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What is asthma?

Asthma is a chronic lung disease marked by acute flare-ups of inflammation and swelling of the airways in the lungs. Asthma is one of the most common childhood diseases, but it also affects adults. According to the Centers for Disease Control and Prevention, more than 17 million adults and 7 million children are living with asthma in the United States. Seventy five percent of new asthma cases are diagnosed before the 7th birthday.

Asthma affects the bronchioles, small hollow passageways in the lungs, and the alveoli, which are attached to the bronchioles. The alveoli are tiny sac-like structures where oxygen is absorbed into the bloodstream.

During an asthma attack, the bronchioles and alveoli overreact to certain triggers and become inflamed, irritated, and swollen. This hinders the flow of air into the lungs and causes wheezing, chest tightness, difficulty breathing, and coughing. The smooth muscles surrounding the airways react by tightening, further blocking airflow. Mucus production increases, further exacerbating breathing troubles.

Minor shortness of breath can be treated at home by following your treatment plan or at a doctor’s office. If you have trouble breathing, with or without chest tightness or wheezing, after taking your medications according to your treatment plan, contact your health professional. More severe asthma attacks can quickly progress from minor shortness of breath to a life-threatening situation.

Get immediate help (call 911) for symptoms such as sweating and severe difficulty breathing, which may be combined with pale or blue lips, fast heart rate, and anxiety.


What are the symptoms of asthma?

Symptoms of asthma include shortness of breath, cough, chest tightness, and wheezing. Wheezing is a "whistling" noise that occurs while breathing. It can be heard through a stethoscope or, in certain cases, by the naked ear. Early signs of an asthma flare-up can be subtle and include restlessness, anxiety, and wheezing that cannot be heard by the naked ear. It may also be difficult to hear wheezing in extreme asthma flare-ups because the airways have become so narrow that there is not enough air moving through them to create a sound. Physicians are particularly concerned when patients are experiencing poor air movement through their lungs.

Common symptoms of asthma

You may experience asthma symptoms daily or just once in a while. At times any of these asthma symptoms can be severe:

  • Anxiety and restlessness

  • Breathing difficulty and shortness of breath

  • Chest retractions

  • Chest tightness

  • Difficulty speaking

  • Fatigue

  • Flared nostrils, especially in children

  • Need to sit upright

  • Pale skin

  • Persistent cough or cough that is worse at night

  • Rapid breathing (tachypnea) and rapid pulse (tachycardia)

  • Wheezing

Serious symptoms that might indicate a life-threatening condition

More severe asthma attacks can quickly progress from minor shortness of breath to a life-threatening situation. Symptoms that may indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting include:

  • Excessive anxiety

  • Fast heart rate

  • Pale or bluish coloration of the lips or fingernails (cyanosis)

  • Severe difficulty breathing

  • Sweating


What causes asthma?

The exact cause of asthma is not known, but it likely involves a combination of genetic and environmental factors. When asthma is associated with allergies, the disease is referred to as allergic asthma or allergy-induced asthma. Asthma caused by breathing irritating or toxic chemicals encountered on the job is called occupational asthma. Exercise-induced asthma is caused by rigorous physical activity.

Symptoms of asthma are due to an oversensitivity and overreaction of the lungs to certain triggers, resulting in inflammation and swelling of the airways.

Asthma triggers

Asthma triggers vary from person to person, as well as season to season:

  • Air pollution

  • Allergens, such as pollen, dust, mold, animal dander, cockroaches, and dust mites

  • Allergic reactions

  • Aspirin

  • Cold air

  • Exercise

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Respiratory infections

  • Stress

  • Sulfites found in certain foods, such as beer, wine and seafood

  • Tobacco smoke

What are the risk factors for asthma?

