In this article:
- Intermittent inflammation in the airways is known as asthma, which causes chest tightness, shortness of breath, wheezing, and coughing.
- There is no “cure” for asthma yet, but current treatments can provide relief to a satisfactory level in most patients.
- Treatment methods include identifying and avoiding triggers, monitoring using a peak flow meter, and managing the symptoms with bronchodilators and anti-inflammatory medications.
- Asthma is more common among males during childhood but more common among female adults.
What Is Asthma?
Asthma is a chronic lung disease that comes in the form of acute attacks. It is characterized by inflammation and intermittent constriction of the airways, which obstruct airflow into the lungs, making it difficult to breathe.
The airways are the part of the respiratory system responsible for transferring air in and out of the lungs. In asthma, the inside walls of these tubular structures are sensitive and highly susceptible to allergens and irritants.
When asthma is triggered, the airways become swollen and narrow, hindering airflow into the lungs. (1)
Global Burden of Asthma
As reported in the World Health Organization Estimates, asthma currently affects approximately 235 million people, with its highest mortality rate in older adults. (2)
Although asthma-caused death rates are more significant in low- and lower-middle-income countries, it is nevertheless prevalent in high-income countries as well.
It often goes undiagnosed and untreated, and it poses a considerable strain on families and individuals, altering the patient’s lifestyle. (2)
A few facts about asthma are listed below:
- Approximately 8.3% of Americans have been diagnosed with asthma. Out of these 26.5 million affected people, 20.4 million are adults, while the other 6.1 million are children. (3)
- Children (9.4%) are more prone than comparison to adults (7.7%), and it is more prevalent among females (9.2%) than males (7%). (3)
- African-Americans are two to three times more probable to die because of asthma. However, around 25% of black adults have insufficient financial resources for regular asthma treatment. (4)
- The severity is dependent on the underlying disease as well as response to medications and may vary with time.
- While asthma is incurable, the frequency and intensity of the attacks and other symptoms can be controlled.
Severity Levels of Asthma
Asthma varies in severity among individuals. Some patients may have mild asthma throughout, whereas others might face severe asthma later in life as a result of disease progression.
Asthma severity is classified into four groups:
- Mild intermittent asthma: This type of asthma is relatively easy to control as the symptoms are occasional. Treatment involves a nominal amount of medicines.
- Mild persistent asthma: This type of asthma is characterized by a normal lung function of 80% or more. The symptoms manifest more than two times in a week, but not every day.
Flare-ups at night may be experienced beyond twice a month but less than one time in a week.
- Moderate persistent asthma: This type of asthma requires regular use of rescue medication as symptoms appear every day. At nighttime, flare-ups may happen more than one time in a week. The frequent attacks significantly affect daily activity.
- Severe persistent asthma: Around 10% of patients with asthma have consistent coughing, shortness of breath, wheezing, and chest tightness. Individuals with severe asthma are the most adversely affected in comparison to other groups.
Types of Asthma
There are several types of asthma, and the common ones include:
- Allergen-triggered asthma: The body’s immune system may show a hypersensitive reaction to otherwise harmless factors known as allergens, resulting in the development of asthma symptoms. This is the most frequent type of asthma and can be triggered by dust, mold, pollen, animal dander, etc.
- Non-allergic asthma: It usually starts in the later stages of life but is not common. It is also known as non-atopic asthma, and the causes are not well known. It is not related to any allergy and is more severe than allergic forms.
- Exercise-induced asthma: At times, strenuous physical activity may cause constriction of the airways, leading to asthma symptoms.
Approximately 90% of individuals with asthma develop exercise-induced bronchitis as well. However, it is uncommon for people with exercise-induced bronchitis to have asthma. (5)
- Cough-variant asthma: Cough is highly prevalent among people and is one of the primary signs of asthma. Cough-variant asthma, as its name indicates, causes cough only, while other common symptoms such as wheezing and dyspnea, are absent. (6)
- Occupational asthma: This refers to asthma induced in the workplace. It is caused by any factors that lead to constricted airflow, inflammation, or hyper responsiveness, but only in the professional environment and not outside.
Work-related asthma (WRA) includes both work-exacerbated and occupational asthma. (7)
- Aspirin-induced asthma: Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may aggravate asthma in some adults and even in children rarely. Aspirin-induced asthma is associated with severe asthma, and the sensitivity toward the drugs is lifelong.
Therefore, patients with aspirin-induced asthma should refrain from taking aspirin or any product that contains cyclooxygenase-inhibiting analgesics. (8)
Causes of Asthma
Asthma is caused by inflammation in the airways as a result of sensitization toward certain factors. However, the phenomenon behind it remains unknown.
