The document discusses asthma, including its causes, triggers, treatment, and management during an asthma attack. Asthma is a chronic inflammatory disease of the airways that causes narrowing of the airways. It can be triggered by factors like allergens, infections, exercise, and weather changes. Treatment involves reliever inhalers for acute symptoms and preventer inhalers for long-term control. During an attack, the person should use their reliever inhaler and seek medical help if no improvement.

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Asthma Management

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Understanding Asthma
• Asthma is a chronic inflammatory disease
which affects the airways – the small tubes
that carry air in and out of the lungs.
• When the airways come into contact with
an asthma trigger, the muscles around the
walls of the airways tighten and become
narrower.

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Understanding Asthma
• The lining of the airways swells and
produces a sticky mucus. As the airways
narrow, it becomes difficult for air to move
in and out.

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What Causes Asthma?
• It's difficult to say for sure what causes
asthma. Factors include:
• Family history
• Lifestyle – e.g. hygiene and diet and
environment
• Smoking
• Adult onset asthma may develop after a
viral infection

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What Causes Asthma?
• Exposure to irritants in the workplace such
as dust and chemicals
• Environmental pollution can make asthma
symptoms worse

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What Can Trigger an Asthma
Attack?
• A number of factors can trigger an Asthma
attack; most of these air airborne irritants
but other environmental or physical factors
can cause or exacerbate the symptoms.
• Knowing these factors can help you
prevent a casualty from experiencing an
attack or help relieve the symptoms by
being aware of their environment or
changing their behaviours.

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What Can Trigger an Asthma
Attack?
• Animals
Furry and feathery animals are a common
trigger of asthma symptoms. The allergens
are found in their saliva, flakes of skin, fur
and urine.
• Air pollutants
Air pollutants, like cigarette smoke and car
exhaust fumes, release gases and
particles into the atmosphere, which can
irritate your airways.

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What Can Trigger an Asthma
Attack?
• Colds & viral infections
Colds and viral infections are very
common triggers of asthma and can be
almost impossible to avoid.
• At your asthma review, you should talk to
your doctor or asthma nurse about having
the flu vaccination. These are normally
available every autumn.

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What Can Trigger an Asthma
Attack?
• People who are regularly taking steroid
tablets should also talk to their doctor
about having the pneumococcal
vaccination.
• Emotions
Stress, depression, anxiety or even a fit of
laughter can trigger asthma symptoms.

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What Can Trigger an Asthma
Attack?
• Exercise
Asthma should not prevent anyone from
undertaking exercise; indeed, it is
beneficial to everyone especially those
with asthma. Exercise should be preceded
with gentle warm-ups to gradually prepare
the body, as well as appropriate
management of medications.

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What Can Trigger an Asthma
Attack?
• Food
In some cases, certain foods, including
cow’s milk, eggs, fish, shellfish, yeast
products, nuts, and some food colourings
and preservatives, can make symptoms
worse.

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What Can Trigger an Asthma
Attack?
• Hormones
Some women find their asthma can be
affected around puberty, before their
periods, during pregnancy and during
menopause.

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What Can Trigger an Asthma
Attack?
• House-dust mites
Many people with asthma are sensitive to
the droppings of house-dust mites that live
in the dust that builds up around the
house, in carpets, bedding, soft
furnishings and soft toys.

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What Can Trigger an Asthma
Attack?
• Medicines
Aspirin and non-steroidal anti-
inflammatory tablets such
as ibuprofen and voltarol can trigger
attacks. Other medicines that can
sometimes lead to asthma attacks include
beta-blockers, used to treat heart disease
and glaucoma, and some cold and flu
remedies.

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What Can Trigger an Asthma
Attack?
• Moulds & fungi
Moulds release tiny seeds called spores
into the air, which can trigger asthma
symptoms in some people. Mould spores
are found in any damp place – from piles
of autumn leaves and woody areas, to
bathrooms, kitchens and even piles of
damp clothes.

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What Can Trigger an Asthma
Attack?
• Pollen
Pollen can trigger asthma symptoms in
some people. Pollen is a powder-like
substance produced by certain types of
trees, grasses, weeds and flowers.
• Smoking
Smoking not only increases one chance of
developing asthma, it is also one of the
most aggressive triggers.

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What Can Trigger an Asthma
Attack?
• Weather
Cold air, a sudden change in temperature,
windy or hot, humid days and poor air
quality are all known triggers for asthma.
• Thunderstorms
Thunderstorms can release large amounts
of pollen, in very small particles, into the
air.

