Spirometry, FeNO test, and peak flow monitoring
- Treatment: Reliever and preventer inhalers, written asthma action plan
- NHS cost: Free prescriptions via pre-payment certificate
- Review frequency: Annual asthma review with GP or nurse
TABLE OF CONTENTS
What is Asthma?
Asthma is a chronic inflammatory condition of the airways. When triggered, the muscles around the airways tighten (bronchospasm), the lining swells, and excess mucus is produced — all of which narrow the airways and cause breathing difficulty.
Asthma affects people of all ages but often starts in childhood. In the UK, it is one of the most common chronic conditions and costs the NHS approximately £1 billion per year in treatment and lost productivity.
💙 NHS Asthma Management
The NHS follows NICE guideline NG80 for asthma diagnosis and management. Your GP or asthma nurse will create a personalised asthma action plan and review your treatment at least once a year.
Recognising Asthma Symptoms
The four main symptoms of asthma are:
- Wheezing — a whistling or squeaky sound when breathing
- Breathlessness — difficulty catching your breath
- Chest tightness — a squeezing sensation in the chest
- Persistent cough — especially at night or early morning
Symptoms vary in severity. Some people have mild, infrequent symptoms while others experience daily symptoms that significantly affect their quality of life.
⚠️ Signs of a Severe Asthma Attack
- Blue lips or fingertips (cyanosis)
- Breathing too fast to speak in full sentences
- Reliever inhaler not helping within 10 minutes
- Silent chest (no wheezing — a very serious sign)
NHS Diagnosis of Asthma
Diagnosing asthma involves a combination of medical history, physical examination, and objective tests. The NHS now recommends objective testing before starting treatment where possible.
Spirometry
Spirometry measures how much air you can breathe out and how quickly. An obstructive pattern (reduced FEV1/FVC ratio) combined with reversibility after a bronchodilator suggests asthma.
FeNO Testing
A Fractional exhaled Nitric Oxide (FeNO) test measures airway inflammation. A reading above 40 parts per billion (ppb) in adults suggests eosinophilic airway inflammation, supporting an asthma diagnosis.
Peak Flow Monitoring
A peak flow meter measures how fast you can breathe out. Variability in peak flow readings of 20% or more over two weeks supports a diagnosis of asthma. Your GP may give you a peak flow diary to complete at home.
NHS Asthma Treatment
Reliever Inhalers
Reliever inhalers (typically blue, containing salbutamol or terbutaline) are fast-acting bronchodilators used to relieve symptoms when they occur. They should not be needed more than three times a week — if you use yours more frequently, your asthma is not well controlled.
Preventer Inhalers
Preventer inhalers (typically brown or red, containing inhaled corticosteroids such as beclometasone or fluticasone) reduce airway inflammation over time. They must be used daily, even when you feel well. They take 2–4 weeks to reach full effectiveness.
MART Therapy
Maintenance and Reliever Therapy (MART) uses a single combination inhaler (such as Symbicort or DuoResp) for both daily prevention and relief of symptoms. This approach is increasingly recommended by NICE for adults with moderate asthma.
Add-On Therapies
For people with uncontrolled asthma, additional treatments may include long-acting beta-agonists (LABAs), leukotriene receptor antagonists (montelukast), or biologics such as mepolizumab for severe eosinophilic asthma.
💊 Inhaler Technique Matters
Up to 70% of people use their inhaler incorrectly. Ask your GP or pharmacist to check your technique, or watch NHS video guides. Poor technique significantly reduces the effectiveness of your medication.
Common Asthma Triggers
Identifying and avoiding your personal triggers is an essential part of asthma management. Common triggers include:
- Respiratory infections (colds, flu, COVID-19)
- Allergens: pollen, house dust mites, pet dander, mould
- Exercise — particularly in cold, dry air
- Air pollution and cigarette smoke
- Occupational exposures: flour dust, isocyanates, latex
- Cold air and sudden weather changes
- Strong emotions and stress
- Some medications: aspirin, NSAIDs, beta-blockers
Your Asthma Action Plan
Every person with asthma in the UK should have a written, personalised asthma action plan provided by their GP or nurse. The plan typically uses a traffic light system:
- Green zone: Symptoms well controlled — continue regular treatment
- Yellow/amber zone: Symptoms worsening — increase treatment as directed
- Red zone: Severe symptoms — take reliever, seek emergency help
Research shows that people with written action plans have fewer emergency hospital admissions and better quality of life. Ask your GP or asthma nurse for yours at your next review.
When to Call 999
🚨 Emergency Signs — Call 999 Immediately
- Reliever inhaler not working after two doses 10–15 minutes apart
- Unable to speak in full sentences due to breathlessness
- Lips or fingernails turning blue
- Confusion or exhaustion due to breathing effort
- Silent chest (no wheeze with severe breathlessness)
While waiting for the ambulance: sit upright, use your reliever inhaler every minute (up to 10 puffs), and stay calm. If you have a spacer, use it.
Frequently Asked Questions
Frequently Asked Questions
How is asthma diagnosed on the NHS?
Your GP will ask about your symptoms and triggers, then arrange breathing tests including spirometry (which measures airflow) and home peak flow monitoring over 2–4 weeks. You may also be referred for a FeNO (fractional exhaled nitric oxide) test or a bronchodilator reversibility test to confirm the diagnosis.
What is the difference between a reliever and a preventer inhaler?
Reliever inhalers (usually blue, containing a SABA such as salbutamol) relax the airways rapidly for immediate symptom relief and are used during or before an attack. Preventer inhalers (usually brown, containing an inhaled corticosteroid) are taken daily to reduce underlying airway inflammation and prevent attacks from occurring.
When should I call 999 for an asthma attack?
Call 999 immediately if: the reliever inhaler (blue) has no effect after 10 puffs, breathing remains very difficult, lips or fingertips turn blue, the person is unable to speak in full sentences, or symptoms continue to deteriorate. Severe asthma attacks are life-threatening emergencies requiring immediate emergency treatment.