Asthma: Everything You Need To Know

By: Elaine Hinzey RDN, LD

red and blue illustration of lungs

Asthma, a common lung disease, causes inflammation and narrowing of the airways. This constriction is accompanied by excessive mucus production. It becomes hard to breathe when the airways become irritated from any number of triggers such as cleaning products or dust. At the same time, the bronchial tubes in the lungs become inflamed and swollen. Some people only have attacks when they have viral infections, such as a cold or flu, or when exercising, especially in cold or dry weather (via WebMD). For others, though, asthma is something that they must contend with and plan around every day. 

Symptoms

woman coughing


For asthmatics, symptoms vary widely from day to day, and two individuals with asthma can experience very different manifestations of the condition. People with asthma often find themselves coughing, especially when they first wake up or at night. They might wheeze and complain of difficulty breathing accompanied by tightness, pain, or a feeling of pressure in the chest (via WebMD).

There are also some “unusual” asthma symptoms that you might want to be aware of, such as feeling tired, moody, unable to concentrate, and irritable. Anxiety and frequent sighing are also sometimes noted (via WebMD). Healthline adds that people with allergic asthma might complain of an itchy face and throat, as well as skin rashes and common allergy symptoms such as congestion and sneezing that accompany traditional asthma symptoms like difficulty breathing or feeling like there’s a weight on their chest.

When an Asthma Attack is an Emergency

healthcare provider holding oxygen mask on patient

Luckily, most asthma attacks are relatively mild and last only a few minutes or, at the most, a few hours. Severe attacks, however, can be medical emergencies. Signs of a severe asthma attack include:

  • Fast breathing.
  • Pallor or blueness of the face, lips, or fingernails.
  • Trouble breathing, walking or talking (via WebMD).

If you care for someone with asthma, the Allergy and Asthma Foundation of America recommends that you keep an eye out for rapid movement of the nostrils, an expanded chest that does not deflate after exhalation, and chest retractions (when the skin becomes tight around the chest plate or rib bones during inhalation). Furthermore, it is not uncommon for infants with asthma to fail to respond to or recognize their parents during a severe asthma attack.

Types of Asthma

boy blowing his nose

Many people are shocked to learn how many different types of asthma there are and to discover that a person can have more than one type simultaneously. In fact, you could have one type early in life and then develop more as a young adult or even an older adult (via Verywell). Adult-onset asthma has similar symptoms to childhood-onset asthma. Yet, it has a more rapid trajectory in terms of lung function changes, is more challenging to treat, and has a constancy that childhood-onset asthma doesn’t have.

More than half (and up to 80%) of asthma cases are believed to be triggered by allergies to things like pollen, mold, and pet dander. Non-allergic asthma is triggered not by things like pollen and mold but by other environmental changes such as cold weather, high humidity, stress, or air pollution. Non-allergic asthma is more severe and likely to plague women.

If you’ve ever had the pleasure of sitting beside someone with a dry cough from morning to night, they might have had cough-variant asthma. Sometimes the only symptom of this condition is the cough, which makes diagnosis difficult. Just under a third of people with cough-variant asthma will eventually develop classic asthma. Many people have a worsening of asthmatic symptoms at night — a condition known as nocturnal asthma, which affects about half of adults with asthma. Although nocturnal asthma symptoms are no different from classic asthma symptoms, nocturnal asthma increases the risk of asthmatic complications such as heart disease, respiratory failure, and even death.

Classifications of Asthma Severity

ill boy in bed

There are four primary classifications of asthma: Intermittent, mild persistent, moderate persistent, and severe persistent (via Healthline). Intermittent asthma is precisely what it sounds like — occasional and mild asthma, occurring fewer than two days per week or two nights per month. Thankfully, this is the most common form of asthma, and it doesn’t generally interfere with daily life. Mild persistent asthma occurs more than the intermittent form, but not every day. Moderate persistent asthma occurs daily and at least one night each week. Individuals with moderate persistent asthma often report that it does affect their daily life to some degree. Severe persistent asthma is the diagnosis reserved for people who experience symptoms every day and most nights. These individuals are likely to have severely limited daily activities because of their asthma. Classifications can change over time, and a person in any category can have severe asthma attacks that require prompt medical attention.

Risk Factors

young kid smoking a cigarette

Individuals with asthma often have parents or siblings who also have the condition. Because allergic conditions tend to cluster together, it is not uncommon for someone with asthma to have another condition such as atopic dermatitis or hay fever. Certain professions that require exposure to volatile chemicals, including those used on farms and hair salons, are also high-risk (via Mayo Clinic). Healthline specifies that occupations that call for contact with dust, dyes, gases, fumes, industrial chemicals, animal protein, and rubber latex increase the risk of asthma.

Overweight individuals and those who either smoke or are frequently exposed to secondhand smoke are also at an increased risk. Recent research has found that infants born to mothers who smoked while pregnant are more likely to develop asthma (via the NIH). Obesity might increase the chances of developing asthma by either increasing inflammation or altering immunity.

