Instant Genius - Why we need to be taking asthma more seriously

Episode Date: September 27, 2026

Currently, around one in ten of us are living with asthma. For many, the symptoms can be relatively mild, but for others, attacks can be severe, debilitating, and even life-threatening. For the most part, we’ve relied on the same method of treatment to manage the condition for the last few decades. However, new research is showing great promise in helping those who suffer from this often-overlooked condition. In this episode, we’re joined by Dr Samantha Walker, director of research at Asthma + Lung UK. She tells us how asthma occurs in several different forms, why we still have so much to learn about the root causes of asthma, and how new technology can help us to treat this often-misunderstood condition more effectively. Take your curiosity further with a subscription to BBC Science Focus magazine. Every issue is packed with fascinating insights into the science behind everyday life, the latest breakthroughs and expert analysis, delivered straight to your door. Receive an extra £5 when you subscribe using the code SF5OFF, (minimum spend £20, see full terms and conditions on our website). https://www.ourmediashop.com/bbc-science-focus-magazine-pod30 Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Every Monday and Friday you'll hear world-leading scientists and experts talking about the most fascinating ideas in science and technology today. I'm Jason Goodyear, commissioning editor of BBC Science Focus. Currently, around 1 in 10 of us are living with asthma. For many, the symptoms can be relatively mild, but for others, attacks can be severe, debilitating, and even life-threatening. For the most part, we've relied on the same methods of treatment to manage the condition for the last few decades.

However, new research is shown great promise in helping those who suffer from this often overlooked condition. In this episode, we're joined by Dr. Samantha Walker. Director of Research at Asthma and Lung, UK. She tells us how asthma occurs in several different forms, why we still have so much to learn about the root causes of asthma, and how new technology can help us to treat this often misunderstood condition more effectively. So welcome to the podcast. Thanks so much for joining us. My pleasure.

So today we're talking about the latest research surrounding asthma. So before we get into some of all, all the, this fascinating stuff. We need to sort of establish exactly what it is we're talking about. So everyone's likely heard of asthma and we'll know it's a respiratory condition. But what exactly is happening in our bodies when we're having an asthma attack? You know, what is asthma? So asthma is essentially at its most easy to understand and picture is a sort of overtwitchiness of your airways. So the insides of your airways, which is the tubes that take, air into your lungs gets disturbed and twitchy. And often that's in response to things like air pollution

or cat allergen or all the things that we know that cause asthma attacks. Your airways get super twitchy. And what happens is that the airways narrow so that it becomes very difficult to breathe. And that makes a noise like a wheeze, which most people who have asthma would recognize. but also there is overproduction of mucus and all sorts of other things, which basically just reduce the size or the narrowness of your airways down. It makes hard to get air in and out. And it affects about 7 million people in the UK, millions more globally, of course. But it can be caused by lots of different things, as I say,

from allergens like cat and house dust mite, air pollution, but also moulds. And also it can be triggered by stress or anxiety. So there are lots of different causes of individual attacks, but the asthma as a condition is basically inflamed airwaves. And these attacks can be very severe, can they? They can. And I think one of the big challenges with asthma is that a lot of people have it, but only a relatively few people ever have a visit to hospital because of their asthma.

That's about 60,000 a year in the UK. So what the challenges is, is knowing, who's at risk of an attack and who isn't and how you manage that, and trying to explain to people that they need to take the right treatment to prevent attacks is quite hard sometimes for people to get the head around. Because if they don't feel as if they've got symptoms at the moment, sometimes it can be quite difficult to stick to a routine that says, you need to take medicine every day for something that might not happen.

Do you see what I mean? So I think if you've had an attack, you're much more likely to have another attack. So they're the ones we tend to identify as people who are more at risk of future attacks if you've had them previously. Does it change or develop over somebody's lifetime? Because sort of anecdotally, I've heard people saying, well, you know, I used to have asthma when I was a child, but I'm okay now. Is there any truth to that? Yes. The research suggests that there are quite simplistically a few different subtypes of asthma. Often you get under fives get preschool whee's,

and some of those people, children go on to develop asthma, many don't. So children just have developing airways, which is sometimes that persists and sometimes it doesn't. Then you get the allergic types of asthma, which is the grass pollen, house dust, mccats and things, is often most common in teenagers and young adults. And they're the ones that tend to grow out of it. So if you have asthma as a child and as a early teenager, you quite often grow out of that. And then you've got a group of people who develop asthma completely new in their mid-40s. And that group of people tends to have worse asthma.

