Asthma can be triggered by anything from dust and pet hair to cigarette smoke, foods and even emotions — and while there is no cure, it is a condition that can be managed. In the run-up to World Asthma Day next Tuesday, Linda Stewart talks to three people who live with the ‘silent killer’.
Amy Hunter (38), from Templepatrick, a youth and family co-ordinator for the Presbyterian Church, lives with her parents. She was diagnosed with asthma at 11 but it has become more serious in the last few years, culminating in a life threatening attack last year.
"I would have been doing PE at school and we must have been doing athletics because we were running - and I couldn't, because my chest was so tight," she says.
"I can just remember feeling as if I was going to be sick and I knew it wasn't right and everybody else was okay.
"I said to my mum about it and we went to the GP. It was the GP who diagnosed me with asthma and I was put on an inhaler at the time and that did help. It was very manageable at that point."
At that stage it was so readily managed that not everyone took it very seriously.
"Asthma is the one thing that there wouldn't always be much talk about how serious it can be," Amy says. "One of my teachers would have said, 'stop complaining'. She just didn't believe that asthma was even a thing. She thought it was nonsense."
However, the asthma became much worse when Amy was 15 or 16.
"I was referred to hospital and then put on a more structured programme or different inhalers - I went through a couple of years when it was quite severe," she says.
"It became well controlled again because of the medication, until last year."
Last year, Amy developed a viral infection in her glands and throat which continued for a few weeks.
"I noticed my chest was starting to feel a bit tight. Things that wouldn't bother me normally were starting to irritate me," she says.
She rang the GP on the Friday but no steroids were prescribed because she was able to talk normally. However, by the Sunday evening she was much worse.
"In middle of the night I was rushed to A&E - I nearly died of an asthma attack," Amy says.
"I went from having asthma that was so completely well controlled that few people even knew I had it, to someone who now has very brittle asthma.
"They made me do peak flow and I just went boom, it just floored me.
"I just bottomed out. There was no air moving in my lungs and they had to ring ICU and put me on a salbutamol drip which they don't like to do because it makes your heart race. They said if I hadn't been in hospital at the time I wouldn't have made it.
"I've recovered very well, but it has taken its time and they would say I have brittle asthma now."
Amy says she is now sensitive to a number of triggers which wouldn't have affected her before, particularly cigarette smoke and cleaning products.
"Even walking past someone smoking on the street could trigger me," she says. "And even the likes of the alcohol gel in the hospital tightens my chest and brings on an asthmatic cough.
"However, it's more the things you can't control. To get to my asthma appointments in hospital, I have to walk through a whole bunch of people smoking at the door. People will stand at the doorway to smoke outside - they don't think.
"Instead of banning smoking, they should have a place for people to smoke and enforce it strictly."
Amy says her own GP died of an asthma attack and at the time she wondered how that was even possible - but her recent experiences have taught her more.
"You can go and get all the help in the world but it does not guarantee that you can get it in time or that you can get the medication you need," she says.
She says she used to think of her teenage attacks as serious but she knows better now. "Now that I've had a really bad one, I understand the difference," she says. "I knew people could die from it but I now really appreciate how quickly somebody's life can change from asthma."
Teacher Peter McKinstry (41), from Doagh, is married to Rebekah. He says that he has had asthma since childhood.
"I don't remember not having it. I had problems breathing when I was in primary school," he says.
"It was worse when I was younger. When I was in primary school, even secondary school, it was bad enough that I had to go into hospital and go on onto the nebuliser.
"Now, for someone who has serious asthma, you can get a home nebuliser which you can use in your house.
"I've seen children bringing them into school if they need them.
"It means they don't have to go in and out of hospital when they need help.
"It wasn't available when I was in primary school and I would have gone to the hospital - that was through primary school right into secondary school."
Peter admits he doesn't remember much about his childhood attacks.
"I've heard since that one of the reasons is that your brain is trying to reallocate what oxygen it gets, so it doesn't prioritise the memory and it's not uncommon for young children not to remember much about asthma attacks," he says.
"I do remember coming round in hospital - they keep you in for a day or so to make everything has settled down. So I remember coming round and talking to the other patients on the ward, but the attacks themselves I don't remember that clearly."
Peter's asthma has calmed down in recent years and the last bad attack happened when he was in his first year at university and had come home to visit his family for the weekend after coming down with a chest infection.
He admits that having an attack was probably a scary experience when he was younger, but says you get used to it.
"One of the best things you can do is try to keep calm and try not to get scared. If you let yourself get scared, it can exacerbate the problem," he says.
"When I was growing up I didn't live too far from hospital and could get help fairly quickly.
"When I have an attack I make as much effort to breathe deeply as my body will let me.
"My asthma is much better and pretty well controlled now."
Peter says he doesn't have many triggers, but dust is one of them.
"Sometimes as a teacher if you're clearing out a cupboard that hasn't been touched for a while, there can be a lot of dust, so I have to be sure to have my inhaler on me when I'm doing a job like that," he says.
"Pet hair is another trigger, but it usually takes a little longer to affect me.
"It would vary between different types of pets and even different breeds of pets.
"Over the last couple of years hayfever has begun to trigger it a bit and I haven't had that before.
"Antihistamine helps to prevent it becoming an issue in the first place and I make sure I have a ventolin inhaler with me," he adds.
Bangor-born Lorna Cowan (39) is an executive assistant for a PR company and now lives in east Belfast. She believes she has had asthma since childhood, but it wasn't diagnosed until she was in her 20s.
"I think as a child we just assumed it was hayfever," she says. "I have distinct memories of shortness of breath. It tended to be when I was out in the open and around a lot of grass cuttings. But it wasn't until I moved away from home at the age of 19 that it got worse."
At that stage Lorna discovered she was allergic to cats.
"I grew up in a house full of cats. But every time I came back home from university I thought it was a cold, but really it was an allergic reaction," she says.
"I went to see the doctor about it and that was when I was diagnosed with asthma - I've probably always had it but I just didn't know."
Lorna says she is lucky enough to have a milder form of asthma.
"I've never had what you would probably call a full asthma attack, but I would experience shortness of breath quite a lot of time if I am round animals," she says.
"Grass cuttings would trigger it, dust, strong smells such as strong perfumes would trigger it - and even extreme heat or cold, exercise. If I am around air conditioning or the heat blasting, that would trigger it."
Triggers such as strong air con or heating would make her feel uncomfortable and struggling to catch a breath, she says - and that can make some social situations awkward.
"If I'm waiting at a bus stop and somebody is smoking, you can't really tell people to stop, so I have to remove myself from the situation," Lorna says. "It's a little embarrassing as well - you don't want to make a fuss and say I'm struggling to breathe."
Lorna uses as preventative inhaler every morning and also carries a reliever inhaler during her day. "I try to have a couple of those stashed in my desk or handbag and carry them at all times," she says.
She admits that in her 20s and 30s she wasn't as good at keeping on top of her medication as she could have been and she had a good telling off from the asthma nurse as a result.
"I've got a bit better at managing it over the years," she says. "Things seem to be okay. I don't know at this stage whether it will become a more serious condition.
"I suppose, through my own personal research, I have become aware of how severe an illness it is - people die from it. And I suppose I never took it seriously, but as I've become older I've become more aware that it can be very serious and it's quite frightening.
"It shocked me (that people had died from asthma attacks) because I had never thought about it being something that killed.
"I'm lucky that I have a manageable condition if you take it seriously - which I am now starting to do."
It is estimated that 182,000 people in Northern Ireland live with asthma, including 36,000 children.
The main symptoms are:
These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen.
Asthma is usually treated by using an inhaler, a small device that lets you breathe in medicines.
The main types are:
For more information, visit www.nhs.uk/conditions/asthma. To find out more about World Asthma Day, visit ginasthma.org