Asthma symptoms can be as innocent as a little trouble catching your breath to severe wheezing. You could have one sign of asthma one day and something else–or nothing–the next, and your friend with asthma might have an entirely different set of symptoms.
To make things even more confusing, many of the common symptoms of asthma mimic those of other conditions.
Here’s a guide to recognizing asthma symptoms. Although only your doctor can tell you for sure (through your medical history and a physical exam), being familiar with the signs will help lead you to the right treatment.
“Most asthmatics should be able to be treated so they can lead a normal life and exercise and do things they want,” says Albert A. Rizzo, MD, senior medical advisor for the American Lung Association.
Coughing is a sign that your airways are inflamed, a hallmark of asthma. Inflamed airways are also sensitive airways; the increased sensitivity makes you more likely to cough in response to allergens such as pollen or irritants like perfume in an effort to ease the irritation. (When allergens trigger your asthma symptoms, you’re said to have allergic asthma.)
Coughing can also be a result of smoking or a sign of a viral infection, but it’s more likely to be asthma if it lingers for more than two weeks, keeps coming back, or is triggered by allergens like pollen. Asthma-related coughing tends to be worse at night and in the early morning.
Coughing is the only symptom of a type of asthma called cough-variant asthma (CVA). People with CVA usually need an inhaler to control their chronic cough, according to the American College of Allergy, Asthma, and Immunology.
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Wheezing, or a squeaking or whistling sound when breathing, is a sign that the inflamed airways have narrowed even more. Asthma-related wheezing tends to happen more while exhaling than inhaling.
But wheezing can also be a sign of inflammation from many other conditions, notably chronic obstructive pulmonary disorder (COPD), bronchitis, respiratory infections, allergies, emphysema, sleep apnea, heart failure, and even some medications. Noting whether or not your wheezing comes with other symptoms like coughing and shortness of breath can help you zero in on the cause of your symptoms, says Todd Rambasek, MD, an asthma specialist in Cleveland, Ohio.
Wheezing is more likely to be asthma when it persists, sometimes for years, especially in kids under the age of three. “Most pediatricians will be cautious about diagnosing asthma in really young children,” says Dr. Rizzo. “The first several years of life [periodic symptoms including wheezing] are more likely viral and not really asthmatic.”
Asthma is a more likely culprit in kids if one or both parents have a condition like eczema or hay fever and if one or both parents have allergies with asthma.
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Shortness of breath
Running out of air, along with other signs like a cough, as well as a family history of asthma or allergies, can also signal asthma. Some people say they have no problem breathing in but that breathing out can be difficult.
Of course, shortness of breath can also have many other causes: obesity, heart problems, emphysema, COPD, and more. Chances are it’s not asthma if the symptoms started after the age of 50, if you also have lightheadedness or palpitations, if asthma medications don’t help, or if you have a history of cigarette smoking.
Chest tightness can also feel like pain, pressure, or squeezing. It’s caused by “constriction of the muscles around the airways,” says Dr. Rambasek.
In some cases, this tightness is a sign of a heart attack, but more commonly, it’s a sign of acid reflux, especially if the tightness happens after you eat or when you lie down. “Reflux acid in the esophagus can trigger the same types of symptoms as asthma,” says Dr. Rizzo, even if a person doesn’t experience the typical burning sensation of reflux.
Asthma and acid reflux are linked, although experts don’t entirely understand why. Each condition can make the other worse, and they frequently occur together. In fact, about 75% of asthma patients have severe acid reflux, or gastroesophageal reflux disease (GERD.) Treating GERD often alleviates asthma symptoms.
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Fatigue is often a byproduct of asthma. Coughing, wheezing, and trying to catch your breath all the time can tire you out. If all the symptoms are turning up at night, you may also have trouble sleeping peacefully.
“When the airways become narrow, it makes the patient work a little harder to breathe on a more constant basis,” says Dr. Rizzo. “Some people with uncontrolled asthma don’t sleep as well. If you have symptoms at night you could have chronic sleep deprivation.”
Talk to your doctor if you’re always tired, especially if you don’t have the other classic symptoms of asthma. Fatigue can be a symptom of other conditions, many of which, like asthma, can be treated.
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Problems breathing after exercise
When the hallmark symptoms of asthma–coughing, wheezing, shortness of breath, chest tightness–happen during or especially after working out, you could have a type of non-allergic asthma called exercise-induced asthma.
Usually this happens five to 15 minutes after being active and, if you rest, will go away within an hour. Symptoms tend to be worse when it’s cold. “The airways get cooled by ventilation associated with exercise and go into spasm, producing wheezing and tightness,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital in New York City. Some people may “pre-treat” with one or two puffs of an inhaler before exercise to prevent these symptoms, he says.
Skin and/or lips that are tinged blue–a condition called cyanosis–indicate you’re not getting enough oxygen. “What that’s saying is [your asthma is] so severe, you’re not only having trouble getting air in and out, but your oxygen is dropping,” says Dr. Rizzo. “That’s not something that would be present in mild or even moderate asthma.” Cyanosis means your asthma isn’t well controlled and you need to get to a doctor.
Cyanosis can also be a sign of another respiratory problem, like COPD, pneumonia, or whooping cough, or of heart disease.
Deciding when to contact your doctor or visit the ER for asthma symptoms varies from individual to individual. “If you’ve never been diagnosed, you might go the first time [you have symptoms],” says Dr. Rambasek. “Wheezing is not normal.”
If you are already working with a doctor, you should have an Asthma Action Plan, recommends the Asthma and Allergy Foundation of American. The plan will tell you what types of medication to take in which situations and when to call your doctor. If the instructions on the plan aren’t working, then you know to go to the emergency room.
In general, if your symptoms suddenly get worse, your medications aren’t helping, or you can’t catch your breath even when you’re resting, find medical help. “Asthma should be controllable,” says Dr. Horovitz.