Asthma

What Is Asthma?

Asthma is a chronic, or long-term, condition that intermittently inflames and narrows the airways in the lungs. The inflammation makes the airways swell. Asthma causes periods of wheezing, chest tightness, shortness of breath, and coughing. People who have asthma may experience symptoms that range from mild to severe and that may happen rarely or every day. When symptoms get worse, it is called an asthma attack. Asthma affects people of all ages and often starts during childhood.

Types of Asthma

As many different factors come together to cause asthma, there are many different types of the disease, separated by age and severity.

Adults and children share the same triggers for symptoms that set off an allergic response in the airways, including airborne pollutants, mold, mildew, and cigarette smoke.

Childhood asthma

Children are more likely to have an intermittent form of asthma that presents in severe attacks. Some children might experience daily symptoms, but the common characteristic among children with asthma is a heightened sensitivity to substances that cause allergy.

Second-hand tobacco smoke causes severe problems for children with asthma. Between 400,000 and 1 million children experience worsening asthma symptoms as a result of second-hand smoke, according to the American Lung Association.

The Centers for Disease Control and Prevention (CDC) advise that children experience more emergency visitsTrusted Source and admissions for asthma than adults.

Mild asthma might resolve without treatment during childhood. However, there is still a risk that the condition might return later on, especially if symptoms are moderate or severe.

Adult-onset asthma

Asthma in adults is often persistent and requires the daily management of flare-ups and preventing symptoms. Asthma can begin at any age.

Allergies lead to at least 30 percent of adult presentations of asthma. Obesity is a strong risk factor for adult-onset asthma, and women are more likely to develop the condition after the age of 20 years.

People over 65 years of age make up a large numberTrusted Source of deaths from asthma.

Occupational asthma

This is a type of asthma that occurs as a direct result of a job or profession.

Symptoms will become apparent after attending a particular workplace. Industries with regular associations to occupational asthma include baking, laboratory work, or manufacturing.

In this type, the work environment leads to the return of childhood asthma or the start of adult-onset asthma.

Other symptoms might include a runny nose and red eyes.

Difficult-to-control and severe asthma

These types involve consistent, debilitating asthma symptoms and breathing difficulties. Around 12 percent of people with asthma have difficult-to-control or severe asthma.

With the correct medication and effective trigger avoidance, those in this category can bring asthma symptoms back under control.

Roughly 5 percent of people with asthma do not see improvements after using the standard asthma medications. These people have severe asthma, and there are several types of severe asthma depending on the cause.

Newer medications are becoming available to address the different forms of severe asthma, such as eosinophilic asthma that does not link to any allergic reactions.

Seasonal asthma

This type occurs in response to allergens that are only in the surrounding environment at certain times of year, such as cold air in the winter or pollen during hay fever season.

People still have asthma for the rest of the year but do not experience symptoms.

How Is Asthma Classified?

1. Mild intermittent asthma. Mild symptoms less than twice a week. Nighttime symptoms less than twice a month. Few asthma attacks.
2. Mild persistent asthma. Symptoms three to six times a week. Nighttime symptoms three to four times a month. Asthma attacks might affect activities.
3. Moderate persistent asthma. Symptoms three to six times a week. Nighttime symptoms three to four times a month. Asthma attacks might affect activities.
4. Severe persistent asthma. You have ongoing symptoms both day and night. They’re so frequent that you have to limit your activities.

Symptoms

Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times — such as when exercising — or have symptoms all the time.

Asthma signs and symptoms include:

• Shortness of breath
• Chest tightness or pain
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

• Asthma signs and symptoms that are more frequent and bothersome
• Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
• The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

• Exercise-induced asthma, which may be worse when the air is cold and dry
• Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
• Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)

Causes

Many different aspects of a person’s environment and genetic makeup can contribute to the development of asthma.

Asthma is the most common chronic disease among children. The first symptoms become clear at around 5 years of age in the form of wheezing and regular infections in the respiratory tracts.

