Mayuri Bhakta, FNP-BC
Chances are someone you know has asthma, but do you know what asthma is?
According to the CDC, 1 in 13 people has it.1 Asthma is a frequent cause of visits to the emergency department, of missed days at work and at school, and of economic burden. Asthma is serious and can be fatal if not treated: about 9 people die from asthma each day. Research from the CDC indicates that too few people, especially adults, are taught how to recognize their asthma symptoms and do not have an asthma action plan that can save their life.2
What is Asthma?
Asthma is a chronic disease which affects people worldwide. It is characterized by swelling and inflammation of the airways which makes the airways narrow and makes it more difficult for air to pass through them. However, this inflammation and narrowing of airways is either mostly or completely reversible with treatment.
What are Signs and Symptoms of Asthma?
Signs and symptoms of asthma can include the following:
- Coughing, especially at night or in the morning
- Shortness of breath
- Difficulty breathing
- Chest tightness
What Causes Asthma?
In most cases, the cause of asthma is unknown, but some people are more likely to develop asthma. People who have a family history of asthma, people who have allergies, and people who are African American or Hispanic are more likely to be diagnosed with asthma. Environmental factors, such as pollution, poor air quality, smoking (including second-hand smoke), frequent symptoms of wheezing during the first year of life, eczema, and allergic diseases can also increase the risk of developing asthma.
Most cases of asthma are diagnosed in childhood. Approximately fifty percent of children diagnosed with asthma in childhood will have decreased symptoms or will outgrow their asthma in early adulthood. Children with severe asthma are more likely to experience symptoms throughout their lifetime. People who are diagnosed with asthma as adults will likely have symptoms throughout their lifetime.
What is an Asthma Attack?
An asthma attack, or asthma flare-up, happens when people with asthma are exposed to an asthma trigger. Asthma attacks can be mild, moderate, or severe. Asthma attacks occur when airways become inflamed and narrower. Narrowing of the airways makes it more difficult for air to get in and out of the lungs and can also cause mucous from the lungs to pool in the airways. Wheezing occurs as the result of this narrowing.
Mild asthma attacks can lead to shortness of breath and wheezing.
Moderate asthma attacks can cause increased shortness of breath and wheezing, leading to an increase in respiratory (breathing) rate, more pronounced wheezing, inability to talk in full sentences, and the inability to lie down flat. Flaring of the nostrils or pulling in the muscles of the chest indicate the body’s increased effort to breathe.3
Severe asthma attacks are marked by shortness of breath and wheezing, leading to difficulty breathing at rest, significantly increased respiratory rate, loud wheezing, abnormal pulling of the chest muscles, and flaring of the nostrils. Someone having a severe asthma attack may sit up in a hunched position with hands resting on their thighs and may only be able to speak in single-word phrases. Severe asthma attacks can lead to respiratory arrest (a complete stop of breathing).4
Asthma attacks can rapidly worsen in severity. It is important to get treatment right away with any signs of an asthma attack. 9-1-1 emergency services should be contacted for anyone having symptoms of a moderate to severe asthma attack.
What are Asthma Triggers?
Asthma triggers can include the following:
- Environmental exposures from dust mites, mold, cockroaches, animal dander, and pollen
- Viral illnesses
- Use of certain medications
- Tobacco smoke
- Environmental irritants, such as perfumes, paint fumes, household cleaning sprays
- Smoke from burning wood or grass
- Air pollution
- Change of seasons and temperatures
How do I know if I have Asthma?
If you experience signs and symptoms of asthma, it is important to talk to your healthcare provider. Your healthcare provider will ask you questions about the frequency of your symptoms and any risk factors you may have. Your healthcare provider may perform a lung function test called spirometry. Often you will have initial testing, then be treated with an inhaled bronchodilator medication and will have repeat testing to see if there are any changes in the test results. Bronchodilator medications are used to help open narrowed airways. If you only experience signs of asthma with exercise, your provider may perform an exercise spirometry test. The results of your spirometry test will help your provider make the diagnosis of asthma.
How can Asthma Affect my Life and How is it Treated?
Based on the frequency and severity of your symptoms, your provider will discuss the most appropriate treatment options with you and establish an asthma action plan with you.
If you do not have asthma symptoms frequently, your provider may only prescribe an inhaled “rescue” medication such as albuterol or levalbuterol to use as needed. If you have symptoms that are persistent, you may be placed on daily controller medications which can include inhaled medications and/or medications by mouth as well as “rescue” medications as needed. If you have moderate or severe asthma or difficult to control asthma, your provider may refer you to a lung specialist (pulmonologist).
If you have environmental allergies, you may also be referred for allergy testing. This will help your provider determine what your triggers are and how to best avoid them. If you are a smoker, you should quit smoking. If you have a child or family member with asthma, it is important not to smoke around them, in the car or at home, as passive smoke can be a trigger.
The goals of asthma treatment include maintaining control of your asthma symptoms, maintaining a normal lifestyle and normal activities including exercise, preventing asthma attacks, and keeping lung function as close to normal as possible. Asthma triggers are individual, so it is very important to know your asthma triggers and how the disease affects you so that you can get treatment as soon as possible if you have an asthma attack. It is important to take all medications as prescribed and to carry rescue medication with you at all times. Poorly controlled asthma over time, can lead to remodeling, or changing, of your airways and decreased lung function.
- Centers for Disease Control and Prevention, “Asthma,” updated April 24, 2018, http://www.cdc.gov/asthma
- Centers for Disease Control and Prevention, “Asthma’s Impact on the Nation,” https://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf
- Michael J Morris, “Asthma,” Medscape, January 7, 2019, https://emedicine.medscape.com/article/296301-overview
Christopher H Fanta, “An overview of asthma management,” UptoDate, updated October 5, 2017.
Augusto A Litonjua and Scott T Weiss, “Natural history of asthma,” UptoDate, updated May 23, 2019.
Christopher H Fanta, “Diagnosis of asthma in adolescents and adults,” UptoDate, updated June 13, 2019.