Mastering Asthma Management: How To Manage & Control Your Asthma

Asthma is a chronic respiratory disease that affects the airways through ongoing inflammation and episodes of bronchoconstriction, leading to symptoms that can range from mild to life-threatening if poorly controlled.

This article explains what asthma is, why it develops, what triggers symptoms, how it is diagnosed, the modern approach to treatment and inhaler use, how to respond safely during an asthma attack and how long-term management guided by NICE, BTS, SIGN and GINA can reduce preventable asthma deaths, improve asthma control and support emerging approaches such as the SABA-free pathway.

In One Sentence:

Asthma can be effectively managed and controlled by understanding its causes and triggers, using preventer treatment consistently, responding correctly to attacks, and following evidence-based UK asthma guidelines.

Key Takeaways

• What causes asthma to develop? Asthma develops due to a combination of genetic factors and environmental exposures, including allergies, that lead to chronic airway inflammation.

• What are the main triggers? Asthma triggers include allergens, infections, pollution, weather changes and emotional stress, which vary between individuals.

• How do inhalers work? Reliever inhalers open the airways quickly, while preventer inhalers reduce inflammation to lower future risk.

• What is the risk of using only a blue inhaler? Relying only on a blue inhaler increases the risk of severe attacks and preventable asthma deaths due to untreated inflammation.

• What should I do during an attack? Following an emergency protocol and seeking urgent medical help when reliever treatment is not working can be life-saving.

Understanding Asthma: Causes and Triggers

Asthma is a long-term condition caused by a combination of inherited traits and environmental influences that make the airways overly sensitive.

Asthma involves airway inflammation and airway hyper-responsiveness, meaning the breathing tubes react strongly to triggers that would not affect most people.

Biological Causes

Asthma often runs in families due to genetics and a family history of allergic disease.

Many people with asthma have atopy, also known as atopic syndrome, which increases the likelihood of airway hyper-responsiveness and allergic inflammation.

Related Conditions

Asthma frequently occurs alongside other allergic conditions.

These include eczema, also called atopic dermatitis, hay fever (allergic rhinitis), and food allergies, all of which reflect a shared immune tendency.

Risk Factors

Certain early life and lifestyle factors increase the risk of developing asthma. These include:

• Premature birth

• Low birth weight

• Smoking during pregnancy

• Second-hand smoke exposure

• Obesity measured by BMI

• Occupational exposure to irritants such as dusts or chemicals

What are common asthma triggers?

Asthma symptoms are commonly triggered by everyday exposures that irritate inflamed airways or provoke an allergic response.

Triggers differ from person to person and can change over time, which is why identifying personal triggers is central to asthma management [1].

Allergens

Allergens are a major cause of asthma symptoms in sensitised individuals. Common allergens include:

• House dust mites such as dermatophagoides

• Pollen from trees, grass and weeds

• Pet dander from cat and dog saliva and skin

• Mould spores, including Aspergillus and Cladosporium

• Cockroach allergens

Environmental factors

Environmental conditions, such as  your place of work, can worsen airway inflammation even in non-allergic asthma. Key factors include:

• Air pollution

• Nitrogen dioxide NO₂

• Fine particulate matter PM2.5

• Cold air

• High humidity

• Thunderstorm asthma events linked to pollen rupture

Physical Factors

Physical exposures can directly irritate the airways and provoke bronchoconstriction.

Exercise-induced bronchoconstriction (EIB), tobacco smoke, and vaping/e-cigarettes are common triggers.

Emotions

Strong emotions can influence breathing patterns and asthma symptoms.

Stress or intense emotional responses may lead to rapid breathing that worsens airway narrowing.

Weather

Weather changes can affect airway sensitivity.

Cold temperatures, sudden drops in air pressure and high pollen days are common triggers.

Health

Illness and mental well-being play an important role in asthma control.

Respiratory infections such as rhinovirus, influenza, RSV, alongside stress, anxiety, and hormonal changes during menstruation or pregnancy, can all worsen symptoms.

Diet & Medication

Certain foods and medicines can provoke asthma symptoms in susceptible people. These include:

• Sulphites found in wine and processed foods

• NSAIDs like ibuprofen and aspirin

• Beta-blockers

• Strong cleaning products that release VOCs

How is asthma diagnosed and treated?

Asthma diagnosis and treatment depend on testing and regular assessment to confirm inflammation, airflow obstruction and response to therapy.

UK guidance recommends combining clinical history with tests that demonstrate variable airflow limitation and inflammation.

Diagnostic Tests

Objective testing helps confirm asthma and guide treatment decisions. These include:

• FeNO testing for fractional exhaled nitric oxide

• Spirometry

• Bronchodilator reversibility BDR

• Peak expiratory flow PEF

• Monitoring with daily variability

• Specialist-only tests such as the methacholine challenge

Clinical Markers

Test results identify patterns typical of asthma. Markers include:

• Eosinophilic inflammation

• Airway obstruction

• Reduced FEV1

• Altered FVC

• Changes in the FEV1 to FVC ratio

Treatment Goals

Asthma treatment focuses on long-term outcomes rather than symptom relief alone. Goals include:

• Good symptom control

• Reduced risk of attacks

• Improved quality of life

• Regular assessment using tools such as the Asthma Control Test ACT

FeNO test

The FeNO test measures airway inflammation related to eosinophils. 

