What is asthma?
Asthma is a condition where the airways of the lungs are hyperresponsive—they overreact—to a specific trigger such as allergens (including to pet dander, dust mites, or pollen), cold air, or exercise. It can start in childhood, teen years, or adulthood. Symptoms include difficulty breathing, wheezing, cough, and chest tightness.
Most common symptoms
Steps to take if you have asthma: Carry your albuterol inhaler with you at all times. Try to minimize your exposure to any of your known triggers. Make a plan (Asthma Action Plan) with your doctor about what you would do if you develop a severe flare. —Dr. Bina Choi
The airways encounter a trigger that causes an extreme response. They become inflamed, leading to swelling and narrowing of the airways. Mucus production also increases. The combination of these two reactions leads to difficulty breathing, wheezing, coughing, and chest tightness. Symptoms can range from mild to interfering with daily activities to life-threatening.
The symptoms of asthma may happen suddenly—called flares—after exposure to certain triggers such as dust, pets, cold air, and certain medications. Exercise is another common trigger—often 30 minutes to an hour after exercising.
Symptoms come on more frequently in certain places, such as the workplace, in your bedroom at night, or outside during allergy season. Symptoms may improve on their own when you are no longer exposed to the trigger.
- Severe difficulty breathing
- High-pitched (more commonly when exhaling—breathing out)
- (with sputum or dry)
Other symptoms you may have
- Nasal polyps (painless swelling and growth in the inside of your nose that can cause runny or stuffy nose and nosebleeds)
- Frequent sinus infections
- Allergies (runny nose, itchy watery eyes)
- Atopic dermatitis (eczema)
If you are having severe difficulty breathing, call 911 immediately.
In other cases, make an appointment to see your doctor about your symptoms. They may want to do additional testing such as checking your oxygen level, certain blood tests, allergy testing, a chest x-ray, or a pulmonary function test (a breathing test to check your lung function).
Severe asthma attacks can cause such severe blockage of your airways that you are no longer able to breathe on your own without treatment in the hospital. Without prompt treatment, a severe asthma attack can cause death. Make sure to create an Asthma Action Plan with your doctor so you know how to treat an asthma attack at the earliest sign, before it gets worse.
Can asthma go away?
Ask your doctor about new anti-inflammatory medications called “biologics.” They are injections that target specific types of asthma. They may help control symptoms for an extended period of time. Examples include benralizumab, dupilumab, mepolizumab, omalizumab. —Dr. Choi
Asthma is thought to be a reversible and treatable disease, if diagnosed early and you make a plan for when you have a flare.
If you are diagnosed with asthma, the goals of treatment are to:
1. Reduce the number of flares.
2. Stop flares when they come on.
3. Reduce the severity and long-term effects of flares.
Treatment usually includes using inhaler medications—short-acting inhalers to stop flares when they come on, and sometimes long-acting inhalers that you take regularly, even if you don’t have symptoms that day. Certain (but not most) types of asthma can be treated with other asthma medications in the form of pills or injections. Speak to your doctor about whether these may be the right treatments for you.
- Try to avoid your triggers. If you have flares to allergens, clean aggressively and use HEPA filters.
- Quit smoking and vaping.
- Get the flu shot annually. Talk with your doctor about getting the pneumococcal vaccine as well.
There are many different inhalers. Ask your doctor about the particular inhaler you are prescribed. Be sure to follow the directions for your inhaler, as each can have slightly different instructions. Here are some common ones.
- Albuterol/salbutamol (examples include ProAir, Ventolin, Proventil): a short-acting inhaler (a pump) or nebulizer (aerosolized medicine given through a mask) you take during a flare. You may also be instructed to take it before exposure to a known trigger, such as before you exercise or go to work. Albuterol works within 5 to 10 minutes.
- Inhaled steroids (examples include Flovent, Pulmicort, QVAR) are long-acting medications that reduce inflammation. Depending on the dose and kind of steroid, you may see an effect between 2 to 8 days. During an acute flare, you may also be treated with an oral steroid (such as prednisone), which should work within hours.
- Other long-acting inhalers include long-acting anticholinergics (Atrovent, Incruse Ellipta, Spiriva), a combination of steroids and long-acting beta agonist (Advair, Breo Ellipta, Dulera, or Symbicort), or a combination of long-acting anticholinergics and long-acting beta agonist (Anoro Ellipta, Stiolto Respimat). You should not be using a single-agent long-acting beta agonist (Arcapta, Serevent, Striverdi).
Your doctor may give you a handheld meter called a peak expiratory flow meter, for you to check your lung function at home. This tool can help you monitor your symptoms and be in control of them early. Use this to measure your lung function whenever you think you may be having symptoms. Your peak expiratory flow numbers can be helpful in determining whether you are having a flare, and whether you should go to the hospital.
Kids and asthma
Asthma is more common in children. If you think your child might have asthma, make an appointment to speak to their pediatrician.
If your child is having severe difficulty breathing or wheezing, call 911 immediately.
Not all inhalers are the same. It is very important to understand the specific instructions for each of your inhalers. —Dr. Choi
For reasons that are not completely understood, the airways of people with asthma have higher levels of inflammatory cells and signals (such as IgE, type 2 helper T cells, IL-4, IL-5, and IL-13) that causes their lungs to be hyperreactive to certain triggers.
You can have asthma in childhood or develop it later in life. If not treated, the recurrent inflammation of asthma can cause scarring and permanent changes in the lungs.
Asthma is not contagious but may be inherited.
What makes you more likely to have asthma
You are at increased risk of developing asthma if:
- Current or history of cigarette smoking.
- Allergy to aspirin or NSAIDS (such as ibuprofen).
- Exposure to workplace pollutants such as dust.
- You were born premature, at a low birth weight, or by c-section.
- History of seasonal allergies and atopic dermatitis (eczema).
- Family history of allergies or asthma.
Take your medications as directed. Many inhalers can look similar to each other, so make sure you clarify with your doctor which ones you should take regularly, and which one to take during a flare.
Self-monitoring and prevention can play a very important role in asthma. You should know your triggers and, if at all possible, try to avoid them or use your rescue inhaler before exposure.
Create an Asthma Action Plan with your doctor so you know how to treat an asthma attack at the earliest sign.