Asthma is clinically defined as the combination of variable respiratory symptoms such as wheezing, shortness of breath, cough and chest tightness, and significant variation in lung function.

Asthma is a chronic disease that can be controlled but not cured.

In the event of an asthma attack, triggering stimuli cause the smooth muscles of the bronchi to contract and, consequently, the passage to narrow. The tissue lining of the airway swells as a result of inflammation and secretes mucus (Ortega & Izquierdo 2022a). This narrowing of the airways is usually reversible.

A minor asthma attack can be treated at home with proper medications. A severe asthma attack requires medical intervention and has the potential to be a life-threatening emergency.

The most effective way of preventing an asthma attack is recognising and treating the early signs of an asthma flare-up. In order to do this, it is necessary to have in place and follow an asthma treatment plan that has been made in collaboration with a doctor (Mayo Clinic 2021).

This plan (detailed below) will detail steps to follow in the event that a person’s asthma worsens and what to do in the event of an asthma attack.

Asthma in Numbers

Roughly one in nine Australians have asthma (2.7 million) (ABS 2018).

The prevalence of asthma among Aboriginal and Torres Strait Islander Peoples is about 1.6 times higher than that of non-First Nations people (AIHW 2020), and even higher in the older adult population (Asthma Australia 2022a). Furthermore, Aboriginal and Torres Strait Islander Peoples have double the asthma mortality rate of non-First Nations Australians (Asthma Australia 2022b).

Asthma is also more common in people residing in lower socio-economic areas and more prevalent in regional and remote areas as opposed to major cities (Asthma Australia 2022b).

Fewer than one in five people over the age of 15 have a written asthma treatment plan (lowest out of people aged 25-44), even though it is recommended that every person who has asthma has a written plan (Asthma Australia 2022a).

Common Asthma Triggers

• Upper respiratory infections such as colds and flu
• Allergens
• Cigarette smoke
• Weather e.g. cold, dry air; thunderstorms; temperature changes
• Exercise
• Certain medicines
• Stress.

(National Asthma Council Australia 2022a)

Symptoms of Acute Asthma

Common symptoms of acute asthma include:

• Shortness of breath
• Chest tightness or pain
• Coughing
• Wheezing
• Low peak expiratory flow readings
• Asthma symptoms that do not respond to an inhaler.

(Mayo Clinic 2021)

Most asthma attacks occur in the early hours of the morning. This is generally the time when the effect of protective medicines has worn off and the body is least able to prevent the airway from narrowing (Ortega & Izquierdo 2022a).

The symptoms of an asthma attack can vary from person to person, making it necessary for a person with asthma to work with their medical officer to identify their unique signs and symptoms (Mayo Clinic 2019).

Asthma Diagnosis

There is no single reliable test to form an asthma diagnosis. Commonly, a diagnosis of asthma is made based on:

• History
• Physical examination
• Consideration of other diagnoses
• Documenting variable airflow limitation.

(National Asthma Council 2022b)

The exact causes of asthma are unknown; it is likely asthma is the result of a combination of complex interactions between genes, environmental conditions and nutrition (Ortega & Izquierdo 2022a).

Asthma Severity

Asthma ranges in severity. It is necessary for a person with asthma to know their asthma rating.

• Intermittent: Symptoms will be present two days per week or less and do not interfere with everyday life.
• Mild persistent: Symptoms will be present more frequently than two days per week and may slightly limit activities.
• Moderate persistent: Symptoms will be present daily and may limit some activities.
• Severe persistent: Symptoms will be present throughout the day and interfere excessively with daily life.

(Ortega & Izquierdo 2022)

Lung Function

Lung (pulmonary) tests are taken to evaluate how well a person’s lungs are functioning. Poor lung function indicates that asthma is not currently well-controlled (Mayo Clinic 2021).

Lung function tests include:

• Peak flow: This test measures how quickly a person can breathe out - known as peak expiratory flow (PEF). A peak flow test is performed by blowing into a mouthpiece as hard and as fast as possible in one breath.
• Spirometry: During spirometry, a person takes deep breaths and forcefully exhales into a hose connected to a machine called a spirometer. A typical spirometry measurement is forced expiratory volume, measuring how fast a person can breathe out in one second.
• Nitric oxide measurement: This measures the amount of nitric oxide gas a person has in their breath when they exhale. High nitric oxide readings indicate that a person’s bronchial tubes are inflamed.
• Pulse oximetry: A test that measures the amount of oxygen in the person’s blood; this is measured through the fingernails.

(Mayo Clinic 2021)

When to Seek Emergency Medical Treatment

It is recommended that a person experiencing the following symptoms seeks immediate medical attention:

• Severe breathlessness or wheezing, especially in the early morning or night
• An inability or difficulty to speak because of shortness of breath
• Having to strain chest muscles to breathe
• Low peak flow readings
• No improvement after using a quick-acting (rescue) inhaler.

(Mayo Clinic 2021)

Asthma Action Plans

An individualised written asthma action plan is necessary for people who have asthma. It will be made in accordance with their treatment regimen, the severity of their asthma, their culture, language, and ability to self-manage.

A plan should involve the following:

• The person’s usual asthma and allergy medicines
• Clear instructions on how to change medications
• When and where to get medical care, including during an emergency
• The name of the person preparing the plan
• The date the plan was made.

(National Asthma Council 2022b)

Asthma Treatment

Medicines used to treat asthma allow people to live normal lives. In many cases, the medicines used to treat an asthma attack can be used (in lower doses) to limit the occurrence of attacks.

The main medications used in asthma are:

• Relievers (short-acting ϐ2 agonists)
• Preventers:
  • Non-steroidal preventers
  • Long-acting ϐ2 agonists (LABAs)
  • Inhaled corticosteroids
  • Biological agents.

(Gowan 2019; Ortega & Izquierdo 2022b)

Asthma Prevention

It is strongly advised that people who have asthma learn their triggers and do their best to avoid these.

Other prevention tips include:

• Having an adequate supply of medications and always following instructions for these
• Informing a doctor when medications are less effective or aren’t working
• Paying attention to symptoms in the event of a cold or flu
• Seeking medical help immediately if an acute exacerbation is a possibility.

(Pietrangelo & Sullivan 2023)