29 Jun Forbes asks PCSI ‘What is asthma?’
Asthma is a chronic condition that affects the lungs and airways of millions of people worldwide. People with asthma have sensitive airways that easily become irritated and inflamed, causing a narrowing of the airways and making it difficult to breathe.
Asthma can develop in people of all ages but usually begins in childhood. In the U.S., asthma affects around 25 million people—including 6 million children under the age of 18. In adults, the condition is more common in women than men, but more research is needed to determine the cause of this disparity.
There’s no cure for asthma, but medication and lifestyle modifications can help ease symptoms. With proper treatment, people with asthma can lead full, active lives. Below, learn more about asthma, its effect on the body, available treatments and more.
What Is Asthma?
“Asthma is a common disease that affects people of different ages, characterized by intermittent airway inflammation that ranges in symptoms from shortness of breath, wheezing and sputum (a thick mucus made in the lungs) production to [becoming] life-threatening,” says Luis Javier Peña-Hernández, M.D., a lung health specialist at Pulmonary, Critical Care and Sleep Disorders Institute (PCSI), a pulmonary and chest specialty group in Palm Beach County, Florida.
Inflamed airways are sensitive and can react strongly to certain triggers, such as cold air, exercise, allergies or smoke, which leads to more inflammation. “Environmental exposure, such as certain smells, specific environments, weather, stress, exercise or infection can also trigger these symptoms,” says Dr. Peña-Hernández.
Asthma symptoms vary from person to person and range in severity from mild to severe and disabling. Mild symptoms may appear only during exercise or at other times of increased activity. Severe asthma attacks can cause trouble breathing, chest pain and even a feeling of suffocation.
How Does Asthma Impact the Body?
According to the American Lung Association, asthma causes hypersensitive airways, which are tubes that carry air to and from the lungs. In people with asthma, the airways and surrounding muscles can become inflamed and begin to tighten and swell, which makes it difficult for air to move in and out of the lungs, causing asthma symptoms or an asthma attack.
Long-term inflammation in people with untreated or undertreated asthma can permanently scar the airways, which may lead to irreversible airflow obstruction or airway remodeling, a condition in which the airways become abnormally shaped and lose their elasticity.
Symptoms of Asthma
Asthma symptoms vary from person to person and can negatively affect a person’s quality of life.
Common asthma symptoms, according to Dr. Peña-Hernández, include:
- Shortness of breath
- Wheezing with or without activity
- Increased sputum production
“Chronic inflammation of the airways can cause permanent obstruction of airflow,” he explains. Referred to as asthma with fixed airway disease, this condition is characterized by chronic persistent shortness of breath, decreased exercise capacity, poor quality of life and overall deteriorating health.
Types of Asthma
There are different types of asthma, each with its own set of symptoms and triggers. According to Dr. Peña-Hernández, the four main types of asthma include:
- Allergic asthma: Caused by an allergic reaction to a trigger, such as pollen, animal dander or dust mites
- Non-allergic asthma: Less common than allergic asthma and triggered by factors other than allergens, including viral infections, physical activity, stress and weather changes.
- Occupational asthma: Triggered by exposure to irritants at work, such as chemicals, fumes or dust
- Cough-variant asthma: Characterized by a chronic cough and often mistaken for a cold or other respiratory infection
Several diseases mimic asthma, such as cardiac-asthma, adds Dr. Peña-Hernández. A person with cardiac asthma has inflammation in the lungs due to underlying heart disease and, while symptoms can be similar, the two conditions require different treatment plans.
Causes of Asthma
The exact cause of asthma is unknown but scientists suspect a combination of genetic and environmental factors. Researchers are still working to identify all the genes and factors that contribute to the development of asthma, however, there are several known factors that may trigger an asthma attack.
According to the CDC, common asthma triggers include:
- Tobacco smoke
- Outdoor air pollution
- Indoor allergens, such as dust mites, animal dander, cockroaches and mold
- Outdoor allergens, such as pollens
- Changes in weather conditions
- Certain medications
- Gastroesophageal reflux disease (GERD)
While the cause of asthma hasn’t been identified, there are several known risk factors that may increase your chance of developing the condition. According to the National Heart, Lung, and Blood Institute, these include:
- Environmental factors, such as smoke and certain germs
- A family history of asthma
- Viral infections that affect the respiratory tract
- A history of allergies
- Being African American or Hispanic
- Having obesity
- Occupational hazards, such as chemical or industrial exposure
Risk of Asthma
Asthma has been linked to the development of other health conditions and complications. According to a 2022 review published in the Polish Archives of Internal Medicine, people with asthma have a higher risk of developing:
- Cardiovascular disease
- Allergic rhinitis
- Anxiety and depression
- Diabetes mellitus
- Chronic obstructive pulmonary disease (COPD)
- Obstructive sleep apnea
How is Asthma Diagnosed?
If your healthcare provider suspects asthma, they’ll perform a series of tests to confirm the diagnosis. They may order blood tests and imaging to rule out other conditions as well.
