Worsening of symptoms

Sometimes, no matter how careful you are about taking your asthma medicines and avoiding your triggers, you may find that you have an asthma attack. With the right care and medicines and knowing what to do when your asthma gets worse, you should be able to get you asthma back under control and live a full and active life.

Below are the answers to some of the questions you may have if your asthma has been getting worse. 

It is normal for asthma to be better at some times than others. If your asthma has got worse it may be because you have been in contact with one of your triggers. For example, if you have caught a cold, or if you have been outside when there is a lot of pollen in the air.

If you use preventer medicines, your asthma may also get worse if you have forgotten to take them regularly in the way your doctor or asthma nurse has advised you.

Sometimes, it is not always clear why your asthma has got worse. But whatever the reason, it is important that you take steps to get your asthma back under control as soon as possible.

Most people find that asthma attacks are the result of gradual worsening of symptoms over a few days.

You are having an asthma attack if any of the following things happen:

• your reliever inhaler does not help your symptoms
• your symptoms are getting worse (cough, wheeze, tight chest or finding it hard to breathe)
• you are too breathless to speak, eat or sleep.

The following steps are suitable for both children and adults and explain what you should do if you have an asthma attack.

• Take your reliever inhaler (usually blue), straight away.
• Sit down and make sure that any tight clothing is loosened. Do not lie down.
• If you do not start to feel better straight away, continue to take one puff of your reliever inhaler every minute for five minutes or until symptoms improve.
• If your symptoms do not improve in 5-10 minutes – or if you are in doubt – call 999 or a doctor urgently.
• Continue to take one puff of your reliever inhaler every minute until help arrives.

Do not be afraid of causing a fuss, even at night. If you are admitted to hospital or an accident and emergency department because of your asthma, take details of your medicines with you.

Make an appointment with your doctor or asthma nurse for an asthma review within 48 hours of your attack.

You will also need another review within one or two weeks after your asthma attack to make sure your symptoms are better controlled.

Your family and friends may be worried about what to do if you have an asthma attack. Reassure them that most people don’t have an asthma attack without warning and that asthma usually gets worse gradually over a couple of days. But it is still important that they know what to do if your asthma gets a lot worse, so tell them the information that is written under the question above, ‘What do I do if I have an asthma attack?’.

You could also get an Asthma Attack Card from Asthma UK. This wallet-sized card tells you how to recognise an asthma attack and what you, or anyone around you, should do. To order an Asthma Attack Card, go to the Asthma UK website.

When your symptoms get worse, or you have an asthma attack, you should follow your personal asthma action plan, if you have one. But sometimes this may not help get your symptoms back under control. Your doctor or asthma nurse may have changed your medicines to help you get your asthma symptoms back under control.

You may have agreed with your doctor or asthma nurse increase the dose of your current asthma medicines and you may also be advised to take extra medicines. This is called ‘stepping up’ your treatment and it will help prevent your asthma from getting worse again.
The Asthma UK website has lots more information about asthma medicines.

Get more information about asthma medicines for your child.

When asthma gets out of control and you have an asthma attack, your airways can get very inflamed (swollen) and narrow. Reliever medicine helps open up your airways but it doesn’t tackle the main cause of your asthma attack, which is the inflammation.

Preventer inhalers work to help control the swelling and inflammation in your airways making them less sensitive but the medicine in them may not be strong enough on its own when you have had an asthma attack.

Inhaled medicine may also have trouble reaching the linings of your airways where it’s needed, because of all the inflammation that is there.

A short ‘rescue’ course of steroid tablets works quickly and powerfully to dampen down the inflammation in your airways and help you feel better as soon as possible.

UK asthma treatment guidelines recommend that adults should take a course of steroid tablets for at least five days. Adults should have 40-50mg of prednisolone every day. This is usually taken as 8–10 small tablets a day.

Children will need a smaller dose of steroids, depending on their age. They should take them for at least three days.

