Asthma

Asthma is a lung condition that may cause coughing, wheezing, or trouble breathing. Anyone with allergies or a history of smoking is at risk, and you're also more likely to get asthma if you're obese.
By Jessica Migala
Updated July 14, 2021

Asthma is a lung condition that may cause coughing, wheezing, or trouble breathing. Anyone with allergies or a history of smoking is at risk, and you're also more likely to get asthma if you're obese.

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What Is It

Asthma is a common, chronic condition where airways swell and tighten, setting off symptoms like wheezing, coughing, and shortness of breath. There are an estimated 25 million people in the US who have asthma. People more at risk include women, those who are Hispanic or Black, or have a family history of asthma or allergic diseases.

The condition is more likely to be diagnosed in children, but it is possible to develop it as an adult. Recognizing and avoiding common triggers will go a long way in preventing flare-ups of the disease. With lifestyle management and medications, it's possible to live a healthy and active life with asthma.   

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Types

There are six types of asthma, differentiated by their trigger or time of diagnosis:

Adult-Onset Asthma: Occurs if you develop asthma as an adult, which can happen following a new exposure to a trigger, like a pet, or after a viral infection.

Allergic Asthma: Indoor allergens, such as dust mites or dander, or outdoor allergens, such as pollen, trigger symptoms like difficulty breathing and wheezing.

Asthma-COPD Overlap Syndrome: When you have asthma alongside one or both of the diseases of COPD (emphysema and chronic bronchitis).

Exercise-Induced Bronchoconstriction: Shortness of breath and wheezing is triggered by exercise, which may be made worse by airway irritants like pollution or cold, dry air.

Nonallergic Asthma: Caused by things that are not considered to be allergens, such as extreme weather temperatures, viral respiratory infections, stress, smoke, food, or exercise.

Occupational Asthma: Breathing in irritants in the air while on-the-job can lead to asthma. There are more than 250 of these irritants that can cause these breathing problems, including dust, mold, and fumes from chemicals and cleaning products.

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Symptoms

If you have asthma, there are four main symptoms:

  • Shortness of breath (difficulty breathing or like you can't catch your breath).
  • Cough that won't go away.
  • Chest tightness.
  • Wheezing (a whistling sound when breathing).

You may experience these symptoms rarely, occasionally, or frequently, which can depend on how often you're exposed to your trigger. Symptoms may also be severe enough to make it increasingly difficult to complete daily tasks.

You may suspect that you have asthma if your symptoms become somewhat predictable depending on the time of day or your environment. For example, every time you go to work, you cough and wheeze. Or, when you go outside and run in the cold, you start to cough uncontrollably. When you get a cold, your cough sticks around for a very long time. Or, you start wheezing at night, making it hard to get a full night's sleep. These symptoms are disruptive, and—at times—can be alarming.

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Causes

While the exact cause is unknown, asthma is sparked by chronic airway inflammation. Everyone has their specific triggers that initiate breathing problems. Certain factors in your health history, habits, and surrounding environment can make you more prone to wheezing:

Genetics: Allergic diseases tend to run in families. Having a first-degree relative, such as parents or siblings, who have allergies or asthma may make you more prone to developing asthma.

Having allergies: Allergic to pollen? Dust mites? Pet dander? Allergies are a common trigger for asthma.

Childhood respiratory infections: Viral infections can harm developing lungs, causing long-term damage that makes you more prone to developing asthma.

Your environment: Do you work in an environment thick with fumes, smoke, dust particles, or chemicals? Live in a more polluted area? These can irritate and inflame airways to trigger asthma.

Smoking: Cigarette smoke is damaging to airways. If you are a smoker or are exposed to a lot of secondhand smoke, you have a higher risk of asthma.

Stress: Emotional stress can cause an asthma attack.

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Diagnosis

For diagnosis, see an allergist or immunologist. At your appointment, your doctor will gather your personal health history, talk to you about your symptoms and when and how often they occur, and listen to your breathing. If asthma is suspected, there are several tests appropriate for adults.

Breathing Tests:

Spirometry: Measures your pulmonary function while you breathe in and out through a tube. Your doctor may also have you inhale a medicine called a bronchodilator to see who that impacts breathing effort.

Peak airflow: This test involves blowing as hard as you can into a tube and may be done along with spirometry.

Fractional exhaled nitric oxide (FeNO) tests: Checks the amount of nitric oxide you inhale. Too much nitric oxide indicates inflammation.

Provocation tests: In the safety of the office, your doctor will expose you to an irritant (like smoke) that's suspected to flare symptoms and then give you a spirometry test. Or, if exercise is a suspected trigger, you may be asked to run on a treadmill. You may also be given a medication called methacholine before spirometry, the results of which can be used to diagnose or rule out asthma.

Allergy Testing:

Allergies are a common trigger for asthma symptoms. Your doctor may recommend testing, such as an IgE skin "prick" test to identify the allergens that can set you off.

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Treatment

With the right treatment, your asthma can be well-managed. It won't be done with medication alone, so you'll need identify and practice avoiding asthma triggers.

Medication: Your doctor will talk to you about two different medications. Understanding exactly when to take them and following treatment closely is the best way to control asthma.

Control medicine: These lessen airway inflammation in order to prevent symptoms. These can be taken orally, as an injection, or inhaled. Corticosteroids, leukotriene modifiers, mast cell stabilizers, and inhaled long-acting bronchodilators are all control meds. Biologics are a newer medication available and are given by injection or infusion.

Quick relief: These are prescribed to quickly tamp down inflammation and open up airways during an asthma attack or before exercise. Flare-ups can be dangerous and so it's important that you carry these with you. One of the more common medications are inhaled short-acting beta2-agonists or SABAs. Some severe attacks may be treated with intravenous corticosteroids.

Vaccination: You're more at risk for complications from viral respiratory infections like the flu and pneumonia, so make sure you get vaccinated as advised by your doctor.

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Prevention

Number one: Don't smoke. Being around secondhand smoke is also detrimental to lung function, so try to avoid this as best as you can. In addition, secondhand smoke exposure is a known cause of asthma in children whose lungs are still growing. If you are a smoker and have kids, it's even more important to quit.

In addition, being overweight or having obesity is a risk factor for asthma, possibly because extra weight increases inflammation that affects airways. Asthma is also more severe and can be more difficult to treat in this group. Losing weight is a challenge. Start by talking to your doctor about habits you can incorporate into your existing lifestyle that can help you reach a weight that's healthy for you. 

Then, there's also prevention if you already have asthma. Avoiding asthma attacks means understanding what triggers your breathing problems and effectively managing those triggers. For example, if it's pollen, you might avoid exercising outdoors or sleep with your windows closed to limit exposure. If it's stress, developing strategies that keep you calm in hectic situations or help you unwind at the end of the day.

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