Asthma

Overview

Asthma is a long-term (chronic) disease of the airways, the tubes that carry air into the lungs. In asthma the lining of these tubes is inflamed (swollen and irritated). When something sets it off, the muscles around the tubes tighten, the walls swell further and more mucus (sticky fluid) is made. The tubes become narrow and air cannot move out easily. This causes wheeze (a whistling sound when breathing out), cough, a tight chest and shortness of breath. The symptoms vary from day to day and are often worse at night, early in the morning or after exercise.

Asthma affects both children and adults. The World Health Organization estimates that around 363 million people worldwide were living with asthma in 2023, and it is the most common long-term illness in children. Most asthma deaths happen in low- and middle-income countries, where the condition is often not diagnosed or not treated properly. The good news is that asthma can be well controlled. Inhaled medicines that calm the inflammation and open the airways, together with avoiding known triggers, allow most people to live a normal, active life.

Asthma is not the same as an asthma attack. An attack (also called an exacerbation or flare-up) is a sudden or gradual worsening of symptoms that needs extra treatment and sometimes emergency care. Good day-to-day control is the best way to prevent attacks.

Symptoms

• Wheeze, a whistling or squeaky sound when breathing out (sometimes also when breathing in)
• Cough that keeps coming back, often worse at night or on waking
• Shortness of breath, which in severe cases can happen even at rest
• A feeling of tightness or pressure in the chest
• Symptoms that come and go and change in how bad they are
• Symptoms that get worse with exercise, laughing, cold air, dust, smoke, pollen or a cold
• Waking at night because of cough or breathlessness
• Needing a reliever inhaler often to get through the day

Causes and risk factors

Causes

• The exact cause is not known; a mix of inherited genes and the environment is thought to be responsible
• Long-term inflammation of the airway lining that makes the airways over-sensitive
• Triggers that set off symptoms in a sensitive airway: viral colds and flu, house dust mites, mould, pollen, animal fur or feathers, smoke, fumes, strong perfumes and soaps, cold air, and some medicines
• Chemicals or dusts breathed in at work (occupational asthma)
• Exercise, especially in dry or cold air (exercise-induced asthma)

What makes it more likely

• A parent, brother or sister with asthma
• Other allergic conditions such as eczema or hay fever (allergic rhinitis)
• Being exposed to tobacco smoke before birth or in early childhood, or smoking or vaping yourself
• Indoor and outdoor air pollution, including smoke from cooking fires and traffic fumes
• Being born early or with a low birth weight, or having many chest infections as a young child
• Being overweight or obese
• Living in a city, probably because of several lifestyle and pollution factors
• Breathing in chemicals, dusts or fumes at work

Complications

Poorly controlled asthma disturbs sleep, causes tiredness during the day and makes it hard to concentrate, so children miss school and adults miss work. The most serious complication is a severe asthma attack, which can need emergency treatment or a hospital stay and can be fatal, even in people whose usual symptoms are mild. Asthma that is not treated with an inhaled steroid over many years can lead to a permanent loss of lung function. Using only a reliever inhaler without a steroid inhaler raises the risk of attacks and death. Repeated courses of steroid tablets for attacks carry their own side effects, which is another reason to keep asthma under control.

Diagnosis

There is no single test for asthma. The doctor first takes a careful history, asking about the pattern of symptoms, what sets them off, allergies in the family and any changes on days away from work. The chest examination is often normal between episodes. Because many people are wrongly labelled as having asthma, guidelines advise confirming the diagnosis with an objective test before long-term treatment is started.

The main test is spirometry, a breathing test that measures how much air you can blow out and how fast, repeated after a dose of a reliever inhaler to see if the airways open up. Where spirometry is not available, a simple peak flow meter can be used at home, recording the best blow morning and evening for about two weeks to look for a large day-to-day swing. Blood tests for eosinophils (a type of allergy-related white cell) and a breath test for nitric oxide (FeNO) can support the diagnosis. In some cases a specialist arranges a bronchial challenge test, allergy skin tests, or a trial of inhaled steroid followed by repeat testing. In children under five, lung tests are hard to do, so the doctor may give a trial of treatment and review the response.

