Asthma is a common long-term lung condition that affects approximately 5.4 million people in the UK — around 1 in every 11 children and 1 in every 12 adults. The UK has one of the highest asthma prevalence rates in the world and one of the highest rates of asthma deaths in Europe. Asthma is highly manageable, but it must be taken seriously — three people die from asthma attacks in the UK every day, and most of these deaths are preventable.
What Is Asthma?
Asthma is a condition affecting the airways (bronchi) in the lungs. In people with asthma, the airways are inflamed and oversensitive. When triggered, the airways swell, the muscles around them tighten (bronchoconstriction), and excess mucus is produced — making the airways narrow and breathing difficult.
Asthma is typically characterised by variable, reversible airflow obstruction — symptoms come and go and are usually reversible with inhaler treatment. This distinguishes it from COPD, where airflow limitation is progressive and largely irreversible. Some people have both conditions (asthma-COPD overlap syndrome). See our COPD guide.
Symptoms of Asthma
- Wheezing — a whistling sound when breathing, especially when exhaling
- Breathlessness — particularly during exercise or at night
- Chest tightness — feeling of pressure or squeezing in the chest
- Coughing — often worse at night or early morning; can be the only symptom in some (cough-variant asthma)
Symptoms typically follow a pattern — they worsen at night or early morning, are triggered by specific exposures, and improve with bronchodilator inhalers. Many adults are first diagnosed with asthma in adulthood — it is not solely a childhood condition.
Asthma Triggers
Common triggers that worsen asthma symptoms:
- Respiratory infections — colds, flu, COVID-19 (most common trigger in UK adults and children)
- Allergens — house dust mites (the most common UK allergen trigger), pollen, pet dander, mould
- Exercise — exercise-induced bronchoconstriction affects up to 70% of people with asthma
- Cold air
- Smoke and air pollution — cigarette smoke, vehicle fumes, wood burning
- Strong fumes — cleaning products, perfumes, paint
- Medications — aspirin and NSAIDs worsen asthma in 10–20% of adults; beta-blockers can trigger severe bronchospasm
- Stress and strong emotions
- Occupational exposures — isocyanates (paints, varnishes), flour, latex; up to 1 in 6 adult-onset asthma cases in the UK is occupational
- Gastro-oesophageal reflux
Diagnosis: How the NHS Diagnoses Asthma
NICE guideline NG80 (2017) updated asthma diagnosis to require objective testing — not just clinical history and symptoms. This has led to many previously-labelled “asthma” patients being reassessed:
Spirometry
Spirometry measures how much air you can breathe out (FEV1) and the total amount in one forced breath (FVC). An FEV1/FVC ratio below 0.7 suggests obstructive lung disease. A significant improvement (≥12% and ≥200ml increase in FEV1) after a bronchodilator inhaler supports asthma.
FeNO Test (Fractional Exhaled Nitric Oxide)
The FeNO test measures airway inflammation. A result ≥40 parts per billion (ppb) suggests eosinophilic airway inflammation, supporting an asthma diagnosis. NICE recommends FeNO as part of the diagnostic pathway for adults and children over 5. This test was not widely used before 2017 and represents a significant UK advance in accurate asthma diagnosis.
Peak Flow Monitoring
Peak expiratory flow (PEF) monitoring over 2–4 weeks can demonstrate variability — a hallmark of asthma. A ≥20% variability supports an asthma diagnosis. All people with asthma should have a peak flow meter and know their personal best.
Inhalers: The Foundation of Asthma Treatment
Reliever Inhaler (SABA)
Short-acting beta-agonists (SABAs) — salbutamol (blue inhaler) and terbutaline — provide rapid relief of symptoms by relaxing airway muscles. They work within minutes. However, NICE and the BTS/SIGN guidelines (updated 2019) advise that relying on a SABA more than twice a week indicates inadequately controlled asthma requiring step-up of preventer treatment.
Preventer Inhaler (ICS)
Inhaled corticosteroids (ICS) — beclometasone, budesonide, fluticasone — are the cornerstone of asthma management. They reduce airway inflammation and prevent symptoms. They must be taken every day, even when feeling well. It takes 2–4 weeks to see full benefit. Always rinse your mouth after use to prevent oral thrush.
MART (Maintenance and Reliever Therapy)
NICE guidelines recommend MART as the preferred approach for adults and children over 12 with moderate asthma — using a combination ICS/formoterol inhaler (e.g. Symbicort or DuoResp) as both daily maintenance and as-needed reliever. This approach reduces exacerbations and is simpler than using separate inhalers.
