Medically Reviewed

Asthma: Everything You Need to Know

We’ve got medically vetted info on causes, symptoms, treatments, and other facts and tips that can make life with this respiratory condition easier.

Albert J. Polito, M.D.
Leonard B. Bacharier, M.D.
Reynold Panettieri, M.D.
Our Experts: Albert J. Polito, M.D.; Leonard B. Bacharier, M.D.; Reynold Panettieri, M.D.
Albert J. Polito, M.D.
Albert J. Polito, M.D.Chief of the Division of Pulmonary Medicine and Medical Director The Lung Center at Mercy Medical Center Baltimore, MD
Leonard B. Bacharier, M.D.
Leonard B. Bacharier, M.D.Professor of Pediatrics, Allergy/Immunology/Pulmonary Medicine Vanderbilt University Nashville, TN
Reynold Panettieri, M.D.
Reynold Panettieri, M.D.Pulmonologist and Professor of Medicine Rutgers University New Brunswick, NJ

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, but we are here for you with the antidote to those feelings: a solid body of info to help you 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 your asthma, but also thrive with it.

We’re sure you’ve got a lot of questions, and we’ve got the expert-vetted answers you need. Ready? Take a deep breath—and let’s dive in.

Definition

What Is Asthma?

Most of the time, we don’t give a thought to breathing. Our bodies are on autopilot when it comes to 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 the complexities behind our system of oxygen intake.

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, or bronchial tubes, that carry air in and out of your lungs. If you have asthma, these tubes are inflamed, which causes swelling that narrows the passageway into your lungs. As a result, air has a harder time getting into your lungs when you inhale and out of them when you exhale, leaving you gasping, coughing, wheezing, and feeling short of breath.

According to the Asthma and Allergy Foundation of America, more than 27 million children and adults in the U.S. have asthma. That translates to one in 12 people in the U.S. currently living with this chronic condition. While most cases of asthma (nearly 80%, per a study in Frontiers in Pediatrics) begin in the first six years of life, 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 so much by adulthood that you barely notice it. On the other hand, it can also resurface when triggered by, say, a respiratory infection, a new 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, as long as you’re vigilant about following your treatment plan. In order to do that, it’s helpful to first get familiar with what type of asthma you have.

Types

Types of Asthma

Doctors divide asthma into types, based on what triggers it. These are some of the main types described by the American College of Allergy, Asthma, & Immunology (note that some of them can overlap):

  • Adult-onset asthma. This means your symptoms didn’t show up until you were over age 18.

  • Allergic asthma. In this type of asthma, symptoms arise from exposure to allergens like dust, pollen, and pet dander.

  • Exercise-induced asthma. This type flares after a workout—think an intense gym session, game of flag football, or run around the park.

  • Occupational asthma. This form of asthma happens when you work around irritants like dust or chemical fumes that get into your lungs and set off symptoms.

  • Pediatric asthma. As the name suggests, this is asthma that starts in childhood.

  • Non-allergic asthma. In this type of asthma, your symptoms are triggered by something other than an allergen or occupational irritant, such as stress, an infection, or changes in the weather (heat to cold, for example).

Causes and Risk Factors

Asthma Causes and Risk Factors

As with so many other chronic illnesses, experts don’t know for certain what causes asthma; all that they can say for sure is that the condition is caused by an interaction between heredity and the environment.

While it’s not entirely clear what directly causes asthma, there are a number of known risk factors for this condition. According to the American Lung Association, factors that increase your likelihood of developing asthma include:

  • Allergies. Asthma is linked to allergic conditions like hay fever (a.k.a. allergic rhinitis). When you’re allergic to, say, your dog’s fur, your immune system releases chemicals that make your nose run and your eyes water. Those same chemicals also irritate your airways, says the Mayo Clinic.

  • Childhood respiratory infections. Common infections like colds, the flu, respiratory syncytial virus (RSV), and COVID-19 can trigger wheezing and other asthma symptoms, according to the Asthma and Allergy Foundation of America. Sometimes the wheezing persists after the infection clears, and kids develop chronic asthma that persists into adulthood.

  • Excess body weight. Being overweight or obese is linked to an increased risk for asthma. Researchers aren’t totally sure of the reason for the link, but they think the common denominator is inflammation. Fat tissue releases inflammatory chemicals, which can also inflame the lungs.