African Americans and Puerto Ricans are at the highest risk for asthma, and African American and Hispanic children are more likely to die from asthma than non-Hispanic white Americans. More boys have asthma than girls as children, but more women have asthma than men in adulthood.

Triggers

man sleeping at desk with head on computer

Exposure to airborne allergens is a significant risk factor for an asthma attack. These allergens can include smoke, pollen, dust mites, mold spores, pet dander, or cockroach waste (via Mayo Clinic). As mentioned, exposure to cold air, infections including the common cold, and physical activity can be taxing for those with asthma. Some medications have been recognized as a cause of asthma attacks, including beta-blockers, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs). People who have suffered an asthma attack often realize that their symptoms were preceded by unusual emotions or stress. Household cleaning products, perfumes, and aerosol hair care products, such as hairspray, can also trigger attacks (via Healthline).

There are many things that people living with asthma can do to take control of their environment and help to prevent another attack, including using protective covers on your mattress and pillowcases to act as a barrier against dust mites, using a vacuum with a HEPA filter, not sleeping with the windows open, paying attention to the air pollution level in your area before heading out, and promptly fixing water leaks in your house if you become aware of them (via the CDC).

Diagnosis of Asthma

physician in lab jacket wearing glasses holding a clipboard

The diagnosis of asthma generally starts with an “H & P,” which stands for history and physical. After getting the details of what you’ve been experiencing, listening to your lungs, checking your blood pressure, etc., a doctor will generally order specialized testing if asthma is suspected. Lung function tests and tests to determine how your airways react when exposed to allergens or medicines might be carried out (via MedlinePlus).

The Cleveland Clinic describes spirometry, a common pulmonary function test, as a means of determining the amount of air in your lung and the flow of air as it moves through the lungs by measuring the speed and force of your exhalations. Fractional exhaled nitric oxide (FeNO) testing similarly measures the amount of nitric oxide in your breath when you exhale; a high level could indicate excessive lung inflammation. Allergy testing is often carried out on those found or suspected of having asthma. Chest or sinus x-rays are also frequently ordered (via the Asthma and Allergy Foundation of America).

Long-Term Asthma Treatments

blonde girl using an asthma inhaler

Long-term asthma treatments, referred to as control medications, prevent the inflammation and swelling of the airways that make breathing difficult and help to halt asthma attacks before they begin. Corticosteroid inhalers are the cornerstone of preventive treatment (via the Mayo Clinic). Combination inhalers combine corticosteroids with a long-acting beta-agonist; the corticosteroids reduce inflammation while the beta-agonist widens the airways to make breathing easier (via Verywell). Corticosteroids cannot be used in people with a milk allergy and are used cautiously in people with particular heart and eye conditions, diabetes, epilepsy, or hyperthyroidism. According to the University of Michigan Health, the main side effects of inhaled corticosteroids are a sore mouth or throat and a hoarse voice. Rarely, people develop oral thrush, which is a fungal infection in the mouth. Rinsing your mouth after every use dramatically reduces the risk of developing this painful condition.

Leukotriene modifiers, another type of controller medication, are not used as often as they once were. Some have been linked to psychological reactions, including suicidal thinking, aggression, and liver damage. Theophylline, a daily pill used to relax the muscles surrounding the airways, is also not used as often as corticosteroid-containing inhalers because of their side effects, which might include irritability, insomnia, gastrointestinal symptoms, and headache (via MedlinePlus).

People sometimes mistake long-term asthma controller medication as rescue medication and only use it during an exacerbation. This is one of the most common mistakes that physicians see among asthmatics. Controller medication is meant to be used every day, regardless of how you feel.

Rescue Inhalers

one hand holding an inhaler and the other hand holding an illustration of silhouette of a coughing person

Rescue inhalers are bronchodilators used during asthma attacks to dilate and relax the airways. They generally provide relief within 15-20 minutes. Side effects of rescue inhalers include a feeling of anxiety, shakiness, a rapid heart rate, muscle aches, and a surge in energy (via Medical News Today). If symptoms of an asthma attack continue 20 minutes after the bronchodilator has been used, it’s time to call 911. Healthline reminds readers that it’s essential to stay calm during an asthma attack and use your rescue inhaler as soon as you feel an attack coming on.

While you must use a rescue inhaler when you need to, recent research has found that more than a quarter of asthmatics overuse their bronchodilator (via Healthgrades). As helpful as rescue inhalers are, they won’t prevent you from having an attack in the future. That’s why you need to use control medication every day. People with asthma are cautioned not to use rescue inhalers more than twice a week, and using them more often can increase asthma symptoms — triggering a vicious cycle. Also problematic are recent studies indicating that overusing rescue inhalers might increase the risk of mental health problems, such as depression.

