Asthma is a disease of the lungs that affects people of all ages and both sexes. About 1 in 13 people in the United States has asthma, according to the Centers for Disease Control and Prevention.
Not everyone’s symptoms are the same, but the most common are wheezing, coughing, shortness of breath and tightening of the chest, according to the Asthma and Allergy Foundation of America (AAFA). People with asthma also may find that the frequency of their symptoms changes over time.
What is asthma?
Asthma causes difficulty breathing because, when triggered, the inner lining of your airways can swell and the muscles around them tighten, leaving little room for air to move freely through your lungs. When your airways swell, it also may cause more mucus to be created, further blocking your air passages.
Asthma is a lifelong or chronic condition. This means that once you have asthma, it’s most likely you will have it for the rest of your life. Asthma often starts in people when they’re young. However, some people don’t develop asthma until they’re adults.
Asthma is one of the most common chronic conditions in children. More male children (7%) than female children (5.4%) have asthma, according to the AAFA. In adults, the highest rates are among Black and Indigenous Americans.
If asthma isn’t managed, it may be a cause of death. It’s important to know how to manage your asthma and when you should seek help from medical professionals right away.
Asthma can’t be cured, but with management and monitoring, it may be well controlled.
When your symptoms flare, it’s known as an asthma attack. Not everyone has the same triggers—things that set off an attack or worsen your symptoms may be different from others with asthma.
Many people with asthma also have more than one asthma trigger.
However, some triggers that many people with asthma experience include:
Being exposed to allergens found indoors. Dust mites, molds, fur, pet dander, etc.
Being exposed to allergens found outside. Pollen and molds
Being under stress. Intense emotions, such as anger, tears or laughter
Being active. Physical activities, such as running or jumping
Having an infection. Examples may include colds, flu or COVID-19
Taking certain medications. Certain medicines, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and beta blocker heart medications, may trigger asthma attacks in some people with severe asthma.
Breathing poor-quality air. Very cold air may sometimes be a trigger, too. People who live in urban areas that have more pollution are also at a higher risk for asthma.
Other factors that may increase the risk of asthma include:
Genetics. People whose parent or parents had asthma are more likely to develop asthma than those whose parents never had asthma.
Smoking. People who smoke increase their risk of developing asthma because the smoke from cigarettes and other tobacco products may irritate the lung’s airways.
Obesity. Adults and children who are overweight or obese are at increased risk of asthma. It’s not clear why, but experts speculate that the extra weight causes low-grade inflammation throughout the body, including the airways.
Asthma types
At one time, asthma was looked at as one disease. Now, medical professionals often categorize it differently depending on the cause. It’s important to know which type you have because the type can help determine the most appropriate way to manage it.
Allergic asthma. This type of asthma causes your airways to tighten when you inhale particles you're allergic to, such as pollen or dander. In addition to shortness of breath, coughing and wheezing, it may cause stuffy nose, itchy eyes and rash.
Aspirin-induced asthma. Some people have a sensitivity to aspirin and other NSAIDs. The cause of the reaction is not known.
Cough-variant asthma. With this type of asthma, a dry cough is the only symptom. You do not experience traditional symptoms, such as wheezing or shortness of breath. It may be triggered by exercise, cold air or changes in the weather.
Exercise-induced asthma. This type of asthma causes symptoms such as shortness of breath, coughing and wheezing when exercising or doing strenuous activities. It’s also called exercise-induced bronchospasm.
Nighttime asthma. Also known as nocturnal asthma, this is asthma where symptoms worsen at night. It’s rather common.
Steroid-resistant asthma. People with this type of asthma show very poor or no response to high doses of inhaled or systemic steroids, which are often used to treat asthma.
Occupational asthma. This is a type of asthma caused by exposure to irritants that are inhaled in the workplace. Examples of workplace irritants that may cause occupational asthma are dusts, gasses, fumes and vapors.
People with asthma often describe their breathing difficulties as trying to breathe through a straw that is stuffed with cotton.
Some people may have mild symptoms that last for only a few minutes, and some people may have more severe symptoms that last for hours.
Here are some of the most common symptoms of people with asthma:
Most people find their symptoms are worse at night.
First, it’s best if you can avoid an asthma attack. The key is to limit your exposure to irritants and allergens that cause your asthma to flare. However, if you can’t, know what medications you should use. Everyone with asthma should have an “asthma action plan” that outlines their triggers and provides instructions for taking medication.
