Asthma
A chronic respiratory condition affecting the airways in your lungs
Quick Facts
- Type: Chronic Respiratory
- ICD-10: J45
- Prevalence: ~8% of population
- Onset: Any age, often childhood
Overview
Asthma is a chronic respiratory condition that causes inflammation and narrowing of the airways, leading to breathing difficulties. The airways become swollen, produce extra mucus, and the muscles around them can tighten, making it hard to breathe. This condition affects people of all ages but often starts in childhood. While asthma cannot be cured, its symptoms can be controlled with proper management, allowing most people with asthma to live normal, active lives.
The severity of asthma varies greatly among individuals. Some people experience only minor symptoms occasionally, while others have frequent and severe attacks that can be life-threatening. Asthma symptoms can be triggered by various factors including allergens, irritants, exercise, cold air, or respiratory infections. The condition is characterized by reversible airway obstruction, meaning that symptoms come and go, and the airways can return to normal between episodes.
Modern asthma management focuses on two main goals: achieving good symptom control and minimizing future risk of attacks. This involves identifying and avoiding triggers, using medications appropriately, and monitoring lung function. With proper treatment and self-management, most people with asthma can participate fully in all activities, including sports and exercise. Understanding your asthma and working closely with healthcare providers is key to maintaining good quality of life.
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. The frequency and severity of symptoms can change over time.
Common Symptoms
Additional Symptoms
- Difficulty breathing during physical activities
- Coughing up sputum (mucus from the lungs)
- Nasal congestion (often with allergic asthma)
- Sharp chest pain during severe attacks
- Allergic reactions that trigger symptoms
- Fever if accompanied by infection
- Coryza (runny nose) with allergic asthma
Signs of Worsening Asthma
- Symptoms becoming more frequent and bothersome
- Increasing difficulty breathing (measured by peak flow meter)
- Need to use quick-relief inhaler more often
- Waking up at night due to asthma symptoms
- Symptoms limiting daily activities
Causes
The exact cause of asthma isn't fully understood, but it's thought to result from a combination of genetic and environmental factors. Asthma involves complex interactions between inflammatory cells, mediators, and the cells and tissues in the airways.
Underlying Mechanisms
- Airway inflammation: Chronic inflammation makes airways sensitive and swollen
- Bronchial hyperresponsiveness: Airways overreact to various stimuli
- Airway remodeling: Long-term changes in airway structure
- Mucus overproduction: Excess mucus blocks airways
- Smooth muscle contraction: Muscles around airways tighten
Common Asthma Triggers
Allergens
- Dust mites
- Pet dander
- Pollen (trees, grasses, weeds)
- Mold spores
- Cockroach allergens
Irritants
- Cigarette smoke and secondhand smoke
- Air pollution
- Chemical fumes
- Strong perfumes or cleaning products
- Dust or particles in the air
Other Triggers
- Exercise: Especially in cold, dry air
- Weather: Cold air, humidity changes, thunderstorms
- Emotions: Stress, anxiety, strong laughter or crying
- Medications: Aspirin, NSAIDs, beta-blockers
- Food additives: Sulfites and preservatives
- Respiratory infections: Colds, flu, sinusitis
- GERD: Gastroesophageal reflux disease
Risk Factors
Several factors increase the likelihood of developing asthma:
Genetic Factors
- Family history of asthma or allergies
- Personal history of allergic conditions (atopic dermatitis, hay fever)
- Certain genetic variations affecting immune response
Environmental Factors
- Exposure to tobacco smoke (including in utero)
- Air pollution exposure
- Occupational chemicals and dusts
- Early childhood respiratory infections
- Low birth weight or premature birth
Lifestyle Factors
- Obesity (increases risk and severity)
- Sedentary lifestyle
- Poor diet (low in fruits and vegetables)
- High stress levels
Demographic Factors
- Age: Often begins in childhood, but can develop at any age
- Sex: More common in boys during childhood, in women during adulthood
- Race/Ethnicity: Higher prevalence in certain populations
- Socioeconomic status: Associated with exposure to triggers and healthcare access
Diagnosis
Diagnosing asthma involves a combination of medical history, physical examination, and lung function tests. Since asthma symptoms can be similar to other conditions, accurate diagnosis is important for proper treatment.
Medical History
Your doctor will ask about:
- Symptom patterns and triggers
- Family history of asthma or allergies
- Other medical conditions
- Medications you're taking
- Environmental and occupational exposures
- Impact on daily activities
Diagnostic Tests
Spirometry
Primary test measuring how much and how fast you can exhale:
- FEV1 (Forced Expiratory Volume in 1 second)
- FVC (Forced Vital Capacity)
- FEV1/FVC ratio
- Bronchodilator response test
Additional Tests
- Peak flow monitoring: Measures maximum speed of exhalation
- Methacholine challenge: Tests airway sensitivity
- Fractional exhaled nitric oxide (FeNO): Measures airway inflammation
- Chest X-ray: Rules out other conditions
- Allergy testing: Identifies specific triggers
- CT scan: For complicated cases
Asthma Classification
Based on symptom frequency and lung function:
- Intermittent: Symptoms ≤2 days/week
- Mild persistent: Symptoms >2 days/week but not daily
- Moderate persistent: Daily symptoms
- Severe persistent: Symptoms throughout the day
Treatment Options
Asthma treatment aims to achieve good symptom control, maintain normal activity levels, and prevent asthma attacks. Treatment plans are individualized based on asthma severity, triggers, and response to medications.
