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Asthma in adults

Key points about asthma in adults

Asthma (mate huango) is a common lung condition that affects the breathing tubes (airways) that carry air in and out of your lungs.
Asthma causes wheeze, a tight chest and cough, and can make it difficult to breathe.
Although asthma can't be cured, it can be well managed with self-care and appropriate use of medicines.
This page focuses on asthma in adults. For information about children with asthma, see the asthma in children page.

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Aotearoa New Zealand has one of the highest rates of asthma in the world – asthma affects up to 1 in 7 children and 1 in 8 adults. It's more common among Māori adults and tamariki.

If you have asthma, your airways are sensitive and react to certain triggers such as allergens (substances that cause an allergic reaction), viruses, cold or humid weather, exercise and air pollutants such as cigarette smoke.

These triggers cause your air passages to tighten up, swell on the inside (become inflamed) and produce more mucus. As a result, the airways become narrower, making it difficult for air to move into your lungs, and even more difficult for air to move out.

Video: What is asthma? Causes, signs and symptoms, diagnosis and treatment

(Medical Centric, US, 2018)

Asthma is thought to be caused by a combination of genetic and environmental factors.

Genetic factors

Asthma and allergies are closely linked. It's been estimated that about 70 to 80% of asthma in Aotearoa New Zealand is associated with allergies. Often people with asthma also have eczema (allergic skin rash) or hay fever, or have close family members who have asthma, eczema or hay fever. The tendency for these 3 conditions to occur together is known as atopy. If you are atopic, allergies can be a trigger for your asthma.

Environmental factors

Certain things in our environment thought to have a role in causing asthma include:

allergens
air pollution (including tobacco smoke and petrol fumes)
workplace chemicals.

Asthma is ongoing and your symptoms may come and go.

Common symptoms of asthma include:

difficulty breathing, feeling out of breath or as though you can't get enough air out of your lungs
a tight feeling in your chest like something is squeezing or sitting on your chest
wheezing (a whistling, musical or squeaky noise in your chest)
a cough, which can be worse at night or in the morning.

If you have any of these symptoms, see your healthcare provider so they can assess if this is due to asthma or something else.

If you are using a peak flow meter, a more than 20% day-to-day change in your recordings is a sign of asthma, or that your existing asthma needs better care.

Severe asthma symptoms

From time to time, your symptoms may get gradually, or suddenly, worse – these are called flare ups or exacerbations.

Seek urgent medical help if you have any of these severe symptoms:

it's difficult to talk
your lips and/or fingernails have a bluish tinge
your nostrils flare when you breathe
the skin around your neck and/or ribs pulls in when you breathe
your heart is racing
it's hard to walk
your peak flow recordings are muck lower than usual.

For severe asthma symptoms, you should use your reliever inhaler immediately and call an ambulance on 111 or go to your nearest Accident & Emergency clinic.

Learning what triggers your asthma and finding ways to avoid or reduce the effects is an important part of managing your asthma.

Common asthma triggers include:

house dust mite
infections of your airways, such as colds and flu
pollen
mould
pets
cigarette smoke
weather, such as change in temperature, cold weather or humid weather
exercise
stress and high emotion
chemicals that irritate the airways, such as sprays, perfumes, cleaning fluids
some medications (read more about medications that may trigger asthma).

Asthma can generally be diagnosed from:

a description of your asthma symptoms now and in the past
listening to your breathing with a stethoscope
checking how your lungs are working with breathing tests, such as a peak flow meter (a device that measures changes in your breathing over the day)
a spirometry test (with a machine that measures lung function) – this may be available at your healthcare provider's practice or you may need to go to your local hospital.

More detailed testing may be required, such as:

a blood test (blood eosinophils and IgE level)
a skin-prick test to test for allergens
a chest X-ray to rule out other conditions.

Other lung function tests such as an exhaled nitric oxide test (FeNO) or airway challenging testing may be required. If these lung function tests are needed, you'll be referred to a specialist clinic.

Once a diagnosis is made, your healthcare provider will prescribe the type of medicines you need to take and should set up an asthma action plan(external link). This plan reminds you how to manage your asthma every day and how to recognise and manage your asthma when your symptoms get worse. Regular peak flow monitoring may help you achieve good control and peak flow reading targets may be included in your asthma action plan.

Aims of treatment

While asthma can't be cured, the correct use of medicine combined with other self-care measures means that symptoms can be well controlled for most people.

Asthma treatment aims to keep your symptoms under control and prevent asthma attacks, or sudden worsening of symptoms. This is so that your asthma doesn't interfere with your daily activities and you can enjoy a full and active life.

Treatment

Treatment of asthma consists of inhaled medicines. It's crucial to receive good education on how to use the different inhalers properly.

There are 2 types of inhalers:

Metered dose inhalers (MDIs), and
dry powder inhalers.

MDIs are best used with a spacer to make sure the medicine is delivered to your small airways or breathing tubes.

Generally there are 2 main approaches to the treatment of asthma, depending on whether you are using a budesonide/formoterol inhaler or a steroid inhaler with/without long-acting bronchodilator.

Budesonide/formoterol

Examples of Budesonide/formoterol inhalers:

Mild symptoms

Use budesonide/formoterol when required for relief of asthma.
This is also called anti-inflammatory reliever (AIR) therapy or single-inhaler maintenance and reliever (SMART) therapy.

Moderate to severe symptoms

Use budesonide/formoterol every day PLUS when required for relief of asthma symptoms.
Also called single-inhaler maintenance and reliever (SMART) therapy.

Steroid inhaler with/without long-acting bronchodilator

Mild symptoms

Use your steroid inhaler every day, even when you're not having symptoms.
Examples of steroid inhalers include:
- Beclometasone (Beclazone®, Qvar®)
- Budesonide (Pulmicort®)
- Fluticasone (Flixotide®)

Use salbutamol or terbutaline for symptom relief when needed.
If you’re using them more than twice a week, see your healthcare provider to review your treatment.

Moderate to severe symptoms

Use your steroid inhaler PLUS long-acting bronchodilator every day, even when you're not having symptoms.
For examples of steroid inhalers and long-acting bronchodilator inhalers, see asthma medications.
Use salbutamol or terbutaline for symptom relief.
If you're are using them more than twice a week, see your healthcare provider to review your treatment.

For severe flare ups or exacerbations of asthma or for asthma attacks your healthcare provider will prescribe prednisone for a short period. Prednisone is a tablet to help reduce inflammation. It shouldn't generally be used long term for asthma treatment. If you need prednisone regularly each year you should be referred to a specialist clinic. Extra inhaler treatment might be needed or, for some people, new generation biological treatments (eg, benralizumab, mepolizumab).

After each flare up you should have your inhalers reviewed – including your preventer treatment and your asthma action plan.

There are other less commonly used medicines for asthma prevention such as montelukast tablets.

Flu and COVID-19 vaccines

People with asthma are at increased risk of complications from the flu, even if their symptoms are mild or well-controlled by medicine. Complications include pneumonia (lung infection), heart failure and worsening asthma symptoms. The flu is also associated with increased risk of hospitalisation for people with asthma.

Ask your healthcare provider about getting the flu vaccination to reduce your risk of flu.
The flu vaccine is usually free for people with asthma, if you are on regular preventative therapy.
It is best to get vaccinated before the start of the winter season, before the flu enters the community.
It’s important to get the flu jab every year because each year the flu vaccine is developed to match the different strains of flu virus you are likely to come across.
Have your COVID-19 booster vaccination if you can.
Some people are eligible for the respiratory syncytial virus (RSV) vaccine.
Read more about influenza and the flu vaccine and the COVID-19 vaccine.

Keep an eye on your symptoms. If you're getting wheezy more than twice a week, it means your asthma is not well controlled. See your healthcare provider for a check-up.
If you have symptoms of hay fever (allergic rhinitis), such as nasal congestion, runny nose, sneezing and itchy eyes, talk to your healthcare provider about medicine to treat these symptoms, such as antihistamines or nasal steroid sprays. Treating hay fever can improve your asthma symptoms.
Many people with asthma have other long-term health conditions which can cause symptoms that are similar to asthma, but may not respond to the usual inhaler treatments. Your healthcare provider should review whether this is happening for you.
If your asthma is severe, or hard to treat, you may be referred to a specialist clinic.

There are many things you can do to improve how well your asthma is controlled. By working with your healthcare provider to create an asthma action plan(external link), you can reduce the severity of your asthma symptoms and how often you have them.

Understand your asthma and learn to recognise your symptoms and your triggers.
Take your prescribed medicine, especially your preventer, every day, regardless of whether you have asthma symptoms or not.
Be confident that you're using your inhalers properly – be certain the medicine is delivered to the small breathing tubes or bronchi.
If you smoke, try to quit. Try to keep clear of anyone else who smokes and of any other fumes.
If you vape, try to quit.
Ask your healthcare provider about managing allergies if these are a known trigger for you.
Use the asthma under control test(external link) to check if your asthma is well controlled or not.
Use a peak flow meter to take and record regular readings to check that your asthma is under control.
Stay active – physical activity improves how well your lungs work, and people who are fit usually find they have less asthma and cope better when they do have it. There are many elite athletes with asthma.
Visit your asthma team (your healthcare provider, your practice nurse and your pharmacist) regularly. They will review the medicines you're taking and can teach you how to use your inhaler properly so you get the most benefit.
Keep your dust-mite allergy under control.
Ask for a specialist referral if your asthma is severe or seems difficult to treat in spite of:
- you using your inhalers as prescribed, and
- other factors that increase asthma-like symptoms being ruled out.

Read more about an asthma action plan.(external link)

Apps reviewed by Healthify

You may find it useful to look at some asthma apps.

Support

Asthma New Zealand(external link) provides education, training and support to individuals with asthma/COPD and their whānau.

It can be hard to remember directions or instructions from your healthcare provider. That's why you also need an asthma action plan. This is a written document to help you remember what you need to do to manage your asthma well.

It includes information on how to:

manage your asthma daily, including taking medications correctly
identify and avoid exposure to allergens and irritants that can bring about asthma symptoms
recognise and handle worsening asthma symptoms, and when, how, and who to contact in an emergency.

You can develop your asthma management plan with your healthcare provider. It will be based on how severe your asthma is and your preferences. At each visit with your healthcare provider, you can review your plan and make changes as needed.

Regular peak flow monitoring may help you to get good control of your asthma. Your peak flow reading target may be included in your asthma action plan.

What are the benefits of an asthma action plan?

Using an asthma action plan that meets your individual needs has been found to:

reduce absences from work or school
reduce hospital admissions
reduce emergency visits to general practice
reduce reliever medication use
improve lung function.

Sample asthma action plans

Asthma + Respiratory Foundation NZ has action plans for adults and children(external link).

New Zealand Sign Language videos about asthma, produced by Platform Trust, in partnership with Deafradio and Healthify He Puna Waiora, NZ. These videos are NZSL translations of Healthify pages on asthma.