Common tests used to diagnose asthma include:
- Spirometry, a common test that measures how much air you can breathe in and out, as well as how fast you can breathe out.
- Peak expiratory flow tests, which measure how well you can breathe out in short bursts.
- Bronchoprovocation tests, also known as methacholine challenge tests, used to measure your airway response to a trigger that tightens the airway, such as an allergen.
- Fractional exhaled nitric oxide test, which determines the level of nitric oxide in your breath, which is a marker for airway inflammation.
- Allergy testing, which can identify allergens that may trigger your asthma.
Treating asthma is a complex process that requires ongoing care. The best way to treat asthma is to avoid triggers and take medications as prescribed. Your care team may suggest a variety of drugs to treat your asthma, including oral medications and medications inhaled directly into the lungs.
Individual asthma symptoms are different, so the type of medication you need may vary. The severity of your asthma, your age and other factors all play a part in determining the best medication for you.
- Inhaled corticosteroids: These are the most effective long-term control medication for asthma that works by reducing airway inflammation. Inhaled corticosteroids are usually taken twice a day as part of a daily asthma control plan.
- Oral corticosteroids: Similar to inhaled corticosteroids, the oral form also helps reduce inflammation in the airway to provide short-term asthma symptom relief. These come in tablet and liquid form and are usually prescribed for asthma flare-ups.
- Leukotriene modifiers: Usually prescribed as a daily medication, leukotriene modifiers help prevent and relieve asthma symptoms by blocking leukotrienes, chemicals that are known to cause inflammation. They come in tablet and granule forms.
- Long-acting beta-agonists (LABAs): Combined with an inhaled corticosteroid to relieve the symptoms of asthma, LABAs work by relaxing the muscles around the airway to open it up and make breathing easier. They’re typically taken every 12 hours to prevent bronchospasm or before exercise for those with exercise-induced asthma.
- Long-acting muscarinic antagonists (LAMA) or Anticholinergics: Taken as a daily inhaler for asthma maintenance, anticholinergics help prevent symptoms from occurring for up to 24 hours.
- Short-acting beta 2-agonists (SABAs): Used as a quick-relief medication to ease asthma symptoms for up to a six-hour period, SABAs are inhaled when asthma symptoms first begin. They’re also used before exercise to prevent exercise-induced bronchospasm.
- Biologic agents: These are more specific drugs that target receptors in the inflammatory pathway to reduce airway inflammation. While there are no precise guidelines for their use in asthma, biologics may be recommended for people with severe asthma who are not responding to other treatments.
- Allergen immunotherapy: This treatment, which involves a series of allergy shots that helps your body tolerate allergens, may be helpful in patients with allergic asthma.
In addition to medications, there are several lifestyle changes you can make to help manage your asthma symptoms, says Dr. Peña-Hernández, including:
- Avoid triggers: One of the best ways to manage asthma is to avoid triggers. Common triggers include cigarette smoke, dust mites, pollen, pet dander and mold.
- Avoid occupational triggers: If you have asthma, it’s important to avoid occupational triggers at work, including chemicals, dusts and fumes.
- Make environmental changes: Cleaning vent ducts often and controlling mold and mildew growth in your home can also help improve air quality and reduce asthma symptoms.
- Stop smoking: If you smoke, quitting can help reduce your exposure to harmful toxins and minimize asthma symptoms.
- Prepare for the weather: Hot, cold and humid weather can provoke symptoms. It’s also important to dress appropriately for the weather and to stay hydrated, as dehydration has been linked to increased bronchoconstriction.
- Get vaccinated: In some cases, vaccinations, such as the flu and COVID-19 vaccines, can help prevent asthma attacks by reducing the chances of contracting certain respiratory illnesses that may worsen asthma symptoms.Talk to your health care provider about which vaccinations are right for you.
- Exercise regularly: Exercise can help to improve lung function and overall health, which may help reduce asthma symptoms.
- Manage your weight: Maintaining a healthy weight for your body minimizes your overall risk of asthma-related symptoms.
- Reduce stress levels: Stress is a common trigger for asthma attacks, according to the American Lung Association. Finding ways to manage stress can help to reduce the frequency and severity of symptoms.
When to See a Doctor
If you’re experiencing asthma symptoms, it’s important to see a health care provider for accurate diagnosis and treatment.
If you’re having a severe asthma attack, with symptoms such as chest tightness and wheezing, call 911 or go to the nearest emergency room. An asthma attack can be a life-threatening medical emergency. In children with asthma, excessive drowsiness, bluish colored skin or lips and a rapid heartbeat are signs of a medical emergency that requires immediate treatment.
The Bottom Line
Asthma is a chronic condition that affects the airways and lungs. Although there’s no cure, symptoms can be controlled with medications and lifestyle changes. If you think you may have asthma, speak to your health care provider for proper diagnosis. They’ll work with you to create a tailored treatment plan that offers the best chance for symptom control.
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