There are four types of asthma medications that your healthcare provider may prescribe:
Quick-relief medications. They do what they say—they act quickly to relieve your symptoms at the onset of an attack. Quick-acting medications include:
Inhaled short-acting beta2-agonists (SABAs), which are designed to open the airways so air can flow through them during a flare. However, they may cause tremors and rapid heartbeat.
Oral corticosteroids, which are designed to quickly reduce swelling in your airways.
Short-acting anticholinergics are less successful at opening airways than SABAs, but they may help people who experience side effects from SABAs.
Long-term or controller medicines. These are long-acting medicines and work by correcting changes in the airways, such as swelling and excess mucus. Controller medicines may be one medicine or a combination of different medicines.
Controller medicines include:
Corticosteroids (steroid hormone medicines), which are designed to reduce inflammation in the body. They may be given in pill form or inhaled.
Leukotriene modifiers, which are designed to reduce swelling and keep your airways open. You may be given these pills alone or with steroid medicine.
Inhaled mast cell stabilizers, such as cromolyn. These are designed to prevent swelling in your airways when you’re faced with allergens or other asthma triggers.
Inhaled long-acting bronchodilators, such as long-acting beta2-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs). Your healthcare provider may add these to your inhaler to prevent your airways from becoming narrow.
Allergy shots, called subcutaneous immunotherapy (SCIT). Allergy shots are designed to reduce the body’s response to allergens.
Combination quick-relief and controller medicines. The U.S. Food and Drug Administration (FDA) has not yet approved them to be used in this way, but these medicines may provide short-term quick relief and long-term control.
Biologics. Biologics target cells and proteins to keep swelling under control, and they may be given by infusion or injection to people with certain types of persistent and severe asthma.
Asthma medications may be delivered via:
Inhalers or puffers. These allow the medicine to go directly into your lungs. Inhalers can be metered dose, dry powder, breath actuated or soft-mist. If you have an inhaler, you should carry it with you at all times.
Nebulizers. Nebulizers are “breathing machines.” They take liquid asthma medicine and turn it into a mist. You use a mask or mouthpiece to inhale the medicine.
Injectables (biologics). These are given as shots or infusions in a healthcare setting every few weeks.
Bronchial thermoplasty
If your asthma is severe and treatments don’t seem to be working, your healthcare provider may suggest bronchial thermoplasty.
Bronchial thermoplasty is a procedure where your doctor inserts a tube, a bronchoscope, into your lungs. The bronchoscope has a camera at the end. Your doctor uses it to look inside your airways.
During the procedure, your doctor applies heat to the muscles that line your airways. The heat thins them and prevents them from narrowing.
Living with asthma
Because everyone’s asthma is different, you need a plan that’s unique to you. Work with your healthcare team to create your personalized plan. Factors to consider may include:
Your plan should include:
How to avoid allergens and irritants that trigger attacks
How to know if you’re having a flare and what steps you should take and when
Which medicines you should take and when you should take them
When to seek medical help or go to the emergency department
Who you should contact in an emergency
If you’re given medications, know where they are at all times and have them with you should you have a flare.
References
National Heart, Lung, and Blood Institute: What is Asthma?
Centers for Disease Control and Prevention: Most Recent National Asthma Data.
National Heart, Lung, and Blood Institute: Asthma Causes and Triggers.
Asthma and Allergy Foundation of America: Asthma Facts.
American Lung Association: What Causes Asthma?
American Lung Association: Types of Asthma.
Cleveland Clinic: Allergic asthma.
Mayo Clinic: Allergies and asthma: They often occur together.
American Academy of Allergy, Asthma, and Immunology: Aspirin-Exacerbated Respiratory Disease (AERD).
Asthma and Allergy Foundation of America: Medicines.
Cleveland Clinic: Cough-variant asthma.
PNAS: The endogenous circadian system worsens asthma at night independent of sleep and other daily behavioral or environmental cycles.
Pediatric Respiratory Reviews: Steroid-resistant asthma.
Johns Hopkins Medicine: Occupational Asthma.
Asthma and Allergy Foundation of America: Asthma Treatment.
National Heart, Lung and Blood Institute: How is Asthma Treated?
Chest Foundation: Living Well With Asthma.
