Let’s Talk About Asthma
We’ve got the doctor-approved scoop on causes, symptoms, treatments and a ton of other facts and tips that can make life with asthma easier.
Whether you’ve just been diagnosed with asthma or worry you could have it, you’re probably nervous, confused, and maybe a little scared. That’s normal, and everyone featured on HealthCentral with a chronic illness felt like you do now. But we—and they—are here for you. The best way to conquer those worries is to understand the challenges you’ll face with this condition, as well as the best treatments, helpful lifestyle changes, and other crucial information that will help you not just manage this condition, but thrive with it. We’re sure you’ve got a lot of questions … and we’ve got the answers you need.
Our Pro Panel
We went to some of the nation’s top experts on asthma to bring you the most up-to-date information possible.
Albert J. Polito, M.D.
Chief of the Division of Pulmonary Medicine and Medical Director
The Lung Center at Mercy Medical Center
Leonard B. Bacharier, M.D.
Professor of Pediatrics, Allergy/Immunology/Pulmonary Medicine
Reynold Panettieri, M.D.
Pulmonologist and Professor of Medicine
New Brunswick, NJ
No, but it is highly treatable if you are vigilant about using your medications and avoiding your triggers. Only 5% to 10% of the more than 25 million people in the U.S. with asthma have a severe form that is difficult to control. You and your doctor can tailor an asthma treatment plan that’s best for your illness and symptoms.
While it certainly seemed a possibility in the early days of COVID, that has not turned out to be the case. Researchers from the University of Tennessee recently reviewed 150 studies that included 1.25 million asthma patients in 30 countries and found that having asthma does not put you at increased risk for a severe COVID-19 infection. There was no clear evidence of increased risk of diagnosis, hospitalization, severity, or mortality from COVID-19 due to asthma.
Not really, but they do take practice at first. Ask your doctor to watch you to make sure you’re doing it right. If it continues to be a challenge, you can use a device known as a spacer or holding chamber, which attaches to the inhaler and holds the medicine in place so you can breathe it in easier. Another option is a nebulizer, an air-compressor device that turns liquid medicine into a fine mist that you inhale via a facemask.
When it comes to the illness itself, no. The pathogenesis and symptoms are the same, as are the medicines use to treat it. In fact, the dosage of inhaled medications is also the same—it’s based on severity of symptoms, not the age or size of the patient. Children are, however, more likely to have allergic asthma triggered by pets, pollen, mold, dust mites and the like, and their symptoms are likely to be intermittent. On the other hand, people with adult-onset asthma are likely to have more persistent and more serious symptoms.
What Is Asthma?
Most of the time, we don’t give a thought to breathing. Our bodies are on autopilot when it comes this essential function of moving air in and out of the lungs. That is, until we can’t catch a breath—and suddenly, we have a newfound appreciation for exactly how complex our system of oxygen intake really is.
Unlike a sudden struggle to breathe caused by seasonal allergies or a garden-variety cold that will get better, asthma is a chronic disease that continuously affects the airways, otherwise known as the bronchial tubes. If you have asthma, your airways are inflamed, which causes swelling that narrows the passageway into your lungs. As a result, the air you breathe in has less room, leaving you gasping, coughing, wheezing, and feeling short of breath.
According to the Centers for Disease Control and Prevention (CDC), more than 25 million people in the U.S. have asthma—a greater number than ever before—including over 5 million children under 18. That translates to 1 in 13 people in the U.S. currently living with this chronic condition. While most cases of asthma (80% to 90%) begin in childhood, it’s possible for asthma to develop at any age. Asthma can also evolve over time. If you had mild or even moderate asthma as a young child, it may improve to the extent that you barely notice it. On the other hand, it can also resurface as an adult when triggered by, say, another respiratory infection, the adoption of a pet, or a change in living environment.
Asthma can’t be cured, but it can be effectively controlled, allowing you to continue living a full and active life. An asthma diagnosis doesn’t have to turn your life upside down, if you’re vigilant about following your treatment plan. What might that look like? Take a deep breath—and let’s dive in.
What Causes Asthma?
Like so many other chronic illnesses, all that experts can say for sure is that asthma is caused by an interaction between heredity and the environment. A genetic predisposition plays a role: Children born to parents with asthma have an increased risk of developing it themselves. So do children with a family history of allergies, which often go hand-in-hand with asthma. Certain early life events may also increase someone’s risk of asthma, such as having eczema, respiratory syncytial virus (RSV), or bronchiolitis, as well as being exposed to pollutants like secondhand smoke.
Along with a family history and possibly a genetic component, the place you live and things you come in contact with daily play a role in determining the likelihood of you getting this condition. Experts look to specific triggers in the environment that swollen airways may become extra sensitive to, including:
Allergic triggers: Pollen, mold spores, or pet dander top the list.