  • Exposure to air pollution. Air pollution is a known lung irritant that contributes to asthma. Living near a factory or in an area with lots of vehicle exhaust drives up the odds of developing asthma, especially in children.

  • Having a parent with asthma. If your mom or dad has asthma, you’re up to six times more likely to get it, too. You can blame genes in your family tree for the inheritance. More than 100 different genes may be involved in the allergic form of asthma, per the National Library of Medicine (NLM). Many of the involved genes play roles in your body’s immune response and airway function.

  • You smoke or are exposed to secondhand smoke. Along with its many other health risks, smoking irritates the airways and makes them more likely to narrow. Children who were exposed to secondhand smoke in the womb or in their home are more likely to have asthma, compared to kids not exposed to cigarette smoke.

  • You work around irritating substances. Jobs that expose you to dust, chemical fumes, and other lung irritants up your risk.

High-Risk Groups

Who Is at Greatest Risk for Asthma?

According to the Asthma and Allergy Foundation of America, older adults, low-income individuals, and Black, Hispanic, and American Indian/Alaska Native people have disproportionately higher rates of asthma in the U.S., compared to the general population. They also have the highest rates of deaths and hospitalizations due to asthma.

Other people at higher risk of developing asthma include children born to parents with asthma and children with a family history of allergies, which often go hand-in-hand with asthma. Having eczema, respiratory syncytial virus (RSV), or the respiratory infection bronchiolitis early in life, as well as being exposed to pollutants like secondhand smoke during the early years, are also linked to a higher likelihood of asthma.

Triggers

Asthma Triggers

If you have asthma, there are likely to be certain things in the environment—referred to as triggers—that your airways are extra sensitive to, and that therefore set off your asthma symptoms. These can be different for every person. At first, you’ll need to do some detective work to figure out your specific triggers, because symptoms don’t always develop right after exposure—they may not show up until a few hours later. Once you and your health care provider get a handle on your triggers, you can work together to develop an asthma action plan that will include which triggers you should avoid and what to do when your symptoms flare up.

Common asthma triggers include:

  • Allergens. Pollen, mold spores, or pet dander top the list.

  • Air irritants. These include cigarette smoke, air pollution, wood fires, charcoal grills, chemicals strong fumes, vapors, or odors like paint or perfume.

  • Exercise. Although physical activity overall improves your lung capacity, it ironically can sometimes trigger an attack.

  • Medications. A number of common medications, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and 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) can trigger asthma symptoms.

  • Stress. Feeling and expressing strong emotions like anger, excitement, crying, and yelling can set off asthma symptoms.

  • Weather. Changes in humidity levels or a swing to cold temperatures contribute to asthma attacks.

  • Workplace or environmental irritants. Chemical fumes, gases, and construction dust can all set off asthma symptoms.

The challenge? Asthma is a uniquely subjective illness. Not every person with it reacts to every trigger, and some people are bothered by only a few. The trick is to work with your doctor to identify your particular trigger or set of triggers, and then put plans in place to avoid them when possible (or, in the case of exercise, to take precautions so that your workout doesn’t trigger an attack).

Symptoms

Asthma Symptoms

While each person’s asthma is different, there are certain hallmark symptoms that nearly everyone with asthma experiences at some point. These include:

  • 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)

  • Persistent coughing

  • Rapid, shallow breathing

  • Tightness, pain, or pressure in your chest

  • Trouble sleeping due to coughing, wheezing, or shortness of breath

When or how often you will have symptoms varies widely by person. Some people with asthma have symptoms every day; others may go for long periods without any at all. And a fraction of people with asthma will only experience symptoms when they exercise or when they’re sick with a cold or other respiratory infection.

Asthma Attack Symptoms

Also called an exacerbation or flare-up, an asthma attack can occur at any time when symptoms are triggered. Mild attacks may last for only a few minutes, while more severe ones could go on for hours or days and can lead to a medical emergency. In fact, asthma attacks are responsible for almost 1 million emergency department visits and nearly 100,000 hospital stays annually in the U.S., according to the Centers for Disease Control and Prevention (CDC).

During an asthma attack, there are three things happening in your lungs:

  • 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—in other words, make a squeaky or whistling sound—when you try to breathe.

