Let’s Talk About Asthma Symptoms
The list of asthma symptoms is not long, but their impact can be staggering. Learn more about signs of this condition, and what you can do about them.
Everyone knows the feeling of that cough that won’t quit, stubbornly lingering weeks after the rest of your cold clears up. But if you have asthma, your cough is truly a permanent fixture, hanging out in the background just waiting for something to set it off. Asthma is more than just coughing, of course. Add in chest tightness, wheezing, and difficulty sleeping and it starts to become clear just how challenging this condition is. Medication can greatly reduce asthma symptoms—but first you have to know what to look for. Here’s help.
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
Sadly, no. It’s a misconception that pet hair is the problem and that getting a shorter-haired breed can solve it. In fact, asthma symptoms are triggered by the protein found in a pet’s saliva, dander (super tiny flakes of skin), and urine. Since all dogs and cats have dander, saliva and urine, no one breed is better than another for people with asthma.
Yes, to a certain extent. Regular use of a peak flow meter can help you and your doctor establish your ideal personal peak flow reading when your asthma is under control. Then, as a general rule, if that reading falls to less than two-thirds of the ideal level, it’s time to increase your medication. If it falls to less than half, you should seek immediate medical help. Often, your peak flow meter can reveal these changes before you have symptoms, so you can take action to prevent an attack before it happens.
That is a possibility, but there are things you can do to prevent it from happening. For starters, stay vigilant about using your medication. Uncontrolled asthma is more likely to get worse with age because the airways become damaged by scarring, a process known as airway remodeling, and medications won’t be as effective at this stage. Adult-onset asthma can also have more severe symptoms, but that’s not always the case. Finally, an older person who has heart disease or another medical condition may have more trouble dealing with an asthma attack than a younger person.
There have been some studies linking obesity to asthma, but there is not enough proof to say being overweight causes asthma. What we do know is that most excess weight occurs in the mid-section of the body, which can reduce your lung volume. And overweight and obese people tend to have diets high in sugar and starch, which can lead to the release of inflammatory hormones that can increase lung inflammation and asthma symptoms. In one study, gaining only five pounds was associated with 22% poorer asthma control and a 31% increase in the likelihood of needing a course of oral steroids, so keeping your weight under control should be taken seriously.
What Is Asthma, Again?
Asthma is a chronic lung condition that causes your lower airways to become inflamed, swell, and produce excess mucus, all of which narrows them, making it difficult for air to pass through. The end result: You feel short of breath, wheeze, and cough. More than 25 million people in the U.S. have asthma, including over 5 million children under 18, according to the Centers for Disease Control and Prevention (CDC). While 80% to 90% of asthma cases begin in childhood, it’s possible for asthma to develop at any age.
Currently, there is no cure for asthma, but the condition can be effectively treated and managed so it doesn’t take over your life. Along with a genetic component, environmental factors play a significant role in determining who gets asthma, or at least, how severe it is. That’s because with asthma, your airways, also known as bronchial tubes, are inflamed all the time and hyper-reactive to things you breathe in that might not bother other people. Common asthma triggers include substances that cause allergies (pollen, mold, dust mites, pet dander), irritants in the air (tobacco smoke, air pollution, charcoal grills, paint fumes, perfume), exercise, and changes in weather (cold temps, high humidity). Not everyone has all these triggers, so you and your doctor will need to do some detective work to figure yours out.
Understanding an Asthma Attack
Along with figuring out what causes an asthma attack for you, it’s useful to understand exactly what’s happening during an attack. Think about how your skin becomes red, irritated, and sore when you get sunburned: That’s kind of what the linings of your airways are always like when you have asthma.
When you come into contact with a trigger, the insides of these super sensitive airways swell even more, narrowing the space that air has to move in and out of the lungs. The muscles that wrap around your airways also tighten or constrict, making it even harder to breath. At the same time, mucus production ramps up in the airways, clogging them even more. This is known as an asthma attack, flare up, or episode. An attack can run the gamut from a mild events that lasts just a few minutes to a more serious attack lasting several days.
Fortunately, there are many available medications used to treat asthma on both a daily basis for long-term control and to provide fast-acting relief in the event of an attack. You’ll work with your doctor—either a primary care physician, allergist, or pulmonologist—to develop an action plan that can keep your asthma under control and symptoms to a minimum.
It’s important to proactively seek help for asthma because uncontrolled asthma can lead to a serious condition called airway remodeling. In airway remodeling, the lungs become scarred due to poor management of the asthma. When someone experiences airway remodeling, asthma medicines do not work as well and less air is able to move in and out.
What Are Asthma Symptoms?
Here’s the thing with asthma: Not every person experiences the same symptoms in the same way; asthma symptoms may also vary from attack to attack. What’s more, one episode may be mild while the next is severe. Some asthmatics have symptoms every day while others may go for long periods without any at all. And a percent of people with asthma will only experience symptoms when they develop a cold or exercise.
