Asthma occurs because of inflammation and mucus in the lining of your airways. During an attack, this inflammation causes a wheezing or whistling sound when you breathe, along with other symptoms.
What is asthma?
Asthma is an inflammatory disease that can affect the airways to your lungs. It makes breathing difficult and can make some physical activities challenging or even impossible.
According to the Centers for Disease Control and Prevention (CDC), about 25 million people in the United States have asthma. It’s the most common chronic lung condition among children in the United States: In 2018, the CDC reported that about 1 of every 12 children had asthma.
To understand asthma, it’s necessary to know a little about what happens when you breathe. Usually, with every breath you take, air goes through your nose or mouth, down into your throat, and into your airways, eventually reaching your lungs.
There are lots of small air passages in your lungs that help deliver oxygen from the air to your bloodstream.
Asthma symptoms happen when the lining of your airways swells and the muscles around them tighten. Mucus then fills your airways, further reducing the amount of air that can pass through.
These effects can bring on an asthma “attack,” which involves the coughing and chest tightness that are typical of asthma.
Symptoms
The most common symptom of asthma is wheezing — a squealing or whistling sound that happens when you breathe.
Other possible asthma symptoms include:
coughing, especially at night, when laughing, or during exercise
tightness in your chest
shortness of breath
difficulty talking
anxiety or panic
fatigue
chest pain
rapid breathing
frequent infections
trouble sleeping
The type of asthma you have can determine which symptoms you experience.
Some people experience symptoms consistently throughout the day. Others may find that certain activities make their symptoms worse.
But not everyone with asthma will experience these particular symptoms. If you think the symptoms you’re experiencing could be related to a condition such as asthma, make an appointment to see a healthcare professional.
If you have asthma, remember that even if your condition is well managed, you may occasionally have a flare-up of symptoms. Flare-ups often decrease with the use of quick-acting treatments, such as inhalers, but may require medical attention in severe cases.
Symptoms of an asthma flare-up may include:
coughing
wheezing
throat clearing
difficulty sleeping
chest pain or tightness
fatigue
If your symptoms worsen or don’t improve with the use of an inhaler, you should seek immediate medical treatment.
You should also seek treatment if you have symptoms of an asthma emergency, such as:
severe trouble breathing
gasping for air
confusion
pale or blue lips or fingernails
dizziness
difficulty walking or talking
Causes and triggers
Although asthma is especially common in children, many people don’t develop asthma until adulthood.
Health experts have not identified a specific cause of asthma. Instead, researchers believe it’s caused by a variety of factors, including:
Genetics: If your parent or sibling has asthma, you’re more likely to develop it.
History of viral infections: People with a history of severe viral infections during childhood, such as respiratory syncytial virus infection (RSV), may be more likely to develop asthma.
Hygiene hypothesis: When babies are not exposed to enough bacteria in their early months and years, their immune systems may not become strong enough to fight off asthma and other allergic conditions.
Many factors can also trigger asthma, causing the symptoms to worsen. Triggers for asthma can vary, and some people may be more sensitive to certain triggers than others.
The most common triggers include:
health conditions such as respiratory infections
exercise
environmental irritants
allergens
intense emotions
extreme weather conditions
pests
certain medications, including aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
Types of asthma
Your doctor will need to determine the type of asthma you have. The most common type is allergic asthma, which accounts for 60%Trusted Source of all cases of asthma.
Some types of asthma are related to your stage of life. While asthma can appear at any age, pediatric asthma specifically affects children, and adult-onset asthma doesn’t begin until adulthood.
The sections below describe other specific types of asthma.
Allergic asthma
This common type of asthma is triggered by allergens, including:
pet dander from animals such as cats and dogs
food
mold
pollen
dust
Allergic asthma is often seasonal because it goes hand-in-hand with seasonal allergies.
Non-allergic asthma
Irritants in the air that are not related to allergies trigger this type of asthma. These irritants might include:
burning wood
cigarette smoke
cold air
air pollution
viral illnesses
air fresheners
household cleaning products
perfumes
Occupational asthma
Occupational asthma is triggered by irritants in the workplace, such as:
dust
dyes
gases and fumes
industrial chemicals
animal proteins
rubber latex
These irritants can exist in a wide range of industries, including:
farming
textiles
woodworking
manufacturing
Exercise-induced bronchoconstriction (EIB)
EIB usually affects people within a few minutes of starting exercise and can last until 10–15 minutes after physical activity.
This condition was previously called exercise-induced asthma.
Up to 90% of people with asthma also experience EIB, but not everyone with EIB will have other types of asthma.
Aspirin-induced asthma
Aspirin-induced asthma (AIA), or aspirin-exacerbated respiratory disease, is usually severe.
It’s triggered by taking aspirin or another NSAID, such as naproxen (Aleve) or ibuprofen (Advil).
The symptoms may begin within minutes or hours. People with AIA also typically have nasal polyps.
About 9% of people with asthma have AIA. It usually develops suddenly in adults ages 20–50 years.