  • 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.

These changes in the airways in turn produce symptoms that can range from mild to severe. These include:

  • Chest tightening, pain, or pressure

  • Coughing

  • Rapid breathing

  • Shortness of breath

  • Wheezing (especially common in children)

In severe cases, an asthma attack can lead to life-threatening symptoms that require immediate medical attention. Get help right away if you or a child you are caring for experience:

  • Change in skin color. Your face, lips, and fingernails are very pale or blue.

  • Expanded chest. Your chest does not deflate when you exhale (breathe out).

  • Failure to respond (infants). The baby doesn’t respond to, or recognize, their parents or caregivers.

  • Fast breathing. You breathe so rapidly that your chest retracts (pulls in) when you inhale.

  • No response to medication. Quick-relief medications are not helping to ease symptoms.

  • Rapid nostril movement. You can see the nostrils move when you inhale or exhale through the nose (this is more common in children).

  • Rapid ribs or stomach movement. The ribs and stomach are moving in and out deeply and rapidly (this is more common in children).

  • Trouble speaking. The lack of air makes talking impossible.

Diagnosis

How Is Asthma Diagnosed?

No single test can confirm definitely that you have asthma. Instead, your doctor will diagnose this condition by reviewing your medical history, family history, and symptoms; conducting breathing tests and other tests; and seeing how you respond to asthma medications.

Let’s take a closer look at some of the tests your doctor may use. (A caveat on pulmonary function tests: If you’re not experiencing asthma symptoms at the time when the test is done, the results may come back as normal. Still, lung function tests can add important pieces to the puzzle of your symptoms.)

Spirometry

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, and 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 get 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 Test

FeNO is short for fractional exhaled nitric oxide. Nitric oxide is a substance that plays a role in inflammation. 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 confirm 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.

Challenge Tests

Also known as provocation or trigger tests, these determine how sensitive your lungs are. Your doctor might do challenge tests if your symptoms and other tests don’t convincingly establish a diagnosis of asthma, or if they’re trying to determine which asthma triggers you react to.

There are several types of challenge tests:

  • Exercise challenge: During this test, you will run on a treadmill while your oxygen and heart rate are monitored to see if exercise triggers your symptoms.

  • 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 your lungs respond to these irritants.

  • Methacholine challenge: Methacholine is a drug that will make your airways tighten up at low doses if you have asthma. During the test, you breathe in increasing doses of methacholine through 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, the test is considered positive, and your doctor may consider an asthma diagnosis.

Peak Flow Test

This test isn’t involved in the initial diagnosis of asthma as much as the management of the condition. 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 an asthma diagnosis, peak flow tests are used to help keep your disease under control.

Treatment

Asthma Treatment

The goal of asthma treatment is to control your symptoms so you can live a normal life and rarely need to use your rescue inhaler (a fast-acting treatment for asthma attacks). Many effective medications are available to keep your asthma under control. The caveat: There is a learning curve when it comes to figuring out which medications you’ll need and how often you’ll need to take them. Your prescription might also change over time. You and your doctor will need to work closely together throughout the process to optimize your meds and revise as needed.

As a general rule, asthma medications fall into two categories: long-term maintenance medicines, which you’ll take daily, and quick relief or rescue medications you’ll use as needed for flare-ups. Most asthma medications are inhaled, but some come in pill form. Let’s look at some of the asthma medicines you and your doctor will consider.

Long-Term Control and Maintenance Medications

By taking these drugs daily, you help to prevent a future asthma flare-up. Options include:

  • Inhaled corticosteroids: These are the most effective daily medicines for controlling 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 (LABAs): You take these medications in combination with an inhaled corticosteroid. They relax smooth muscles around the airways to help keep these passageways open. LABAs include formoterol, salmeterol, and vilanterol.

  • Combination inhaled medicines: This drug category includes both a corticosteroid and beta agonist in one convenient dose. Examples are Advair (fluticasone and salmeterol), Breo (fluticasone furoate and vilanterol), Dulera (mometasone and formoterol), Symbicort (budesonide and formoterol), and Trelegy (fluticasone, umeclidinium, and vilanterol).

