What is asthma?

Asthma basics

Asthma is a chronic (long-term) condition where the lungs become inflamed. The lungs are part of the respiratory system, which is responsible for breathing oxygen into your lungs.¹

Asthma is a challenging condition to diagnose because symptoms that underpin asthma are present in many other respiratory conditions. You may feel that your asthma could be misdiagnosed; however, the key to detecting asthma is consistent monitoring of symptoms over time.

What are the symptoms of asthma?

Since the symptoms of asthma are shared with other conditions, two important words to keep in mind are consistency and recurrence. Furthermore, these symptoms may feel worse at night.

Symptoms are:^2,3

• Wheezing
• Breathlessness
• Coughing
• Tight-Chest
• Trouble sleeping when the above symptoms are present

If your symptoms are becoming more challenging in your normal day-to-day life, being aware of possible asthma triggers could help symptom management. Additionally, you could log the times when your asthma feels the worst and what you were doing. It is important to include the time and date of worsening symptoms in your logs because it is critical for medical professionals to understand how frequently the symptoms present to give you the best treatment.

Some asthma triggers include:³

• Exercise
• Airborne substance, including dust, aerosols, and gases
• Allergies, such as pollen and pets

What is an asthma attack?

An asthma attack is caused by your symptoms becoming worse; this could be sudden or over a prolonged period, especially if your asthma is not being controlled through treatment plans.

During an asthma attack, your immune system sends out a signal to warn the body that something bad has entered the airway, causing your body to think it is under attack. Tiny ‘soldiers’ arrive at the lungs and cause the muscle that lines your airways to contract, which tightens the airway; this causes breathing difficulties and results in the feeling that you cannot breathe during an asthma attack. The number one action to take is to use your reliever inhaler (usually blue) every minute for up to ten minutes. Additionally, you should sit up straight and call 999.⁴

What happens with frequent asthma attacks?

Frequent attacks

Asthma can have sudden onsets of worsening symptoms, therefore, having treatment within arm’s reach is critical. Since asthma attacks are common amongst the asthmatic population, an understanding of the condition needs to be improved. Understanding why asthma attacks are triggered and what happens after are vital factors that increase your control and reduce attack frequency. Furthermore, asthma has been shown to be a risk factor in developing psychological and health conditions (specifically related to the cardiovascular system and weight gain).

Long-term effects of frequent acute asthma exacerbations

Effects on lung health

Damage to your lungs

Damage to lungs is called airway remodelling, which means the lining of your lungs has changed. There are a few ways this can happen:^6,7

• Epithelial damage: Your epithelium is the lining of the tubes in your airways, from your nasal cavity all the way into your lungs, and it functions to protect and moisten the airways. Asthma triggers the immune system to send cells that make your epithelial layer more fragile, which subsequently requires reconstruction. Your epithelium has structures called cilia ( jellyfish-like tentacles) that move and sweep up mucus and debris in your lungs. Recurring reconstruction can cause damage to cilia, which results in the cleaning function becoming impaired. Frequent asthma attacks could make this epithelial damage more widespread across the lungs, which is irreversible
• Airway smooth muscle hypertrophy and hyperplasia: hypertrophy refers to an increase in the size of the muscles, and hyperplasia is the increase in the quantity of muscle tissue; this causes the lining of your tubes within the lungs to become thickened, therefore, the space for air to pass through narrows
• Collagen deposition: Collagen is a protein vital for building strong and flexible tissue; this is important in the lungs, to make sure they are able to contract to allow air into the lungs. When the lungs become inflamed overtime, from frequent asthma attacks, this causes excessive collagen to build up, leading to thicker and stiffer lung tissue.

Lung function drops

Frequent asthma attacks will gradually cause damage to the tissue of the lungs, which in time leads to scarring; this condition is called fibrosis. Scar tissue is thicker and stiffer, which takes away from the elasticity the lung muscles require to function properly. As a result, it is harder for air to pass through the lungs, which causes discomfort and shortness of breath. Therefore, managing your asthma symptoms is critical to prevent you from developing unhealthy lungs, which inevitably make the condition worse.⁶

More likely to get sick

In addition to breathing, lungs have evolved to become a barrier to prevent you from being sick; this involves many components, which can all be affected by asthma. Therefore, you become at risk of infections as this system no longer works as well.⁸

Furthermore, the loss of cilia means you are at more risk of developing chest infections, which can cause further inflammation and damage to your lungs. For example, you may be at greater risk of developing pneumonia.⁹

Risk of developing lung disease

All the effects of asthma attacks can have on your lungs lead to irreversible lung damage; this is important to understand because it can allow your body to develop lung disease, which has huge consequences for your quality of life. Examples of lung disease from asthma attacks include:

• Chronic obstructive pulmonary disease (COPD): COPD is particularly challenging because it is a progressive disease with long-term characteristics, like breathlessness and reduced exercise ability, which remain consistent, unlike controlled asthma¹⁰
• Bronchiectasis: Bronchiectasis is a long-term condition that affects your airways, which is characterised by a wider airway that holds too much phlegm. Surely wider airways would be good, no? In this case, it is not because the abundance of phlegm means you are at greater risk of consistent chest infections, which lead to inflammation and the breathlessness you experience with asthma^11,12

Emotional and lifestyle effects

Asthma can have huge impacts on your mental health, including making you feel out of control, scared and frustrated about the future. In more severe cases, panic attacks can be common; people with asthma are sixteen times more likely to have a panic disorder compared to those who don’t have asthma.

Unfortunately, medical professionals do not always pick up on the mental health effects that asthma has can trigger. The effects on mental health are key to understanding how asthma affects your quality of life. If you are feeling stressed and panicked about your asthma symptoms, it is important to get this under control by contacting your GP. These thoughts can impact how you control your asthma journey and can lead to worsening of your asthma symptoms.

Uncontrolled asthma can result in you feeling the burden of physical limitations, with exercise becoming much more difficult to get involved in when your asthma is not controlled.⁵

How can you avoid frequent asthma attacks?

Education

Education is crucial in preventing asthma attacks. Taking medication can improve your symptoms. However, if you can identify the triggers of your asthma and the signs of an asthma attack, then you are on the road to controlling your condition. Knowing how to take medication correctly and understanding when to take it are critical steps in reducing the severity of your asthma.

Medication

Treatment depends on the severity of your asthma. Most cases will require you to have fast-acting bronchodilators. If you find yourself with frequent asthma attacks, it is likely you have more severe asthma. In this case, inhalers may be prescribed in combination with steroids, such as beclometasone.

Avoiding triggers

Taking time to notice any triggers that might be progressing your asthma case is critical to control your condition. If you are exposed to triggers like pets, dust, pollen and aerosols, then these might be the culprit in why you are experiencing more frequent asthma attacks.

See your doctor regularly

Keeping in frequent contact with your GP is important for them to understand the severity and frequency of your asthma, and the treatment required to control it.¹

Summary

Frequent acute asthma exacerbations can cause long-term damage to your lungs, which is mostly linked to airway remodelling. These changes cause stiffening and thickening of your lungs, which makes breathing more difficult. Breathing difficulties can lead to inflammation, which exposes you to more frequent chest infections and an increased risk of developing chronic lung diseases, such as COPD and bronchiectasis. Managing asthma through education, medication, and frequent check-ups with your GP, will all contribute to better asthma control. More control over the symptoms reduces the severity of your asthma and prevents long-term complications.