They have worse higher numbers of attacks and much worse symptoms. So you've got this kind of early childhood adolescent, allergic kind of profile that often can, you can grow out of that if you have it as a young child. and then you've got this cohort of people who develop it as an adult. And that's a worse, they often have worse symptoms, that group. So how about, so you mentioned they're the kind of the close link to allergies. So a lot of people say, well, you know, allergies are getting more and more common now. You know, it seems that a lot of children have one or another allergy of some kind. And is the same thing happening with asthma?

Also, like taking into account, you mentioned there, the effect of air pollution. It's difficult to know the answer to that question because it's very difficult to know exactly what's causing an individual attack without studying each person individually. So if you had an asthma attack today sitting in the office, you wouldn't know what had caused it necessarily. You know, you could have been in a house with a cat last night that made you suddenly unwell today. You could have an office that's highly polluted, but you wouldn't know that. So the allergic bit is quite difficult to measure. And so whilst some allergies are increasing and things like food allergy is quite well reported to be increasing, I don't think there's any evidence that allergic types of asthma are themselves increasing. And we certainly know that if you look at all the data going back over the last 10 years or so, we're not seeing an increase in the numbers of people who get asthma overall.

So it would seem to me that no, you're probably not getting more allergic. But it's quite difficult to know. Yeah. So having said that, how is it diagnosed? You know, if we think, oh, you know, I've had a few events where I've had, like you say, this wheezing or this tightness in my respiratory system, you know, and I think, oh, I should go to the doctors. What happens then?

The diagnosis of asthma is still what is called a clinical diagnosis. So it means a combination of tests and your history and your family history to detect those allergy type things because they're often inherited. If you were to suspect you've got asthma, what your doctor would do would be to ask you a lot of questions about your symptoms, but we can also do tests where you breathe into a machine called a peak flow, and that measures how much air you can get out of your lungs in a certain few seconds. And that shows, essentially, are your lungs working properly? So that's the test that's the test that is most often used. And then there's also a test you can use which measures a chemical in your breath

that is evident when your airways are inflamed. So the inflammation in your airways gives off a gas, if you like, that you can measure. And that correlates quite strongly with certain types of asthma like the allergic type. So it's a combination of the two. And one of the problems with asthma diagnosis is that it takes time. The tests aren't brilliant. They're not brilliant in the absence of asking about the symptoms at the same time. You know, the test is not like saying, are you pregnant? Yes or no, you know, pee on a stick. It's not like that.

If you did the tests independent of a history, they often don't mean very much. So you have to have somebody who's got the knowledge to ask the right questions, to then do the tests, and then it's a sort of composite, if you like. Yeah, so let's move on to treatments then. So we'll look at some of the, you know, the exciting research going on in a moment. But how is it currently treated? How are the sort of symptoms managed? Because I think everyone's probably seen those blue inhalers.

The treatments for asthma haven't changed really very much since the late 80s, early 90s. And as you say, they're a combination of the blue inhalers, which tend to be, they are a drug which act to open up your airways. So if you're having an asthma attack, what they do is open. open up your airway so you can breathe again. The problem is with them is that the reason they've narrowed in the first place is because they're inflamed. So imagine a swollen ankle where it gets all swollen if you twist your ankle. Imagine your lungs are the inside of your lungs are like that. All the blue inhaler does is open them up temporarily, but all that inflammation

underneath is still there. So it comes back. And there's quite a lot of evidence that the blue inhaler works less well the more you use it because it almost is less effective, not over time, but in the same attack. It only has a sort of limited impact up to a point. So in order to then manage that attack, you also need to take regularly an anti-inflammatory inhaler, which is probably equivalent of something like neurofen for a swollen ankle. It's an anti-inflammatory that calms down the inflammation. So the mainstay of asthma treatment for the last 20, 30 years has been a combination of taking a brown inhaler, they're often brown, every day, with a blue one when you need it. The problem is with that is that adherence to the brown inhaler is quite low in asthma.