Higher readings suggest steroid-responsive asthma and help guide inhaled corticosteroid use.

Spirometry

Spirometry assesses lung function by measuring airflow and volume.

Reduced values can indicate obstruction that improves with treatment.

Bronchodilator Reversibility BDR

BDR testing shows how airways respond to bronchodilators.

An improvement in FEV1 after medication supports an asthma diagnosis.

Peak flow testing

Peak flow monitoring tracks daily variation in airway narrowing.

Large fluctuations are characteristic of asthma and help assess control.

The New Gold Standard: Reliever vs. Preventer Inhalers

Modern asthma care prioritises anti-inflammatory treatment rather than reliance on short-term symptom relief [2].

Understanding inhaler classes and their roles is essential for safe asthma control.

Reliever Inhalers SABA

Reliever inhalers provide rapid symptom relief by relaxing airway muscles.

Short-acting beta-agonists (SABA) such as salbutamol, Ventolin, Salamol, terbutaline and Bricanyl act as bronchodilators, but do not treat underlying inflammation.

Preventer Inhalers ICS

Preventer inhalers reduce airway inflammation and lower future risk.

Inhaled corticosteroids (ICS) include beclometasone, Clenil Modulite, Qvar, fluticasone, Flixotide, budesonide and Pulmicort.

MART and AIR Therapy

Combination approaches now form the basis of safer asthma care.

MART, AIR and SMART protocols use formoterol-based inhalers such as Fostair, Symbicort, DuoResp and Fobumix to provide both maintenance and reliever therapy, while addressing blue inhaler reliance.

Raising Awareness: Why Inhaled Corticosteroids ICS Matter

Inhaled corticosteroids are essential for preventing asthma attacks and long-term lung damage.

They reduce exacerbation risk, prevent airway remodelling and counter the dangers of SABA overuse with minimal systemic absorption when used correctly.

Can asthma inhalers have side effects?

Asthma inhalers can cause side effects, though most are mild and preventable.

Relievers may cause tremor or palpitations, while preventers can lead to oral thrush, dysphonia, sore throat or coughing reflex. These can be reduced by using a spacer device such as Volumatic, AeroChamber or Able Spacer, rinsing and gargling after use, and addressing zero-steroid phobia through education.

How can I control an asthma attack?

Fast action during an asthma attack can prevent severe complications and hospital admission [3].

Recognising warning signs and following an emergency plan is vital.

Signs of an attack

Asthma attacks present with clear danger signals. These include:

• Struggling to breathe or breathing very fast

• Wheezing or coughing a lot

• A blue reliever not helping

• Inability to speak in full sentences

• Lips or fingers turning blue due to hypoxia and cyanosis

What to do during an asthma attack

Immediate steps can be life-saving during acute severe asthma [4]. If you are experiencing an asthma attack, follow the advice below:

1. Sit up straight in a tripod position

2. Take one puff of your reliever inhaler every 30 to 60 seconds

3. Take up to 10 puffs (using a spacer if available)

4. Call 999 if there is no improvement or if you become worried at any time

5. Repeat reliever doses if help has not arrived within 15 minutes

Maintenance: Annual Reviews & Inhaler Technique

Ongoing review and correct inhaler technique are essential for long-term asthma control.

Annual Asthma Reviews, a PAAP or written action plan and support from a GP, respiratory nurse specialist or pharmacist through services such as the New Medicine Service (NMS) help maintain control.

How to Use Your Inhaler

Correct technique ensures medicine reaches the lungs effectively. 

Using your inhaler properly depends on the type of inhaler you have. Inhaler types include:

• pMDI inhaler

• pMDI inhaler with a spacer using single breath and hold or tidal breathing

• Turbohaler

• Easyhaler

• NEXThaler

• Ellipta

• Easi-breathe

• Respimat

• Accuhaler

• Spiromax

• Breezhaler

• Genuair

• Autohaler

• HandiHaler

• Zonda

• Forspiro

Final Thoughts

“Asthma management is most effective when it is based on understanding triggers, using preventer treatment consistently, responding quickly to worsening symptoms and engaging in regular review with healthcare professionals. By following evidence-based UK guidance and modern inhaler strategies, most people with asthma can achieve good control, reduce risk and maintain an active, healthy life”.

Sources

[1] Can Asthma Go Away? A Guide To Fighting Asthma | UK Meds

[2] Asthma Treatments Compared | UK Meds

[3] What Is An Asthma Attack? | UK Meds

[4] Allergic Asthma - Medical Glossary | UK Meds

Further Reading

• Asthma - NHS

• Chronic Asthma | British Thoracic Society | Better lung health for all

• Managing asthma in adults

• Diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance