You have asthma symptoms every day, and frequently during the night. 

What is happening in your lungs?

• You have chronic inflammation in the inner lining of the bronchioli, and this inflamed mucous membrane is swollen and red, decreasing the diameter of the lumen of the bronchioli. The inflammation is chronic and severe. Using only a bonchodilator is not enough. The bronchodilator cannot reduce the inflammation. You need treatment to reduce the chronic inflammation, probably due to an allergen or allergens. The only way to reduce chronic inflammation is to treat it daily with an anti-inflammatory drug. In the case of inflammation of the bronchioli,

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  the best and most effective treatment is corticosteroid (an anti-inflammatory) administered directly to the lungs by inhaling it in aerosol form. In summary: You need to take your inhaled corticosteroid every day (most probably twice a day, as prescribed by the doctor). 
• The circular muscles around the bronchioli constrict quite often in your case,  probably triggered by some or other allergen or event. This constriction can narrow the inner, already swollen, lumen of the airways even more. This further narrowing will lead to asthma symptoms: your chest can feel tight, you will feel as if it is difficult to breathe, and you may have a dry, chesty cough. Whenever you feel these symptoms, you need to use your short-acting bronchodilator inhaler. This medication will relax the constricted circular muscle very soon and the whole muscle wall will relax, opening the lumen again.

Your treatment

• You need a short-acting bronchodilator (beta 2 blocker) maybe four to six times a day when your symptoms worsen.
• Your need increased dosages of inhaled corticosteroids to reduce the severe inflammation.
• You also need a long-acting bronchodilator to keep the muscles relaxed. Nowadays the corticosteroid and long-acting beta2 blocker are combined in one inhaler.
• You may even need theophylline intravenously.
• You may need oral corticosteroids for seven to 14 days to gain rapid control over the severe inflammation.

Helpful tips for an action plan

• Your doctor may hospitalise you. 
• Never go without your short-acting bronchodilator inhaler. Use when you need to.
• Use your daily inhaled corticosteroid or combination inhaler as prescrided. 
• Stay in contact with your doctor if you're at home. Don't be on your own.  
• Try to relax so that you can get better. 
• Stay clear of all possible allergens. 

Read more:
Symptoms of an asthma emergency

National Asthma Education Programme (NAEP)
Allergy Society of South Africa (ALLSA)
 

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