Asthma (sometimes referred to as bronchial asthma) is an inflammatory disease that causes swelling and narrowing of the airways, as well as additional mucus production. The condition adversely affects normal function of the lungs (affecting the bronchi in the lungs) and causes breathing difficulties, shortness of breath, tightness in the chest area and also triggers wheezing and coughing (asthma attacks).
It is important to understand the basics of breathing in order to comprehend asthma as a condition. With each breath we normally take, air passes through the nose and down into the throat, eventually reaching the lungs and allowing for comfortable breathing. The lungs have many small air passages that allow oxygen from the air into the bloodstream.
For an asthma sufferer, the lining in these air passages becomes inflamed and swells. Muscles around these passages also tighten. Inflammation causes a build-up of mucus, which then fills the airways. Combined, the inflammation, swelling and mucus build-up reduces the amount of air (oxygen) that can pass through, bringing about an asthma attack.
Asthma is not a curable condition, but it is one that is manageable. It can be a minor nuisance for some people, and more severe for others. In more problematic instances asthma can interfere with normal daily activity and even lead to a life-threatening asthma attack.
The condition typically changes over time, so it is important to keep your doctor in the know with any changes (however subtle) when it comes to signs and symptoms. Treatment will need to be adjusted as symptoms change.
Types of Asthma
The most common variations of asthma are childhood asthma and adult-onset asthma. In the case of adult-onset asthma, symptoms typically appear around the age of 20 (onwards).
Other types of asthma are:
- Allergic asthma / extrinsic asthma: Allergens such as pet dander, food, mould, dust and pollen are triggers for this type of asthma. This type is commonly diagnosed with seasonal allergies.
- Non-allergic asthma or intrinsic asthma: Triggers for this type of asthma are not allergy-related, but rather include irritants such as cigarette smoke, burning wood, air pollution, air fresheners, cleaning products (household), perfumes and fragrances, viral illnesses and even cold air.
- Cough-variant asthma (CVA): Classic symptoms of wheezing and shortness of breath are not typical of this type of asthma. Instead, a persistent dry cough is commonly noted. CVA can lead to full-blown asthma attacks (more common asthma symptoms).
- Exercise-induced asthma (EIA): This type of asthma can affect people within minutes of starting an exercise activity and lasting between 10 and 15 minutes thereafter.
- Nocturnal asthma: As the name suggests, this type of asthma typically has symptoms which worsen at night. Triggers can include heartburn, dust mites, pet dander and even the body’s own natural sleep cycle.
- Occupational asthma: Dust, dyes, fumes, gases, industrial chemicals, animal proteins and rubber latex can trigger this type of asthma. Individuals most affected by this type of asthma typically work in industries such as farming, textiles, manufacturing and woodwork.
What happens when a person experiences an asthma attack?
Muscles around the airways spasm when inflamed and the lining of the mucosal membrane begins to swell. The excess mucus produced also causes the airways to narrow, which in turn forces them to try and work harder to breath. As a result of narrowing and resistance in the airways, breathing becomes increasingly difficult and causes symptoms of coughing (due to irritation inside the airways), wheezing and shortness of breath. Coughing with an asthma attack is also often the body’s way of trying to rid itself of the excess mucus.
Severity of an asthma attack can escalate very quickly. In some instances, and attack can be life-threatening, so it is vital to treat any recognised signs or symptoms immediately.
During an attack, a person’s breathing becomes increasingly laboured and the lungs continuously tighten. In dire situations, a person experiencing an attack will be completely unable to speak and will develop a bluish colouring around their lips (cyanosis). When this occurs, a person may lose consciousness with less and less oxygen in their bloodstream. An asthma emergency requires aggressive treatment, and swiftly.
The disappearance of wheezing or whistling sounds is not necessarily a sign of improvement in the condition of a person experiencing an attack. It is an impending sign of a silent chest where the person is no longer breathing. It is important to transport anyone having an attack to a medical facility as soon as possible for prompt emergency care.
Common Causes and Symptoms
What triggers asthma?
Factors that contribute to this chronic inflammatory disease vary from one person to another. The one thing all sufferers have in common is that airways become inflamed, narrow and fill with mucus build-up when a person comes in contact with a specific trigger (cause). A trigger can use an attack immediately after exposure or even several days (sometimes weeks) later.
