Intrinsic Asthma: Symptoms, Diagnosis, And Treatment

Around 25 million people in the United States have asthma, with the number of people diagnosed every year rising. When your doctor diagnoses you with asthma, they may tell you that you have intrinsic or extrinsic asthma. Understanding the difference can help you avoid triggers that may cause an asthma attack.

This article will focus on understanding intrinsic asthma, its differences from extrinsic asthma, and the treatment options available.

What is asthma?

Asthma is a chronic disease that affects the lungs. If you have asthma, you will periodically experience difficulty breathing when your airways become narrowed and inflamed. The narrow passageways to the lungs make it much more difficult to breathe in and expel air.

This may cause symptoms such as coughing, wheezing, and tightness in the chest.

These symptoms occur during what's often called an "asthma attack." An asthma attack can last anywhere from a few minutes to a few days and vary in severity. Some people can manage mild or moderate symptoms on their own using medication and devices like inhalers or nebulizers.

More severe asthma attacks may require medical intervention, and an average of around 1.6 million people¹ visit the emergency room for asthma treatment each year.

Creating and sticking to a treatment plan can reduce the severity and frequency of asthma attacks. 

Difference between extrinsic and intrinsic asthma

You can have intrinsic asthma or extrinsic asthma. While both types of asthma share the same symptoms, their triggers can be very different. Triggers are things that can cause an asthma attack.

Everyone's asthma triggers vary, and what triggers your asthma may not trigger someone else's. When you know what triggers your asthma, you can work to avoid it. This may reduce the frequency of your asthma attacks, meaning you'll rely less on rescue inhalers and prevent emergency room visits.

Extrinsic asthma

This type of asthma is also known as allergic asthma. It's the most common type of asthma, as up to 90% of people with asthma have this type. Breathing in allergens triggers asthma attacks if you have extrinsic asthma.

Your immune system overreacts to the allergen, creating an allergic reaction that could include an asthmatic episode. 

Common triggers for people with extrinsic asthma include:

• Household dust

• Pet dander

• Plant pollen

• Food allergies such as a shellfish allergy

• Certain medications such as aspirin 

This type of asthma is more common in children and may gradually become less severe as they get older. About 50% of children with extrinsic asthma have no symptoms of the disease by adulthood.

Intrinsic asthma

Intrinsic asthma is also known as non-allergic asthma. This means an allergic reaction doesn't trigger an asthma attack. Instead, it may be a variety of things, including:

• Hormonal changes, such as menstruation

• Exercise

• Changes in the weather

• Respiratory or sinus infections

• Illnesses such as colds or the flu

• Stressful situations

• Air pollution

This form of asthma is more commonly diagnosed later in life. It’s the rarer and often more severe form of asthma. Only 10-40% of people with asthma have intrinsic asthma. It is more common in women than in men.

The importance of understanding intrinsic asthma triggers

It's not always easy to determine the triggers of intrinsic asthma. Doctors can perform tests to assess some triggers, such as physical exercise and certain chemicals or perfumes. However, other potential triggers of intrinsic asthma are impossible to test for, such as hormonal changes and changes in the weather. 

Instead, you'll want to keep a journal to track your asthma attacks and the factors surrounding them. Track information such as weather conditions, your mood, and what you were doing at the time. This can help you and your doctor understand the patterns around your asthmatic episodes and what may have caused them.

When you understand what triggers your intrinsic asthma, you can work to avoid them. The information can also tell you when you will most likely need an inhaler or other medication to control your symptoms. That can reduce the severity and frequency of your attacks and avoid visiting the emergency room. 

Symptoms of intrinsic asthma

The symptoms of intrinsic asthma are the same as those of extrinsic asthma. Some people may experience early warning signs before an asthma attack, such as irritability, fatigue, or anxiety. 