It is speculated that the interaction between environmental and genetic factors results in asthma. Such factors may include:
- Atopy, or the inherent tendency to develop allergic responses
- Family history of asthma
- Exposure to certain triggers during the development of the immune system in early childhood
- Frequent respiratory tract infections during childhood
Asthma can be easily triggered on exposure to various allergens and irritants, causing a flare-up. In extreme cases, it may result in a sudden attack, which might be fatal if not treated promptly. (9)
Asthma triggers may include:
- Physical strain
- Cold weather
- Sulfites in foods
- Cigarette or tobacco smoke
- Air pollution
- Animal dander
- Scented products
- Dust mites
- Smoke from burning grass or wood
- Respiratory infections
- Strong odors from paint or food
- Medications such as NSAIDs, aspirin, and beta-blockers (used for managing heart conditions, high blood pressure, and migraine)
- Extreme emotions such as excessive laughing or crying, stress, fear, or anger
Urbanization has also been shown to cause an increase in asthma cases, but the reason is unclear.
Symptoms of an Asthma Flare-Up
Asthma attacks occur due to a mucus buildup in the airways, resulting in inflammation and constriction. This may be accompanied by symptoms such as:
- Coughing, especially in the morning or at bedtime, which can develop into a dry or phlegm-producing chronic cough
- Chest tightness
- Wheezing during exhalation
- Shortness of breath
- Frequent respiratory infections
- Throat irritation
- Difficulty falling and staying asleep
- Trouble in breathing, which may be characterized by rapid breathing or breathing through the mouth
- Fluctuating respiratory rate
- Elevated heart rate
Different cases of asthma produce diverse symptoms and might include symptoms other than those listed above.
Risk Factors for Asthma
Certain factors can predispose you to develop asthma, including:
- Gender: Asthma is more common among boys in childhood. In teenagers and adults, women are more prone to asthma.
However, its incidence in women decreases progressively as they reach menopause, with the exception of females undergoing postmenopausal hormone replacement therapy.
- Genes: A history of asthma, eczema, hay fever, or allergies in your family increases your risk of developing asthma.
- Ethnicity: Asthma is highly prevalent among African-American children and Puerto Ricans. The association of asthma and related death with certain ethnicities may be due to the low economy, poor air quality, allergens, lack of patient education, and lack of access to health care.
While Puerto Ricans are most affected by it in comparison to other ethnic groups, African-Americans face the highest asthma mortality in the United States.
- Obesity: High amounts of fat consumed by obese people can cause metabolic disorders and inflammation, thus decreasing lung volume. This elevates the risk of developing asthma by 50% in obese individuals.
- Occupational hazard: Exposure to gases, chemical fumes, or dust during mining, spraying, and welding increases the chances of acquiring asthma.
- Alcohol: Despite being a mild bronchodilator, alcohol may induce asthma symptoms due to its acetaldehyde and sulfite content.
Wine contains a high amount of histamine, a natural chemical found in foods. It can trigger asthma, as it is the same chemical involved in the body’s immune reaction to allergens.
- Smoke: Individuals who smoke are highly prone to asthma. Children may develop asthma when exposed to secondhand smoke or if their mothers smoked at the time of pregnancy.
- Allergies: Susceptibility to allergens, such as dust mites and mold, increases the chances of developing asthma. You are likely to be asthmatic if you were exposed to allergens during childhood.
These allergens can include mold, dander, dust, and pollen. If you are allergic to multiple factors, you are at a higher risk of having asthma.
Asthma Care: Diagnosis and Treatment
While a timely diagnosis accompanied by suitable treatment is essential for regulating asthma, periodic follow-ups and aftercare are also vital in the maintenance of health.
The following factors are important for asthma control and maintenance:
- Appropriate medication
- Recognition of environmental triggers
- Use of self-management skills
- Prolonged regular monitoring for condition assessment and treatment modification
Detailed information about the available treatment options and self-care remedies can be acquired here.
Asthma and Pregnancy
Generally, asthma does not cause any problems during pregnancy. However, in some cases, the hormonal changes associated with pregnancy can affect the mother’s respiratory system.
An asthma attack in the gestation period can hinder oxygen flow to the fetus. Asthma symptoms may also worsen due to the higher chances of heartburn or acid reflux during pregnancy.
It is necessary to get your asthma under control with the help of your doctor before planning to conceive.
Additionally, discuss the medications you can use in case of a flare-up during pregnancy, as the usual medications for asthma may have side effects and thus can be unsafe.
Asthma and Menstrual Periods
It is common for the symptoms of asthma to worsen during menarche (start of periods). This problem usually subsides once the menstrual cycle becomes regular.
Some women with severe asthma experience aggravation at the time of or before menstruation. It may be helpful to keep track of your condition by using a peak flow meter or maintaining a diary of symptoms.
The attacks can be caused by certain medications used for period pains, including aspirin and other NSAIDs such as ibuprofen (Nurofen) and mefenamic acid (Ponstan).
Paracetamol/acetaminophen is considered a safe alternative that may be used. Oral contraceptive pills, usually, do not affect asthma control.