Triggers and causes can be mild for some individuals and more severe in others. It’s important to understand what triggers can lead to an asthma attack as a way to control the condition. Your doctor will carefully assess what factors were present when you first experienced symptoms or an attack as the best way to determine the different triggers that most apply to you. As a sufferer, you may not have reactions to all of your triggers. Some reactions to specific triggers may be milder or more severe. You may have only one trigger, or many. Working closely with your doctor will help to determine the cause/s of your asthma, and thus the best ways to avoid or control the symptoms of the condition.
Some of the most common triggers that contribute as causes of asthma are:
- Allergies: Approximately 80% of asthma sufferers have an allergy to airborne substances. These include grass, trees, mould, weed pollens, dust mites, animal dander and even cockroach particles.
- Upper respiratory infections (viral or bacterial): Inflammation and mucus build-up in the membranes lining the sinuses can cause sinusitis. The secretion of excess mucus also narrows the airways prompting a sinusitis-induced asthma attack. It is important to treat a sinus infection swiftly, as well as any other respiratory infections such as cold and flu, and bronchitis to help alleviate asthma symptoms. It is also important to take additional care for up to two months after an infection, as airways may still be sensitive and narrow easily after recovery.
- Food and food additives: An asthmatic reaction (food-induced anaphylaxis) to this trigger can range from mild to life-threatening, but very rarely causes an isolated attack without the presence of other symptoms. Foodstuffs that most commonly trigger a reaction include peanuts, soy, wheat, eggs, cow’s milk, fresh fruits, shrimp and other shellfish, and fish. Preservatives, such as sulphite (sodium and bisulfite, potassium bisulfite, and sodium sulfite) can also cause an asthmatic reaction.
- Heartburn and GERD: The majority of asthma sufferers also experience severe heartburn (or gastroesophageal reflux disease), most commonly at night (when lying down). When stomach acid travels back up into the oesophagus, irritation and inflammation occurs, causing an asthma attack. A doctor may suggest a change in diet and medications to assist in keeping attacks at bay.
- Physical activity / exercise: Increased physical activity can often cause a narrowing of the airways in the majority of individuals suffering from asthma, and typically triggers symptoms of chest tightness, difficulties with breathing and coughing. Symptoms usually happen quickly (within 5 to 15 minutes) of strenuous exercise and subside within an hour. It’s not uncommon for another attack to occur within a 12-hour period. Asthmatic sufferers are often encouraged to warm-up slowly before partaking in any exercise activity to reduce the probability of an attack.
- Medications: Medicinal triggers can include aspirin or anti-inflammatory based drugs. Ibuprofen, naproxen and beta-blockers are known to trigger asthmatic reactions. A sensitivity to medications will need to be documented by your doctor. It is also a good idea to double check all medication ingredients before taking anything recommended by a pharmacist.
- Smoking: Symptoms of coughing and wheezing can worsen with persistent / regular smoking habits. Those who are asthmatic are generally discouraged from smoking as a result, and also as a way to protect the lungs. Asthma sufferers can also experience an attack when exposed to smoke from wood-burning appliances or fireplaces.
- Other triggers: These can include perfume (fragrances), cleaning agents, occupational dust or vapours, air pollution, weather changes (cold air and humidity) and even strong emotions related to stress or anxiety.
What are the signs and symptoms of asthma?
Some sufferers may experience symptoms periodically, while others will experience symptoms every day. Some may experience different signs of the condition at different times, while others may not experience all of the most common symptoms at once.
Some sufferers may only experience asthmatic reactions when exercising or when ill with a viral infection.
