What You Need To Know About Asthma

What is asthma?

Asthma is a chronic inflammatory condition that affects your lungs. It’s a disease that is commonly seen in both children and adults. A person with asthma will experience symptoms frequently or sporadically, depending on the severity and type of their condition.

Asthma symptoms are caused when the muscles in your lower airways (tubes that pass air in and out of your lungs) become inflamed and tighten, holding onto the air and making it difficult to breathe out. The airways create more mucus than usual, which also obstructs the passage of air through them.

This condition can affect people of any age, but in many cases, it begins in childhood and can go away completely or persist to some extent in adulthood.

Types of asthma

There are several forms of asthma, and they are classified according to the severity, the age it begins, or what is responsible for triggering the condition. 

Based on age

  • Childhood asthma: This is also called pediatric asthma. It typically begins before the age of 5 years. In most cases, the disease is mild and children outgrow the condition. But it may also persist into adulthood, particularly when it is severe and risk factors are present, such as exposure to allergens, allergic predisposition, and a history of asthma in the parents.

  • Adult-onset asthma: If you have asthma symptoms for the first time after the age of 18, then it’s classified as adult-onset asthma. Symptoms of adult-onset asthma are likely to be more severe and persistent, and there is more likely to be a progressive effect on lung function. Onset after age 40 is more common in women. Risk factors for the development of this type of asthma include obesity, smoking, increasing age, a history of wheezing, rhinitis, or chronic cough, and low socioeconomic status. Because childhood asthma is more common, adult-onset asthma may be underdiagnosed.

Based on severity

  • Persistent asthma: A person with persistent asthma will have frequent symptoms that may be categorized as mild, moderate, or severe. They will experience symptoms two or more days a week and some interference with regular daily activities.

  • Intermittent asthma: Intermittent asthma is a more manageable form of the condition. Unlike with persistent asthma, this person will experience sporadic symptoms and periods of asthma recurrences. On a regular basis, symptoms will occur less than two days a week, and there’ll be no interference with normal daily activities. 

Other types of asthma

  • Occupational asthma: This type of asthma is caused by exposure to irritants that trigger symptoms in your workplace. These could include chemical substances, dust, paint, some types of mold, sawdust, cleaning products, and smoke. Some research shows that people who work as bakers, drug manufacturers, millers, woodworkers, farmers, and detergent manufacturers are at a higher risk of developing occupational asthma.

  • Exercise-induced asthma: Intense exercise can trigger asthma in some people who may not have symptoms at other times. This form of asthma is also called exercise-induced bronchospasm. Many of these patients have only used their rescue inhalers before physical activity (and no other therapy), but this practice is now being discouraged in favor of ongoing treatment with one or more daily preventive medications.

  • Allergic asthma: This very common form of asthma is caused by an allergic predisposition. Being allergic to mold, dust, or pollen could trigger asthma symptoms when they are inhaled. Many will also have eczema, food allergies, allergic rhinitis (“hay fever”), and a strong family history of allergies and asthma. This type of asthma is more likely to continue into the adult years.

  • Asthma-COPD overlap: Chronic obstructive pulmonary disease (COPD) is an umbrella term defining illnesses that affect the lungs and cause difficulty breathing. It’s different from asthma; however, a person can have both conditions simultaneously. The most common cause of COPD is smoking, whereas asthma has many causes and associations.

Statistics

According to the Centers for Disease Control and Prevention (CDC), about 1 in 13 people¹ in the United States have been diagnosed with asthma, with more than 25 million affected by asthma currently.

Adults over 18 account for more than 20 million people in this number, while around 5 million children under 18 are affected.