It can be as low as 30, 40%. People don't like taking something every day that they don't think they need because they haven't got symptoms at the time. And I've got asthma. But I can imagine that that's quite tricky to take an inhaler every day, twice a day sometimes, to prevent something that in your mind you think, well, may not happen. So I think it's, from a patient perspective, it's quite tricky. So that's been the mainstay of treatment.

And I think one of the things that is very interesting about that is that because people don't like taking their medicines, you've got the people that most at risk of an asthma attack are often the people who don't like taking the brown inhaler. So they're really at much higher risk of an asthma attack. So that's been the mainstay. I think the most recent developments in the sort of inhaler, inhaled drugs field are combining those two drugs in the same inhaler. So that a bit like when they put fluoride in the water all those years to go to help us have strong teeth, it's putting a low dose of an anti-inflammatory drug in your blue inhaler.

So that every time you take your blue one, you're getting some of the brown one. And that has the potential to be really much more palatable. for most people who just don't want to take a brown one every day. New from an espresso. Blend wellness into your coffee routine with a coffee plus range, infused with functional benefits. Choose the coffee you love with added B vitamins, like coffee plus B12 to help support immune function,

and coffee plus B6 to keep your day moving. Or go with the flow and choose ginseng delight. Our new double espresso with ginseng extract. Whatever lies ahead, don't change your mind. morning. Let your morning change you. Discover Coffee Plus on Nespresso.com. Okay. When I sell my business, I want the best tax and investment advice. I want to help my kids, and I want to give back to the community. Ooh, then it's the

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You're richer than you think. Yeah, so as you said, look, we've been doing the sort of same or similar, taking the same or similar approach for a few decades now. So what are some exciting pieces of new research that you can share with us? So from a treatment perspective, I think these new generation of combination drugs have the potential to be absolutely game-changing. And I think that is amazing. And that's, interestingly, we did some research a few years ago,

where we showed that the sort of psychological profile or the persona of people can be divided into blue inhaler people and brown inhaler people. Brown inhaler people are people who are quite adherent. They take the medicines regularly. They don't mind taking these brown inhalers every day. And they're often quite well controlled. They're not a particular age or a particular severity. They're just a personality type.

The sort of person I always think that joins a gym but never goes, but thinks by being a member of the gym that's going to improve their fitness. So those sort of people, they're going to be probably quite punctual people, quite organised people, but they're not the ones at risk. Then you've got a population of blue inhaler people who don't want to take the brown one at all. And they're a completely different persona. They're often, they don't want to engage with their asthma. They don't want to have asthma. They don't want to think about asthma.

They don't want to take drugs to control it. And they're the ones most at risk of an asthma attack. And at the moment, we're not looking after those people very well. So I think we need to explore how to help those people. Because I don't think you're ever going to turn a blue inhaler person into a brown inhaler person. In the same way that I'm a brown inhaler person. I mean, I don't have asthma. My personality type is that I'm punctual for everything.

I turn up early. I prep. I write notes. I'm a that sort of person. If you said to me, we want to manage your asthma by not taking any medicines, but going to A&E in the middle of the night every three months with an asthma attack, I would find that immensely stressful. So the other way around, you can't expect those people to say,

suddenly become really compliant members, you know, people who are going to take their medicines. So that's very interesting. And those people could be really well served by these combination inhalers because it means you don't have to take it all the time. You can just take it when you need it, but you're getting some of this anti-inflammatory drug at the same time, which is brilliant. Then I think there are coming down the line, I hope, better ways of diagnosing asthma in the first place. We're working with a big funder, government funder at the moment on some projects looking at whether your phone could diagnose asthma. Because your voice changes when you have asthma, you wheeze, you get different noises coming in and out of your chest. Apparently,

the way your lips move is different. It can potentially predict asthma attacks. So there are new technologies that might make it much easier for us to diagnose asthma in the first place, which would be amazing. And then I think from a sort of very basic science or lab science way, we're to discovering more and more about different cells that seem to be implicated in asthma attacks. And there are drugs that are currently being used for severe asthma, that companies are starting to look at people with mild or moderate symptoms to see if there's a way of using those drugs in a cost-effective way to prevent attacks or prevent people having worsening symptoms.

