Asthma
Also called: reactive airway disease, bronchial asthma
A long-term condition where the airways become inflamed and narrow in response to triggers, causing wheeze, cough and breathlessness that come and go.
Quick answer
- What it is
- The airways are persistently inflamed and over-reactive. When triggered, the muscle around them tightens and the lining swells, narrowing the passage air moves through.
- Common symptoms
- Wheezing, coughing (often worse at night), chest tightness and shortness of breath — typically coming in episodes rather than being constant.
- How it's treated
- A reliever inhaler for symptoms, and for most people a daily controller inhaler that treats the underlying inflammation.
- Who can help
- Diagnosis and the treatment plan come from a physician or nurse practitioner. Pharmacists check inhaler technique, which is where a great deal of treatment is lost.
- Warning signs
- Reliever not working, difficulty speaking a full sentence, or lips turning blue — call 911.
Managing this long term? Pill4Me pharmacists in Chilliwack can help.
Book a medication reviewWhat is asthma?
Asthma is an inflammatory condition, not simply a mechanical one. Between episodes the airways can look and feel normal, but the underlying inflammation is still present — which is why treatment that only opens the airways during symptoms addresses half the problem. The reliever inhaler relaxes the muscle around the airway and works within minutes; the controller inhaler, usually an inhaled corticosteroid, reduces the inflammation that makes the airways twitchy in the first place.
That distinction drives most of what matters in asthma care. Needing a reliever inhaler frequently is not a sign to use more reliever, it is a sign the underlying inflammation is not being controlled well enough. As a rough guide, needing it more than about three times a week — or going through more than one reliever inhaler in a few months — is worth a review.
Asthma varies enormously between people and over time. Triggers differ, severity differs, and control can change with seasons, infections, and life circumstances. The plan that worked two years ago is not automatically the right one now.
Common symptoms
Symptoms tend to come and go, and are often worse at night or early morning. They can include:
- Wheezing — a whistling sound when breathing out
- Coughing, particularly at night, after exercise, or with cold air
- Shortness of breath
- Chest tightness
- Difficulty sleeping because of coughing or breathlessness
- Symptoms that flare with colds, allergens, exercise or smoke
Having these symptoms does not confirm a diagnosis — they overlap with other conditions. Assessment by a pharmacist, physician or nurse practitioner is what establishes the cause.
Causes and risk factors
What causes it
- Airway inflammation that persists between episodes and makes the airways over-reactive
- A combination of genetic and environmental factors — asthma often runs alongside eczema and hay fever in the same person or family
- Early-life exposures including respiratory infections and tobacco smoke
What raises the risk of developing it
- A family history of asthma, eczema or allergies
- Personal history of eczema or allergic rhinitis
- Exposure to tobacco smoke, including in childhood
- Air pollution, and occupational exposures such as dusts, fumes and isocyanates
- Obesity
- Frequent respiratory infections in early childhood
Risk factors make a condition more likely across a population — they are not causes, and having several does not mean you will develop it.
When should I seek medical care?
Seek urgent or emergency care
- Reliever inhaler not helping, or wearing off much faster than usual
- Difficulty speaking a full sentence without stopping for breath
- Lips or fingernails turning blue or grey
- Sucking in of the skin between the ribs or at the neck when breathing, particularly in children
- Any of these mean call 911 — a severe asthma attack can worsen quickly
If you are unsure how urgent something is, call 8-1-1 to speak with a HealthLink BC nurse at any hour, or 911 in an emergency.
Worth asking a pharmacist
- Inhaler technique — a very large share of people use inhalers incorrectly, and this is quick to check and fix
- Whether a spacer would help, and how to use and clean one
- Running out of reliever inhalers more quickly than expected
- Side effects such as hoarseness or oral thrush from a controller inhaler, which technique and rinsing usually resolve
- Refills and coverage questions
See a physician or nurse practitioner
- Needing your reliever inhaler more than about three times a week
- Symptoms waking you at night
- Asthma limiting your activity or exercise
- More than one course of oral steroids in a year
- Symptoms starting for the first time in adulthood, which should be properly assessed rather than assumed to be asthma
How is asthma treated?
Lifestyle measures
- Identifying and reducing your own triggers, which vary widely between people
- Stopping smoking, and avoiding second-hand smoke and vaping
- Annual influenza vaccination, which is recommended for people with asthma
- Managing allergic rhinitis if present, since untreated nasal symptoms make asthma harder to control
- Keeping a written asthma action plan from your prescriber, so you know what to do when symptoms change
Medication
Reliever inhalers such as salbutamol open the airways within minutes and are used for symptoms. Controller inhalers containing an inhaled corticosteroid treat the underlying inflammation and are taken daily whether or not you feel unwell. Combination inhalers pair a corticosteroid with a long-acting bronchodilator. Canadian practice has moved away from relying on reliever-only treatment for most people. Which regimen suits you depends on how often you have symptoms, your age, and how well controlled you are.
Monitoring
Control is assessed by how often you have symptoms, how often you need your reliever, whether symptoms wake you, and whether asthma limits activity. Lung function testing is used at diagnosis and periodically. Inhaler technique is worth rechecking at least once a year — it degrades over time without anyone noticing.
This is a general overview, not a treatment plan. What is right for you depends on your history, your other conditions and everything else you take — that is a conversation with your prescriber or pharmacist.
Medications used for asthma
These are commonly used in Canada for this condition. Being listed here does not mean a medication is appropriate for you — that depends on your assessment.
Browse every guide in the Drug Information A–Z.
Can a BC pharmacist assess asthma?
Not for diagnosis
Asthma is diagnosed and managed by a physician or nurse practitioner and is not one of the minor ailments BC pharmacists can diagnose and prescribe for. Where pharmacists make the biggest practical difference is inhaler technique — a substantial proportion of people do not get the full dose into their lungs, which looks like poorly controlled asthma and gets treated with more medication. We can also fit a spacer, manage refills, and flag when reliever use suggests a review is due.
Coverage in British Columbia
Coverage of inhalers depends on the specific product, your indication and your PharmaCare plan, and some devices require Special Authority. Reliever inhalers are generally inexpensive; some combination controller inhalers are not. Ask Pill4Me Pharmacy to check what applies before you fill — 604-705-3644.
Coverage depends on the medication, indication, PharmaCare plan and, for some medications, Special Authority requirements — see BC PharmaCare.
Frequently asked questions
What is the difference between a reliever and a controller inhaler?
How often is too often to use my blue inhaler?
Can a pharmacist prescribe an inhaler in BC?
Do I really need a spacer?
Why do I get hoarse or get thrush from my controller inhaler?
Related reading
Guides and services
Managing this long term?
Most of what goes wrong with long-term conditions is medication-related — interactions, side effects that quietly stop people taking things, doses that drift out of step. A pharmacist review covers all of it, and moving your prescriptions to Pill4Me means someone is watching Asthma between appointments.
Pill4Me Pharmacy is at 5625 Promontory Rd Unit 101, Chilliwack, BC. We deliver free to Chilliwack, Sardis, Promontory, Vedder and Yarrow, and you can reach a pharmacist directly at 604-705-3644.