Still, there are some hallmark asthma symptoms that occur for nearly everyone who develops this condition. These are a few red flags to look for:
Attacks of coughing and wheezing that get worse when you have a respiratory illness
Feeling short of breath, like you can’t take in enough air
Making a whistling or wheezing sound while breathing (this is especially common in children)
Rapid, shallow breathing
Tightness, pain, or pressure in your chest
Trouble sleeping due to coughing, wheezing, or shortness of breath
Severe Asthma Symptoms
In addition, you’ll need to be able to recognize the symptoms of a severe asthma attack. Warning signs that you should seek immediate medical help include:
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
Depending on the frequency of your symptoms, your asthma will be classified into one of four categories:
Mild intermittent: Mild symptoms up to two days a week and up to two nights a month.
Mild persistent: Mild symptoms more than twice a week, but no more than once in a single day.
Moderate persistent: Symptoms once a day and more than one night a week.
Severe persistent: Symptoms throughout the day on most days and frequently at night.
Developing an Asthma Action Plan
Once you’re diagnosed, the next step will be to work with your doctor to create an asthma action plan in writing to prevent and control asthma attacks. This plan will help you assess your symptoms, decide which medications to use, and know what to do in an emergency. There are several easy-to-follow templates that feature three asthma zones—green, yellow, and red—created by the National Institutes of Health. (You can download an asthma zone template from the Asthma and Allergy Foundation of America.)
You’ll also need a peak flow meter, an inexpensive handheld device you can use at home to gauge how well air is flowing in and out of your lungs. First, work with your doctor to determine what your personal best peak flow meter reading is—the highest number you can achieve over a two- to three-week period when your asthma is under good control. Then you’ll use your current reading each day to help determine if you’re moving into a yellow (caution) or red (emergency) zone. The plan also lists your recommended medications and dosage for the symptoms that categorize each zone, and signs you need to seek medical help immediately. Here’s how it works:
Green Zone for Asthma
If you’re in the “green zone” on your asthma action plan, it means you’re doing well. Maybe you have no symptoms at the current time, or the ones you do have are being controlled successfully by medication. At this point, continuing to take your long-term control medicine is all you need to do. You are in the green zone if:
You don’t have coughing, wheezing, chest tightness, or trouble breathing.
You can do all the things you usually do.
Your current peak flow reading is 80 percent or higher than your best peak flow.
Yellow Zone for Asthma
If your action plan reveals that you are in the “yellow zone,” it means your asthma is getting worse. You can help your situation by continuing to take your quick-relief medicine and your long-term control medicine, while regularly monitoring your symptoms. You are in the yellow zone if:
You have some coughing, wheezing, chest tightness or trouble breathing, or
You wake up at night due to asthma symptoms, or
You can’t do some of the things you usually do, or
Your peak flow reading is only half to three-quarters of your best peak flow.
Red Zone for Asthma
This is where things get serious for an asthma patient. Red zone symptoms, left unchecked, can lead to a true medical emergency. In general, the red zone is a medical alert. Take your additional quick-relief emergency medications and call your doctor. If your symptoms don’t get better and you can’t reach your doctor, go to the emergency room. You are in the red zone if:
You’re having a lot of trouble breathing, or
Your quick-relief medicines aren’t helping, or
You can’t do any of the things you usually do, or
You’ve been in the yellow zone for 24 hours and aren’t getting better, or
Your peak flow reading is less than half of your best peak flow.
Early Warning Signs of Asthma
As unpredictable as asthma may sound, attacks seldom occur without some kind of warning. Once you become more familiar with your symptoms and triggers, it will get easier to recognize some early red flags that an episode is imminent.
Neck or throat itchiness
Shortness of breath
Feeling extremely tired when exercising
Wheezing and coughing after exercising
Coughing frequently, especially if it gets worse at night
A decrease in your usual lung function as measured by a peak flow meter
Having a cold or allergy symptoms like nasal congestion, sneezing, sore throat, and headache
Remember: The key to controlling your asthma is taking your long-acting medications every day, and aggressively jumping on your quick relief medications at the earliest sign that things are getting worse. The airways to the lungs narrow slowly, so your airways may be badly blocked before you feel symptoms. This is where using your peak flow meter daily comes in: It can detect narrowing in your airways hours and even days before an episode. With this important tool, there’s no reason an asthma attack has to sneak up on you.
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 Severity: Global Allergy and Airways Patient Platform. (n.d.) “What Is Asthma?” http://gaapp.org/what-is-asthma/
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
Indoor Asthma Triggers: Environmental Health Perspectives. (2015.) “Indoor Environmental Exposures and Exacerbation of Asthma.” https://ehp.niehs.nih.gov/doi/10.1289/ehp.1307922
Weight and Asthma Control: Respiratory Medicine. (2008.) “Effect of Weight Change on Asthma-related Health Outcomes in Patients with Severe or Difficult- to-Treat Asthma.” https://www.resmedjournal.com/article/S0954-6111%2808%2900304-1/fulltext