Air irritants: These include cigarette smoke, air pollution, wood fires, charcoal grills, chemicals, and strong fumes, vapors, or odors like paint or perfume.
Exercise: Ironically, activities aimed at improving lung capacity can sometimes trigger an attack.
Medications: Common meds, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or beta blockers can lead to an asthma attack.
Other health conditions: Food allergies, gastroesophageal reflux disease (GERD), obstructive sleep apnea, and respiratory infections (to name a few) raise your risk of developing asthma.
Stress: Feeling and expressing strong emotions like anger, excitement, crying, and yelling are asthma contributors.
Weather: Changes in humidity levels or a swing to cold temperatures can contribute to asthma.
Workplace triggers: Chemical fumes, gases, and construction dust can cause asthma.
We know what you’re thinking—and yes, that’s quite a list. But relax. Asthma is a uniquely subjective illness and not every person with it reacts to every trigger—some people are bothered by only a few. At first, you’ll need to do some detective work to figure out your specific triggers because asthma symptoms don’t always develop right after exposure—it can be a few hours later. But once you and your healthcare provider get a handle on your triggers, you can work together to develop an asthma action plan that will include which medications to take when, as well as signs you need to seek medical help.
Do I Have Asthma Symptoms?
Make no mistake: Asthma is different from other respiratory problems. We’ve all had the cough that won’t quit, phlegmy chests, or moments of labored breathing, but usually they’re temporary annoyances that we recover from. Asthma doesn’t go away, however, and although it’s very treatable, in the worst-case scenario, it can threaten your life.
While asthma is a chronic condition, an asthma attack is an acute occurrence with specific symptoms. Here’s a peak at what’s happening inside when you have an asthma attack:
Airway muscles constrict. This tightening, which limits airflow, is known as a bronchospasm. Your chest will feel tight and it will be hard to catch your breath. You may wheeze—make a squeaky or whistling sound—when you try to do so.
Inflammation increases. Your already hypersensitive airways become even more inflamed and swollen.
Congestion occurs. Your body produces a thick mucus that further clogs the airway.
This narrowing of the airways may happen very quickly or over time. Either way, it results in its own set of symptoms, which can range from very mild to very severe. You can expect:
Chest tightening, pain, or pressure
Shortness of breath
Trouble sleeping due to coughing or wheezing
Wheezing (especially common in children)
An asthma attack, also called an asthma episode or asthma flare-up, can occur at any time. Mild symptoms may last for only a few minutes, while more severe symptoms can go on for hours or days and can lead to a medical emergency. In fact, asthma attacks are responsible for 1.8 million emergency department visits annually in the U.S., and are the third ranking cause of hospitalizations in children under the age of 15, according to the Asthma and Allergy Foundation of America.
You should seek immediate medical help if you’re having any of the following signs of a severe asthma attack:
Change in skin color: Very pale or blue coloring in the face, lips, and fingernails
Expanded chest: Chest does not deflate when you exhale
Failure to respond: Infants may not respond to, or recognize, parents
Fast breathing: Breathing so rapidly that your chest retracts when you inhale
No response to medication: Quick-relief meds are not helping ease symptoms
Rapid nostril movement: Visible inhale/exhale through the nose (more common in children)
Rapid ribs or stomach movement: Ribs and stomach are moving in and out deeply and rapidly (more common in children)
Trouble speaking: Lack of air makes conversation impossible
When to Call Your Doctor
You may experience upper respiratory symptoms similar to asthma due to other illnesses, but they will go away after the acute period has passed, which is typically about two weeks. The big clue with asthma is that those symptoms never seem to clear up, suggesting an underlying condition may be to blame. See your primary care physician first, who in many cases can diagnose and treat asthma. Depending on your triggers and symptoms, you may also need a specialist. For instance, children, who are more likely to have allergic asthma, may also need an allergist. Adults who are former or current smokers may also need a lung specialist known as a pulmonologist. Anyone whose asthma is proving difficult to manage should also see one of these specialists.
How Is Asthma Diagnosed?
There is no one test available that confirms you have asthma. Instead, your doctor will diagnose it by reviewing your medical history, family history, and your recurrent symptoms, while also watching for improvement when you start on asthma medications. There are also a number of tests that may be done as part of your evaluation, including chest x-rays, blood tests, and allergy tests. Pulmonary function tests may also be performed, but they come with a caveat: If you’re not experiencing asthma symptoms at the time they’re administered, these tests may come back as normal. Still, they can add important pieces to the puzzle. Let’s take a closer look at some of the tests your doctor may use.
