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What is asthma
Diseases & Conditions / May 24, 2024

Asthma is a disease that affects your lungs.

It’s a chronic (ongoing) condition, meaning it
doesn’t go away and needs ongoing medical
management.

This condition can make breathing difficult

and trigger coughing, a whistling sound
(wheezing) when you breathe out and
shortness of breath.

Asthma can’t be cured, but its symptoms can

be controlled. Because asthma often changes
over time, it’s important that you work with
your doctor to track your signs and symptoms
and adjust your treatment as needed.

Table of Contents
1. Symptoms of asthma
2. Causes of asthma
3. What is asthma attack
4. Types of asthma
5. Classification of asthma
6. Triggers of asthma
7. Complications of asthma
8. Prevention of asthma
9. Diagnosis of asthma
10. Treatment of asthma

Symptoms of asthma
The most common symptom of asthma is
wheezing. This is a squealing or whistling
sound that occurs when you breathe. Other
asthma symptoms may include:

tightness in the chest

coughing, especially at night, when
laughing, or during exercise
shortness of breath
difficulty talking
anxiousness or panic
fatigue
chest pain
rapid breathing
trouble sleeping
frequent infections

The type of asthma that you have can

determine which symptoms you experience.
Some people experience symptoms
consistently throughout the day. Others may
find that certain activities can make
symptoms worse.

Not everyone with asthma will experience

these particular symptoms. If you think the
symptoms you’re experiencing could be a
sign of a condition such as asthma, make an
appointment to see your doctor.

Also, keep in mind that even if your asthma is

well-managed, you may still occasionally
experience a flare-up of symptoms. Flare-ups
often improve with the use of quick-acting
treatments, like an inhaler, but may require
medical attention in severe cases. Signs of an
asthma flare-up may include:

wheezing
coughing
throat clearing
difficulty sleeping
fatigue
chest pain or tightness

Note: 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

experience symptoms of an asthma
emergency, including:

severe breathing difficulty

gasping for air
confusion
pale lips or fingernails
dizziness
difficulty walking or talking
blue lips or fingernails

You can also read about symptoms and

causes of lung cancer.

Causes of asthma
It isn’t clear why some people get asthma and
others don’t, but it’s probably due to a
combination of environmental and inherited
(genetic) factors.

Certain risk factors are thought to increase

your chances of developing asthma. They
include:

Allergies: Having allergies can raise your

risk of developing asthma.
Genetics: If your family has a history of
asthma or allergic diseases, you have a
higher risk of developing the disease.
Respiratory infections: Certain
respiratory infections, such as
respiratory syncytial virus (RSV), can
damage young children’s developing
lungs.
Environmental factors: People can
develop asthma after exposure to things
that irritate the airways. These
substances include allergens, toxins,
fumes and second- or third-hand smoke.
These can be especially harmful to
infants and young children whose
immune systems haven’t finished
developing.
Being a smoker.
Having obesity or being overweight.

You can also read about causes and risk

factors of stroke.

What is asthma attack

When you breathe normally, muscles around
your airways are relaxed, letting air move
easily and quietly. During an asthma attack,
three things can happen:

Inflammation: The lining of your airways

becomes swollen. Swollen airways don’t
let as much air in or out of your lungs.
Bronchospasm: The muscles around
the airways constrict (tighten). When
they tighten, it makes your airways
narrow. Air cannot flow freely through
constricted airways.
Mucus production: During the attack,
your body creates more mucus. This
thick mucus clogs airways.

When your airways get tighter, you make a

sound called wheezing when you breathe, a
noise your airways make when you breathe
out. You might also hear an asthma attack
called an exacerbation or a flare-up. It’s the
term for when your asthma isn’t controlled.