Once the asthma attack begins, common symptoms include: 

• Coughing

• Wheezing

• Tightness in the chest

• Feeling short of breath or breathless

• Difficulty taking in a full breath

If left untreated, the symptoms of an asthma attack may become more severe and could even become life-threatening. Watch for signs that indicate you need to seek medical attention, including:

• Difficulty walking or moving because you can't breathe

• Lips or fingertips getting pale or turning blue

• Confusion or becoming unresponsive

These symptoms indicate a medical emergency. You should call 911 or visit your nearest emergency room right away. 

Causes of intrinsic asthma

It's unclear why some people develop asthma while others do not. However, there are strong indications that genetics and environmental factors play a part. 

If you have a parent with asthma, you have a 25%² chance of developing the condition. If both of your parents have asthma, you'll have a 50% chance of having it. 

Environmental factors may also contribute to the development of asthma. These include exposure to certain types of chemicals or viral infections as an infant or in early childhood. 

Diagnosis of intrinsic asthma

Your doctor will talk to you about your symptoms to make an asthma diagnosis. They will want to learn more about your health history and your family’s medical history. 

They may also do a physical examination and run a series of tests, including using a spirometer. This device measures the amount of air you can exhale, which tells your doctor how well your lungs work. You may also need a chest x-ray or other imaging scans to ensure no other underlying medical issues are causing your symptoms.

Blood tests can help your doctor determine whether you have intrinsic or extrinsic asthma. The test will allow them to check for certain antibodies, which could indicate your asthma results from an allergic reaction. Your doctor may do other types of testing to determine what triggers your asthma attacks, including exercise challenges and exposure to specific allergens and irritants.

Based on your diagnosis, your doctor will work with you to create a plan to manage your asthma.

Treatment of intrinsic asthma

Intrinsic asthma is treatable. Most people can manage their asthma symptoms themselves with the support of a doctor. Part of asthma management will involve being aware of your triggers and avoiding them as much as possible.

Other treatment options include medication and surgical intervention in the most severe cases where usual asthma treatment does not work. 

Lifestyle changes can also reduce the severity and frequency of your asthmatic episodes. This might include losing weight, stopping smoking, or reducing your stress levels. 

Your doctor will work with you to create a treatment plan. It will include long-term management and quick-relief options to alleviate the symptoms of an asthma attack once it begins.

Types of asthma medications

There are various types of medications available to manage asthma symptoms. 

Long-term asthma management options 

These might include daily medications to prevent the onset of an asthmatic episode. These medications, such as corticosteroids, can reduce inflammation in the lungs and airways. This should make it easier to breathe.

Rescue options

These include bronchodilators, which treat the immediate symptoms of an asthma attack. They relax the muscles in the airways, allowing them to open up so you can take in oxygen more efficiently. Quick-relief options should be on hand at all times so you can use them as needed. 

Asthma medications can include oral pills. You might also use inhalers or nebulizers that deliver medicine directly to the lungs. If you haven't responded well to pills or inhalers, your doctor may recommend biologic injections. They target the chemicals in your body that cause lung inflammation.

When to visit a doctor

If you are experiencing any asthma symptoms, including chest tightness, coughing, wheezing, or difficulty catching your breath after mild physical activity, make an appointment with your doctor. They can determine if asthma or another condition is causing your symptoms. 

If you are having difficulty breathing to the point that your lips are turning blue or you are becoming unresponsive, call 911. 

The lowdown

Asthma is a chronic condition affecting the lungs. It's unclear what causes asthma, but it's likely a combination of genetic and environmental factors. Asthma symptoms include wheezing, coughing, or feeling a tightness in the chest. 

Intrinsic asthma is also known as non-allergic asthma. Many things can trigger it, including hormonal changes, changes in the weather, or stress. Everyone has different asthma triggers, and determining your triggers can help you avoid them and prevent asthmatic episodes. 

Avoiding triggers is a part of a good asthma management plan, which may also include medications such as bronchodilators and corticosteroids. 

Medications can help with the long-term management of the condition and provide quick relief of symptoms during an asthma attack. If you are experiencing any asthma symptoms, make an appointment with your doctor.