• Coughing, which is usually worse in the morning or at night, or that is worsened by viral infection, such as with a cold or the flu.
• Shortness of breath
• Tightness, pain or pressure in your chest
• Wheezing (a whistling sound when breathing) (this is a common sign of asthma in children)
• Trouble sleeping caused by breathing problems.

When to see your doctor:​

Because severe asthma attacks can be life-threatening, you must know when your symptoms are worsening and when you need emergency treatment, such as:

• Sudden and rapid worsening of shortness of breath or wheezing with no improvement even after using a quick-relief inhaler.
• Breathlessness when you are doing mild physical activity that usually does not affect your breathing.
• If your medication does not seem to ease your symptoms and you need to use your quick-relief inhaler more often.

According to the Global Initiative for Asthma (GINA), almost 4 million South Africans have asthma, including 10 % of children and 5 % of adults. It is not entirely clear what predisposes people to asthma, but it is thought that it is due to a combination of environmental and genetic factors.

The different types of asthma and their causes include:​

• Exercise-induced asthma which is brought on by physical activity and may worsen in cold, dry weather conditions.
• Occupational asthma which can be triggered by workplace irritants such as chemicals in dusts or fumes.
• Allergy-induced asthma which is usually triggered by airborne substances that produce allergies (allergens), such as pollen, mould spores and pet dander.

• Respiratory infections, such as the common cold or flu
• Cigarete smoke and air pollution.
• Certain medications, including beta-blockers, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
• Stress.
• Some preservatives in foods and beverages.
• Gastroesophageal reflux disease (GERD), a condition in which stomach acid can reflux (flow back) into your oesophagus and sometimes into the throat.

A number of factors are thought to increase your risk of developing asthma, including:​

• A family history: Having a close family relative, such as a parent or sibling, with asthma, means that you are also at increased risk of developing asthma.
• Atopy: If you have another allergic condition, such as atopic dermatitis or hay fever, increases your risk of developing asthma.
• Lifestyle factors: Being overweight or obese, cigarette smoking or exposure to second-hand smoke, exposure to air pollution (such as car fumes) and exposure to occupational triggers (such as chemicals used in agriculture, hairdressing and manufacturing), all increase your risk of developing asthma or aggravating your asthma symptoms.

Some tips to help you manage your asthma symptoms and avoid asthma attacks include:

• Follow your asthma action plan, including a treatment/medication plan: Speak to your doctor about how exactly to take your medication and be sure to follow the instructions. Taking control of your treatment can make you feel more in control of your life.
  It is very important that you do not change your medications without first talking to your doctor, even if your asthma symptoms seem to be improving.
• Identify and avoid your asthma triggers: A number of outdoor allergens (like pollen) can trigger asthma attacks. Find out what causes or worsens your asthma and take steps to avoid these. This includes making your home allergy-free.
• Get vaccinated for influenza and pneumonia: Staying current with vaccinations can prevent flu and lower respiratory tract infections, which can trigger asthma attacks.
• Identify and treat asthma symptoms early: If you act quickly, you are less likely to have an asthma attack. Be able to identify symptoms such as breathing changes and a wheeze. Or, you can also use your peak flow measurements to alert you to an oncoming attack. Once you have recognised your symptoms, take your medication as planned. Also, immediately stop any activity that may have triggered the attack. If your symptoms do not improve, get medical help.
• Pay attention to how often you use your quick-relief inhaler: If are relying on your quick-relief inhaler too much, your asthma may not be under control and you will need to see your doctor about adjusting your treatment.
• Stay generally healthy: Regular exercise strengthens your heart and lungs, which helps relieve asthma symptoms. If you exercise in cold temperatures, you can wear a face mask to help warm and moisten the air you breathe. Also, maintain a healthy weight through a healthy diet and manage stress, as being overweight and experiencing emotional distress can worsen asthma symptoms. Additionally, avoid cigarette smoke as a known trigger of asthma symptoms. Talk to your doctor about ways to quit smoking.
• Control heartburn and gastroesophageal reflux disease (GERD): Acid reflux that causes heartburn may damage lung airways and worsen asthma symptoms. If you have frequent or constant heartburn, talk to your doctor about treatment options.
• Support your child if they have asthma: Encourage your child by focusing your attention on the things they can do. Involve teachers, coaches, friends and relatives in helping your child manage asthma.

