Imagine breathing through a straw. Now imagine you’re running or very stressed and trying to breathe through that straw. This is what millions of people with asthma experience when they have an asthma “attack,” or flare-up.
But what exactly is asthma?
Asthma is a chronic illness that affects your airways as they narrow and swell, sometimes filling with mucus. The word “asthma” comes from the Greek aazein, which means to pant with your mouth open — a good fit given how the disease affects your breathing.
Asthma symptoms
Asthma symptoms vary from person to person and they can also change, sometimes making diagnosis tricky.
Symptoms of asthma can include:
- Feeling short of breath
- Chest tightness or pressure
- Wheezing (a whistling sound when you breathe out)
- Feeling out of breath, coughing or wheezing while trying to sleep
- Coughing or wheezing that gets worse with a cold or a respiratory virus
Signs that asthma is worsening include:
- More frequent symptoms
- Lower readings on a peak flow meter, which measures how much air your lungs can push out
- Needing rescue medications more often
If symptoms get to the point that you can’t catch your breath or speak without gasping, this is a medical emergency. Call 911 immediately.
Asthma types and severity
Asthma ranges from mild to life-threatening and may improve or worsen over time.
Clinicians classify asthma cases based on the frequency and severity of symptoms:
- Mild intermittent: Symptoms no more than two days a week or two nights a month
- Mild persistent: Symptoms more than twice a week, but not every day
- Moderate persistent: Symptoms happen daily and more than one night a week
- Severe persistent: Symptoms go on for most of the day, almost every day and often at night
There are also different types of asthma:
- Allergic: Linked to inhaled allergens like pollen, dust or animal dander
- Exercise-induced: Triggered by physical activity
- Cough-variant: Coughing is the main or only symptom
- Occupational: Caused by triggering substances in the workplace
- Nocturnal: Symptoms appear mainly at night
- Aspirin-induced: Triggered by aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Steroid-resistant: Doesn’t respond to standard steroid treatments
Asthma risk factor and triggers
Anyone can get asthma, but it tends to run in families. You might be more likely to have asthma if you:
- Have a parent with asthma
- Have allergies like allergic rhinitis (also called hay fever) or allergic conditions like eczema (atopic dermatitis)
- Are exposed to dust, chemical fumes or molds at work
- Smoke cigarettes or are exposed to second-hand smoke
- Live in areas with high air pollution
- Are living with overweight or obesity
Triggers for an attack are anything that causes your airway to react. They can be allergic or non-allergic.
Common allergic triggers include:
- Dust
- Animal dander
- Pollen
- Mold
- Food allergies
Common non-allergic triggers include:
- Smoke, smog and air pollution
- Exercise
- Respiratory infections
- Cold air
- Changes in the weather
- Perfumes, detergents and other scented products
- Intense emotions
Although intense emotions can trigger an asthma attack, this doesn’t mean that asthma is “all in your head,” as many people used to believe. Laughing and crying and other emotions can cause your body’s muscles, including those around your airway, to tighten up.
Who you are and where you live also affects asthma risk and control. Black, Hispanic and Indigenous populations in the U.S. have higher asthma rates, more emergency department visits and hospitalizations, and often more difficulty accessing doctors and medications compared to white people.
People in lower-income neighborhoods may be exposed to more indoor and outdoor pollution, dampness, mold and pests.
Diagnosing asthma
To get an asthma diagnosis, you’ll have a physical exam and answer questions about your symptoms and family history, and then your clinician will do some testing.
The most common test for asthma is spirometry, which measures how much air you can breathe in and quickly blow out. If your clinician suspects allergies, you may be given allergy testing. If you notice symptoms with exercise, you might be given an exercise test, such as walking on a treadmill or climbing stairs. Another possible test for exercise-induced asthma is the methacholine challenge test, which involves inhaling medication and repeating the spirometry to see how your airway reacted to the drug.
Asthma treatment and management
People with mild or well-controlled asthma are usually followed by their primary care clinician. People with more complex, uncontrolled or severe asthma may be referred to a pulmonologist (lung doctor) and maybe an allergist.
There’s no cure for asthma, but most people can control symptoms with medications and lifestyle changes to avoid triggers.
Asthma medications are usually divided into two groups: quick relief (rescue) and long-term, preventive (controller) drugs.
Quick relief drugs are usually inhalers, working quickly to relax your airways. They may contain corticosteroids (steroids) to reduce inflammation, bronchodilators to widen the airways or both. If the inhalers can’t get your symptoms under control, you may need oral corticosteroids, like prednisone, or in severe cases, intravenous corticosteroids.
Steroids can be life-saving, but they can also cause serious side effects like high blood pressure, bone loss (osteoporosis) and a higher risk of infections if used too often or for long periods of time. To reduce this risk, your clinician might prescribe preventive medications if you have frequent asthma flare-ups.
Long-term control drugs, also known as maintenance medications, help reduce the number of asthma attacks, but they don’t work as emergency medications because they take time to work and must be taken regularly even when you don’t have symptoms.
Long-term controller medications are typically inhaled corticosteroids and long-acting bronchodilators.
Other options include leukotriene modifiers (pills), older medicines such as theophylline and newer biologic medicines. Biologics can be given as injections or infusions and can be used as add-on treatments for some people with moderate-to-severe asthma whose symptoms remain uncontrolled despite treatment.
Living well with asthma
With good control, most people with asthma live full lives and are able to work, exercise and enjoy their usual activities.
Key steps to keeping your asthma under control include:
- Taking prevention medicines exactly as prescribed
- Keeping rescue inhalers close by and using as directed
- Avoiding known triggers when possible
- Staying up-to-date on recommended vaccines, such as the flu shot
- Regular visits with your clinician
It’s important to talk to your clinician if you’re experiencing new or worsening symptoms. You may need to make adjustments to your treatment plan.
Resources
Allergy & Asthma Network – Access to Medications for People with Allergies and Asthma
Allergy & Asthma Network – How to Get Your Meds Approved: Appealing an Insurance Denial
This educational resource was created with support from Sanofi and Regeneron.