Add-On Therapies
- LABA (long-acting beta-agonists — salmeterol, formoterol) — added to ICS for patients not controlled on ICS alone; never used without an ICS in asthma
- LAMA (tiotropium) — add-on for adults not controlled on ICS/LABA; approved by NICE
- LTRA (montelukast) — anti-leukotriene; useful for exercise-induced or aspirin-sensitive asthma
- Oral theophylline
Biologic Treatments for Severe Asthma
For people with severe, uncontrolled eosinophilic asthma, NHS-funded biologic therapies are available:
- Mepolizumab (Nucala) — anti-IL-5; monthly injection; NICE approved TA431
- Benralizumab (Fasenra) — anti-IL-5 receptor; fortnightly then 8-weekly injection; NICE approved TA565
- Dupilumab (Dupixent) — anti-IL-4/IL-13; also approved for atopic dermatitis; NICE approved TA751
- Tezepelumab (Tezspire) — anti-TSLP; broadest efficacy across asthma phenotypes; NICE approved 2023
- Omalizumab (Xolair) — anti-IgE; for severe allergic asthma; NICE approved TA278
Referral to a specialist severe asthma centre is required to access biologics. If you have severe asthma and are still experiencing frequent attacks, ask your GP for a referral to a tertiary asthma clinic.
Asthma Attack: What to Do
Signs of a worsening asthma attack that is NOT responding to reliever inhaler:
- Reliever inhaler not helping after 10 puffs over 10 minutes
- Symptoms are severe: struggling to speak, lips turning blue
- Breathing is very fast or laboured
- Peak flow below 33% of best
Call 999 immediately if an attack is severe or life-threatening. While waiting: sit upright, use reliever inhaler (1 puff every 30–60 seconds, up to 10 puffs), take prescribed oral prednisolone if available.
Your Asthma Action Plan
All people with asthma should have a written Personalised Asthma Action Plan (PAAP), produced with their GP or asthma nurse. It uses traffic light zones based on symptoms and peak flow to guide self-management. The Asthma + Lung UK website provides templates. Research shows people with written action plans have fewer emergency admissions and better asthma control.
NHS Annual Asthma Review
Every person with asthma is entitled to an annual review with their GP or asthma nurse. This should include: symptom control assessment (using the Asthma Control Test or RCP 3 Questions), inhaler technique check, medication review, and updating the asthma action plan. Poor inhaler technique is a major cause of uncontrolled asthma — up to 90% of patients use their inhaler incorrectly.
UK Support and Resources
- Asthma + Lung UK — asthma.org.uk | Helpline: 0300 222 5800 | UK’s leading respiratory charity with personalised advice
- British Thoracic Society (BTS) — brit-thoracic.org.uk | BTS/SIGN asthma guideline
- NHS Asthma Information — nhs.uk/asthma
- Allergy UK — allergyuk.org | For allergy-triggered asthma management
What Major Health Sites Often Miss About Asthma
1. The UK’s Unique MART Approach to Treatment
The UK’s BTS/SIGN and NICE guidelines (2019 update) recommend the MART strategy — using a single combination inhaler as both maintenance and reliever — as the preferred approach for adults and adolescents with moderate asthma. This is not the dominant approach in US guidelines. MART is supported by strong evidence showing fewer exacerbations and better adherence than separate SABA reliever use.
2. The UK’s Preventable Asthma Death Crisis
The National Review of Asthma Deaths (NRAD, 2014) found that 90% of asthma deaths in the UK were potentially preventable. The Asthma + Lung UK “Left Gasping” campaign highlighted ongoing failures — including inadequate prescribing of preventer inhalers, lack of action plans, and missed annual reviews. The UK has more asthma deaths than comparable European countries — an important and often missing context on international health sites.
3. FeNO Testing: A UK Diagnostic Innovation
FeNO testing is now mandated by NICE as part of the asthma diagnostic pathway — helping distinguish true asthma from other causes of wheeze and cough. Before NICE NG80 (2017), over-diagnosis of asthma in the UK was significant. Now, many people previously labelled as asthmatic are being re-evaluated. If you were diagnosed with asthma before 2017 and your symptoms don’t respond well to inhalers, it may be worth asking your GP for a formal reassessment.
Related Health Guides on YourHealthXpert
- COPD — chronic obstructive pulmonary disease shares symptoms with asthma and can coexist
- Hay Fever and Allergic Rhinitis — allergic rhinitis is a common trigger for asthma
- Eczema — asthma, hay fever, and eczema are the “atopic triad” and often occur together
- Anxiety and Depression — common in people with chronic asthma; can worsen breathing symptoms
- Acid Reflux (GORD) — a common asthma trigger that is often overlooked