The right medication for your asthma depends on your age, symptoms and triggers, amongst other things.

Preventive, long-term control means reducing swelling (inflammation) in your airways that leads to symptoms, while quick-relief inhalers (bronchodilators) quickly open up swollen airways that are limiting breathing. You may also need allergy medications.

Long-term asthma control medications are generally taken daily and keep asthma under control so that you are less likely to have an asthma attack.

• Inhaled corticosteroids: These medications include fluticasone propionate, budesonide, ciclesonide, beclomethasone, mometasone, and fluticasone furoate. You may need to use these medications for several days to weeks before they you feel they exert a beneficial effect. Unlike oral corticosteroids, inhaled corticosteroids have a relatively low risk of serious side effects.
• Leukotriene modifiers: These oral medications (montelukast, zafirlukast and zileuton) help relieve asthma symptoms. However, some of these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations and depression. Seek medical advice right away if you experience any of these reactions when taking these medications.
• Combination inhalers – Long-acting beta2-agonist & corticosteroid (LABA): Medications (such as fluticasone-salmeterol, budesonide-formoterol, formoterol-mometasone and fluticasone furoate-vilanterol) contain a long-acting beta2-agonist (see under quick-relief medications) along with a corticosteroid. A long-acting beta2-agonist is a bronchodilator that widens the tubes in the lungs, while the steroid helps control the underlying inflammation in the lungs.
• Theophylline: This is a daily oral medication (tablet) that helps relax the muscles around the airways. You may need to have a blood test for your doctor to prescribe this medication.
• Quick-relief (rescue) medications are used as needed for quick but short-term relief of symptoms. They may also be used before exercise if recommended by your doctor.

• Short-acting beta2-agonists: These are typically inhaled using a portable, hand-held inhaler or nebuliser (a machine that converts asthma medications to a fine mist inhaled through a mouthpiece or face mask), and rapidly cause your airways to open (bronchodilators). Beta2-agonists typically exert an effect within minutes to especially relieve symptoms during an asthma attack. They include salbutamol. However, you should not be using your quick-reliever pump often as it shows that your asthma is not being managed properly. Therefore, keep a record of how many puffs you use per day or week, and if you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor who will probably have to adjust your long-term control medication.
• Anticholinergic agents: These are also bronchodilators and include ipratropium and tiotropium. These medications act quickly to immediately relax the muscles in your airways, making it easier to breathe. They are mostly used for the management of chronic obstructive disorder (COPD) but are also used for the treatment of asthma.
  • Oral and intravenous corticosteroids: These medications, which include prednisone, relieve inflammation in the airways. However, they can cause serious side effects when used over a long term. Therefore, these drugs are usually only used on a short-term basis.

• If your asthma is not managed properly, you can experience complications, including:
• Problems with sleep, work and other activities, including sick days from work or school during asthma flare-ups and emergency room visits and hospitalisations for severe asthma attacks.
• Side effects from long-term use of some medications, especially corticosteroids or theophylline.
• Airway remodelling from chronic inflammation in the airways that causes airway wall to thicken and increased mucous production, leading to coughing and difficulties with breathing.
• Asthma attacks and respiratory failure: Respiratory failure occurs when not enough oxygen can get from your lungs to your blood. While life-threatening asthma is rare, it typically causes symptoms that worsen over several days.
• Status asthmaticus which is an extreme form of sudden asthma exacerbation that is life-threatening and, as such, constitutes a medical emergency.