A number of factors are thought to increase your chances of developing asthma. Common risk factors include:

  • Being born with low birth weight

  • Being exposed to irritating chemicals or air pollution

  • Being exposed to secondhand smoke, or having a mother who smoked during pregnancy

  • Being overweight

  • Having a parent or sibling with asthma

  • Having allergies

  • Having atopic dermatitis or eczema

  • Having frequent colds or other respiratory infections, such as bronchitis, especially in children

  • Smoking


How is asthma treated?

Although there is no cure for asthma, you can control it with regular medical care and by consistently following your treatment plan. Asthma treatment plans use a multifaceted approach and are individualized to the type and severity of your asthma.

In addition to medication, a treatment plan for asthma generally includes lifestyle modifications to minimize and eliminate exposure to triggers, such as allergens, air pollution, and smoke. Allergy testing also may be recommended to determine if you are allergic to any specific substances.

Medications to treat asthma include long-term control medications and quick-relief “rescue” medications. Most asthma drugs work by reducing airway inflammation (anti-inflammatories, such as corticosteroids) and/or by opening the airways (bronchodilators).

Long-term control asthma medications

Long-term control medications are inhaled or taken orally every day to control and prevent symptoms. Generally, the most effective long-term control medications are inhaled corticosteroids.* Long-term control medications include:

  • Immunomodulators: Omalizumab (Xolair)

  • Inhaled corticosteroids: Budesonide (Pulmicort Flexhaler, Pulmicort Respules); flunisolide (Aerobid Aerosol); fluticasone propionate (Flovent HFA); triamcinolone acetonide (Azmacort Inhalation Aerosol)

  • Leukotriene modifiers: Montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo CR)

  • Long-acting beta agonists (bronchodilators): Salmeterol (Serevent Diskus); formoterol (Foradil Aerolizer); albuterol sulfate (VoSpire ER Extended-Release Tablets)

  • Methylxanthines(sustained-release theophyline)

  • Combination medications: Advair Diskus, Symbicort

Quick-relief asthma medications

"Rescue" or quick-relief medications treat acute symptoms and are generally inhaled through a device called an inhaler. Rescue medications are used on the spot when a person feels a sudden onset of asthma symptoms. Fast-acting asthma medications include:

  • Anticholinergics: Ipratropium bromide HFA (Atrovent); tiotropium bromide (Spiriva)

  • Oral or intravenous corticosteroids: Methylprednisolone

  • Short-acting beta agonists (bronchodilators): Albuterol sulfate (ProAir, Proventil, Ventolin, AccuNeb Inhalation solution); levalbuterol HCl (Xopenex); pirbuterol (Maxair)

  • Combination medications: Ipratropium bromide/albuterol sulfate (Combivent Inhalation Aerosol)

Many inhalers look alike but contain different quick-relief medications. Therefore it is very important not to share asthma medications.

Other treatments for asthma

Other methods for controlling asthma include alternative treatments and more emergent care:

  • Acupuncture

  • Adrenaline

  • Allergy medications and shots

  • Hospitalization

  • Intubation and ventilation (for exhaustion or respiratory arrest due to severe asthma)

  • Supplemental oxygen

What you can do to improve your asthma

In addition to reducing your exposure to asthma triggers, you can also prevent or limit asthma attacks by:

  • Avoiding cold air

  • Avoiding or eliminating exposure to triggers, such as smoke, air pollution, animal dander, and dust

  • Dehumidifying the air

  • Eating a diet rich in fruits and vegetables

  • Losing excess weight

  • Quitting smoking today

  • Reducing your stress levels

What are the possible complications from asthma?

Complications of untreated or poorly controlled asthma can be serious and even life-threatening. They include:

  • Bronchitis

  • Hypoxia (low levels of oxygen in the blood)

  • Inability to participate normally in activities

  • Inability to sleep well

  • Permanent narrowing of breathing passages

  • Pneumonia

  • Respiratory arrest

  • Upper respiratory infection

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Asthma. Centers for Disease Control and Prevention.
  2. Asthma Overview. American Academy of Allergy Asthma & Immunology
  3. Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051)
  4. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012
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