Rethinking asthma: From symptom relief to long-term control

Asthma is a chronic inflammatory disease of the airways, affecting around one in ten people. It is characterized by two key features: inflammation in the lining of the airways and spasms in the surrounding muscle layer.  

Together, these changes make breathing difficult and trigger symptoms such as wheezing, coughing and shortness of breath. 

For many years, asthma treatment focused mainly on providing quick relief for symptoms. Today, however, medical understanding has shifted: asthma is recognized as an inflammatory condition, and modern treatment increasingly prioritizes long-term control. 

To understand this change, we spoke to Professor Desmond Murphy, consultant respiratory physician and asthma specialist at Cork University Hospital. He has treated people with asthma for decades and describes it as “a condition defined by areas of inflammation and hyper-responsiveness.”  

A helpful way to picture it, Professor Murphy explains, is to imagine a skin rash.  

“If your skin is inflamed and irritated, then adding an irritant makes it worse. The airways are a bit like that. When inflamed, they are more sensitive to everyday

triggers.”  

This is why long-term treatment is so important, says Murphy.  

By targeting the underlying inflammation, patients can avoid flare-ups, reduce their risk of infections and hospitalization, and improve their quality of life.

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Asthma is common, but with proper management it does not prevent a full and active life.

Preventive treatment at the centre  

Asthma treatment is often associated with rapid relief from symptoms, typically through the use of reliever inhalers. They start working almost immediately, relaxing the muscle layer around the airways. It provides quick relief, Professor Murphy explains, but it does not do anything for the inflammation.  

Preventive treatment – such as an inhaler containing inhaled steroids – is now at the heart of modern asthma guidelines. Taken regularly, it calms inflammation and prevents flare-ups.  

Preventive treatment is the cornerstone of modern asthma care, Professor Murphy says. If you regularly use a preventer inhaler, you may notice that you need less medication to relieve airway constriction.  

“The goal is not only to treat symptoms but to address the root cause of the condition.”

Care that supports an active life

Asthma is common, but with proper management it does not prevent a full and active life, Professor Murphy says. Many people, including elite athletes, live with asthma and excel at the highest levels.  
“You can have a normal life expectancy, you can exercise, you can do whatever you want essentially, if you look after the condition,” he says. 

Professor Murphy notes that the environment plays a key role in asthma symptoms, with damp housing, air pollution, seasonal changes, and indoor air quality all critical factors.  

Since triggers vary widely, identifying personal ones is vital, he says, adding that modern guidelines also emphasise that patients should reflect on how they feel. In clinic he uses tools such as the Asthma Control Questionnaire to track symptoms and guide treatment.  

“We’ve moved away from classifying asthma just based on lung function tests.” 

Though asthma has no cure, it can be well controlled through preventive treatment and managing inflammation, allowing patients to minimize risks and live well.  

“With proper care you have a normal life expectancy, you will feel well, and it should be only a minor inconvenience rather than something that holds you back.”