Long-term Control Medications
Taken daily to maintain control:
Inhaled Corticosteroids (First-line therapy)
- Fluticasone (Flovent)
- Budesonide (Pulmicort)
- Beclomethasone (Qvar)
- Mometasone (Asmanex)
Combination Inhalers
- ICS + Long-acting beta agonists (LABA)
- Examples: Advair, Symbicort, Dulera
Other Controllers
- Leukotriene modifiers (Montelukast)
- Long-acting bronchodilators
- Theophylline
- Biologic therapies for severe asthma
Quick-relief (Rescue) Medications
Used for rapid symptom relief:
- Short-acting beta agonists (SABA): Albuterol, levalbuterol
- Anticholinergics: Ipratropium
- Oral corticosteroids: For severe attacks
Non-medication Management
- Trigger avoidance: Identify and minimize exposure
- Allergy treatment: Immunotherapy for allergic asthma
- Breathing exercises: Improve breathing patterns
- Asthma action plan: Written instructions for managing symptoms
- Regular monitoring: Peak flow meter, symptom diary
- Vaccinations: Annual flu shot, pneumonia vaccine
Proper Inhaler Technique
Essential for medication effectiveness:
- Remove cap and shake inhaler
- Breathe out fully
- Place mouthpiece in mouth, seal lips
- Press down while breathing in slowly and deeply
- Hold breath for 10 seconds
- Wait 1 minute between puffs if prescribed
Prevention
While asthma cannot be prevented entirely, you can take steps to control the condition and prevent attacks:
Primary Prevention (Reducing Risk)
- Breastfeeding infants for at least 6 months
- Avoiding tobacco smoke exposure during pregnancy and childhood
- Maintaining healthy weight
- Reducing exposure to air pollution
- Managing allergies effectively
Preventing Asthma Attacks
Environmental Control
- Use allergen-proof bedding covers
- Wash bedding weekly in hot water
- Keep humidity levels below 50%
- Remove carpets from bedrooms
- Use HEPA air filters
- Minimize pet exposure if allergic
Lifestyle Modifications
- Take medications as prescribed
- Monitor peak flow regularly
- Follow your asthma action plan
- Exercise regularly with proper warm-up
- Manage stress and emotions
- Stay up-to-date with vaccinations
- Treat GERD if present
Avoid Common Triggers
- Don't smoke and avoid secondhand smoke
- Stay indoors on high pollen/pollution days
- Avoid strong fragrances and irritants
- Prevent respiratory infections (hand hygiene)
- Be cautious with aspirin/NSAIDs if sensitive
When to See a Doctor
Seek Emergency Care (Call 911)
- Severe shortness of breath or wheezing
- Inability to speak in full sentences
- Lips or fingernails turning blue (cyanosis)
- Peak flow readings in red zone (less than 50% of personal best)
- No improvement after using rescue inhaler
- Feeling of impending doom or panic due to breathing difficulty
- Rapid pulse, sweating, and severe anxiety
Schedule an Appointment
- Frequent use of rescue inhaler (>2 times per week)
- Waking up at night with asthma symptoms
- Symptoms interfering with daily activities
- Peak flow readings consistently below 80% of personal best
- Need for refills of rescue medication more than twice a year
- After any emergency department visit or hospitalization
- If you think you have asthma but haven't been diagnosed
- To review or update your asthma action plan
Regular Follow-up
Even with well-controlled asthma:
- Every 3-6 months for routine monitoring
- Annual comprehensive asthma review
- After any change in medications
- If planning pregnancy
- Before starting new exercise program
Frequently Asked Questions
Currently, there is no cure for asthma. However, with proper treatment and management, most people with asthma can control their symptoms effectively and live normal, active lives. Some children with asthma may experience improvement or remission of symptoms as they grow older, but asthma can return later in life.
Yes! Exercise is important for overall health and can actually improve asthma control. Many professional athletes have asthma. The key is proper management: use your prescribed pre-exercise medication, warm up gradually, avoid exercising in cold/dry air or high pollution, and keep your rescue inhaler nearby. Work with your doctor to develop an exercise plan.
Most asthma medications are safer than uncontrolled asthma during pregnancy. Uncontrolled asthma poses risks to both mother and baby, including low birth weight and preterm delivery. Most inhaled asthma medications are considered safe during pregnancy. Always consult with your healthcare provider to adjust your treatment plan when planning pregnancy or if you become pregnant.
While both affect breathing, asthma typically starts in childhood, symptoms vary over time, and airway obstruction is largely reversible with treatment. COPD usually develops in adults with a history of smoking, symptoms are more constant, and airway obstruction is not fully reversible. Some people have features of both conditions (asthma-COPD overlap).
Not necessarily. While pet dander is a common trigger, not everyone with asthma is allergic to pets. If you are allergic but want to keep pets: keep them out of bedrooms, wash them regularly, use HEPA filters, remove carpets, and consider allergy medications or immunotherapy. Some people find certain breeds less triggering, though no pet is truly "hypoallergenic."