Asthma is a common chronic (long-term) lung disease in which the lungs’ bronchial tubes, or airways, become inflamed.
This inflammation causes the airways to become sensitive to environmental triggers, such as dust, smoke, pet dander, or cold, dry air.
In reaction to these triggers, an asthma attack can occur. The muscles around the bronchial tubes tighten, the lining of the airways becomes inflamed, and the airways overproduce mucus, making it difficult to breathe.
While there’s no cure for asthma, it can be effectively managed.
Read on to learn what experts know about this breathing disorder, why some people develop it and others don’t, lifestyle changes that can help you manage asthma, and how to avoid complications linked to the condition.
Thanks to advances in asthma research, doctors have been able to identify the different types of asthma. The type of asthma you have depends on your specific triggers.
It’s not always easy to determine which type of asthma you have. Proper diagnosis and regular communication with your doctor can help you to determine the best course of action.
Asthma is a chronic lung disease, so it’s important to receive treatment as soon as possible to ensure that your condition doesn’t worsen.
How to Tell if Your Asthma Is Severe
Doctors differentiate severe asthma from other, milder forms of asthma according to the frequency and intensity of a person’s symptoms.
For starters, severe asthma is persistent, which doctors define as asthma that causes symptoms more than twice a week, explains Patricia Takach, MD, an allergist-immunologist in Philadelphia. For many severe asthma sufferers, symptoms occur daily.
Also, people with severe asthma require a mixture of medications that includes a high-dose inhaled corticosteroid or a systemic (oral) corticosteroid and, potentially, a biologic medication. Research suggests that between 4 and 10 percent of people with asthma have severe asthma.
Also, and somewhat confusingly, severe asthma is not the same as a “severe acute asthma” attack or episode. This term refers to an asthma attack so severe that it requires immediate medical attention.
If you have asthma, performing normal daily activities can be strenuous, and it may take longer to recover from a respiratory infection, such as a cold or flu.
An asthma attack or flare-up is a sudden worsening of these symptoms, including severe wheezing, uncontrollable coughing, rapid breathing, sweating, and anxiety. These symptoms require immediate medical attention.
But not everyone experiences asthma in the same way. Symptoms vary from person to person, can change with age, differ between attacks, and may intensify during exercise, with a cold, or under periods of elevated stress.
It’s unknown what causes asthma, but scientists believe that both genetic and environmental factors play a role in the development of the disease. These include:
Family History Asthma tends to run in families, suggesting there’s an inherited component to the disease. You’re more likely to have asthma if one of your parents has it.
Allergies You’re also more likely to have asthma if you have atopic syndrome, or atopy, a predisposition toward certain allergic hypersensitivity reactions, such as atopic eczema and hay fever (allergic rhinitis). Asthma and allergies often go hand in hand.
Occupational Exposures In some cases, exposure to certain industrial or wood dusts, chemical fumes and vapors, and molds can cause asthma to develop.
Air Pollution Exposure to the main component of smog (ozone) raises the risk for asthma.
Obesity Children and adults who are overweight or obese are at a greater risk of asthma. This may have to do with inflammation in the body.
Smoking Cigarette smoke irritates the airways. Smokers have an increased risk of asthma, and exposure to secondhand smoke also increases the risk of asthma.
Having a severe respiratory infection during childhood is another risk factor for asthma. These infections can cause inflammation in the lungs and can damage lung tissue, affecting lung function later in life.
Similarly, research suggests that early contact with airborne allergens, irritants, and certain viral infections — in infancy or early childhood, before the immune system is fully developed — raises your risk of developing asthma.
What Triggers an Asthma Attack?
Numerous triggers can cause asthma attacks, including:
Tobacco Smoke While smoking is unhealthy for anyone, it’s particularly dangerous for people with asthma. If you smoke, you should quit. Secondhand smoke can also trigger an asthma attack. Avoid situations in which people around you smoke. And don’t let people smoke in a place where you spend a lot of time, such as your home or car — even if you’re not present when they smoke.
Smoke From Wood or Grass Even though it may seem “natural,” smoke from these sources contains harmful gases and particles. Avoid burning wood in your home. If you live in an area where wildfires occur, monitor air quality forecasts and try to stay inside when particle levels are at their worst.
Outdoor Air Pollution Emissions from factories, cars, buses, lawn mowers, leaf blowers, and snow blowers can all trigger an asthma attack. Try to avoid exposure to these sources whenever possible.
It’s also a good idea to check air quality measurements related to pollution in your area, such as ozone and small particles, and to stay inside as much as possible when they’re elevated.