The most common symptoms are:
- Chest pain or a tightness in the chest
- Shortness of breath
- Coughing and / or wheezing
- A whistling sound (when exhaling / breathing)
- Sleeping problems (as a result of the above-mentioned symptoms)
Early warning signs of a potential asthma attack can include:
- A frequent cough (especially at night or following exercise)
- Fatigue or moodiness
- Sleeping problems
- Tiredness or feeling weak when exercising
- Easily becoming short of breath
- Signs of allergy or a viral infection (sneezing, nasal congestion, runny nose, headache or sore throat)
Symptoms of an asthma attack include:
- Severe wheezing (when inhaling and exhaling)
- Chest pain or intense pressure
- Persistent coughing
- Intense or rapid breathing
- Difficulties with being able to talk
- Tightened chest and neck muscles
- Pale and / or sweaty face
- Blue lips and / or fingernails
- Anxiety or panic
Signs of a worsening condition are:
- Common symptoms becoming more frequent and disruptive to your daily life
- Increased breathing difficulties
- A more frequent need to use a quick-relief inhaler
Diagnosing and Treating Asthma
When should you see a doctor?
- If you suspect asthma due to persistent signs (symptoms that last more than a few days). Early treatment can prevent long-term damage to the lungs or worsening of symptoms over time.
- If your symptoms begin to worsen. It can happen that medications may not alleviate symptoms sufficiently. Overuse of medication can cause side effects which can worsen asthma. A person may also find that they need to use a quick-relief inhaler more frequently than before. Any changes in symptoms should be carefully monitored by a doctor.
- To monitor and control asthma, as well as review treatment plans. It is strongly advisable to see your doctor periodically once asthma has been diagnosed. Long-term control will help to alleviate symptoms and prevent attacks which can be life-threatening. As a condition, asthma typically changes over time, so treatment adjustments are needed in order to keep it under control.
What can you expect from your initial appointment?
A family doctor or general practitioner (GP) is the best place to start. He or she may feel it necessary to refer you to an allergist or a pulmonologist following an initial assessment.
Your doctor will ask a series of questions in order to make a diagnosis and better understand the nature of your condition in case they need to refer you to a specialist.
Questions can include:
- What symptoms are you experiencing?
- When did your symptoms begin?
- Would you describe your symptoms as mild or severe?
- Are you aware of any allergies? Do you have problems with hay fever?
- Have you had bronchitis frequently?
- Does anyone in your family suffer from an allergy or have asthma?
- Have you noticed anything that may worsen or improve your symptoms?
- Do you have or are you already treating a chronic condition?
- How frequently do you exercise and what do you do?
- What sort of diet do you have?
- What type of home and work environment do you have?
How you answer these questions will help your doctor to not only diagnose asthma, but also classify the severity of the condition. Your doctor will need to do this in order to determine the best means of treatment. This will become a repetitive process once diagnosed as well. The degree of severity changes over time, and means that your treatment plan will continuously need to be adjusted.
The four asthma classification categories are:
- Mild intermittent (the patient experiences mild symptoms up to 2 days a week or up to 2 nights a month)
- Mild persistent (the patient experiences symptoms more than twice a week, but not more than once in a single day)
- Moderate persistent (the patient experiences symptoms at least once a day or more than one night in a week)
- Severe persistent (the patient experiences symptoms on most days / throughout the day and frequently at night)
Diagnosis and tests
Your doctor will want to perform a physical exam, not only to diagnose asthma, but also rule out any other potential conditions, such as respiratory infections or COPD (chronic obstructive pulmonary disease).
Your doctor will also perform a series of tests to assess your breath (or ability to breathe comfortably).
Pulmonary function tests can include:
- Spirometry test: This estimates how much air you are able to exhale following a deep breath, as well as how quickly you are able to breathe out. The test is used to help determine the narrowing of your bronchial tubes.
- Peak flow test: A device is used to measure how hard you are able to exhale. Low peak flow readings can signal an impairment in lung function (your lungs may not be working well or an asthmatic condition may be worsening / becoming more severe).
These types of tests are commonly performed before and after taking a bronchodilator (medication to open the airways). An improvement in lung function once this medication has been taken can mean that you have asthma.
Other tests performed to make a diagnosis include:
- Allergy testing: A skin or blood test can help to identify a potential allergy to pets, pollen, mould or dust. This will help to determine a potential allergy trigger.
- Provocative testing: Airway obstruction may be measured before and after strenuous physical activity (exercise-induced asthma) or taking in several breaths of cold air (asthma triggered by weather changes).
- Methacholine challenge: A known asthma trigger, methacholine will cause mild constriction of the airways when inhaled. A reaction may help to determine an asthma diagnosis.