The following are the primary causes of asthma.

Allergies

A strong link exists between allergies and asthma.

One 2013 study in the Annals of Asthma, Allergy, and Immunology suggests that over 65 percentTrusted Source of adults with asthma over the age of 55 years also have an allergy, and the figure is closer to 75 percent for adults between the ages of 20 and 40 years.

Common sources of indoor allergens include animal proteins, mostly from cat and dog dander, dust mites, cockroaches, and fungi.

Smoking tobacco

Research has linked tobacco smoke to an increased risk of asthma, wheezing, respiratory infections, and death from asthma. In addition, the children of parents who smoke have a higher risk of developing asthma.

Smoking makes the effects of asthma on the airways worse by adding coughing and breathlessness to its symptoms, as well as increasing the risk of infections from the overproduction of mucus.

Environmental factors

Air pollution both in and out of the home can impact the development and triggers of asthma.

Allergic reactions and asthma symptoms often occur because of indoor air pollution from mold or noxious fumes from household cleaners and paints.

Other asthma triggers in the home and environment include:

• pollution
• sulphur dioxide
• nitrogen oxide
• ozone
• cold temperatures
• high humidity

Heavy air pollution tends to cause a higher recurrenceTrusted Source of asthma symptoms and hospital admissions.

Smoggy conditions release the destructive ingredient known as ozone, causing coughing, shortness of breath, and even chest pain. These same conditions emit sulfur dioxide, which also results in asthma attacks by constricting the airways.

Changes in the weather might also stimulate attacks. Cold air can lead to airway congestion, constricted airway, extra secretions of mucus, and a reduced ability to clear that mucus.

Humidity might also lead to breathing difficulties for populations in some areas.

Obesity

Some studies, such as this reportTrusted Source from 2014, suggest a link between obesity and asthma, although the American Academy of Asthma, Allergies, and Immunology does not recognize obesity as a formal risk factor for asthma.

However, the report in question suggests that the inflammatory mechanisms that drive asthma also link to obesity.

Pregnancy

If a woman smokes tobacco or illicit substanes while pregnant, an unborn child might grow less in the womb, experience complications during labor and delivery, and have a low birth weight.

These newborns might be more prone to medical problems, including asthma.

Stress

People who undergo stress have higher asthma rates. Increases in asthma-related behaviors during stressful times, such as smoking, might explain these increased rates.

Emotional responses, including laughter and grief, might trigger asthma attacks.

Genetics

A parent can pass asthma on to their child. If one parent has asthma, there is a 25 percent chance that a child will develop asthma. Having two parents with asthma increase the risk to 50 percentTrusted Source.

Many genes are involved in passing on asthma. These genes can interact with the environment to become active, although confirming these findings may require further research.

Atopy

Atopy is a general class of allergic hypersensitivity that leads to allergic reactions in different parts of the body that do not come in contact with an allergen. Examples include eczema, hay fever, and an eye condition called allergic conjunctivitis.

During atopy, the body produces more immunoglobin (IgE) antibodies than usual in response to common allergens.

The most common type of asthma is atopic asthma, and atopy plays a key role in its development. Environmental allergens lead to overproduction of IgE antibodies and trigger asthmatic reactions.

The menstrual cycle

One type of asthma, known as perimenstrual asthma (PMA), leads to acute symptoms during the menstrual cycle and a particular sensitivity to aspirin.

The sex hormones that circulate during menstruation, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), impact immune activity. This increased immune action can cause hypersensitivityTrusted Source in the airways.

Diagnosis

Three main components comprise an accurate asthma diagnosis: Medical history, observations during a physical exam, and results from breathing tests.

A primary care physician will administer these tests and determine the level of asthma as mild, intermittent, moderate, or severe in people who show signs of the condition, as well as identifying the type.