Certain Foods and Food Additives While almost any food can cause an allergic reaction, a few additives (like sulfites and other preservatives) are widely believed to cause adverse reactions in some people.Acid reflux can also trigger an asthma attack in some people, so any food that aggravates this condition may also be responsible for symptoms.
Respiratory Infections These include influenza (flu), the COVID-19 virus, the common cold, respiratory syncytial virus (RSV), and sinus infections.
Strong Emotional States Negative emotions like stress, anxiety, depression, or fear can cause an attack by causing your muscles to tighten or your breathing rate to increase.
Certain Medications While different people have different triggers, common medication culprits include aspirin.
If you’re having trouble breathing, wheezing, or having chest tightness, let your doctor know so he or she can determine if you have asthma or if something else is wrong. In some cases your primary care provider will refer you to a specialist for a diagnosis.
Diagnosing asthma typically involves your doctor taking your personal and medical history; a physical exam, during which your doctor will listen to you breathe; and a pulmonary function test (a type of breathing test to evaluate your lung function).
Your doctor may run additional tests to help determine the type of asthma you have and to determine the severity of it. The type of asthma and its severity will help the doctor come up with an appropriate treatment plan for you.
In rarer cases, your doctor may also use a breath test called a fractional exhaled nitric oxide (FeNO) test to assess the level of inflammation in your lungs if it’s not clear whether you have asthma based on the results of other tests.
In younger children, doctors may diagnose asthma based on only symptoms, a family history, and a physical exam. Though in children 5 and older, the steps taken to diagnose asthma tend to be the same as in adults.
There is no cure for asthma, but with treatment you can alleviate and prevent your symptoms through quick-relief and long-term control medication.
Long-term control medication works to reduce inflammation to make your airways less sensitive to asthma triggers. It’s usually taken daily through an inhaler or as an oral pill. Quick-relief medicines help to relieve symptoms when they happen, relaxing the tight muscles around your airways and easing the flow of air.
Medication Options
According to the Allergy and Asthma Network, there are four main types of asthma medication:
Bronchodilators that relax and open the airways to relieve asthma symptoms. Bronchodilators include:
Short acting beta-agonist bronchodilators, or SABA, such as albuterol and levalbuterol, which provide quick relief
Long-acting beta-agonist bronchodilators, or LABA, such as formoterol, salmeterol, and vilanterol, typically used in combination with an inhaled corticosteroid
Long-acting muscarinic antagonists, or LAMA, which are usually prescribed for COPD, though a few are approved for severe asthma, including tiotropium and umeclidinium. They’re also typically used in combination with an inhaled corticosteroid.
Controller medications that reduce and prevent lung inflammation. These include inhaled corticosteroids, oral corticosteroids, and leukotrine modifiers (leukotrines are chemicals involved in inflammatory immune system responses).
Combination inhaler medications combine up to three asthma medications in an inhaler and are typically used daily. The devices may contain inhaled corticosteroids, a SABA, LABA, or LAMA.
Biologics that target the specific pathways that cause inflammation. They’re typically administered as an injection every two to eight weeks for people with severe asthma. Biologics for asthma include omalizumab, benralizumab, dupilumab, mepolizumab, reslizumab, and tezepelumab.
Peak Flow Meter
A peak flow meter is a portable device that measures air flow, or peak expiratory flow rate. It can help you manage your condition by determining how severe your asthma is at any given time.
According to the American Academy of Allergy, Asthma & Immunology, a peak flow meter can help you:
Assess how you respond to treatment during an attack
Monitor progress in treatment of chronic asthma and provide information for any changes in your therapy
Detect worsening lung function
A decrease indicated by your peak flow meter may alert you even before your symptoms worsen, and it may indicate that you should increase your medication.
Complementary and Integrative Therapies
There are few evidence-backed natural remedies for asthma, particularly if your case is severe. But lifestyle changes, such as controlling stress, and some complementary therapies, such as acupuncture, may help manage symptoms.
If your asthma is triggered by allergies, doing all you can to reduce your exposure to your trigger allergen — such as pollen, pet dander, dust mites, or cockroaches and rodents — may help. Allergy shots may help, too.
While there are steps you can take to lower the risk of developing asthma, there’s no way to prevent it because doctors aren’t entirely sure why it happens in the first place. But you can reduce your chances of an asthma attack or flare.
Avoid, to the extent that you can, breathing in air pollution and airborne allergens, irritants, or toxins. It’s possible that avoiding airborne pollens, mold, chemicals, and traffic-related pollution may lower your risk of developing asthma in the future.
