🫁 Men's Health

Asthma in Adults (Nigeria Guide)

Q: Can I use my blue inhaler every time I'm breathless?

The blue (salbutamol) inhaler relieves breathlessness but does not treat the underlying inflammation. Using it more than 2 days per week means your asthma is not controlled — you need a preventer (brown, red, or purple) inhaler. Relying only on the blue inhaler without a preventer is a major cause of asthma attacks and death.

Q: Is it safe to exercise with asthma?

Yes — exercise is beneficial for asthma. Exercise-induced bronchoconstriction (wheeze during exercise) is preventable: take 2 puffs of salbutamol 15 minutes before exercise. Warm up slowly. Swimming is particularly good for asthma as the warm, humid air is less irritating to airways.

Q: Can asthma be cured?

Asthma cannot currently be cured, but it can be completely controlled. With appropriate preventer treatment, most people with asthma have no symptoms, no limitations on activity, and no attacks. 'Controlled asthma' means no night waking, no reliever use (or <2 days/week), normal activity, and normal lung function.

Q: Does asthma get worse with age?

It varies. Some children 'grow out' of asthma (though it often returns in adulthood). Some adults develop new asthma. With good treatment, asthma does not inevitably worsen. Poorly controlled asthma causes progressive airway remodelling (permanent lung changes) — another reason for consistent preventer therapy.

Breathlessness, wheeze, and chest tightness — achieving asthma control in Nigeria

Asthma is a chronic inflammatory airway disease characterised by episodic breathlessness, wheeze, chest tightness, and cough — typically worse at night or early morning. It affects approximately 6–8% of Nigerian adults. In Nigeria, asthma is frequently undertreated — many patients rely only on short-acting reliever inhalers (salbutamol/Ventolin) without the anti-inflammatory preventer therapy that controls underlying inflammation. This leads to preventable attacks, hospitalisations, and deaths. Well-controlled asthma means living a fully active life.

Signs and Symptoms

✓ Recurrent episodes of breathlessness, wheeze (high-pitched whistling sound when breathing), chest tightness, and cough

✓ Symptoms worse at night or early morning

✓ Symptoms triggered by cold air, exercise, dust, smoke, respiratory infections, strong emotions

✓ Symptoms that vary from day to day — 'good days' and 'bad days'

✓ Rapid relief with a salbutamol (blue) inhaler confirms the diagnosis

✓ Persistent dry cough as the only symptom in some — 'cough-variant asthma'

Risk Factors

Allergic rhinitis or eczema — the atopic triad
Family history of asthma
Tobacco smoking or second-hand smoke exposure
Air pollution — urban Nigerian air quality, generator exhaust, kerosene cooking
Occupational exposures — flour dust (bakers), chemical fumes, latex
Obesity — associated with severe, difficult-to-control asthma
Viral respiratory infections — often trigger asthma episodes
NSAIDs or aspirin — trigger asthma in 10% of adults with asthma

When to Seek Help

Emergency — call 112Severe breathlessness at rest, unable to speak in sentences, blue lips or fingertips (cyanosis), peak flow <50% of best, not improving with repeated reliever inhaler — acute severe or life-threatening asthma

Same dayAsthma attack requiring reliever inhaler more than every 4 hours, or night waking with breathlessness

Within 1 weekUsing reliever inhaler more than 2 days per week — asthma not controlled, preventer therapy needs review

RoutineAsthma review every 6–12 months — check inhaler technique, step up or down treatment, assess control

SoonNew onset breathlessness and wheeze in an adult over 40 with smoking history — must exclude COPD and cardiac causes

Tests & Diagnosis

🧪 Peak expiratory flow (PEF)

Simple bedside test — patient blows as hard and fast as possible into a peak flow meter. Reduced and variable PEF supports asthma. Morning dipping (lowest PEF in the morning) is characteristic. Every asthma patient should have a peak flow meter

🧪 Spirometry

FEV1/FVC ratio <0.7 = airflow obstruction. Significant reversibility (≥12% and ≥200 ml increase in FEV1 after salbutamol) confirms asthma. Available at most tertiary hospitals in Nigeria

🧪 Bronchial challenge test

Methacholine or mannitol challenge — for suspected asthma with normal spirometry. Rarely available in Nigeria

🧪 Chest X-ray

Normal in asthma — used to exclude other causes (pneumothorax, pneumonia, heart failure)

🧪 Total IgE and blood eosinophil count

Elevated in atopic (allergic) asthma — guides biologic therapy decisions in severe asthma

🧪 FeNO (fractional exhaled nitric oxide)

Measures airway inflammation — high FeNO suggests steroid-responsive eosinophilic inflammation. Not widely available in Nigeria yet

Treatment Options

Avoid triggers

Stop smoking. Remove sources of indoor air pollution (generators, kerosene stoves — use outdoors or install extraction). Treat allergic rhinitis. Avoid known allergens. Use clean cooking fuels where possible

Reliever inhaler (SABA) — for symptom relief

Salbutamol (Ventolin) 100 mcg — 1–2 puffs as needed for breathlessness, wheeze, or chest tightness. If using more than 2 days per week, asthma is not controlled and preventer therapy must be started or increased

Preventer inhaler (ICS) — the cornerstone of asthma treatment

Inhaled corticosteroids (ICS): beclomethasone, budesonide, or fluticasone — taken EVERY DAY regardless of symptoms. Reduces airway inflammation, prevents attacks, reduces hospitalisation and death. Many Nigerians do not use preventer inhalers because they 'don't feel anything' — educate that they prevent future attacks

ICS + LABA combination inhalers (step up if ICS alone insufficient)

Seretide (fluticasone + salmeterol) or Symbicort (budesonide + formoterol) — once or twice daily. Do not use LABA without ICS — increases asthma death risk

MART therapy (for Symbicort)

Maintenance and reliever therapy — Symbicort 200/6 used both as daily preventer AND as-needed reliever (instead of separate salbutamol). Reduces severe attacks. Can be used with a single inhaler

Inhaler technique — essential

Correct technique delivers the drug to the lungs — poor technique means the drug hits the back of the throat and is ineffective. Use a spacer device (makes inhaler use much easier, especially in attacks). Every asthma review should include inhaler technique assessment

Oral prednisolone for acute attacks

40 mg prednisolone daily for 5 days for moderate-severe attacks. Do not stop abruptly. After an attack, review preventer therapy

Biologic therapies (severe uncontrolled asthma)

Omalizumab (anti-IgE) and mepolizumab (anti-IL-5) for severe allergic or eosinophilic asthma not controlled on high-dose ICS+LABA. Available at specialist centres. Transformative for a subset of severe asthma patients

Asthma action plan

Written personalised plan: what to do at each level of control (green/amber/red zones based on symptoms or peak flow). Every patient should have one and know how to follow it

Frequently Asked Questions

Can I use my blue inhaler every time I'm breathless?

The blue (salbutamol) inhaler relieves breathlessness but does not treat the underlying inflammation. Using it more than 2 days per week means your asthma is not controlled — you need a preventer (brown, red, or purple) inhaler. Relying only on the blue inhaler without a preventer is a major cause of asthma attacks and death.

Is it safe to exercise with asthma?