  1. Most recent national asthma data | Centers for Disease Control and Prevention

Symptoms

Signs and symptoms of asthma look a little different from person to person and tend to vary in children and adults. They can range in intensity, depending on the form of the condition you have, and can be either mild, moderate, or severe. Some of the most common symptoms of asthma include:

  • Difficulty breathing

  • Coughing

  • Chest pain

  • Chest tightness

  • Wheezing

  • Fast heartbeat

  • Fatigue

  • A feeling of anxiety

Symptoms of asthma may sometimes closely resemble those of respiratory infections. However, asthma symptoms follow a pattern that helps distinguish them from respiratory infections. Symptoms due to asthma will characteristically:

  • Vary in intensity throughout the day

  • Worsen at night

  • Be triggered by or worsen with physical activity

  • Worsen with viral infections such as a cold

  • Be triggered by allergies

Recognizing an asthma attack

The easiest way to understand what happens during an asthma attack, also called an exacerbation or flare-up, is to view it as an overall worsening of your asthma symptoms. It can creep up on you gradually or occur suddenly. But unlike your usual asthma symptoms that will come and go, a flare-up tends to stick around for days, making it difficult for you to function normally.

During an asthma flare-up, your airways become more inflamed and constricted, making it difficult for you to breathe. People with asthma describe the feeling as chest tightness or a weight on their chest. Others state it feels like the air is being sucked out of their lungs. Either way, an asthma attack can be a very frightening encounter.

If you’ve had frequent asthma exacerbations, you are either not getting adequate treatment for your condition, or it has worsened. And if nothing is done to heal your airways, your condition could become worse and you may need oxygen, hospitalization, or, in extreme cases, die.

You are likely to experience most or all of your typical asthma symptoms during an asthma attack, but they will be worse and harder to treat.

When to call a doctor

If you’ve already been diagnosed with asthma, a mild asthma flare-up can usually be managed at home with the prescribed treatment and management techniques. You should call your doctor when indicated by your asthma action plan or if your symptoms are not improving with home measures.

You should immediately contact emergency services if you notice any of the following signs:

  • You have difficulty breathing.

  • Your skin begins to take on a blue tint, particularly around the lips.

  • Your heart starts to beat very rapidly.

  • You have a persistent cough that is worsening rapidly and affecting your ability to function.

  • You have difficulty speaking or cannot eat or drink due to your symptoms.

Asthma triggers

Any number of things can trigger asthma symptoms. These triggers are highly individual, range in their impact from person to person, and can evolve over time. For instance, two people may not be affected by the same trigger, and a person with childhood asthma might not have the same triggers in adulthood.

Some of the most common include:

  • Smoke: One of the most common triggers is smoke. This could either be smoke from a cigarette, a fireplace or chimney, wildfires in the area, or an exhaust pipe. It’s best to avoid being in close quarters with people who smoke.

  • Respiratory viruses: Respiratory viruses such as the common cold and the flu can worsen asthma symptoms for anyone with the condition. Children who have had respiratory viral infections that cause wheezing are more likely to develop asthma.

  • Rigorous physical activity: Engaging in an activity like high-intensity exercise, for example, could trigger asthma symptoms, particularly in people with exercise-induced asthma or poorly controlled asthma of any type.

  • Pests: The droppings from pests such as cockroaches and mice could set off asthma in some people.

  • Dust: Dust and dust mites can sometimes trigger asthma.

  • Mold: Moldy areas and mold exposure are common provokers of asthma symptoms.

  • Air quality: Being exposed to very cold air or poor air quality could set off asthma symptoms, especially when there is a high concentration of pollutants or poor ventilation.

  • Medication: Certain medicines such as beta-blockers and aspirin have been proven to cause breathing difficulties in people with asthma.

  • Allergies: The most common allergies to inhaled substances, such as dust mites, mold, and pet dander, along with more seasonal allergens like grass, pollen, and ragweed, can set off or worsen asthma symptoms. These can be managed by limiting exposure, allergy medicines, and allergy shots.

  • Reflux: Some research suggests that acid reflux can trigger or worsen asthma symptoms, although the exact relationship between the two conditions is still somewhat controversial. Treating acid reflux may improve asthma symptoms in some people.

  • Emotional states: It’s not commonly known that your emotional state can initiate asthma symptoms. Research shows a link between strong emotions such as stress or anxiety and asthma control.