Treatment

1. Confirm the diagnosis, agree the goals of treatment and learn correct inhaler technique with a pharmacist, nurse or doctor; a spacer should be used with a pressurised (puff) inhaler, especially in children
2. Everyone with asthma should be on an inhaled corticosteroid (ICS, a steroid medicine that calms airway inflammation). Guidelines say asthma should never be treated with a reliever (salbutamol-type) inhaler on its own, because this increases the risk of severe attacks
3. The preferred approach for adolescents and adults is an inhaler combining a low-dose ICS with formoterol, used as the reliever when needed and, if symptoms are more frequent, also taken regularly (maintenance and reliever therapy, MART)
4. Where a combined ICS-formoterol inhaler is not available or not suitable, the doctor prescribes a regular ICS inhaler (on its own or combined with a long-acting bronchodilator) plus a separate reliever inhaler for symptoms. In children aged 5 to 11 a regular low-dose ICS plus a reliever is the usual start
5. If control is still poor, the doctor first checks inhaler technique, adherence (taking the medicine as prescribed), smoking, triggers and other illnesses such as rhinitis or reflux, and then steps up the ICS dose or adds another medicine such as a leukotriene receptor antagonist or a long-acting antimuscarinic bronchodilator
6. A short course of steroid tablets may be prescribed during an attack; severe or difficult asthma is referred to a specialist, who may consider injectable biologic medicines
7. Review at least once a year and after every attack; once asthma has been well controlled for a few months the dose can be stepped down slowly, but the ICS is not stopped in adults

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Biologic injections for severe asthma (anti-IgE, anti-IL-5, anti-IL-4 receptor and anti-TSLP antibodies), prescribed by specialists, Oxygen during a severe attack, given in hospital

Self-care and prevention

Self-care

• Use your preventer inhaler every day as prescribed, even when you feel well; the inflammation is still there
• Learn and practise your inhaler technique and ask the pharmacist to check it; use a spacer with a puff inhaler
• Keep a written asthma action plan that says which medicines to take, how to step up when symptoms worsen and when to get urgent help
• Do not smoke or vape, and keep your home and car free of tobacco smoke
• Find out your own triggers and reduce contact with them where this is practical, for example dust, mould, animal fur, strong fumes and cooking smoke
• Stay physically active; exercise is good for you and symptoms during exercise can be managed with your doctor's advice
• Treat hay fever (allergic rhinitis) and, if you are overweight, aim to lose weight, as both improve asthma control
• Keep your vaccinations up to date, including flu and other respiratory vaccines as advised locally

Prevention

• Avoid smoking in pregnancy and around babies and children; tobacco smoke exposure early in life raises the risk of asthma
• Reduce indoor smoke from cooking fires and avoid heavy outdoor air pollution where possible
• If you have asthma, attacks are prevented by taking your inhaled steroid regularly and never relying on a reliever alone
• Keep an up-to-date action plan and see your doctor for a review at least once a year and after any attack
• If symptoms are worse at work and better on holiday, tell your doctor; removing the exposure early can prevent permanent asthma

Common questions

Can asthma be cured?

No. Asthma is a long-term condition and there is no cure. However, with regular inhaled treatment and trigger avoidance most people have few or no symptoms and can live a normal life. Some children have fewer symptoms as they grow up, but the tendency can return.

Are steroid inhalers safe to use for years?

Inhaled steroids work directly in the airways in very small amounts, so the risks are much lower than with steroid tablets. Guidelines say they are the essential medicine for everyone with asthma and that they reduce attacks and deaths. Rinsing the mouth after use and using a spacer reduce the small local side effects. Your doctor chooses the lowest dose that keeps you well.

Why can I not just use my blue reliever inhaler when I need it?

A reliever opens the airways for a short time but does nothing for the inflammation underneath. Using a reliever on its own is linked to more attacks, worse lung function and a higher risk of death. International and UK guidelines now say asthma should never be treated with a reliever alone; every person should have an inhaled steroid, either in a combined inhaler or separately.

What is a spacer and do I need one?

A spacer is a plastic chamber that fits onto a puff (pressurised) inhaler, with a mouthpiece or mask at the other end. It holds the spray so you can breathe it in slowly, which gets more medicine into the lungs and less into the mouth. Guidelines recommend a spacer with a puff inhaler, especially for children and during attacks.

Is it safe to exercise with asthma?

Yes. Regular physical activity is recommended for people with asthma and may slightly improve control. If exercise brings on symptoms, tell your doctor; this can usually be managed with the right treatment plan before exercise. Well controlled asthma should not stop you playing sport.

Sources

1. Global Initiative for Asthma (GINA). Summary Guide for Asthma Management and Prevention: For Adults, Adolescents and Children 6-11 Years (2026 GINA Summary Guide) (2026).
2. NICE / BTS / SIGN. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) NG245 (2024).
3. World Health Organization. Asthma (2026).
4. MedlinePlus (US National Library of Medicine). Asthma | Asthma Symptoms | Asthma Attack | MedlinePlus (2026).
5. BMC Pulmonary Medicine (PMC). Epidemiology of asthma and associated factors in an urban Pakistani population: adult asthma study-Karachi (2018).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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