So I think there's quite a lot of interesting stuff going on at the moment, which is great. Yeah, are those taken orally, you know, like, or something like that? No, at the moment there are the biologics, as they're called, they're injections and you have to be referred to a specialist at least once to get you started. But then there are, I think you can have the injections in primary care and even at home people can self-inject or after they've got started.

And they are, for the people they work in, they are can be phenomenally effective. We've got patients who we do a lot of work with who've gone from not being able to work, not being able to do very much to climbing Ben Nevis or whatever. You know, they are, when they work, they're amazing. The problem is they tend to only work for that allergic type, fema type at the moment. That's where most of the research has been done. So that's that allergic subtype. That responds very well to these drugs.

The sort of pollution-driven or late-onset asthma that we were talking about, that seems to respond less well to these new drugs. drugs. So there's lots of work in progress, which is hugely exciting. Yeah, so whenever we're talking about medical conditions of various sorts, the kind of holy grail is finding, you know, what we'd call a cure. How close are we in that battle against asthma? It's a very difficult question about a cure because it can be triggered by so many things. in lots of ways it's your immune system overreacting to something that it shouldn't. But it's really quite hard to turn your immune system off because then you get lots of other diseases

because your immune system's there to protect you for a reason. And if you start fiddling about with your immune system, you have to be really careful that you're not inadvertently opening you up to getting infections, for example, because it might make you more susceptible infections if you do something to your immune system. I think in terms of a cure, nobody talks about it in those terms. I think it's a long way off. What they're talking about these days is can you help somebody to be as well as they can possibly be on medicines that are acceptable to them. And that's still a very promising avenue to explore?

Yeah, I think so. I mean, you know, we're discovering more and more about why people get asthma. but I think there are still a lot of unknowns and unpicking the mechanisms that cause individual attacks are quite tricky still. The allergic type is really well researched. That's where the treatments have been flourishing the last 15 years or so. What's much less clear is, for example,

if you were to be out with a friend and you start laughing and then you laugh so much that you start wheezing and then you end up in hospital because you've had an asthma attack, We don't really know what's causing that type of attack. So it's very interesting to sort of slightly, to try and unpick that. I can't imagine the treatment at the moment that is going to be a cure, but I can see combinations of treatments that together could stop symptoms happening.

When people have reviewed nationally asthma deaths, it's being redone at the moment, but some years ago, If you look at who died of asthma, about two-thirds of those deaths are preventable. So that's something we have to not forget is that we need to help those most at risk of dying from an asthma attack to make sure they're on the right treatment. If they don't want to take regular medicine, they take one of these combined combination inhalers, or that we get better managing the blue inhaler people who probably just need, a bit more support and it might be that digital self-management apps which aren't very good at the

moment could be absolutely transformational for some people you know if you had an if your phone could say to you Jason we've noticed that your step count has gone down massively over the last two days because your fitbit's told me that I can hear that your voice has changed on the phone to your mum because and we think that that means you're going to have an asthma attack in two days time, you need to go and get yourself a brown inhaler, that's also the kind of technology that could be transformational, as well as the fancy drugs at the other end, is how do we help, how do we use 21st century technology that's already available in being researched, is how do you put that in a format, which a person who's a blue inhaler, slightly disorganized, chaotic kind

of person, doesn't say, do this every day, but gives you a prompt to take action. So I think that two-thirds of deaths are preventable is really important. We need to recognise that the saddest thing in the world for me is when I talk to parents of children who've died or spouses of a partner who's died. And almost always they say, but we didn't know. We didn't know this could kill. And that to me is the single biggest mistake, particularly of people who have a history of having asthma attacks,

is they themselves often don't or don't want to take that seriously. And that seems to me to be something that we really need to address and to talk to people about. We don't want to scare the life out of everybody by saying everybody with 7 million people in asthma in the UK at risk of dying from asthma. But I do think there's a realism that people with asthma, particularly if you've had an attack,

you should take that seriously. You yourself should take it seriously and demand that your doctor or your practice nurse takes it seriously. So that's the most important thing to me. That's always what gets me emotionally is the sadness of people not doing that. And I think that's really important. Thank you for listening to this episode of Instant Genius, brought you from the team behind BBC Science Fakers. That was Dr Samantha Walker. If you enjoyed what you just heard, then please do consider subscribing to Instant Genius on your preferred podcast platform. If you'd like to see our guests and

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