Maintain a healthy weight to reduce your risk of developing asthma. Obesity is a risk factor for developing asthma.
Follow your doctor’s instructions when it comes to taking your medication and avoiding your asthma triggers. Have an asthma action plan in place.
Get vaccinated. Viruses and infections can trigger flare-ups. You can lower your odds of developing one of these triggers by getting your seasonal flu shot and other scheduled vaccinations.
Monitor your asthma. Keeping tabs on your condition using a peak airflow meter can help you spot and head off impending flare-ups.
Keep an eye out for warning signs. A cough or frequent inhaler use are two signs that a bad flare-up is in the cards. Recognizing these sorts of red flags can help you take steps to prevent a bad attack.
Making certain lifestyle modifications can help you control your asthma.
Maintain a healthy weight. Being overweight or having obesity can make asthma harder to manage.
Eat a healthy diet, especially one loaded with fruits and vegetables.
Exercise regularly. Check with your doctor about what level of physical activity is right for you.
Manage stress. Meditation and other relaxation techniques can help, as can talk therapy.
Quit smoking and avoid secondhand smoke.
Get quality sleep. Set a sleep schedule and try to stick to it, avoid screens before bed, and make sure your bedroom is comfortable and dark.
The long-term prognosis for someone with asthma varies. Some people get better over time — though their symptoms never fully go away — while others get worse.
For adults with asthma, the condition is usually chronic — meaning they will have it for the rest of their life. But one study has found that about 20 to 50 percent of patients with severe asthma met criteria for clinical remission within one year of biologic treatment, depending on how “remission” was defined. The study found that patients with less severe disease and shorter duration of asthma before biologic initiation had a better chance of achieving remission after biologic treatment.
Some children who develop asthma may “lose” it as they grow older and their small airways mature. While asthma may return later in life for some of them, many never have an asthma recurrence. But for others, especially kids with severe asthma, the condition may not ever go away.
Fortunately, by working closely with a doctor to manage symptoms — with medication and also by avoiding asthma triggers — most people with asthma can live a normal, healthy life free of asthma-related complications.
Poorly managed or poorly treated asthma can result in additional problems, including:
Severe asthma attacks leading to emergency room visits
Disruption of your sleep and daily activities and decreased quality of life
Increased risk of pneumonia and other lung infections
Pregnancy complications due to uncontrolled asthma can cause serious complications for mothers, including high blood pressure, toxemia, premature delivery and, rarely, death. It can also increase the risk of stillbirth.
Permanent airway damage that affects your breathing
Mental health problems can occur due to childhood asthma, with people with the condition being at greater risk for developing anxiety and depression than those who don’t have asthma.
According to the most recent data from the Centers for Disease Control and Prevention (CDC), nearly 27 million people in the United States — or 8.2 percent of the population — have asthma.
More than 22 million of these people are 18 or older.
Over 42 percent of people with asthma reported having at least one asthma attack in the previous year.
And asthma attacks resulted in more than 986,000 emergency room visits and 3,517 deaths in the United States.
On a global scale, about 262 million people have asthma, according to the World Health Organization.
Though asthma can affect people of all races and backgrounds, in the United States asthma is more likely to affect racial and ethnic minority groups, and outcomes are worse for these individuals. Children and adults who are Black, Hispanic (particularly people of Puerto Rican descent), and of Indigenous descent develop asthma more often, experience more severe and life-threatening asthma-attack emergencies, and have higher asthma-related death rates than white people and other racial and ethnic groups in America.
The causes driving these disparities are multifactorial. Research has shown that socioeconomic differences make access to healthcare and asthma treatments more difficult for Black families.
And a report from the Asthma and Allergy Foundation of America (AAFA) — a comprehensive overview that looked closely at 15 years of national data about asthma cases, severity, and deaths — concluded that systemic racism, discriminatory housing policies, and environmental injustice also all contribute to these disparities in asthma prevalence and outcomes.
There are some illnesses and health conditions that appear to be linked to asthma in that people with one are more likely to have the other, such as:
Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, which can result in symptoms like wheezing, coughing, chest tightness, and shortness of breath.
Effective management of asthma is possible through the use of prescribed medications, which can include both quick-relief and long-term control therapies.
Avoidance of known asthma triggers, such as air pollution and allergens, can significantly reduce the frequency and severity of asthma attacks.
Severe asthma or sudden worsening of symptoms requires immediate medical attention because it can pose serious health risks.
While no cure exists for asthma, research continues to identify new treatments and better understand the disease mechanisms, offering hope for future advancements in asthma care.
