Asthma is a condition that causes tightening (constriction) of the small air passages in your lungs. People with asthma sometimes find it hard to breathe, and often cough, wheeze, or feel short of breath. Your asthma symptoms may be mild and infrequent, or persistent and severe. Asthma affects about 25 million Americans per year and asthma attacks are responsible for nearly two million emergency room visits each year in the United States.
If you follow the guidelines for good asthma management, it should not disrupt your daily life very much. Properly managed asthma is not a life-limiting disease. In this article, you will learn about the signs and symptoms of asthma and what to do if you have asthma.
What Is Asthma?
Asthma is a long-term (chronic) disease that affects your lungs. There is no cure for asthma, but there are effective treatments for managing the condition. Your asthma can change over time, so maintain regular contact with your doctor and report any changes so your treatment can be adjusted accordingly.
If you have asthma, the small airways in your lungs can suddenly narrow, making it hard to catch your breath. Your lungs may also produce excess mucus, contributing to your breathing difficulties. Asthma can trigger coughing, wheezing, shortness of breath, and tightness in the chest. During an asthma attack, the muscles surrounding your airways contract and spasm in an attempt to expel the mucus that is blocking your airways. You will be short of breath, and may wheeze and cough excessively.
Several things can trigger an asthma attack, such as cold weather, exercise, a respiratory infection, or exposure to smoke. It’s important to identify your triggers so you can plan ahead and make sure that you have your asthma medication with you. Well-managed asthma may not affect your day-to-day life too much, but severe asthma can make it hard to be active or play sports until your condition is managed. Whether your asthma is mild or severe, an asthma attack can occur at any time, so be sure to carry any medications on you and inform friends and loved ones what to do in case of an attack.
What Causes Asthma?
While allergies and genetics both play a role in triggering asthma, there is no single known cause of asthma. Researchers think that genetic factors account for around 70% of a person’s risk of developing asthma but anyone can get asthma, even if they have no family history. If you have developed asthma as an adult, it is more likely to have been triggered by an allergen or an environmental stimulus.
An asthma attack can start right after exposure to a trigger or later on. The most common triggers for asthma symptoms and asthma attacks are:
- Environmental allergies: If you have general allergies, it is more likely that you will have asthma too. Nearly 80% of people who have asthma also have allergies to things in the air, such as trees, grass, weed pollens, mold, animal dander, dust mites, and cockroach droppings.
- Food allergies: Food allergies can, in rare cases, trigger asthma as part of a severe, life-threatening reaction called anaphylaxis. The most common foods associated with allergic symptoms are eggs, cow’s milk, peanuts, tree nuts, soy, wheat, fish, shrimp and shellfish, salads, and fresh fruits. Food preservatives can also sometimes trigger asthma.
- Exercise: For about 80% of sufferers, a heavy workout can trigger asthma. This is called exercise-induced asthma. Symptoms are chest tightness, coughing, and trouble breathing within the first 5-15 minutes of an aerobic workout. Usually the symptoms dissipate within 30-60 minutes of finishing the exercise but you could have another attack 6-10 hours later.
- Heartburn: If you regularly suffer from heartburn (also called gastroesophageal reflux disease or GERD), you may also have asthma. If your asthma started in adulthood and you have no family history of asthma, allergies, or bronchitis, your doctor may investigate to see if your symptoms are triggered by GERD.
- Smoking: You are more likely to get asthma if you smoke cigarettes. As a smoker, your asthma symptoms are likely to be more severe than in non-smokers. If you are a woman and you smoked during your pregnancy, your baby will be at greater risk of developing wheezing and asthma. Children of smoking parents are more likely to develop asthma. Quitting is one of the best things you can do to protect your lungs and the lungs of your family.
- Sinusitis: Sinusitis causes inflammation in the mucous membranes that line your sinuses, causing them to produce more mucus than usual. If you have asthma alongside inflamed sinuses, your airways can get blocked very easily. Get your sinus infection treated as soon as possible to ease your asthma symptoms.
- Other infections: Colds, flu, and bronchitis (both viral and bacterial) can trigger asthma attacks. If you have recently recovered from an upper respiratory infection, your risk of having an asthma attack goes up.
- Medications: Certain drugs can cause asthma symptoms. The most common example of this is aspirin-induced asthma. If you know or suspect that you are sensitive to certain drugs, discuss it with your doctor who can advise you about alternative medications.
- Weather: You can develop asthma as a result of weather conditions. Cold air, a sudden change in temperature, extreme heat and a boost in humidity can all cause an asthma attack.
