What is asthma?

Asthma is a long-term condition that causes swelling of the airways that carry air to the lungs. This causes the airways to narrow, become inflamed, and produce extra mucus, making it difficult to breathe. Asthma happens sporadically and is triggered by environmental factors and allergens. In the United States, Asthma is a very common disease. According to the Centers for Disease Control and Prevention^[1] (CDC), 1 in 13 people have asthma. Substantial advances in asthma management have been made in the past decades. Although asthma has no cure, there are many effective ways to control the disease. Asthma can be managed by taking medications as directed and learning to avoid triggers that cause asthma symptoms. Before we take an in-depth look into the treatments for asthma, let’s further explore what asthma is.

Airway hyperresponsiveness

Airway hyperresponsiveness^[2] is defined by an exaggerated response of the airways to stimuli. When people without asthma breathe in dust, for example, their airways will narrow to increase the speed of airflow in order to dislodge the dust. In someone with asthma, this response is exaggerated. The airways constrict more dramatically and might take longer to relax. Sometimes, the airways close off completely. A severe experience of asthma symptoms is known as an asthma attack. An exaggerated narrowing of the airway can be caused by a combination of factors. The nerves connected to the airway may have a tendency to twitch. Or the airway muscles could be too large, and the structures supporting the airway may be weak.

What causes asthma?

Scientists are continuing to explore why certain people have asthma. Though its exact causes are not yet known, several factors^[3] have been linked to developing asthma.

• Environment. The strongest risk factors for developing asthma are inhaled substances and particles that may irritate the airways or provoke allergic reactions. Some common triggers include smoke, air pollution, dry air, dust, mold or mildew, cold temperatures, emotional stress, and exercise. Asthma is common in childhood, but it can develop at any point in life. Adults often develop occupational asthma from exposure to chemicals and dusts on the job.
• Allergies. Certain allergic conditions are linked to people who get asthma. Common allergens (substances that cause an immune reaction in people sensitive to them) include pollen, animal dander, and foods such as peanuts, soy, wheat, shrimp and other shellfish, fish, eggs and fruits.
• Respiratory Infections. Respiratory infections are known to cause inflammation and damage to the lung tissue. Damage caused in early childhood can impact long-term lung function.
• Genetics. Genetics play a large role in causing asthma, and it tends to run in families.

Asthma symptoms

Asthma symptoms are different for each person based on lifestyle and health history. Some people only have symptoms at certain times—such as when exercising—or have symptoms all the time. Some common asthma symptoms include:

• Shortness of breath. During an asthma attack, the lungs do not receive enough oxygen. This feeling is commonly compared to that of attempting to breathe through a straw after intensive exercise. Shallow breathing is usually accompanied by increased heart rate and dizziness.
• Coughing. The body coughs to get rid of foreign particles, irritants, microbes, mucus, and bacteria. Coughing alone may not mean that someone has asthma. In an asthmatic, coughing is accompanied by the other symptoms on this list. Some people who have asthma can cough up phlegm, a sign that the airways are inflamed.
• Wheezing. Or hearing a whistling sound when exhaling (this is common for children with asthma).
• Trouble sleeping. This can be caused by shortness of breath, coughing or wheezing.
• Chest tightness or pain. When asthma is triggered, the chest can feel heavy, like it is being pulled down by a weight.

Asthma symptoms may be triggered or worsened by certain events:

• Colds or other respiratory infections
• Allergy-causing agents (allergens), such as dust, pet dander, mold spores, or pollen
• Activity or exercise
• In infants, feeding
• Cigarette smoke (second-hand) or other airborne irritants
• Intense emotions, like laughing or crying
• Gastrointestinal reflux
• Changes or extremes in weather

If you have frequent coughing or wheezing that lasts more than a few days or any other symptoms of asthma, see your provider. If asthma is treated early in life, it can mitigate long-term lung damage and prevent the condition from getting worse.

Asthma in children

Asthma is the leading chronic disease in children. Asthma in children^[4] can be particularly serious, since they have undeveloped immune systems and smaller airways than adults. Childhood asthma and adult-onset asthma share the same symptoms and have similar treatments. Diagnosing and managing asthma in infants and young children can be difficult since other conditions can cause wheezing and coughing. If a young child has a cold or a respiratory infection accompanied by wheezing, their likelihood of having asthma is higher if:

• One or both parents have asthma
• The child has signs of allergies
• The child wheezes even when they don’t have a cold or other infection

If your child has asthma, they may say things such as, "My chest feels funny" or "I'm always coughing." Crying, laughing, yelling, or strong emotional reactions and stress also might trigger coughing or wheezing. To help a child's health provider make a correct diagnosis, be prepared to provide information about family history of asthma or allergies, the child's overall behavior, breathing patterns and responses to foods or possible allergy triggers. Often, a provider will use a lung function test to diagnose asthma. A provider may also use a 2- to 6-week trial of asthma medication with a follow up to see if they make a difference in the child's symptoms. If you experience a severe asthma attack, it’s important to get to the emergency room, as it can be life-threatening. Signs and symptoms of an asthma emergency include:

• Gasping for air
• Trouble speaking because of restricted breathing
• A quick-acting (rescue) inhaler having no effect

You can help minimize asthma symptoms by following a written asthma action plan you develop with your child’s provider to monitor symptoms and adjust treatment as necessary. For some children, the severity of asthma symptoms may decrease as they grow older.