It is very important that your steroid course is continued until you are completely recovered, and quite often this takes longer than five days (or three days for children). Sometimes you may need to take your steroid tablets for two or three weeks.

You are recovered when you are having very few asthma symptoms, you hardly need to use your reliever inhaler and your peak flow reading is back to your personal best.

For a small number of people, a short course of steroid tablets can lower the body's resistance to chickenpox, so you should contact your doctor if you or your child are taking steroid tablets and you/they come into contact with chickenpox. If your doctor thinks you are at risk they can give you an injection to protect you.

Other possible side effects from taking a short course of steroid tablets are mood swings (especially in children) and increased hunger.

There are very few other side effects from taking occasional (three to four) short courses of steroids per year.

You can find out more about steroid tablets and possible side effects from the Asthma UK website.

Parents and carers often have lots of questions about using steroids for their children. There are answers to the most commonly asked questions on the Asthma UK website.

You can also call the Asthma UK Adviceline where you can talk to a trained asthma nurse in confidence. Call 0845 7 01 02 03 on Monday to Friday, 9am to 5pm, calls are charged at a local call rate of 4p per minute.

There are a few things you can do that will help you to stay well and keep your asthma under control.

• Follow the advice agreed with your doctor or asthma nurse. This should be written down in a personal asthma action plan. The plan should be completed by your doctor or asthma nurse and you. It should include information about your asthma medicines, how to tell when your symptoms are getting worse and what you should do about it. It should also tell you what to do if you have an asthma attack.
• If you have preventer medicines, make sure you take them every day, even when you are feeling well. You may forget to do this sometimes. Try to take your regular inhalers at the same time as a daily activity, such as cleaning your teeth, and leave the inhalers in a place which will jog your memory. Some people find setting an alarm is also helpful.
• Make sure you can use your inhalers properly. If you find it difficult to use any of your inhalers, the medicine may not reach your airways effectively. Ask your asthma nurse, doctor or pharmacist to check your inhaler technique. If you are not happy with any of your inhaler devices, ask your doctor or asthma nurse to help you find one that you are more comfortable using.
• Avoid your asthma triggers wherever possible.
• If you smoke, think about trying to stop. Smoking is particularly bad for someone who has asthma. It can increase your risk of having an asthma attack and it could permanently damage your airways. Smoking may also prevent some of your asthma medicines from working properly.
  Get more information about asthma and smoking on the Asthma UK website.
• Try and follow a healthy lifestyle. Eating a healthy diet with plenty of fresh fruit and vegetables will help you stay well so you can fight off cold and flu viruses which are common asthma triggers.

The Asthma UK website has lots of information about asthma. The section called ‘All About Asthma’ is a good place to start.

Asthma UK has lots of information to help you manage your asthma that you can order online.

Or speak to Asthma UK’s Supporter & Information Team, info@asthma.org.uk or call 08456 03 81 43.

You can also talk to an asthma nurse specialist, in confidence, by calling the Asthma UK Adviceline 08457 01 02 03  (weekdays 9am to 5pm), calls are charged at a local call rate of 4p per minute.

The Asthma UK Adviceline can be contacted using Typetalk, and an interpreting service is also available if required.

Or if you have a simple question about your asthma, you can send an email to the Asthma UK Adviceline nurses.

Finding out that you have asthma can be confusing and frightening, especially if you have had an asthma attack. It is important to remember that if you learn to take control of your asthma you can still live a full and active life.

Sometimes sharing your feelings with other people who also have asthma can help and reassure you. There may be a local support group in your area. Your doctor or asthma nurse should be able to give you this information. You might also want to share your feelings with your family and friends so they know how your asthma affects you.

The Asthma UK website also has an online discussion forum where you can share your experiences and feelings about your asthma. To take part you will need to register.

If you would like to speak to someone about your asthma face-to-face, make an appointment to have an asthma review with your doctor or asthma nurse. You can also ask your pharmacist if you can discuss your asthma with them next time you are in your pharmacy. They can offer you a Medicines Use Review where you can discuss your medicines and how they work.