Asthma is a chronic respiratory condition that affects both young and old. 

Around 5% of Singapore residents aged 18 to 69 years are diagnosed with Asthma. 

A patient with Asthma has air passages that are more sensitive to triggers compared to others without Asthma. When exposed to these triggers, patients usually present with symptoms such as:

• Coughing, 

• Wheezing, 

• Tightness in the chest, as well as 

• Breathlessness

Asthma can be diagnosed using a test called Spirometry, which assesses your inhalation and exhalation patterns. It is important to manage Asthma with medications delivered by inhaler devices to reduce the inflammation within the air passages.

If you have a question about asthma that you've been wanting to get off your chest, don't miss this limited-time chance to ask our doctor now!

About Dr Navpreet Kaur

Dr Navpreet Kaur is a Family Physician at SingHealth Polyclinics - Marine Parade. She graduated from Barts and the London School of Medicine and Dentistry (UK), and completed the Master of Medicine in Family Medicine, MMed (FM) training in Singapore in 2018. 

She has a deep interest in education, and is a faculty within the SingHealth Family Medicine Residency Program, where she guides residents during their specialisation within the field.

Questions and answers on asthma

1. Question by Terrie

Hi doctor,

I would like to check why lately I feel breathless and have increase my Seratide dosage and frequent use of my Salbuair to temper my breathlessness.

What else can I do to improve situation? Thank you for your advice.

Answer by Dr Navpreet Kaur

Hi Terrie,

You are advised to visit your physician for a detailed assessment to determine the cause of your breathlessness, as it may be caused by any other medical conditions, such as a cardiac issue. However, frequent use of salbutamol inhaler is a sign of poorly controlled asthma.

If your symptoms are caused by asthma, I would advise you to look out for factors that trigger your attack and to avoid them. At your next physician's visit, you should check if your technique to administer your inhaler is correct. You can also explore other treatment options to obtain better control of your Asthma. For example, there are other inhalers such as Symbicort, which may be used as a single maintenance or reliever therapy, and Relvar, which can be prescribed based on your physician's advice.

You are also advised to take your annual Influenza vaccination to protect yourself against the flu.

2. Question by anonymous

Hi Dr,

What daily habits can I adopt to prepare for my golden years, considering my asthma? Are there specific exercises or dietary choices that could benefit me in the long run?

Thank you for considering my question and I look forward to receiving your reply. Have a nice day!

Answer by Dr Navpreet Kaur

Hi, you may consider the following healthy habits:

• Healthy diet
  - Consume a diet rich of fruits and vegetables for its general health benefit

• Weight Reduction and Physical Activity 
  - Ensure your BMI is within the normal range 
  - Participate in regular physical activities to improve your cardiopulmonary fitness once your Asthma is well controlled. There is no evidence to recommend a specific physical activity over another.

• Medications and Vaccinations
  - Ensure you have completed your Pneumococcal (2 vaccinations for patients aged 65 years and above) and the annual Influenza vaccination 
  - Do inform any of your care providers of your Asthma diagnosis if a new medication is being prescribed, as some medications may worsen your Asthma

• Smoking Cessation
  - Try to cut down and eventually stop smoking if you are a current smoker for better control of your Asthma. We now have Smoking Cessation Clinics at some of our polyclinics to assist our patients to quit smoking.

3. Question by Sherry

Dear Doctor Kaur,

I would like to know if cold sweat and breathing difficulties are related to asthma. Thank you.

Answer by Dr Navpreet Kaur

Hi Sherry,

Asthma is a condition where there is inflammation in the airways. It presents with symptoms of wheezing, shortness of breath, chest tightness and cough. These symptoms get better with time with the appropriate treatment.

Having just cold sweats and breathing difficulties could also point to other conditions, such as cardiac issues. Do consult your physician to carry out more extensive checks to assist you in obtaining an appropriate diagnosis for your symptoms. 

4. Question by Lisa

Dear Dr,

Does the steroid in Seretide cause hair loss? I have been taking a puff of Seretide once a day for a few decades already and have been experiencing hair loss gradually through the years.

Answer by Dr Navpreet Kaur

Hi Lisa,

Hair loss can be due to multi factorial reasons. There is no clear evidence for the link between hair loss and Seretide usage. Do explore this issue of hair loss with your physician at your next appointment.

5. Question by Li Lian

Dear Doctor,

I am 56 years old female. I have asthma since childhood. However, I do not need constant medication and I jogged regularly in my early 40s and stopped in late 40s due to knee problem. Then 4 years ago when I discovered that my lungs were grasping for air when I picked up jogging again.  To tackle this, I took inhaler before I jogged. This has helped with the breathing. I then stopped jogging due to knee problem again.

I started 15-min indoor slow-jog last year and have no issue with breathing.  But then when I took upstairs-climbing as an exercise recently, I started to grasp for air from 6 storey onwards. So I went to my GP and was prescribed Seretide which I "puffed" twice a day. This has helped greatly with my breathing and stairs-climbing exercise.

What has happened to me? Is there a "flare-up" of asthma?

Answer by Dr Navpreet Kaur

Hi Li Lian,

Asthma can be triggered by various reasons including exposure to allergens, intercurrent illnesses, smoke and pollution (e.g. haze, weather changes, stress, obesity etc.)

You have done the right thing by seeking help from your GP and starting regular preventative therapy. Once your symptoms settle down, you can discuss with your physician on a regime to tail down your preventative therapy.

In the meantime, identify and avoid any triggers, eat healthily, and engage in regular exercise as tolerated to build up your cardiopulmonary fitness. Do also note that climbing stairs may not be the best exercise choice in view of your knee problems. You may consider doing other exercises that have a lower impact, such as swimming, cycling etc.

6. Question by Mayvia

Hi Dr Navpreet Kaur,

I have 2 types of inhalers (Salibuaur and Iprovent) and would like to check which one should I use for everyday?

Answer by Dr Navpreet Kaur

Hi Mayvia,

These are both short acting inhalers (also known as reliever therapy) which should not be used regularly. These are meant to be used for fast relief of symptoms including cough, wheezing, or chest tightness during an exacerbation.

If you are using these inhalers regularly, it means your condition is not well controlled and you should see your doctor to titrate your preventative medications. The key to obtaining good asthma control is by using a regular inhaler (a preventer) with medications that contain Inhaled Corticosteroids.

7. Question by Marina

Dear Hi Dr Kaur,

My mum who is turning 73 this Sep 2024, has asthma since young.

She was infected with Covid in June 2022 and since then, her health has been going downhill.

She's perpetually coughing and has asthma attacks every now and then, causing her to be hospitalised 2-3x/year as she was unable to breathe normally.

Is there any hope that her asthma will get better at her age?

She is a very stubborn woman, she does not listen to our advice and continues to indulge in her favourite fried food and unhealthy snacks daily.

We are at your wits' end and really don't know what to do with her.

I look forward to hearing your advice. Thank you very much!

Answer by Dr Navpreet Kaur

Hi Marina,

Asthma flares occur due to various reasons. It is important to identify the triggers and try to avoid them.

There are some things that you can do to reduce the frequency of her attacks and in turn help her to achieve better control over her Asthma.

• Compliance to inhalers 
  - Do ensure that she takes her prescribed inhalers regularly
  - Ensure that the technique that she uses to administer her inhaler is appropriate (some elderly may benefit from using a spacer to assist them to get a better inhalation of medication) 
  - Speak to your physician whether her medication regime needs to be changed or if you need to be reviewed by a Respiratory specialist to consider other treatments (e.g. Biologics).

• Vaccinations
  - Ensure that your mother has taken her Pneumococcal Vaccinations (2-part series) as well as an annual Influenza Vaccination

• General well-being
  - Encourage her to eat healthily and participate in regular exercises to keep her immunity up

8. Question by Constance

Hi Dr,

Is it possible to get a Spirometry test done at a polyclinic?  If no, how can one arrange for a Spirometry test?

Is it possible to develop asthma only in one's 50s?

Is it possible to have asthma that only presents with breathlessness and chest tightness (and no coughing and no wheezing)?  (A heart condition has been ruled out after various tests)

Thank you for your advice.

Answer by Dr Navpreet Kaur

Hi Constance,

There are different forms of asthma. There is a variant called "Adult-onset Asthma", which usually presents much later in adult life. These patients may require stronger treatment regimes to get their Asthma under control.

Yes, a Spirometry can be performed at some of our polyclinics. Do make an appointment to see a Physician who will evaluate you and order the relevant investigation based on your symptoms.

Asthma is a condition where there is inflammation in the airways. It usually presents with symptoms of wheezing, shortness of breath, chest tightness and cough. Your symptoms of breathlessness and chest tightness can be evaluated further with a Spirometry to determine if Asthma could be the cause.

9. Question by Francis

Dear Doctor,

I often suffer from Asthma after I have flu or fever from other infection (viral or bacteria). My asthma does not come alone. It is always after my body has been compromised then the asthma come back.

I am not sure how to avoid being on short or long-term steroids which I am not keen on.

I do not want to be financially burden and dependent on medication for long term.

I get flu sometimes once a year and the asthma follows the flu.

Do you have any advice for me? Thank you for your time.

Answer by Dr Navpreet Kaur

Hi Francis,

Asthma is a chronic condition for which there is no cure. It can be kept under control with various medications that you have mentioned including inhaled corticosteroids.

There are different types of steroids. The potency of oral steroids which are taken for short durations when you have an asthma flare, is much higher than the regular inhaled steroids that are prescribed for day-to-day usage. By taking the regular inhaled steroids, you are reducing the chances of a flare and hence reducing the side effects that are experienced by the potent oral steroids.

Apart from the medication regimes, you could also consider the following to help reduce the number of exacerbations that you experience:

• General Measures
  - Consider wearing masks
  - Good hand hygiene
  - Avoiding close contact with people who have respiratory symptoms

• Healthy Diet
  - Consume a diet rich of fruits and vegetables for its general health benefits

• Weight Reduction and Physical Activity
  - Ensure your BMI is within the normal range
  - Participate in regular physical activities to improve your cardiopulmonary fitness - There is no evidence to recommend a specific physical activity 

• Medications and Vaccinations 
  - Ensure you have completed your Pneumococcal (2 vaccinations for patients aged 65 years and above) and the annual Influenza vaccination
  - Do inform your care providers of your asthma diagnosis if a new medication is being prescribed, as some medications may worsen your Asthma

• Smoking Cessation
  Try to cut down and eventually stop smoking if you are a current smoker for better control of your Asthma. We now have Smoking Cessation Clinics at some of our polyclinics to assist our patients to quit smoking. 

10. Question by Ms Carol

Hi Dr Navpreet

a) Is asthma an allergic reaction that has no cure?

b) Can a person suddenly have asthma as he ages? Asthma can develop in any person at any age? Thank you.

Answer by Dr Navpreet Kaur

Hi Ms Carol,

There are different types of Asthma. Allergic Asthma is the most common type, which has associations with other allergic conditions such as eczema, allergic rhinitis etc. However, there is also a type of asthma called "Non-allergic Asthma" that is not associated with an allergy. There are other forms of asthma such as "Adult- Onset Asthma" that present in adulthood for the first time.

It is possible to keep Asthma under control and live a very normal life with very effective medications such as the inhaled corticosteroids. There is however no 'cure' for Asthma at present.

11. Question by Ms Jac

Dear Dr Kaur,

My history:

I am a 50-year-old female and some history of asthma and rhinitis in my teens to adulthood. I can recall a few very bad attack at 23yo and 40+yo. I do not use my salbultor inhaler on a daily basis unless I am sick and wheezing bad or breathless from constant cough.

Recently I had a a very bad flu in nov2023 which led to cough ,nose block, lost of voice and had to use my inhaler and i did a covid booster jab in dec2023 + 1 flu jab in Jan 2024.

In late Jan2024 and Feb CNY was down with flu again despite all the vaccines. I lost my voice again, cough developed to bronchitis which led to asthma and I was treated at neighbourhood GP (antibiotic and nebuliser), tcm and polyclinic.

I was eventually given different types of inhaler and nose spray as I was coughing constantly till my ribs and chest hurt; I could not speak properly as I will cough nonstop. I had to stop using the Belcom inhaler as it was causing terrible ulcer all over my mouth despite gargle with water after each use).

Finally, I was referred to a Respiratory Clinic for spirometer tests as i had been coughing and having nose back drip issue. The tests in April finally confirmed that I do not have asthma at that point of time and I am given nose spray to help with the nose issue instead. I am also scheduled to return to both Respiratory and ENT for further investigation.

I have avoided deep fry and spicy food. I was feeling better only for a couple of weeks and now the nose back drip and cough starts again. My throat hurts from all the constant cough and I know I will lose my voice again.

My question is:  How can I prevent asthma/ constant cough caused by the nose mucus backdrip issue? I have tried acupuncture which helps to stop the back drip for a day or two.

Appreciate any advice. Thank you!

Answer by Dr Navpreet Kaur

Hi Ms Jac, 

Postnasal drip is a common issue faced by many people. This can be triggered by allergies, viral infections, changes in weather etc. You should see a doctor to consider re-starting the use of intranasal steroid spray to reduce inflammation of the nasal turbinates. 

Do ensure the technique of the spray is also correct. Make sure you tilt your head forward and close the nostril that you are not treating. Point the spray away from the central nose ridge. Breathe in gently while you press down on the top of the spray to release the medications. 

This should be used regularly for 4-6 weeks to see improvement in your symptoms. 1-2 sprays should be directed into each nostril 1-2 times per day as per your doctor's advice.

12. Question by Eileen

Hi Doctor, 

In this humid weather, I'm experiencing recurrence of asthma attacks, especially when my pet hamster is in the same aircon room as me.

Previously, I will only have asthmatic symptoms during flu and cough. However, the recent recurrences were not related to any flu sickness.

I notice that I get triggers whenever I'm near my pet hamster. Can such a small animal brings about such effect on my asthma attack?

I was advised by my GP to use the steroid inhaler on long term basis. I'm concerned about gaining weight from the usage and would prefer not to use.

Is there any other alternative from using steroid inhaler, e.g avoiding the sources which triggers, doing Qigong? Thanks.

Answer by Dr Navpreet Kaur

Hi Eileen,

Trigger avoidance is a key player in prevention of asthma attacks. You might consider taking allergy tests to determine what you are allergic to, allowing you to make the necessary changes to your environment. Apart from that, you may consider keeping your pet hamster in a different room, or get a HEPA filter to see if your symptoms improve accordingly.

The mainstay of treatment for Asthma are inhaled corticosteroids to help prevent Asthma flares. The side effect of weight gain is more prominent in patients who have to take regular oral corticosteroids, called prednisolone. This usually happens in patients who have bad flares of asthma and need to rapidly reduce the airway inflammation.

Besides using steroids inhalers, it is also important for patients with asthma to consider the following:

• Eat healthy
  - Consume a diet rich of fruits and vegetables for its general health benefits

• Weight Reduction and Physical Activity
  - Ensure your BMI is within the normal range
  - Participate in regular physical activities to improve your cardiopulmonary fitness - There is no evidence to recommend a specific physical activity 

• Medications and Vaccinations 
  - Ensure you have completed your Pneumococcal (2 vaccinations for patients aged 65 years and above) and the annual Influenza vaccination
  - Do inform your care providers of your asthma diagnosis if a new medication is being prescribed, as some medications may worsen your Asthma

• Smoking Cessation
  Try to cut down and eventually stop smoking if you are a current smoker for better control of your Asthma. We now have Smoking Cessation Clinics at some of our polyclinics to assist our patients to quit smoking. 

13. Question by Chiou Har

Dear Dr,

I was coughing for almost a year in 2018 and was later diagnosed as due to reflux and asthma in a private hospital’s ENT doctor. He based the result on checking on my symptoms. The omeprazole and seretide evohaler solved my problem.

In 2023 I had shingles and led to breathlessness. My GP referred me to SGH ENT who referred me to lung specialist. After spirometer test, the specialist said I had no asthma. He did not want to prescribe seretide evohaler. Instead I was given salbutamol inhaler.

I tried the inhaler for a few months but it is not working. I woke in middle of night coughing. Somehow the seretide just helped but not the inhaler.

What could be the issue if I don’t have asthma yet I have coughing which is not helped by the salbutamol?

I hope you could provide me advice. Currently I went to GP to get the seretide and it is more expensive. Thanks.

Answer by Dr Navpreet Kaur

Hi Chiou Har,

Chronic cough could be a manifestation of various conditions.

First, ensure that your reflux condition is being properly managed, as it could also be contributing to your chronic cough. Do seek medical consultation so the doctor can check for any possible causes of your cough, such as a postnasal drip, infection etc. 

If required, your physician may consider repeating a spirometry or other investigations (e.g. chest x-ray) as your condition may have changed over time since the last review with your specialist.

14. Question by Michelle

Hi Dr Navpreet,

My asthma comes and goes every few years. I was being monitored by a SingHealth specialist and eventually able to stop my inhaler meds.

Recently with the incredibly hot and humid weather, I found it difficult to take deep breaths although I could still breathe fairly well.

However, I found being in an aircon environment helped a lot. Can high humidity be the cause and is this related to asthma? Thank you!

Answer by Dr Navpreet Kaur

Hi Michelle,

Asthma can be triggered in hot and humid weather as well because mould and dust mites are able to grow better in such an environment. 

It would be good for you to identify your allergens and try to avoid them to prevent recurrent attacks. 

If you do get recurrent attacks, discuss with your physician if you should be re-starting the Inhaled Corticosteroids.

15. Question by Fiona

Hi Dr Navpreet,

As a child and teen, I used to have asthma attacks when days were hectic and stressful/did not have enough rest.

Then as an adult, it became fewer. However, each time I had a cold or flu, this would exacerbate a severe asthma attack and I would need to have rounds of nebuliser.

Can you please help me understand how cold symptoms trigger an asthma attack? Thank you very much.

Answer by Dr Navpreet Kaur

Hi Fiona,

Infections can triggers bronchospasm, where your airways will become narrow and tight. This is why you feel short of breath and you might also produce a wheezing sound when you breathe. 

This may also lead to inflammation within your airways, that causes you to cough and produce sputum. 

The inhaled corticosteroids prescribed for asthma help to target the inflammation and bronchospasm to reduce these symptoms and in the long run, reduce the sensitivity of your lungs to prevent these symptoms from recurring.

Below are other preventive measures you may consider:

1. Take the annual influenza vaccination to reduce the risk of asthma exacerbations.

2. See your doctor for your regular asthma reviews so that they can adjust the doses of your medications accordingly.

16. Question by Paul

Dear Doctor Kaur,

I am a 76. I had asthma when I was 9 years old until I was about 21. However, recently about 3 months ago, I had a bad flu which I believe triggered the return of the illness.

I now use the inhaler twice a day in the morning and night. Even after using the inhaler, I still have wheezing which triggered my coughing. When I cough, thick dark greenish phlegm coupled with sticky mucus came out of my mouth and nose. This happens a few times a day. Other than the phlegm and mucus, I feel fine, no headache or other symptoms.

How do I get rid of the thick phlegm and stick mucus? Thanks.

Answer by Dr Navpreet Kaur

Hi Paul,

Patients with asthma may also be prone to allergic rhinitis. An intranasal steroid spray may sometimes help to reduce the sensitivity of the turbinates, and in turn reduce the mucus production.

Do take note that prolonged cough with fever can also be a sign of bacterial infection. Do schedule a consultation so your doctor can examine you and determine if any additional medications are required.

Home remedies to loose thick mucus involve staying hydrated, taking warm fluids and doing nasal rinses.

It is also important to control the symptoms of your asthma to reduce inflammation within your airways and hence reduce mucus production. The inhaler regime that you are on may have to be modified. Your physician may consider stepping up to a higher dose or changing to another inhaler to have better control over your asthma symptoms.

Ref: H24