During this simple breathing test, you blow into a mouthpiece that’s connected to a device called a spirometer to see how much air you can inhale and exhale, as well how fast you can exhale. You’ll be told to first take a deep breath, then blow air out of your lungs and into the mouthpiece as fast and hard as you can. You may need to repeat this process a few times. If the results show reduced lung function, you’ll then be given an inhaled medication known as a bronchodilator to open your airways. Then you’ll repeat the test again after the medicine has had time to work to see if your lung function has improved. Expect to encounter this test often: Your doctor will likely continue to use it at each checkup to track changes in your lung function and determine if your medications are working.
FeNO is an acronym for fractional exhaled nitric oxide. By measuring the amount of nitric oxide in your breath, your doctor can tell how much inflammation you have in your airways. It’s quick and non-invasive—you just blow into a handheld device for about 10 seconds at a steady pace and get immediate results. A FeNO test early on can support or rule out an asthma diagnosis. Later it may be used to identify the type of asthma you have, track inflammation over time, and determine if your medications and asthma action plan are working.
Also known as provocation or trigger tests, these determine how sensitive your lungs are. Challenge tests may be performed if your symptoms and other tests don’t convincingly establish a diagnosis of asthma, or if your doctor is trying to determine which asthma triggers you react to. There are three types of challenge tests:
Methacholine challenge: Methacholine is a drug that will make your airways tighten up at low doses if you have asthma. During the test, you’ll breathe in increasing doses of methacholine via a nebulizer—a device that turns liquid medicine into a fine mist—followed by spirometry tests to measure lung function changes. If methacholine causes a 20% drop in your breathing ability, it’s considered positive and a diagnosis of asthma should be considered.
Irritant challenge: Your doctor will expose you to specific airborne asthma triggers such as perfume, chemicals, or smoke, then you’ll take a breathing test to see how you respond.
Exercise challenge: During this test, you will run on a treadmill while your oxygen and heart rate are monitored to determine if exercise triggers your symptoms.
Peak flow test: A peak flow meter is a handheld device that measures how well air is moving in and out of your lungs. You blow a quick blast of air into the mouthpiece and get a reading on a built-in scale. After diagnosis, peak flow tests are used to help keep asthma under control.
The goal of asthma treatment is to control your symptoms so you can live your normal life and rarely need to use your rescue inhaler, a fast-acting treatment for asthma attacks. Happily, there are many effective medications that are highly likely to keep your asthma under control and your life normal. The caveat: There is a learning curve when it comes to figuring out which medications you’ll need and how often. That prescription might also change over time.
As a general rule, asthma meds fall into two categories—long-term maintenance meds which you’ll take daily, and the aforementioned quick relief or rescue meds you’ll use as needed for asthma attacks. Most of these medications are inhaled, but some come in pill form. Here’s the play-by-play on what you’ll likely need in your medicine cabinet after diagnosis and as you learn to control your symptoms.
Long-Term Control and Maintenance Medication
By taking these drugs daily, you are working with your body to prevent a future asthma flareup.
Inhaled corticosteroids: These are the most effective daily medicines for preventing and reducing airway swelling and reducing mucus. They include: Alvesco (ciclesonide), Arnuity Ellipta (fluticasone furoate), Asmanex (mometasone), Flovent (fluticasone propionate) and Pulmicort (budesonide).
Inhaled long-acting beta agonists (LABA): These medications are taken in combination with an inhaled corticosteroid. They relax the so-called smooth muscles around the airways to help keep them open. LABAs include formoterol, salmeterol, and vilanterol.
Combination inhaled medicines: This drug category features both a corticosteroid and beta-agonist in one convenient dose and includes Advair (fluticasone and salmeterol), Breo (fluticasone furoate and vilanterol), Dulera (mometasone and formoterol), Symbicort (budesonide and formoterol), and Trelegy (fluticasone, umeclidinium, and vilanterol).
Biologics: This medication is delivered as an injection or infusion every few weeks. They work by targeting a cell or protein in your body to prevent airway inflammation. However, biologics are very expensive and are usually only prescribed for severe asthma that has been difficult to control. Biologics include Cinqair (reslizumab), Dupixent (dupilumab), Fasenra (benralizumab), Nucala (mepolizumab), and Xolair (omalizumab).
Leukotriene modifiers: This medicine is available in pill or liquid form and is used to reduce airway swelling and relax the smooth muscles surrounding the airways. They include Accolate (zafirlukast), Singulair (montelukast), and Zyflo (zileuton).
Cromolyn sodium: This generic inhaled non-steroid prevents airways from swelling when they come in contact with a trigger.
Theophylline: This medication also helps open the airways and comes as a tablet, capsule, or liquid. Brand names include Theo-24, TheoDur, and Uniphyl.
Oral corticosteroids: If other medications aren’t keeping your asthma under control, you may be prescribed a corticosteroid such as prednisone or methylprednisone in pill or liquid form for a short period.
