It’s typical for asthma that the symptoms “come and go”. You have trouble breathing and your chest feels tight. You can hear wheezing when you breathe or cough. These symptoms often come during exercise or during the night.

You may get used to the asthma symptoms and not realize that the your airflow is impaired and can be improved by treatment.

A major worsening of symptoms, usually rather sudden, is called an asthma attack. During an asthma attack, your have noticeably more trouble breathing. Attacks can range from mild to severe.

Some causes and triggers are common to all people with asthma, and some are more individual, especially allergens (what you are allergic to). The severity of the symptoms or an attack can differ and also be different for different people, and the treatment more or less effective for the individual asthmatic.

The following triggers can cause asthma symptoms or start an asthma attack:

• Infections - usually caused by a virus (e.g. colds or flu)
• Allergens – most often from house dust mites, pets or pollen
• Exercise - especially in cold weather
• Emotions - such as excitement, fear or anger
• Irritants - such as tobacco smoke or air pollution
• Food additives or allergens – such as tartrazine (an artificial food colouring) or peanuts (in sensitized or allergic people, there can be a systemic allergic reaction).

It is important to remember that if asthma is properly treated, the risks are lower, the severity of the symptoms or attack is less, and most people can have long symptom-free periods. Since the condition is not constant, but changes over time, every person with asthma has good or better days (or periods) and bad or worse ones

• Rapid worsening of symptoms that do not get better even after you take your airway opener medication 
• Symptoms don't improve at all, or rapidly return after you have taken your airway opener medication. 
• Difficulty talking because you are short of breath.
• A peak flow reading below 40% of your normal value, which is not improved by the airway opener medication.
• A peak flow reading that – according to your Asthma Management Plan – puts you at risk of an asthma attack.

Unfortunately, deaths still occur in acute, severe asthma. But this is unusual and can be prevented.

It has been shown that in most asthma deaths, there has not been enough treatment, perhaps because the asthmatics did not realize or want to admit how serious it was, or perhaps because they had not been guided correctly by their doctors and nurses.

The correct use of controlling and preventive medication is the key to preventing these tragedies.

Many people with asthma forget or choose not to take their anti-inflammatory medication, especially during periods when they are feeling well. When their asthma becomes worse they try to make up for this by increasing the doses of airway opener medication to open up their airways. This will however not treat the underlying inflammation. It is very important to remember that asthma medication is not only for treating the symptoms, but also for treating the underlying inflammation. If treatment of the underlying inflammation is not maintained, it may lead to severe life-threatening attacks.

When you lose your breath because of an asthma attack, it is because the airways have become narrow. This is what happens: 

• The lining of the airways becomes swollen because of inflammation. 
• The production of mucus (phlegm) increases and may block the airways.
• The muscles in the walls of the airways tighten.

During an asthma attack, all of these things happen in different degrees.  You can lose your breath for other reasons than asthma, for example during physical exercise, especially if you are not in good shape.

If you lose your breath without typical asthma symptoms and if asthma medication has no effect, then other reasons should be discussed with your doctor.

During an asthma attack, you will find it harder to breathe because your airways have become narrower.

Wheezing occurs and you may also feel tightness in your chest and experience a dry, irritating cough.

You may feel as if you are trying to breathe through a straw while holding your nose.

If the PEF value drops to half of the usual level, it’s time to seek emergency help.

When the usual treatment does not give the effect you wish – control of your asthma – you should see your doctor again.
Someone who regularly measures his/her PEF (Peak Expiratory Flow), or knows how much it is when the asthma is well controlled, can have as a rule of thumb that if the PEF value declines to less than two-thirds of the usual level, it is time to be cautious, and to increase the amount of medication.

A PEF value that is about half or less than half of the usual level often indicates the need for immediate help. But note that this varies from person to person.

It is best if you and your doctor together define a personal PEF value for you that indicates when it is time to increase the dose of medication or seek acute help. This should be combined with a written treatment plan for your medications.

Yes. Asthma medications are not only very effective as relievers - even more important, they act as controllers, and can prevent most asthma attacks when used regularly.