Biologics

blue and white syringe

Biologics are a reasonably new treatment option for individuals with severe asthma. They are considered in patients who are already taking controller medication, avoiding triggers, and treating other medical problems appropriately, but who are still having asthma attacks several times a week. Because biologics are expensive compared to other treatment options, you’ll want to make sure that you’ve tried other options first. These injectable medications, administered every two to eight weeks, are made from the cells of a living organism, such as bacteria or mice, modified to target specific antibodies involved in the inflammatory process that causes asthma symptoms. Biologics’ most common side effects include soreness after injection, headache, sore throat, and fatigue (via the American Academy of Allergy Asthma & Immunology).

Biologics have been proven to reduce the frequency of asthma attacks, lessen the chances of going to an emergency room or requiring hospitalization, or needing oral steroids. People on biologics report a higher quality of life. Overall, biologics appear to improve lung function in the long term (via Verywell).

Exercising with Asthma

female running down a road with a blue sky and mountains on the horizon

People with asthma often find themselves avoiding physical activity out of fear of an attack (via WebMD). This is one of the worst things you can do for yourself because exercise is critically important for building and maintaining lung health by improving lung capacity and blood flow to the lungs and heart. If you’re out of shape when you begin an exercise program, your symptoms will lessen as your fitness level improves (via the American Lung Association).

Daily controller medication will also help, and some people need additional medication right before starting a physical activity. By warming up and cooling down, keeping your mouth covered in cold temperatures, and monitoring air quality, most people with asthma can participate freely in the activities that interest them. If you feel an attack coming on, stop immediately and take a few minutes to relax. Listening to your body is crucial when you have asthma.

Dietary Considerations

cherry yogurt

The Western diet (sometimes referred to as SAD for Standard American Diet) is rich in refined carbohydrates, high-fat dairy products, processed and red meats, and sugar, which are well-recognized as inflammatory. This type of diet is high in calories, saturated fat, sugar, and sodium. Compared to the Mediterranean diet, built on a solid foundation of fruits, vegetables, and whole grains, it’s easy to see why the Western diet is associated with many common health conditions, including asthma.

Fresh fruits and vegetables are excellent sources of vitamins, minerals, fiber, and phytochemicals. The healthy fats in seafood, especially fatty fish such as salmon and tuna, reduce the risk for several chronic diseases and stifle the inflammation that underlies conditions including asthma. According to a study published in Nutrients, a single high-fat meal can increase immune response and inflammation markers in the saliva for up to four hours. Reducing saturated fat consumption, on the other hand, reduces these measurements.

You might want to add some yogurt to that lovely inflammation-reducing fruit parfait. The gut microbiome is a vital component of the immune system. The fiber in fruits and vegetables produces short-chain fatty acids, which reduce inflammation when digested by healthy bacteria in the gut. Those beneficial bacteria are increased in population and diversity when we consume probiotic-containing foods such as yogurt. At the same time, a high-fat diet throws off balance between good bacteria and invasive bacteria and reduces the concentration of those healthy short-chain fatty acids.

Emotions, Stress, and Asthma

faces with different expressions

It’s a concrete fact that emotions and stress trigger asthma attacks and that asthma is linked to both anxiety and depression. When we become emotional, our breathing changes, whether or not we have asthma. For people with asthma, this causes muscles to tighten and breath to speed up. Some people even have attacks when they laugh (via the Asthma and Allergy Foundation of America).

Of course, you can’t go through life without ever having a tense or upsetting moment, or God forbid, laughing. Still, you can learn to control these situations by planning ahead and being mindful of how you react to pressure and upheaval.

Never be afraid to reach out and admit that you need help, whether it’s professional help for a problem that’s just too big to handle alone or help from your partner, family members, or friends. Relaxation exercises, such as deep breathing, yoga, and visualization, are helpful for many people with health concerns worsened by stress and emotion (per the Cleveland Clinic). Another win for exercise is that it burns off excess energy and gets you outside your head for a few minutes. Lastly, sleep deprivation makes it difficult to cope with unexpected stressors and problems that arise in everyday life, so work on improving your bedtime habits if they aren’t already on point.

Self-Care

hand holding a pen

Although sometimes just a buzzword used to push products, self-care is a real thing, and it is precious for individuals with asthma. Asthma self-care means doing something for yourself that will improve your control and lessen the symptoms that you experience (via the American Lung Association). Keys to managing your condition include:

  • Educate yourself about the disease and ways to treat it.
  • Know and track your unique symptoms.
  • Find health care providers that you can trust and confide in.
  • Modify your lifestyle as necessary.
  • Develop an asthma action plan.

The CDC explains that your trusted provider can help you to develop this essential asthma action plan, which is a document that lists everything that you need to do when your asthma is well-controlled to stay in this zone, what to do when your asthma is worsening, and how to know when your asthma has declined to the point that you need to seek immediate medical attention. Empowered with this information, you will be able to live your life to the fullest.