Quick Relief and Rescue Medicines
When you feel a sudden asthma attack coming on you’re in the middle of nowhere and struggling to breathe, these meds can help you get your breathing under control.
Short-acting beta agonists: These inhaled meds are usually the first choice for quick relief of asthma symptoms and include Asthmanefrin and Primatene Mist (epinephrine); ProAir and Ventolin (albuterol); and Xopenex (levalbuterol).
Anticholinergics: Also known as long-acting muscarinic antagonists (LAMA), these drugs reduce mucus and help open your airways, but will take longer to work than your rescue inhaler so should not be used in place of one. Brand names include Atrovent (ipratropium) and Spiriva (tiotropium).
Combination quick-relief medicines: These feature both a short-acting beta-agonist and an anticholinergic and are sold as Combivent (ipratropium and albuterol) and DuoNeb (ipratropium and albuterol).
Side Effects of Asthma Meds
All medicines come with them, but most asthma medications are well-tolerated and the benefits outweigh the consequences, with minimal side effects reported. Depending on what your doc prescribes you, the dose, and how it’s taken (i.e. orally or inhaled), side effects can range from thrush (a fungal infection of the mouth) to headache and dizziness to decreased bone density. Your doctor will fill you in on potential side effects for your specific treatment plan, as well as how to manage them.
Despite the downsides to some meds, the reality is that you will be far better off with these meds than without them. Also, good-to-know info on the inhaled corticosteroids which you will likely be taking every day: They do not pose nearly the same risks as oral corticosteroids because they are inhaled in much lower doses and they only target the airways and lungs. When you take steroids orally, they have a systemic effect—meaning they travel throughout your entire body—that results in greater side effects, which is why you should only take them short term (no more than three months and ideally only a few weeks).
Surgery for Severe Asthma
Never heard of asthma surgery? That’s not surprising: Only very rarely is a surgery-like procedure used to treat asthma and it’s reserved for those with severe uncontrolled asthma who have evidence of long-standing irreversible changes to their airways that are making it difficult to breathe. In these cases, a procedure known as bronchial thermoplasty may be done. It involves using a bronchoscope—a tube inserted through the nose or mouth into the lungs—to deliver thermal energy into the airways to reduce the swelling and thickness of the smooth muscles that are constricting the airways.
What’s It Like Living With Asthma?
That depends. With well-controlled asthma you can enjoy the life you want; uncontrolled asthma, however, will result in more frequent and serious symptoms that limit and perhaps even threaten your life. Making sure that doesn’t happen is in large part up to you and how committed you are to following your treatment plan. For starters, you’ll need to incorporate using your long-term control medications into your daily routine (yes, even when you feel good) and carry your rescue inhaler with you at all times in case symptoms occur. Sure, it’s a bit of a hassle to bring your inhaler to work, school, vacation, gym, or a special night out. But that’s the trade-off for avoiding a trip to the ER: The most common reason people with asthma seek emergency care is because they don't have treatment available when symptoms occur.
You’ll also need to pay close attention to your triggers—and how to avoid them. That may mean staying inside with the windows closed during pollen season, covering your mouth and nose with a scarf when you go outside in cold weather, pretreating with your rescue inhaler before you exercise, and passing up the opportunity to adopt a dog to avoid pet dander. And it goes without saying (but we’ll say it anyway) that smoking cigarettes, marijuana, or e-cigarettes puts you on the fast track to an asthma attack.
By taking precautions and sticking religiously to your asthma treatment plan, you should be able to live your best life with very few limitations to your daily activities. If that’s not the case, then discuss it with your doctor, a board-certified allergist, or pulmonologist. We know enough about asthma at this point that if one treatment doesn’t work, another one will. Life with asthma isn’t easy, but we’re here to help you gain control.
Asthma Statistics: Centers for Disease Control and Prevention. (2019.) “Most Recent National Asthma Data.” https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm
Asthma Statistics: Asthma and Allergy Foundation of America. (2021.) “Asthma Facts and Figures.” https://www.aafa.org/asthma-facts/
Asthma Management: Allergies and Asthma Foundation of America. (2019.) “Your Guide to Managing Asthma.” https://www.aafa.org/media/1751/your-guide-to-managing-asthma.pdf
Asthma Diagnosis: American Lung Association. (2020.) “How is Asthma Diagnosed?” https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/how-is-asthma-diagnosed
Asthma Medications: American Academy of Allergy, Asthma and Immunology. (n.d.) “AAAAI Allergy and Asthma Drug Guide.” https://www.aaaai.org/tools-for-the-public/drug-guide/drug-guide-overview
Asthma and COVID: American Journal of Respiratory and Critical Care Medicine. (2021.) “Asthma in Adult Patients with COVID-19. Prevalence and Risk of Severe Disease.” https://www.atsjournals.org/doi/full/10.1164/rccm.202008-3266OC