Asthma in Infants
Due to the smaller airways of infants and toddlers in comparison to older children, asthma-like symptoms may develop easily. Blockages caused by mucus, tight airways, or viral infections may produce asthma symptoms.
Hence, diagnosing asthma in toddlers and infants is relatively difficult, and the difficulty is compounded by their inability to explain their problems.
Also, a child can be irritated by many things, but they can show activeness despite breathing difficulties and chest tightness, making the diagnosis even more challenging.
The co-occurrence of symptoms of asthma and chronic obstructive pulmonary disease (COPD) in patients is known as asthma-COPD overlap syndrome (ACOS).
The exact symptoms of ACOS may vary among cases, but the condition is generally characterized by continual airflow constriction in individuals above 40 years of age with large bronchodilator reversibility or asthma. (10)
COPD refers to a group of lung diseases that include chronic bronchitis, emphysema, and refractory asthma, which obstruct the airways and cause difficulty in breathing. Although not common, the development of both asthma and COPD in an individual may occur.
ACOS has a higher morbidity and mortality impact than either of the conditions. Patients with ACOS experience a quick decline of lung function and frequent exacerbations, thus affecting their quality of life to a great extent. (11)
Asthma vs. Bronchitis
Inflammation in the airway and a few other symptoms are common in bronchitis and asthma, but both conditions vary greatly in their causes.
Bronchitis refers to inflammation and reddening in the lining of the breathing tubes (bronchial tubes), which connect the lungs to the windpipe. These tubes are involved in mucus production for the protection of tissues and organs of the respiratory system.
However, in bronchitis, the swelling may increase the mucus production, resulting in a cough. On the other hand, asthma affects the flow of air to the lungs and is caused by hypersensitivity of the airways to irritants such as mold, dust mites, and smoke.
On exposure to these irritants or allergens, the airways become swollen, making breathing difficult. Asthma is a long-term problem and may be fatal if not treated timely.
Complications Related to Asthma
Rarely, asthma may result in the following complications:
- Lung infections, such as pneumonia
- Persistent exhaustion
- Respiratory failure characterized by a severe drop in oxygen levels or alarmingly high carbon dioxide levels
- Psychological problems, such as depression, anxiety, or stress
- Airway remodeling, which refers to any structural changes that may occur in the airways due to persistent inflammation or frequent flare-ups
- Lung collapse involving the whole or a part of the lung
- Severe asthma attacks, which are unresponsive to regularly prescribed medications, also known as status asthmaticus
- Health problems such as obesity and high blood pressure due to the inability to exercise
Warning Signs of an Asthma Attack
Asthma attacks are generally preceded by warning signs that may occur 24-48 hours before the attack. Initially, these signs may be difficult to identify as they are mild and may seem unrelated.
However, after a few episodes, you can easily recognize the warning signs. A mention of these signs in your Asthma Action Plan by your doctor facilitates recognition.
All patients have different signs that may include:
- Excessive coughing
- Chest tightness
- Fingernails or lips turning grey or blue
- Confusion and lack of response
- Frequent use of quick-relief inhalers (more than once within 4 hours)
- Unresponsiveness to blue reliever inhalers
Some General Queries
Can one breastfeed while on asthma medications?
It is safe to breastfeed while on a course of asthma medications as the inhaled medicines do not mix into the breast milk. Other medications are prescribed after taking into account the balance of risk and benefit to the mother and the fetus.
How long does asthma stay?
Since asthma is incurable, its course varies among individuals. If properly treated, children may get relief from asthma, or the condition may subside to a certain degree. This is more frequent in cases of intermittent asthma, or asthma caused by viral respiratory infections.
The disease can either progress with age or become less frequent if caused by viral infections alone in childhood.
It is important to get proper treatment and follow preventive measures to keep asthma in control. Periodic checkups are necessary to determine if medicines have to be continued.
Active asthma should not be left untreated in the hope that it will resolve on its own, as this may lead to severe complications.
Can you wheeze and not have asthma?
Wheezing is a common symptom of bronchial asthma that occurs due to obstructed airways or bronchospasm. It may be recognized by the patient or acknowledged by the doctor during a physical exam.
However, wheezing can also be a symptom of various other diseases such as aspiration of foreign objects into the airways, airway tumors, tracheal stenosis (narrowing), and pulmonary edema, which can happen in patients with congestive heart failure. (12)
Can ginger help relieve asthma?
Asthma refers to chronic inflammation in the airways, for which no cure is available yet. Nevertheless, it is easy to manage the symptoms with the help of proper treatment regimens and self-care.
Natural strategies may be used as adjunct. While the medications can provide quick relief, they have various side effects.
Therefore, the best approach toward managing asthma includes a combination of changing your diet, taking preventive measures, modifying your lifestyle, and taking the prescribed drugs.
These steps not only lower the severity of the condition but also reduce the chance of developing complications.