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How is Asthma Treated?
• Asthma is commonly treated with an
inhaled medication; a delivery route which
is very fast acting. It can also be
controlled by parental (digested)
medication.

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How is Asthma Treated?
• A casualty suffering from an asthma attack
needs their medication as quickly as
possible – an inherent problem with
breathing condition that relies on an
inhaled medication for treatment is that the
worse the condition becomes, the harder it
can be for the casualty to medicate.

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Relievers
• Everyone with asthma should have a
bronchodilating reliever inhaler. Reliever
inhalers are usually blue and contain the
beta-2 agonistsalubutamol (Ventolin® )
or Terbutaline, another common
bronchodilator which goes by the trade
name Bricanyl®. Terbutaline is often
delivered in a blue Turbohaler

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Relievers
• Relievers are medicines that are taken
immediately to relieve asthma
symptoms. They quickly relax the
muscles surrounding the narrowed
airways allowing the airways to open
wider, making it easier to breathe again.

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Relievers
• A casualty should take a dose of reliever
inhaler as soon as they feel symptoms of
an Asthma attack. A casualty who needs
to use their reliever inhaler three or more
times a week may not be well controlled
and should have their medication
reviewed.

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Preventer Inhalers
• Preventers control the swelling and
inflammation in the airways, reducing their
sensitivity and the risk of severe
attacks. The protective effect builds up
over a period of time so they need to be
taken every day (usually morning and
evening) even when they are feeling well.

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Preventer Inhalers
• Preventers do not give immediate or quick
relief when the casualty is breathless but
instead they reduce long-term
inflammation. Preventer inhalers usually
contain a low dose of chorticosteroid
medicine.
• Preventers are usually brown, red or
orange inhalers.

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Preventer Inhalers
• Preventer inhalers will not relieve the
symptoms of an Asthma attack and should
never be offered to a casualty where a
reliever inhaler is needed.

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Using Inhalers
• Using an inhaler is the most common way
of taking asthma medicines. It is also a
very effective way because inhaling the
medicine takes it straight into the lungs.
• It is important that the casualty takes the
medicine properly. Their doctor or asthma
nurse should have explained how to use
their inhaler so that every dose they take
provides the most benefit.

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Using Inhalers
• Spacers
• Spacers are large plastic or metal
chambers which have an aperture at one
end for the reliever inhaler to fit. The
space enables the medication to be
aerated, making it easier to inhale.
• Spacers are very important because:
• they make aerosol inhalers easier to use
and more effective

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Using Inhalers
• they get more medicine into your lungs
than when using the inhaler on its own
• they are convenient and compact and
work at least as well as nebulisers at
treating most asthma attacks in children
and adults

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Using Inhalers
• they help to reduce the possibility of side
effects from the higher doses of preventer
medicines by reducing the amount of
medicine that is swallowed and absorbed
into the body

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Using Inhalers
Hints on how to use a spacer and mask
with young children
• Fit the mask on to the spacer if necessary.
• Shake the inhaler well.
• Fit the inhaler into the opening at the end
of the spacer.
• Place the mask over your child's face so it
seals around the nose and mouth.

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Using Inhalers
• Press the inhaler once and allow your
child to take five slow breaths in and out of
the spacer. This is called tidal breathing.
• Remove the inhaler and shake again.

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Using Inhalers
• Repeat steps 2 to 5 for each dose of
medicine. Their doctor or asthma nurse
will tell them how many puffs are
needed. Always check with them if you
are not sure and ask them to write this
down on a personal asthma action plan for
your child.

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Using Inhalers
Remember:
• Only put one puff of medicine into the
spacer at a time. If you put in more than
one puff, the droplets of spray stick
together and coat the sides of the spacer
so your child actually gets less medicine.

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What to do in an Asthma Attack
• The casualty is having difficulty breathing
– this is incredibly distressing and,
remembering that emotions can trigger an
Asthma attack it can by psychosomatic;
the more anxious the casualty becomes,
the worse their symptoms become, the
harder it is to breathe, the more anxious
they become...

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What to do in an Asthma Attack
• Remember that asthma attack are often
caused by triggers so attempt to remove
the causalty form the trigger.
• Sit the casualty down, on a chair or on a
floor against a wall. Do not attempt to lie
them down. The chest has weight and
casualties with chest pain or breathing
conditions often find lying down
exacerbates their conditions.

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What to do in an Asthma Attack
• Sit the casualty forward slightly.
• Loosen anything around the casualty's
neck; the first couple of shirt buttons or an
inch or two of zip.
• Look into the casualty's eyes and hold
their attention.
• Ask them; “Do you have Asthma?” , “Do
you have your medication?”