Asthma complications

In cases where asthma is misdiagnosed, improperly treated, or very severe, it could cause other medical complications, such as recurrent and more serious respiratory infections, frequent hospitalizations, being placed on oxygen or a ventilator, and worsening disease. The most immediate fear is typically respiratory failure, which could lead to death.

Long-term use of certain asthma medications such as corticosteroids can result in bloating, weight gain, and eyesight changes. Most commonly, a fungal infection called thrush can occur in people who don’t rinse their mouth after using their corticosteroid inhalers.

Living with poorly managed asthma has adverse effects on your quality of life. You are likely to find engaging in physical activities taxing and become quickly fatigued. Its symptoms can also interfere with sleep, causing you to sleep poorly and wake up tired.

Causes

Researchers are yet to identify what exactly causes asthma. Environmental factors and genetics have been identified as the most likely culprits. Certain factors also make some people more susceptible to developing the condition. They include:

Genetics

Having a family history of asthma or other related respiratory diseases increases your risk of developing asthma. This risk is highest when both parents have been diagnosed with asthma.

Sex

Childhood asthma appears to occur more frequently in boys than girls¹, at least up until the age of puberty, when it begins to even out. On the other hand, adult-onset asthma is more common in women than men, particularly in older ages.

Allergic predisposition

Also known as atopy, this means that asthma and allergies are closely linked. People who are predisposed to allergies such as hay fever, food allergies, or eczema are more likely to also develop asthma. This can also be true when family members have a history of atopy.

Other conditions

If you’ve already been diagnosed with conditions such as obesity or COPD, you are at higher risk. There is also some association with celiac disease in those who also have a family history of asthma. Premature birth with low birth weight is also a set-up for the development of childhood asthma.

Environmental factors

Working or living in an area where you are likely to have regular exposure to hazardous chemicals, fumes, particulates (such as flour), or irritants increases your likelihood of developing the condition. Research demonstrates that people living in urban homes have twice as much exposure to indoor pollutants than those in rural areas, and a larger percentage also have evidence of water damage or mold growth.

Tobacco smoke

It’s not difficult to imagine that smoking heightens the risk of asthma. Many studies have also shown that even secondhand exposure to tobacco smoke is associated with an increased risk for both children and adults.

Respiratory infections

Having a history of recurrent lower respiratory tract infections, especially in childhood, seems to increase the risk of asthma, although the mechanism has not yet been determined. It could be that immune factors are triggered, or lung tissue becomes inflamed, leading to changes in its responsiveness to environmental triggers.

Age

Asthma is most likely to occur in childhood when you are still growing and your immune system is still developing.

Diagnosing Asthma

There is no single test for diagnosing asthma. If your doctor suspects you have the condition, they’ll take a thorough look into your medical and family history. Then, they’ll do an examination and attempt to rule out any other respiratory diseases that could be responsible for your symptoms. Some of the tests you are likely to undergo might include:

  • Lung function tests: Asthma affects your ability to breathe with ease. Lung function tests are often ordered to assess how well your lungs are working. One such test is called spirometry. You’ll be asked to take deep breaths into a spirometer, a machine that takes measurements of your airflow. You’ll then be given medication to help you breathe more easily and asked to breathe in and out of the device again. Finally, your before and after results will be compared to determine the efficiency of your lung function and responsiveness of your airways.

  • Fractional exhaled nitric oxide tests: The inflammatory response in asthma causes a chemical called nitric oxide to build up in your lungs. Fractional exhaled nitric oxide tests help determine the nitric oxide levels, which are a marker for the amount of inflammation in your lungs.

  • Bronchoprovocation tests: This test is done to gauge how your airways react when exposed to certain substances such as dust or pollen. Your breathing is measured before and after the test to determine if these substances affected you.

  • Allergy tests: Allergy tests are frequently recommended to see how your body responds to allergens known to trigger asthma, such as dust, pollen, and smoke. Your doctor will also examine your family and medical history for any allergic tendencies. 

Diagnosing Asthma in Children

Diagnosing asthma in very young children can be a little tricky. This is because they cannot cooperate well enough to do specific tests, such as the lung function test. Some research shows that about 4 out of 10 children² who make wheezing sounds when breathing are eventually diagnosed with asthma.