A detailed family history of asthma and allergies can help a doctor make an accurate diagnosis. A personal history of allergies is also important to mention, as many share mechanisms with asthma and increase the risk.

Keep a note of any potential triggers of asthma symptoms to help guide treatment, including information about any potential irritants in the workplace.

Be sure to identify any health conditions that can interfere with asthma management, such as:

• a runny nose
• sinus infections
• acid reflux
• psychological stress
• sleep apnea

Young children who develop asthma symptoms before the age of 5 years find it more difficult to receive a clear diagnosis. Doctors might confuse asthma symptoms with those of other childhood conditions.

If children experience wheezing episodes during colds or respiratory infections in early life, they are likely to develop asthma after 6 years of age.

Physical exam

A physical examination will generally focus on the upper respiratory tract, chest, and skin. A doctor will listen for signs of wheezing, or a high-pitched whistle on breathing out, in the lungs during a breath using a stethoscope. Wheezing is a key sign of both an obstructed airway and asthma.

Physicians will also check for a runny nose, swollen nasal passages, and soft growths on the inside of the nose and check for skin conditions including eczema and hives. These are allergic conditions that link to asthma and suggest heightened immune activity that could be causing any wheezing.

People with asthma do not always show physical symptoms, and it is possible to have asthma without presenting any physical maladies during an examination.

Asthma tests

Lung function tests are another component of an asthma diagnosis. They measure how much air a person inhales and exhales and the speed with which a person can expel air from the lungs.

A spirometry test can provide an indication of lung function.

Risk factors

A number of factors are thought to increase your chances of developing asthma. These include:

• Having a blood relative (such as a parent or sibling) with asthma
• Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
• Being overweight
• Being a smoker
• Exposure to secondhand smoke
• Exposure to exhaust fumes or other types of pollution
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Complications

Asthma complications include:

• Signs and symptoms that interfere with sleep, work or recreational activities
• Sick days from work or school during asthma flare-ups
• Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
• Emergency room visits and hospitalizations for severe asthma attacks
• Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Prevention

While there’s no way to prevent asthma, by working together, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.

• Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan.

  Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.

• Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.
• Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
• Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter.
• Identify and treat attacks early. If you act quickly, you’re less likely to have a severe attack. You also won’t need as much medication to control your symptoms.

  When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don’t improve, get medical help as directed in your action plan.

• Take your medication as prescribed. Just because your asthma seems to be improving, don’t change anything without first talking to your doctor. It’s a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you’re using your medications correctly and taking the right dose.
• Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn’t under control. See your doctor about adjusting your treatment.

Asthma Treatment

There are many asthma treatments available to relieve your symptoms. Your doctor will work with you to create an asthma action plan

that will outline your treatment and medications. They might include:

• Inhaled corticosteroids. These medications are used to treat asthma in the long term. That means you’ll take it every day to keep your asthma under control. They prevent and ease swelling inside your airways, and they may cut down mucus production. You’ll use a device called an inhaler to get the medicine into your lungs. Common inhaled corticosteroids include:
  • Beclomethesone (QVAR)
  • Budesonide (Pulmicort)
  • Fluticasone (Flovent)
• Leukotriene modifiers. Another long-term asthma treatment, these medications block the action of leukotrienes, substances in your body that trigger an asthma attack. You take them as a pill once a day. Common leukotriene modifiers include:
  • Montelukast (Singulair)
  • Zafirlukast (Accolate)
• Long-acting beta-agonists. These medications relax the muscle bands that surround your airways. You might hear them called bronchodilators. You’ll take these medications with an inhaler — even when you have no symptoms. Frequently used long-acting beta agonists include:
  • Formoterol (Foradil)
  • Salmeterol (Serevent)
• Combination inhaler. This device gives you an inhaled corticosteroid and a long-acting beta-agonist together to ease your asthma. Common ones include:
  • Budesonide and formoterol (Symbicort)
  • Fluticasone and salmeterol (Advair Diskus)
  • Fluticasone and vilanterol (Breo)
  • Mometasone and formoterol (Dulera)
• Theophylline. It opens up your airways and eases tightness in your chest. You take this long-term medication by mouth, either by itself or with an inhaled corticosteroid.
• Short-acting beta-agonists. These are known as rescue medicines or rescue inhalers. They loosen the bands of muscles around your airways and ease symptoms like wheezing, chest tightness, coughing, and shortness of breath. Examples include:
  • Albuterol (Accuneb, ProAir, Proventil, Ventolin)
  • Levalbuterol (Xopenex HFA)
• Anticholinergics. These bronchodilators prevent the muscle bands around your airways from tightening. Common ones include:
  • Ipratropium (Atrovent)
  • Tiotropium bromide (Spiriva)