- Irritants: There are several irritants that are often present in the environment that can trigger asthma attacks. Examples are tobacco smoke, smoke from wood-burning appliances or fireplaces, strong odors from perfumes, cleaning agents, air pollution, exhaust fumes from cars, and chemical fumes.
- Strong emotions: Stress and asthma often occur together. Stressful situations or those that cause anxiety, tears, anger, or even laughter can bring on an asthma attack if you are sensitive to these triggers.
Keeping an asthma diary
Figuring out your personal asthma triggers can be an important aspect of your asthma management. The best way to do this is to keep an asthma diary where you record any symptoms you had, how you were feeling, where you were and what you were doing right before the flare-up, if you used medication, and how much. This information will help you and your doctor see patterns and recognize warning signs of asthma attacks.
Your doctor may prescribe the use of a device called a peak flow meter (an inexpensive, hand-held gadget that measures the strength of your exhale) to help you better gauge how well you are breathing in different situations. Paying attention to your PEF (peak expiratory flow) reading can also help you build up a picture of your asthma triggers.
Asthma Symptoms and Warning Signs of an Asthma Attack
Asthma symptoms vary from person to person. Asthma signs and symptoms include:
- Shortness of breath
- Tightness or pain in the chest area
- Sleep difficulties caused by shortness of breath, coughing or wheezing
- Making a whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
- Coughing or wheezing attacks triggered by a respiratory virus, such as a cold or the flu
Signs that your asthma is getting worse include:
- Your asthma symptoms are more frequent and interfere with your daily life
- You are finding it increasingly difficult to breathe (as noticed by yourself or measured with a peak flow meter)
- You need to use a quick-relief inhaler more often than before
If your child has asthma, they may have the same symptoms as an adult with asthma or they may have no signs except for a chronic cough. If you notice that your child has one or more of the following symptoms, make an appointment with a doctor:
- Difficulty sleeping
- A constant cough, which can be triggered by a viral infection, cold air, or exercise
- Wheezing sound during exhalations
- Shortness of breath
- Rapid breathing
- Chest tightness or congestion
What to Do in an Asthma Attack
Asthma attacks can be rapidly life-threatening. If you or a loved one is having a severe asthma attack, follow these directions:
- Call 911
- Seat yourself upright and stay calm. Remaining calm is essential. The body’s natural stress response (sometimes called “fight or flight” mode) can make symptoms worse. Take slow, deep, deliberate breaths.
- Give yourself a single inhaler puff every 30-60 seconds.
While you are waiting for emergency services to arrive:
- Take long, deep breaths: This helps to slow down your breathing and prevents hyperventilation. Breathe in through your nose and out through your mouth to regulate your breathing.
- Stay calm: I know it’s easier said than done, but staying calm will prevent further tightening of your chest muscles and make your breathing easier.
- Remove yourself from any triggers: If you know what the trigger was, get away from it quickly and go to an air-conditioned environment with clean air.
Types of Asthma
The different types of asthma are distinguishable by the cause of the symptoms.
- Allergic asthma: If you suffer from allergies, you are more prone to developing asthma. Allergic asthma can be triggered by any allergen, such as dust, pollen, and pet dander.
- Nonallergic asthma: This type of asthma is not related to allergies. It can flare up in response to weather conditions such as extreme heat, humidity, or extreme cold. It can also be triggered by stress, an infection, a cold, or flu.
- Occupational asthma: Occupational asthma is caused by breathing in chemical fumes, gases, dust, or other substances you might be exposed to at work. Repeated exposure to these substances can, in rare cases, cause permanent lung damage.
- Exercise-induced asthma (exercise-induced bronchoconstriction): This type of asthma is triggered by strenuous exercise. Symptoms are shortness of breath, wheezing, and coughing that begins during or after exercise. If you have exercise-induced bronchoconstriction, you do not have to give up sports. However, you will probably need to take medications before and after exercise and have your inhaler nearby at all times.
- Adult-onset asthma: Adult-onset asthma is asthma that develops in adulthood. It is more common for asthma to develop in childhood, but it can arise at any age. According to the American Lung Association (ALA), one in twelve adults has asthma. Allergies trigger at least 30% of cases of adult asthma.
- Childhood asthma: Childhood asthma is not a different disease from adult asthma, but children face unique challenges. Childhood asthma is a leading cause of emergency visits, hospitalizations, and missed school days. Talk to a doctor if your child coughs a lot, wheezes or makes whistling sounds when breathing, gets short of breath or breathes rapidly at times, complains of chest tightness, gets repeated episodes of suspected bronchitis or pneumonia, or finds it hard to breathe during sports.
- Cardiac asthma: Although this sounds like a form of asthma, cardiac asthma is actually coughing or wheezing caused by heart failure. Heart failure can cause signs and symptoms similar to those caused by asthma, but it is not asthma. If you think you might suffer from cardiac asthma, seek medical attention immediately.
- Asthma-COPD overlap (asthma-COPD overlap syndrome): Chronic obstructive pulmonary disease (COPD) is a collection of lung diseases that cause breathing problems and obstruct airflow. One of the diseases that COPD can cause is asthma. It is important to note that most people with asthma will not develop COPD, and many people with COPD do not have asthma.
As well as classifying your asthma by the specific type you have, some doctors classify the condition by severity, as follows:
- Mild intermittent: You have mild symptoms up to two days a week and up to two nights a month.
- Mild persistent: You have symptoms more than twice a week, but no more than once in a single day.
- Moderate persistent: You have symptoms once a day and more than one night a week.
- Severe persistent: You have symptoms throughout the day on most days and frequently at night as well.
How Is Asthma Diagnosed?
Asthma can be diagnosed by a doctor or an allergist who will take a thorough medical history and conduct breathing tests to measure how well your lungs are working. The following tests may all be part of the intake process:
- Physical exam: Your doctor will conduct a physical exam to rule out other possible issues, as well as complete a full intake of your medical history.
- Lung function tests: You might be administered lung function tests which can help measure the amount of air moving through the lungs as you breathe. Examples of these tests are the peak flow test and spirometry.
- FeNO test: The FeNO test, which stands for fractional concentration of exhaled nitric oxide, helps find out how inflamed the lungs are, and the ability of steroids to help decrease the inflammation.
- Allergy testing: As many people with asthma also have allergies, your doctor may perform allergy tests as well. If allergy triggers are identified, your doctor might recommend allergen immunotherapy to help reduce your asthma symptoms.
- Methacholine challenge: The methacholine challenge involves inhaling methacholine, an asthma trigger that narrows the airways, to see if you have a reaction which could indicate asthma.
- Imaging tests: Imaging tests, including CT scans and chest X-rays, can help find diseases or structural issues that can cause difficulty breathing.
- Sputum eosinophils: This test looks for certain white blood cells called eosinophils in your saliva and in the mucus that comes out when you cough.
- Provocative testing: These tests, which check for cold-induced or exercise asthma, involve your airways being measured prior to and after physical activity.
Risk Factors and Complications of Asthma
The following factors make your risk of developing asthma higher:
- Family history
- Viral respiratory infections
- Occupational exposures
- Air pollution
- Overweight and obesity
If asthma is left untreated, there is a greater risk for long-term effects and severe complications, such as:
- Rapid heartbeat
- Throat irritation
- Oral yeast infections
- Gastroesophageal reflux
- Airway remodeling: For some people, asthma causes permanent structural changes in the airways.
- Respiratory failure: People with severe asthma have an increased risk of respiratory failure.
- Mental health problems: One study concluded that depression was associated with a 43% increased risk for developing adult-onset asthma.
Although asthma is a common disease, it is a serious condition that demands a proper medical diagnosis and treatment. Always get help for your asthma. Talk to your doctor and work out which asthma medications will best help you manage your condition.
Asthma Treatment Options
Asthma symptoms can be controlled by taking medications and learning to avoid triggers. Treatments offer both short-term relief and long-term control. Your doctor will decide what medications are best suited to you and will advise you on how and when to use them.
These asthma inhalers are to be used at the time of an attack to offer immediate relief. There are a number of fast-acting medications that your doctor might prescribe:
- Short-acting beta-agonists: These are often the first choice for quick relief of asthma symptoms. Examples are albuterol (AccuNeb, Proventil HFA, ProAir HFA, Ventolin HFA) and levalbuterol (Xopenex, Xopenex HFA).
- Anticholinergics: These medications reduce mucus in the lungs and open up your airways. They take longer to work than short-acting beta-agonists. Examples are ipratropium and tiotropium.
- Oral corticosteroids: These medications reduce swelling in your airways so you can breathe more easily. Examples are prednisolone (Pediapred) and prednisone (Deltasone).
- Combination quick-relief medicines: Combination medications contain both an anticholinergic and a short-acting beta-agonist and combine the benefits of both. If you have difficulty using an inhaler, your doctor may suggest using a nebulizer – a device that helps you breathe in the medicine more easily. Examples are albuterol (ProAir HFA, Proventil HFA, Ventolin HFA), levalbuterol (Xopenex HFA), and metaproterenol.