  • Biologics: These medications come as an injection or infusion that you get once every few weeks. They work by targeting a cell or protein in your body that contributes to 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), Tezspire (tezepelumab-ekko), 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. Examples include Accolate (zafirlukast), Singulair (montelukast), and Zyflo (zileuton).

  • Cromolyn sodium: This generic inhaled non-steroidal drug prevents the 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, your doctor may prescribe a corticosteroid such as prednisone or methylprednisone in pill or liquid form for a short period of time to manage your symptoms.

Quick Relief and Rescue Medications

When you feel a sudden asthma flare coming on, or you’re struggling to get enough air, these medicines can help get your breathing under control.

  • Short-acting beta agonists: These inhaled medicines are usually the first choice for quick relief of asthma symptoms. They 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. Because anticholinergic drugs take longer to work than your rescue inhaler, they shouldn’t be used in place of one. Brand names include Atrovent (ipratropium) and Spiriva (tiotropium).

  • Combination quick-relief medicines: These medications contain both a short-acting beta-agonist and an anticholinergic medication. They are sold as Combivent (ipratropium and albuterol) and DuoNeb (ipratropium and albuterol).

Side Effects of Asthma Medicines

All medicines come with some side effects, but with most asthma medications the side effects are usually minimal and the benefits outweigh the risks. Depending on what your doctor prescribes for you, the dose, and how you take it (i.e., by mouth 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 the potential side effects of your specific treatment plan, as well as how to manage them.

Despite the downsides to some asthma medications, the reality is that you will be far better off with than without them. Also good to know about the inhaled corticosteroids you will likely be taking every day is that they don’t pose as many risks as oral corticosteroids. You inhale them 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. That’s why you should only take oral steroids short term (no more than three months, and ideally for only a few weeks), whereas inhaled corticosteroids can be taken indefinitely.

Surgery for Severe Asthma

If you’ve never heard of asthma surgery, there’s a reason: Only very rarely is a surgery-like procedure used to treat asthma. Surgery is reserved for those with severe, uncontrolled asthma who have evidence of irreversible changes to their airways that are making it hard for them 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 heat into the airways. The heat shrinks smooth muscles so they can’t tighten and narrow the airways.

Prevention

Preventing Asthma Attacks

While asthma isn’t curable, it is manageable. You can cut down on the number of coughing and wheezing attacks you have by knowing your triggers and working with your doctor, say experts at the Centers for Disease Control and Prevention (CDC).

First, get together with your asthma doctor and create an asthma action plan, the CDC suggests. This will include the combination of medicines you’ll take to prevent asthma attacks and make any attacks you do have much less intense. Then, learn your triggers. Keep a log of when your asthma symptoms start and what you were doing at the time to figure out if tobacco smoke, pollution, dust, mold, or something else sets your symptoms in motion.

Finally, get up to date on your recommended vaccines. A nasty bout of the flu, pneumonia, or another respiratory infection could trigger an asthma attack, even if your condition is well-controlled with medicine, the CDC says.

Outlook

Outlook

Because it affects breathing, asthma can be a serious and even life-threatening condition. But thanks to better methods to diagnose and treat asthma, the outcome for people with this condition has improved dramatically, as reported in a study in the European Respiratory Journal. By getting on the right inhaled medication, avoiding your triggers, and working with your doctor, you can get your asthma symptoms under control and live a full and active life.

Asthma
Frequently Asked Questions

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 27 million people in the U.S. with asthma have a severe form that is difficult to control, says the American Lung Association. 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. Most of the studies that have been done have not found an increased risk of getting COVID-19, or of having more severe COVID-19 in people with asthma, according to the American Academy of Allergy Asthma & Immunology.

Not really, but they do take practice at first. Ask your doctor to watch you to make sure you’re using yours correctly. 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 way it develops and its symptoms are the same in children and adults, as are the medicines use to treat it. The dosage of inhaled medications is also the same—it’s based on severity of symptoms, not the age or size of the person. There are a couple of notable differences, though. Children are more likely to have allergic asthma triggered by pets, pollen, mold, and dust mites and their symptoms come and go, while adult-onset asthma symptoms tend to be more persistent and serious.

This article was originally published June 1, 2021 and most recently updated December 4, 2023.
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Reza Samad, M.D., FCCP, Pulmonary and Critical Care Physician: