Asthma: Symptoms, First Aid and Staying in Control

Around one in nine Australians has asthma. Most manage it well for years, then a cold or a few missed preventer doses tips things over - usually at the worst hour. If breathing is difficult tonight and your clinic is shut, an after-hours GP consultation or a telehealth appointment can help - though a severe attack is a 000 call, not a booking.

What is asthma?

Asthma is a long-term condition of the airways. The walls are inflamed and easily irritated, so when a trigger arrives they swell, the surrounding muscle tightens and mucus builds up. The tube narrows. Air still gets in, but getting it out becomes hard work - which is where the wheeze comes from.

That narrowing is reversible, which separates asthma from most other lung conditions. Treat it and the airway opens again.

What causes asthma?

There is no single cause. Asthma runs in families and sits alongside eczema and hay fever often enough that the three are treated as related. Early childhood infections, air pollution and tobacco smoke also contribute.

Triggers are a separate thing, and the practical part. Colds and flu, pollen, dust mites, pets, cold air, exercise, smoke, fumes and stress are the usual ones. Most people have a handful rather than all of them - working out your own is worth more than any general list.

Asthma symptoms

Four symptoms turn up most often, in any combination:

• Wheezing - a whistling sound, usually breathing out

• Shortness of breath, or not being able to fill your lungs

• A tight or heavy chest

• Coughing, often dry, worse at night or early morning

Night coughing is the one people miss. A cough that wakes you repeatedly, or shows up every time you run for a bus, is worth raising even if you have never wheezed. In young children the signs are subtler - tiring quickly, not finishing sentences, going quiet.

Thunderstorm asthma

This one is specific to Australia in a way most asthma information is not. In grass pollen season, certain storms break pollen into fragments small enough to reach deep into the lungs, then spread them across a city in minutes.

Melbourne, November 2016 is the reference case. Thousands presented with breathing difficulty within hours and ten died. What made it so dangerous was who it hit - many had hay fever and no asthma diagnosis, so no reliever at home and no reason to think they were at risk.

If you get hay fever in spring, that includes you. The season runs roughly October to December, varying by state. Keep hay fever treated, watch pollen forecasts, stay inside with windows shut when a storm rolls in, and if you have a preventer, this is the season to take it properly.

Asthma treatment, puffers and inhalers

Treatment works on two fronts. A reliever - the blue or blue/grey puffer - opens the airways within minutes and is what you reach for during symptoms. A preventer is taken daily whether or not you feel unwell, reducing inflammation so attacks come less often and less severely.

The daily part is where things fall apart. Preventers do nothing noticeable in the moment, so people stop once they feel fine and the protection quietly disappears. Needing your reliever more than twice a week is a recognised sign control has slipped - see your doctor rather than buy another puffer.

Technique matters more than people expect. A spacer gets far more medicine into the lungs than a puffer alone, and plenty of long-term users have drifted into using theirs wrong. Ask a pharmacist to watch you.

Your asthma action plan

An asthma action plan is a written document your regular GP prepares with you. It sets out your medicines, how to tell when things are worsening, what to do at each stage and when to call for help. Australian asthma guidelines recommend everyone with asthma has one, and people who do are hospitalised less often.

Keep it somewhere you would actually find at 3am, and give a copy to school, work or childcare. Review it yearly and after any flare-up. Your regular GP writes it - an after-hours service handles the acute episode, not the plan.

When to see a doctor

Book in if you are using your reliever more than twice a week, waking at night, finding exercise harder than it should be, or if your last flare-up was worse than usual. New wheeze, or a cough lasting weeks, should be checked at any age.

13CURE covers the after-hours gap. Bookings run Monday to Friday 6pm to 8am, Saturdays from 12pm, and 24 hours Sundays and public holidays. Consultations are bulk billed for eligible Medicare and DVA cardholders - the bulk billing GP page covers eligibility. A bulk billed telehealth appointment suits most questions, and a home doctor visit may be available depending on location, listed on the areas we cover page.