Your child’s doctor will instead rely on history, a physical examination, and possibly X-rays to rule out other conditions that could be responsible for your child’s symptoms. They might also start your child on a low dosage of asthma medications to see how well they respond. 

Often, it takes time to come to a final diagnosis of asthma, particularly when your child has had symptoms associated with respiratory infections. Asthma involves recurring episodes of wheezing, so if your child has had one or two episodes have occurred with a cold or flu, it may only give enough information for a preliminary diagnosis. 

If the symptoms continue and recur, a diagnosis and treatment recommendations will be given to help manage the condition so that your child can lead a normal life.

Treatments

There’s currently no cure for asthma. However, there are many ways to effectively manage the condition with medical devices and medications. 

Medications

Asthma medicines help to open up your airways and reduce the inflammation and production of mucus. This makes it easier to breathe and participate in the activities of daily life. You’ll typically be prescribed medications for long-term control and different ones for quick relief. 

Long-term control medicines

Medication regimens for the long-term control of asthma are typically made up of anti-inflammatory drugs. These are medicines that prevent the inflammation and constriction of your airways. The idea is that if you control the underlying problem instead of just treating symptoms when they occur, you can manage asthma with more of a focus on prevention. These medicines include:

  • Corticosteroids: Steroids are usually given in the form of a daily inhaler, like Flovent (fluticasone) or Qvar (beclomethasone), to calm the inflammation that causes your symptoms. Unlike the oral form, inhaled steroids can be taken for longer periods without causing systemic side effects. That’s because you inhale them right into your lungs, where they are needed the most. This is not a medicine used to open up your lungs right away when you have symptoms, so don’t get it confused with your rescue inhaler. Your steroid inhaler needs to be taken daily to improve your airway inflammation over time.

  • Long-acting beta-agonists: These medicines are typically taken by inhalation, like a Serevent (salmeterol) Diskus, and their only action is to keep the airways open. They do not heal inflammation but are often combined with a steroid and taken twice daily in inhaled medication such as Symbicort (formoterol and budesonide) and Advair (salmeterol and fluticasone).

  • Leukotriene modifiers: These are also anti-inflammatory drugs that need to be taken daily to help treat your asthma and prevent asthma symptoms. They work by reducing the inflammatory response that leads to swelling and mucous production, and they relax the bronchial smooth muscle to prevent airway constriction. Singulair (montelukast) is a commonly prescribed medicine in this class.

  • Mast cell stabilizers: Mast cell stabilizers, like Intal (cromolyn sodium), are helpful for allergy-related asthma. They prevent the inflammatory response of your airways to allergens, keeping them open and clear to make breathing easier. However, this medicine does not work to open up the lungs once your symptoms start, and that’s where quick-relief medications come in.

Quick-relief medicines

Medications taken for the rapid relief of symptoms, also known as rescue medicines, are prescribed to quickly open up your constricted airways and make breathing easier. They are referred to as bronchodilators and are typically available for use in the form of an inhaler or nebulizer. They include: 

  • Short-acting beta-agonists: Ventolin HFA (albuterol) and Xopenex HFA (levalbuterol) are typical examples of short-acting beta-agonist inhalers that can be used as rescue medicines. Unlike steroid inhalers, they will work to immediately open up your airways when you have symptoms.

  • Steroids: Oral steroids may be prescribed when you have a flare-up of asthma symptoms that keep coming back and seem to worsen overall. They might also be given through an IV in the emergency department during a severe asthma attack for more rapid action. 

The goal and measure of good asthma management are when daily medicines are given to the point where quick-relief medicines are not often needed. That means airway inflammation is under such good control that a person with asthma can participate in all normal activities of life without limitations.

How to manage your asthma

Aside from sticking steadfastly to the treatment plan prescribed by your doctor, there are several measures you can take to help manage your asthma. Some things you can do include:

  • Keeping an asthma symptom journal: To understand better what’s happening with your body, it would help to keep a journal. You should document when and how often you have asthma symptoms, what triggers them, how long they last, and what treatment provides the most relief. Discussing your journal entries during visits with your doctor would help them track your treatment progress.