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What to do in an Asthma Attack
• Ask “Yes” or “No” questions which they are
able to respond to without talking.
• Enable the casualty to take one to two
puffs of their reliever inhaler (usually blue),
immediately.
• Encourage, gently, calmly and
supportively, the casualty to take a few
gentle breaths.

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What to do in an Asthma Attack
• If they do not start to feel better, take two
puffs of the reliever inhaler (one puff at a
time) every two minutes. They can take
up to ten puffs.
• If the casualty does not feel better after
taking their inhaler as above, or if you are
worried at any time, call 999.
• If an ambulance does not arrive within 10
minutes and there is no improvement,
repeat the medication.

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What to do in an Asthma Attack
• If the symptoms improve and you do not
need to call 999, the casualty should still
see a doctor or asthma nurse within 24
hours.
• A casualty is having an asthma attack if
any of the following happens:
• Their reliever inhaler does not help.
• Their symptoms are getting worse (cough,
breathlessness, wheeze or tight chest).

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What to do in an Asthma Attack
• They are too breathless to speak, eat or
sleep.
• Do not be afraid of causing a fuss, even at
night; If the casualty needs to go to A&E or
is admitted to hospital, take details of their
medicines with you if possible.

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What to do if there is no inhaler
• It is tempting to ask if anyone else has an
inhaler that the casualty can use. We
have to take a legal and responsible
stance and say that it is not appropriate to
give the casualty anyone else's inhaler, for
a number of reasons:

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What to do if there is no inhaler
• The Law:
• Inhaled medications are prescription
medicines. It is illegal to administer such a
medicine without the prescription of a
doctor.
• In some case you may be in a position or
responsibility of handling the casualty's
medication.

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Types of Inhaler
• There are several types of inhaler, each
with their own mechanism of use. The
type of inhaler represents part of the
prescription and will have been prescribed
to the casualty for a reason. The casualty
may not be familiar a different typr of
inhaler or know how to effectively use it.

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Drug type and dose
• While all blue inhalers tend to be for
relieving asthma symptoms, they do not all
contain the same drug, nor the same
dosage. Don't assume all inhalers are the
same.

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Drug type and dose
• If there is no inhaler present continue to
rest and calm the casualty - do not
underestimate the power of emotional
support. Give positive statements such
as "Stay calm" as opposed to "Don't
panic". The brain hears the verb first and
has to process the fact that the instruction
is a negative. What does someone
climbing a ladder do immediately after you
shout "Don't look down!" ?

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Drug type and dose
• If there is no sign of improvement after 5
minutes, the casualty's breathing becomes
undetectable or they loose consciousness,
call 999 immediately.

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After an emergency asthma
attack
• Encourage the casualty to make an
appointment with their doctor or asthma
nurse for an asthma review, within 48
hours of your attack.
• Asthma attacks are the result of gradual
worsening of symptoms over a few days
that you may not have noticed.

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Occupational Asthma
• Some substances that you might come
across at work can actually cause
asthma. The condition can take weeks,
months or even years to develop,
depending on the person and the
substance.

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Occupational Asthma
• If you think your asthma has been caused
by something at work, look out for these
clues: your asthma symptoms are worse
during the working week, at work or after
work
• Your symptoms may get worse after work,
or you may find your sleep is disturbed
during the night

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Occupational Asthma
• Your symptoms improve when you have
been away from work for several days (for
example when you are on holiday).

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Which substances cause
occupational asthma?
• Substances that can cause asthma are
called respiratory sensitisers. Below is a
list of some of the main ones and the jobs
where you are most likely to come across
them.

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Which substances cause
occupational asthma?
• Chemicals called isocyanates are the most
common cause of occupational asthma in
the UK. There are many jobs in which you
might be exposed to these chemicals,
particularly spray painting, foam moulding
using adhesives, and making foundry
cores and surface coatings.
• Dust from flour and grain. Industrial
baking, farm work and grain transport

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Which substances cause
occupational asthma?
• Wood dust, particularly from hard wood
dusts and western red cedar. Carpentry,
joinery and saw-milling.
• Colophony – this is widely present in
soldering fumes but also in glues and
some floor cleaners. Electronics industry
• Dust from latex rubber. Any job involving
latex gloves, such as nursing or dentistry

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Which substances cause
occupational asthma?
• Dust from insects and animals, and from
products containing them. Laboratory
work, farm work or work with shellfish