Types of asthma
Asthma is broken down into types based on
the cause and the severity of symptoms.
Healthcare providers identify asthma as:

Intermittent: This type of asthma

comes and goes so you can feel normal
in between asthma flares.
Persistent: Persistent asthma means
you have symptoms much of the time.
Symptoms can be mild, moderate or
severe. Healthcare providers base
asthma severity on how often you have
symptoms. They also consider how well
you can do things during an attack.
Allergic: Some people’s allergies can
cause an asthma attack. Allergens
include things like molds, pollens and pet
dander.
Non-allergic: Outside factors can cause
asthma to flare up. Exercise, stress,
illness and weather may cause a flare.
Adult-onset: This type of asthma starts
after the age of 18.
Pediatric asthma: Also called childhood
asthma, this type of asthma often begins
before the age of 5, and can occur in
infants and toddlers. Children may
outgrow asthma. You should make sure
that you discuss it with your provider
before you decide whether your child
needs to have an inhaler available in case
they have an asthma attack. Your child’s
healthcare provider can help you
understand the risks.
Exercise-induced asthma: This type is
triggered by exercise and is also called
exercise-induced bronchospasm.
Occupational asthma: This type of
asthma happens primarily to people who
work around irritating substances.
Asthma-COPD overlap syndrome
(ACOS): This type happens when you
have both asthma and chronic
obstructive pulmonary disease (COPD).
Both diseases make it difficult to
breathe.

Classification of asthma
According to National Asthma Education
and Prevention Program (NAEPP)
classification of asthma based on its
severity before treatment.

Asthma is classified into four general

categories:

Intermittent. Most people have this

type of asthma, which doesn’t interfere
with daily activities. Symptoms are mild,
lasting fewer than 2 days per week or 2
nights per month.
Mild persistent. The symptoms occur
more than twice a 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. Daily activities are extremely
limited.

Determining your asthma severity helps your

doctor choose the best treatment. Asthma
severity often changes over time, requiring
treatment adjustments.

Triggers of asthma
You can have an asthma attack if you come in
contact with substances that irritate you.
Healthcare providers call these substances
“triggers.” Knowing what triggers your asthma
makes it easier to avoid asthma attacks.

For some people, a trigger can bring on an

attack right away. For other people, or at
other times, an attack may start hours or days
later. Triggers can be different for each
person. But some common triggers include:

Air pollution: Many things outside can

cause an asthma attack. Air pollution
includes factory emissions, car exhaust,
wildfire smoke and more.
Dust mites: You can’t see these bugs,
but they are in our homes. If you have a
dust mite allergy, this can cause an
asthma attack.
Heavy exercise: For some people,
exercising can cause an attack.
Mold: Damp places can spawn mold,
which can cause problems if you have
asthma. You don’t even have to be
allergic to mold to have an attack.
Pests: Cockroaches, mice and other
household pests can cause asthma
attacks.
Pets: Your pets can cause asthma
attacks. If you’re allergic to pet dander
(dried skin flakes), breathing in the
dander can irritate your airways.
Strong chemicals or smells. These
things can trigger attacks in some
people.
Certain occupational exposures. You
can be exposed to many things at your
job, including cleaning products, dust
from flour or wood, or other chemicals.
These can all be triggers if you have
asthma.
Tobacco smoke: If you or someone in
your home smokes, you have a higher
risk of developing asthma. You should
never smoke in enclosed places like the
car or home, and the best solution is to
quit smoking. Your provider can help.

Complications of asthma
Proper treatment makes a big difference in
preventing both short-term and long-term
complications caused by asthma. This
complications can include:

Sick days from work or school during

asthma flare-ups
Signs and symptoms that interfere with
sleep, work and other activities
A permanent narrowing of the tubes that
carry air to and from your lungs
(bronchial tubes), which affects how well
you can breathe
Side effects from long-term use of some
medications used to stabilize severe
asthma
Emergency room visits and
hospitalizations for severe asthma
attacks

Prevention of asthma
Because researchers have yet to identify the
exact cause of asthma, it’s challenging to
know how to prevent the inflammatory
condition.

However, more information is known about

preventing asthma attacks. These strategies
include:

Taking preventive medication. Your

doctor may prescribe medication for you
to take on a daily basis. This medication
may be used in addition to the one you
use in case of an emergency.
Avoiding triggers. Steer clear of
chemicals, smells, or products that have
caused breathing problems in the past.
Reducing exposure to allergens. If
you’ve identified allergens, such as dust
or mold, that trigger an asthma attack,
avoid them if possible.
Getting allergy shots. Allergen
immunotherapy is a type of treatment
that may help alter your immune system.
With routine shots, your body may
become less sensitive to any triggers
you encounter.

Your doctor can help you put an asthma

action plan in place so that you know which
treatments to use and when.

In addition to using maintenance medications,

you can take steps each day to help make
yourself healthier and reduce your risk for
asthma attacks. These include:

Quitting smoking, if you smoke.

Irritants such as cigarette smoke can
trigger asthma and increase your risk for
COPD.
Eating a healthier diet. Eating a healthy,
balanced diet can help improve your
overall health.
Exercising regularly. Activity can
trigger an asthma attack, but regular
exercise may actually help reduce the
risk of breathing problems.
Managing stress. Stress can be a
trigger for asthma symptoms. Stress can
also make stopping an asthma attack
more difficult.
Maintaining a moderate weight.
Asthma tends to be worse in people with
overweight and obesity. Losing weight is
healthy for your heart, your joints, and
your lungs.

You can also read about complications and

prevention of high blood pressure.

Diagnosis of asthma
Your doctor will perform a physical exam to
rule out other possible conditions, such as a
respiratory infection or chronic obstructive
pulmonary disease (COPD). Your doctor will
also ask you questions about your signs and
symptoms and about any other health
problems.

You may be given lung function tests to

determine how much air moves in and out as
you breathe. These tests may include:

Spirometry. This test estimates the

narrowing of your bronchial tubes by
checking how much air you can exhale
after a deep breath and how fast you can
breathe out.
Peak flow. A peak flow meter is a simple
device that measures how hard you can
breathe out. Lower than usual peak flow
readings are a sign that your lungs may
not be working as well and that your
asthma may be getting worse. Your
doctor will give you instructions on how
to track and deal with low peak flow
readings.

Lung function tests often are done before and

after taking a medication to open your airways
called a bronchodilator, such as albuterol. If
your lung function improves with use of a
bronchodilator, it’s likely you have asthma.
Other tests to diagnose asthma include:

Allergy testing. Allergy tests can be

performed by a skin test or blood test.
They tell you if you’re allergic to pets,
dust, mold or pollen. If allergy triggers
are identified, your doctor may
recommend allergy shots.
Methacholine challenge. Methacholine
is a known asthma trigger. When inhaled,
it will cause your airways to narrow
slightly. If you react to the methacholine,
you likely have asthma. This test may be
used even if your initial lung function test
is normal.
Imaging tests. A chest X-ray can help
identify any structural abnormalities or
diseases (such as infection) that can
cause or aggravate breathing problems.
Nitric oxide test. This test measures the
amount of the gas nitric oxide in your
breath. When your airways are inflamed
— a sign of asthma — you may have
higher than normal nitric oxide levels.
This test isn’t widely available.
Provocative testing for exercise and
cold-induced asthma. In these tests,
your doctor measures your airway
obstruction before and after you perform
vigorous physical activity or take several
breaths of cold air.
Sputum eosinophils. This test looks for
certain white blood cells (eosinophils) in
the mixture of saliva and mucus
(sputum) you discharge during
coughing. Eosinophils are present when
symptoms develop and become visible
when stained with a rose-colored dye.

You can also read about diagnosis and

prevention of diabetes.

Treatment of asthma
The goal of asthma treatment is to control
symptoms, which means:

Have no (or minimal) asthma symptoms.

Can do the things you want to do at work
and home.
Sleep without asthma interrupting your
rest.
Rarely need to use your reliever medicine
(rescue inhaler).

Your treatment plan may also involve learning

your triggers, monitoring your symptoms
carefully, and taking steps to avoid flare-ups.

Medications used for asthma

The right medications for you depend on a

number of things like your age, symptoms,
asthma triggers and what works best to keep
your asthma under control.

Preventive, long-term control medications

reduce the swelling (inflammation) in your
airways that leads to symptoms. Quick-relief
inhalers (bronchodilators) quickly open
swollen airways that are limiting breathing. In
some cases, allergy medications are
necessary.

Long-term asthma control medications,

generally taken daily, are the cornerstone of
asthma treatment. These medications keep
asthma under control on a day-to-day basis
and make it less likely you’ll have an asthma
attack. Types of long-term control
medications include:

Inhaled corticosteroids. These

medications include fluticasone
propionate (Flovent HFA, Flovent Diskus,
Xhance), budesonide (Pulmicort
Flexhaler, Pulmicort Respules,
Rhinocort), ciclesonide (Alvesco),
beclomethasone (Qvar Redihaler),
mometasone (Asmanex HFA, Asmanex
Twisthaler) and fluticasone furoate
(Arnuity Ellipta).You may need to use
these medications for several days to
weeks before they reach their maximum
benefit. Unlike oral corticosteroids,
inhaled corticosteroids have a relatively
low risk of serious side effects.
Combination inhalers. These
medications such as fluticasone-
salmeterol (Advair HFA, Airduo Digihaler,
others), budesonide-formoterol
(Symbicort), formoterol-mometasone
(Dulera) and fluticasone furoate-
vilanterol (Breo Ellipta) contain a long-
acting beta agonist along with a
corticosteroid.
Theophylline. Theophylline (Theo-24,
Elixophyllin, Theochron) is a daily pill that
helps keep the airways open by relaxing
the muscles around the airways. It’s not
used as often as other asthma
medications and requires regular blood
tests.
Leukotriene modifiers. These oral
medications including montelukast
(Singulair), zafirlukast (Accolate) and
zileuton (Zyflo) help relieve asthma
symptoms.Montelukast has been linked
to psychological reactions, such as
agitation, aggression, hallucinations,
depression and suicidal thinking. Seek
medical advice right away if you
experience any of these reactions.

Quick-relief (rescue) medications are used

as needed for rapid, short-term symptom
relief during an asthma attack. They may also
be used before exercise if your doctor
recommends it. Types of quick-relief
medications include:

Oral and intravenous corticosteroids.

These medications which include
prednisone (Prednisone Intensol, Rayos)
and methylprednisolone (Medrol, Depo-
Medrol, Solu-Medrol) relieve airway
inflammation caused by severe asthma.
They can cause serious side effects
when used long term, so these drugs are
used only on a short-term basis to treat
severe asthma symptoms.
Short-acting beta agonists. These
inhaled, quick-relief bronchodilators act
within minutes to rapidly ease symptoms
during an asthma attack. They include
albuterol (ProAir HFA, Ventolin HFA,
others) and levalbuterol (Xopenex,
Xopenex HFA). Short-acting beta
agonists can be taken using a portable,
hand-held inhaler or a nebulizer, a
machine that converts asthma
medications to a fine mist. They’re
inhaled through a face mask or
mouthpiece.
Anticholinergic agents. Like other
bronchodilators, ipratropium (Atrovent
HFA) and tiotropium (Spiriva, Spiriva
Respimat) act quickly to immediately
relax your airways, making it easier to
breathe. They’re mostly used for
emphysema and chronic bronchitis, but
can be used to treat asthma.

If you have an asthma flare-up, a quick-relief

inhaler can ease your symptoms right away.
But you shouldn’t need to use your quick-
relief inhaler very often if your long-term
control medications are working properly.

Keep a record of how many puffs you use

each week. If you need to use your quick-
relief inhaler more often than your doctor
recommends, see your doctor. You probably
need to adjust your long-term control
medication.

Allergy medications may help if your asthma

is triggered or worsened by allergies. These
include:

Allergy shots (immunotherapy). Over

time, allergy shots gradually reduce your
immune system reaction to specific
allergens. You generally receive shots
once a week for a few months, then once
a month for a period of three to five
years.
Biologics. These medications which
include omalizumab (Xolair),
mepolizumab (Nucala), dupilumab
(Dupixent), reslizumab (Cinqair) and
benralizumab (Fasenra) are specifically
for people who have severe asthma.

Bronchial thermoplasty. This treatment is

used for severe asthma that doesn’t improve
with inhaled corticosteroids or other long-
term asthma medications. It isn’t widely
available nor right for everyone.

During bronchial thermoplasty, your doctor

heats the insides of the airways in the lungs
with an electrode. The heat reduces the
smooth muscle inside the airways. This limits
the ability of the airways to tighten, making
breathing easier and possibly reducing
asthma attacks. The therapy is generally done
over three outpatient visits.

Your treatment should be flexible and based

on changes in your symptoms. Your doctor
should ask about your symptoms at each
visit. Based on your signs and symptoms,
your doctor can adjust your treatment
accordingly. For example, if your asthma is
well controlled, your doctor may prescribe
less medication. If your asthma isn’t well
controlled or is getting worse, your doctor
may increase your medication and
recommend more-frequent visits.

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