Nocturnal asthma
In this type of asthma, symptoms worsen at night.
Triggers that might bring on symptoms at night include:
heartburn
pet dander
dust mites
Your body’s natural sleep cycle may also trigger nocturnal asthma.
Cough-variant asthma (CVA)
CVA doesn’t cause the classic asthma symptoms of wheezing and shortness of breath. Instead, it involves a persistent dry cough.
However, if it’s not treated, CVA can lead to full-blown asthma flares that include the more common symptoms.
Diagnosis
No single test or exam can determine whether you or your child has asthma. Instead, healthcare professionals will use a variety of criteria to find out whether your symptoms are the result of asthma.
The following steps can help healthcare professionals diagnose asthma:
Health history: Tell your doctor if you have family members with asthma, since this can mean you have a greater chance of developing it.
Physical exam: Your doctor will listen to your breathing with a stethoscope. They may also perform a skin test to look for signs of an allergic reaction, such as hives or eczema. Allergies increase your risk for asthma.
Breathing tests: Pulmonary function tests measure the airflow into and out of your lungs. For the most common test, spirometry, you blow into a device that measures the speed of the air.
In children
Doctors don’t typically perform breathing tests in children under 5 years of age because it’s difficult to get an accurate reading.
Instead, they may prescribe asthma medications to your child and wait to see whether their symptoms improve. If your child’s symptoms improve with medication, your child likely has asthma.
In adults
Your doctor may prescribe a bronchodilator or another asthma medication if your test results indicate asthma. If your symptoms improve with the use of this medication, your doctor will continue to treat your condition as asthma.
Treatment
To help treat asthma, the National Asthma Education and Prevention Program (NAEPP)Trusted Source classifies the condition based on its severity before treatment.
Asthma classifications include:
Intermittent: Most people have this type of asthma, which doesn’t interfere with daily activities. Symptoms are mild, occurring fewer than 2 days per week or 2 nights per month.
Mild persistent: The symptoms occur more than twice per week, but not daily, and up to 4 nights per month.
Moderate persistent: The symptoms occur daily and at least 1 night every week, but not nightly. They may limit some daily activities.
Severe persistent: The symptoms occur several times every day and most nights, and they greatly limit your daily activities.
Treatments for asthma fall into four primary categories:
quick-relief medications
long-term control medications
a combination of quick-relief and long-term control medications, which is recommended by the most recent asthma clinical guidelines (released in 2020 by the NAEPP) but not yet approved by the Food and Drug Administration
biologics, which are given by injection or infusion and typically used for only severe forms of asthma
Your doctor will recommend one treatment or a combination of treatments based on:
the type of asthma you have
your age
your triggers
Your treatment plan may also involve learning your triggers, carefully monitoring your symptoms, and taking steps to avoid flare-ups.
Quick-relief asthma treatments
These medications should be used only in the event of asthma symptoms or an attack. They provide quick relief to help you breathe again.
Bronchodilators
Bronchodilators work within minutes to relax the tightened muscles around your airways and quickly decrease your symptoms.
Although they can come in the form of an oral medication or injection, bronchodilators are most commonly taken with an inhaler (rescue) or nebulizer.
Your doctor may recommend that you use them to treat sudden asthma symptoms or take them before exercise to prevent a flare-up.
First aid asthma treatment
If you think someone you know is having an asthma attack, tell them to sit them upright and help them use their rescue inhaler or nebulizer.
The dosage will depend on the medication. Check the instructions insert to make sure you know how many puffs of medications you need in the event of an attack.
If symptoms persist for more than 20 minutes and a second round of medication doesn’t help, seek emergency medical attention.
If you need to use quick-relief medications frequently, ask your doctor about another type of medication for long-term asthma control.
Long-term asthma control medications
You can take these medications daily to help reduce the number and severity of asthma symptoms. But they don’t manage the immediate symptoms of an attack.
Long-term asthma control medications include:
Anti-inflammatories: Taken with an inhaler, corticosteroids and other anti-inflammatory medications help reduce swelling and mucus production in your airways, making it easier to breathe.
Anticholinergics: These help stop your muscles from tightening around your airways. They’re usually taken daily in combination with anti-inflammatories.
Long-acting bronchodilators: These should be used only in combination with anti-inflammatory asthma medications.
Biologics
Doctors use biologics to treat severe asthma that doesn’t respond to other medications or to treatment by trigger management.
They work by targeting specific antibodies in your body, disrupting the pathway that leads to asthma-causing inflammation.
There are five types of biologic medications on the market, and others are in development. You can receive this type of medication either as an injection or as an infusion in your doctor’s office.
Bronchial thermoplasty
This treatment uses an electrode to heat the airways inside your lungs, helping to reduce the size of the surrounding muscle and prevent it from tightening.
A doctor will perform this minimally invasive procedure in a clinic or hospital. It usually takes about an hour.
Bronchial thermoplasty is intended for people with severe asthma and can provide relief from symptoms for up to 5 years.
However, because it’s a relatively new procedure, it’s not yet widely available.