Preventative or long-term medications
Preventative medications work long-term to both treat your symptoms and to prevent future asthma attacks. Long-term medications reduce swelling and mucus production in your airways, making them less sensitive and less likely to react to your usual asthma triggers.
Your doctor may prescribe any of the following long-term medications:
- Inhaled corticosteroids: These act to prevent swelling as well as reduce mucus in your lungs. They are the most effective medication for long-term control of asthma. Examples are, beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, or mometasone.
- Inhaled long-acting beta-agonists: These open your airways by relaxing the smooth muscles around them. Your doctor will most likely advise you to take this medication alongside an inhaled corticosteroid. Examples are formoterol and budesonide (Symbicort), formoterol and mometasone (Dulera), and salmeterol and fluticasone (Advair).
- Combination inhaled medicines: These medications pair an inhaled corticosteroid with a long-acting beta-agonist. This is a convenient way to take two effective medications together. Examples are fluticasone and salmeterol (Advair Diskus), budesonide and formoterol (Symbicort), mometasone and formoterol (Dulera), and fluticasone and vilanterol (Breo).
- Biologics: These medications target a cell or protein in your body to prevent airway inflammation. Biologics can be taken as a shot or an infusion that you get every few weeks. As they have significant risks and are very costly, your doctor will probably only prescribe these if other medications have not worked for you. Examples are omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab.
- Leukotriene modifiers: These also relax the smooth muscles around your airways and ease swelling. They are available in pill or liquid form.
- Cromolyn: Prevents your airways from swelling when they come into contact with an asthma trigger. Cromolyn is a non-steroid based medicine that is available as an inhaler.
- Theophylline: This relaxes the smooth muscles that narrow your airways. Theophylline is available in tablet, capsule, solution, or syrup.
- Long-acting bronchodilators: You might be prescribed these along with corticosteroids if you have not responded well to daily treatment with an inhaled steroid. Examples are Advair, Dulera, Symbicort, salmeterol (Serevent), formoterol (Foradil), and formoterol solution for nebulizers (Perforomist).
- Oral corticosteroids: If you have tried other medications without success, your doctor might decide to prescribe oral corticosteroids for a couple of weeks. However, this is not a long-term solution.
What You Can Do at Home
Some natural therapies, including dietary interventions and relaxation methods, may help you manage your asthma symptoms, although the research into these remedies is still limited:
- Breathing exercises: Your doctor may refer you to a specialist to learn special breathing exercises that can help you breathe more efficiently without having to rely on medication to manage your symptoms.
- Herbal and natural remedies: Some natural substances have been shown to help improve asthma symptoms. The most common are black seed oil (Nigella sativa), caffeine, choline (found in liver, eggs, poultry, fish, shellfish, peanuts, and cauliflower or from a supplement), and Pycnogenol (an extract of pine bark), which you can get as a supplement.
- Avoiding asthma triggers: Although not a treatment, your doctor might advise you to avoid asthma triggers in your environment to lower your chances of having attacks.
- Natural supplements: Some natural supplements, such as vitamin D and magnesium, may alleviate asthma symptoms.
- Yoga: Yoga can help decrease stress levels, a known trigger of asthma.
- Asthma diet: Avoiding foods that cause food allergies can help decrease asthma symptoms.
- Biofeedback: Biofeedback can help you relax, thereby decreasing stress levels and asthma attacks.
Some of the symptoms of asthma such as wheezing, coughing, or difficulty breathing also occur with other health conditions that are listed below. If you suffer from any of these health conditions, talk to your doctor as they might be causing your symptoms, not asthma:
- Coronary artery disease
- Gastroesophageal reflux disease (GERD)
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary embolism
- Congestive heart failure
- Upper airflow obstruction
- Vocal cord dysfunction
- Bronchogenic carcinoma
- Pulmonary aspergillosis
- Respiratory syncytial virus (RSV)
When to See a Doctor
To keep yourself healthy and active, your asthma needs constant care and proper management. See a doctor if:
- You want help keeping asthma under control: A doctor can give you the techniques you need to control your asthma and avoid a serious attack.
- Symptoms escalate: You find yourself using your quick-relief inhaler with increased frequency, or your medications are not helping your symptoms.
- You need to change your treatment: If your asthma is no longer responding to your medications the same way it has in the past, or if the symptoms of your asthma change, schedule a visit to your doctor.
Watch out for signs of an asthma emergency, which include:
- Breathing not improving after using a quick-relief inhaler
- Shortness of breath even when you aren’t doing anything particularly strenuous
- Wheezing or shortness of breath that worsens
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