  • Join a support group: Spending time with a group of other people living with asthma and their families can provide emotional support and insight into the condition, no matter when you were diagnosed. It provides access to a wealth of information and resources, even for people who have lived with asthma all their lives.

  • Learn your triggers: Even though the symptoms can be similar, what triggers asthma differs from person to person. It’s essential to learn what sets off your asthma and how best to avoid these triggers so that, along with your prescribed medicine, you can exert some reasonable amount of control over your condition.

  • Maintain a healthy lifestyle: Making healthy lifestyle changes can help you manage your asthma better. Keeping a healthy weight, eating a balanced diet, exercising regularly, getting enough sleep, and managing stressors in your life are great places to start. Many people believe they cannot or should not exercise because they have asthma. That couldn’t be further from the truth. Exercise is therapeutic for people with asthma. If you have symptoms with exercise, it means your disease is not well controlled, and you need to discuss this with your doctor. The goal of asthma treatment is to reduce airway inflammation enough so that you can exercise and live your life symptom-free.

  • Use a peak flow meter: Your doctor might recommend that you purchase and use a peak flow meter to measure how quickly you can blow air out of your lungs at any time. You should use it when you are feeling well to measure your baseline peak flow rates. That way, you’ll have something to compare to the readings you get with symptoms. It also helps you track if your medications are working or if you have airway constriction from worsening inflammation.

  • Have an asthma action plan: An asthma action plan includes what to do when you have an asthma attack or worsening symptoms, the information on your emergency contact person, what medicines you should take, and how to take them during an exacerbation, depending on its severity.

This plan should be given to you by your doctor and reviewed during follow-up visits and with any medication changes to make sure it is kept up to date. It would be best to share your asthma action plan with close friends and family in case you ever experience an incapacitating asthma attack.

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Prevention

While there are many medications available to treat and manage asthma symptoms, there’s no known way to prevent the condition from developing in the first place. 

However, you can do things to reduce the likelihood of you or your child developing asthma. These primarily include reducing exposure to environmental factors such as secondhand smoke, mold, air pollution, and chemical irritants. 

Asthma symptom prevention

The good news for people living with the condition is that it’s possible to manage the frequency of asthma symptoms and reduce their severity. Some of the best tips you can implement to prevent asthma symptoms from occurring include:

Avoiding triggers

To avoid asthma triggers, you must first learn what they are. For people with allergic-type asthma, allergens such as dust, pollen, or pet dander could trigger their symptoms. Others might be triggered by exercise or viral infections. By keeping track of the circumstances around asthma flare-ups, people can begin to learn more about their triggers and how they work to cause symptoms.

Avoid smoke

People with asthma need to limit their exposure to smoke. This means cutting out a smoking habit if you have one and avoiding places where you’ll be exposed to secondhand smoke, like in a crowded bar.

Keep your home allergen-proof

Most allergens have the potential to set off asthma symptoms in anyone with the condition. Keeping your home clean and free from allergens will help prevent you from having frequent asthma flares. You should change the linen and bed sheets weekly, vacuum and dust frequently, and consider installing an air purifier.

Get your flu shots

People living with asthma are more likely to experience severe symptoms when they get the flu. This could also lead to complications like pneumonia or a chest infection. Getting vaccinated for the flu before every flu season helps to prevent this.

Take your medications as prescribed

It’s crucial to stay on top of the medicine schedule prescribed to you by your doctor. Make sure to follow the recommended doses and frequency. Carry your asthma medication, particularly your rescue inhaler, when going to work or school, and don’t forget to bring that and your long-term preventive medicine with you on any trip.

Doctors & specialists

If you suspect you or your child has asthma, your first stop should be to your primary care practitioner or your child’s pediatrician. To confirm your diagnosis, they might refer you to a pulmonologist, a specialist in treating conditions affecting the respiratory system. Allergy specialists also treat people with asthma, particularly if they have associated allergic conditions like seasonal allergies and eczema.