Dr. Prabhat AryaMD · Internal Medicine

Asthma is airways that over-react.

In asthma, the small airways of the lungs are sensitive. Dust, smoke, cold air, a cold or exercise can make them squeeze, swell and fill with mucus, and breathing becomes tight and wheezy. With the right inhalers, most people with asthma lead normal, active lives.

Book a video consultationEverything he looks after

In plain words.

Asthma often starts in childhood but can begin at any age. It runs in families, and often comes with allergies, a blocked nose or eczema. In India, air pollution, smoke from cooking fires, dust and cold weather are common triggers.

There are two jobs for an inhaler. A reliever opens the airways within minutes during an attack. A preventer, which contains a low dose of steroid, calms the swelling over days and weeks, and is taken every day, even when you feel well. Many people now use one combined inhaler for both jobs, as their doctor plans.

Inhalers put the medicine straight into the lungs, so the dose is tiny compared with tablets. They are not addictive, and they do not weaken the lungs. Many problems with asthma come from using the inhaler the wrong way, or stopping the preventer too soon.

Needing the reliever more than twice a week, or waking at night with asthma, means it is not controlled. That is a reason to review the treatment, not to put up with it.

Inside one airway

The lungs with their branching airways, and one small airway magnified and cut across. It has a ring of muscle, a soft lining and an open tube for air. In an asthma attack the muscle squeezes, the lining swells and sticky mucus gathers, so the tube narrows and breathing wheezes. With an inhaler, the reliever relaxes the muscle and the preventer calms the lining, and the airway opens again. one airway, cut across relaxed muscleopen airway tight muscleswollen liningwheezemucus reliever openscalmer lininginhaler

Between attacks the airway is open. A ring of muscle wraps it, and a soft lining inside keeps it moist.

Go to hospital now if

  • Too breathless to speak in full sentences, eat or sleep: go to hospital now.
  • Your reliever is not helping, or you need it more often than every four hours: go to hospital now.
  • Lips or fingertips turning blue or grey, drowsiness or confusion: call 112.
  • Breathing getting weaker from exhaustion, even as the wheeze fades: call 112. A quiet chest in a bad attack is a danger sign.
  • An oxygen reading below 92% on a pulse oximeter: call 112.
  • While you wait: sit upright and call 112 or get to hospital. Take one puff of a blue reliever every 30 to 60 seconds, up to 10 puffs, through a spacer if you have one. If you are no better after 10 puffs, call 112; if help has not come in 10 minutes, repeat. On a combined inhaler, follow your written plan. With a capsule inhaler, take a dose if you can breathe it in, but do not rely on it. With neither a blue reliever nor a plan, do not delay: call 112 or get to hospital now.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

See a doctor within a few days if

  • You use the reliever more than twice a week
  • Asthma wakes you at night
  • You have needed steroid tablets for an attack
  • You are pregnant, or planning to be
  • A cough, wheeze or breathlessness is new and has not been checked

Tests that help.

Not everyone needs every test. He decides which ones are worth doing for you.

TestsA general guide, not a prescription
TestWhat it tells
Spirometry with a reliever testBreathing out hard into a machine, before and after a reliever puff. The key test for asthma.
Peak flow readingsA small meter used at home. Readings that swing between morning and evening point to asthma.
Chest X-rayTo look for other causes when the story is unusual.
Blood count (eosinophils) and IgECan show allergic asthma, and sometimes guides treatment.
Oxygen level (pulse oximeter)During an attack. Below 94% needs a doctor urgently; below 92%, call 112.

Have it ready.

Tick them off as you gather them. The ticks stay on this phone only.

Online, or in person?

Never stop the preventer because you feel well: that is how it keeps you well. And do not rely on the reliever alone. Needing it often means the asthma is not controlled.

A video call can

  • Check your inhaler technique on video
  • Adjust the preventer and reliever, and write a plan for attacks
  • Spot your triggers, and help you avoid them
  • Arrange spirometry and go through the result

Needs a visit in person

  • Spirometry, at a lung-function laboratory
  • Listening to the chest, when a new problem needs examining
  • Nebuliser, oxygen or injections in a severe attack
  • Any sign in the red box: that is an emergency

Talk it through with Dr. Arya.

Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.

Book a video consultation

Dr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759