You can get ipratropium in an inhaler or as a solution for a nebulizer, a device that turns liquid medicine into a mist that you breathe in through a mouthpiece. Tiotropium bromide comes in a dry inhaler, which lets you breathe the medicine in as a dry powder.

• Oral and intravenous corticosteroids. You’ll take these along with a rescue inhaler during an asthma attack. They ease swelling and inflammation in your airways. You’ll take oral steroids for short bursts between 5 days and 2 weeks. Frequently prescribed oral steroids include:
  • Methylprednisolone (Medrol)
  • Prednisolone (Orapred, Prelone, Pediapred)
  • Prednisone (Deltasone)

You’re more likely to get steroids injected directly into a vein if you wind up in the hospital for a bad asthma attack. This will get the medication into your system more quickly.

Biologics. If you have severe asthma that doesn’t respond to control medications, you might try a biologic:

• Omalizumab (Xolair) treats asthma caused by allergens. You get it as an injection every 2 to 4 weeks.
• Other biologics are designed to stop your immune cells from creating substances that cause inflammation. These drugs include:
  • Benralizumab (Fasenra)
  • Mepolizumab (Nucala)
  • Reslizumab (Cinqair)

Asthma home remedies

In general, over-the-counter (OTC) medicines and alternative remedies aren’t encouraged as treatments for asthma. If not treated properly, asthma can be life-threatening.

However, these home remedies may help stop symptoms from escalating and may be effective in an emergency:

Coffee or caffeinated tea

A chemical in caffeine acts similarly to the asthma drug theophylline. It opens up airways and may ease symptoms of asthma for up to four hours.

Purchase coffee and tea online.

Essential oils

Inhaling eucalyptus essential oil may ease breathing difficulties brought on by asthma. Lavender and basil essential oils also show promise. However, for some individuals, inhaling essential oils may make asthma worse. Strong smells and chemicals can trigger asthma or worsen symptoms.

Find eucalyptus, lavender, and basil essential oils online.

Mustard oil

This fatty oil, made from pressed mustard seeds, can be massaged into the skin to help open airways. Mustard oil is different than mustard essential oil, a medicinal oil which shouldn’t be applied directly to the skin.

Frequently asked questions

Is there a cure for asthma? I’ve heard or read about people who were cured.

Is it safe for people with asthma to get a flu shot?

I’m thinking about getting pregnant- what should I do about my asthma?

I’ve heard that being overweight can cause asthma. Is that true?

My doctor has ordered breathing tests for me to see if I have asthma. How are these tests done?

 Do people really die from asthma?

 Why do I have to take medicines every day?

Are some dog breeds, like poodles, better for people with asthma?

 Will moving to a drier climate, like the southwest U.S., help my asthma?

 I’ve read about some alternative treatments that say they help people with asthma. Do they actually help?

Does asthma go away?

Some children do ‘grow out of’ their asthma symptoms. But they might come back later in life. They might be set off by something at work, or by pollution. Women sometimes develop asthma during the menopause.

There’s no cure for asthma, so it doesn’t go away completely. But there are tried and tested asthma medicines to prevent symptoms.