- Sputum eosinophils: A sample of saliva and mucus during coughing will be taken for testing. Eosinophils (white blood cells) are typically present when symptoms develop. These will be visible to your doctor when he or she uses a rose-coloured dye (eosin) on the sample.
- Chest X-ray and CT scan: Imaging tests of the lungs and sinuses (nose cavities) can help to identify or diagnose any infections and abnormalities causing or aggravating normal breathing function.
- Nitric oxide test: Your doctor may wish to measure the amount of nitric oxide (gas) you may have in your breath. Higher than normal levels indicate inflammation in the airways and can be a sign of asthma.
Treatments and medications
Your doctor will recommend a course of treatment that provides you with long-term control, and preventative measures to help make living with the condition more comfortable. It will be a flexible plan that can be adjusted easily as your symptoms change or based on how you respond to treatment options.
A plan involves learning to recognise the key triggers for your condition, and signs of a potential attack. You will also be well informed about how to avoid causes, as well as what steps to take when experiencing adverse reactions. Your doctor will advise on how to go about tracking your breathing (using a peak flow metre) and how to best keep your symptoms under control with medications (taken daily). Flare-ups can also be controlled with quick-relief inhalers (bronchodilators). These open narrowed airways quite quickly, allowing a sufferer to breathe more easily.
Your day-to-day treatment plan may include the following:
- Medications: Your age, symptoms, triggers and classification will help to determine which medications will best treat your condition. Long-term control medications work to reduce inflammation and help prevent the occurrence of symptoms leading to an attack. These can include inhaled corticosteroids, leukotriene modifiers (taken orally), long-acting beta agonists (inhaled), theophylline (taken orally) and combination inhalers. Your doctor may prescribe quick-relief medications for rapid, short-term symptom treatment during an asthma attack. These can either be in the form of portable, hand-held inhalers, nebulisers (inhaled through a mouthpiece or face mask) or oral medications. Allergy medications may also be prescribed, if allergies are predominant triggers. These can include immunotherapy (allergy shots) and omalizumab injections, which can help to alleviate immune system reactions.
- Bronchial thermoplasty: Commonly used for severe asthma that shows little to no improvement through inhaled corticosteroid treatment or other long-term asthma medications. This treatment option reduces airway tightening with the use of an electrode.
Common Complications and Risk Factors
Your chances of developing asthma increase if:
- You have a blood relative with the condition (a parent or sibling)
- You already have an allergy, such as allergic rhinitis (hay fever)
- You are a smoker or are exposed to second-hand smoke
- You are overweight
- You are frequently exposed to certain chemicals, such as those used in manufacturing, farming and hairdressing salons.
Complications (short-term or long-term) associated with asthma include:
- Frequent emergency room visits or hospitalisations (severe asthma attacks).
- Symptoms that interfere with daily functions such as work, home life, recreational activities and sleeping.
- Taking numerous sick days from work or school due to asthma flare-ups.
- Medication side-effects (especially those related to long-term prednisone use which includes weight gain and fat deposits, mainly around your belly, and may also give the appearance of a “moon face”).
Living with Asthma
Lifestyle and home care
Careful use of prescribed medications can go a long way in helping an asthmatic person live a normal and healthy life. There are several other ways a person can help to alleviate potential asthma attacks. These include:
- Reducing your exposure to triggers (wherever possible): Air conditioners are handy in that they reduce the amount of airborne pollen around you, lower indoor humidity levels and exposure to dust mites. You can also minimise dust by replacing carpets with linoleum or hardwood flooring, using washable curtains or blinds and dustproof linens. Humidifiers can help to maintain optimal humidity levels. You can also get into the habit of preventing mould spores (in the kitchen and bathroom), reducing pet dander, cleaning regularly and covering your nose and mouth during cold weather.
- Maintaining a healthy weight through a nutritious diet and regular exercise: An asthmatic person shouldn’t become fearful of exercise. Regular activity can help to strengthen the heart and lungs, which in turn will help to control asthma symptoms. Being overweight also worsens asthma symptoms, as well as causing other health concerns. Foods which worsen asthma symptoms and bring on bouts of heartburn and indigestion (or GERD) can also be avoided.
- Take your medications and follow your action plan: Asthma is an ongoing condition and requires regular monitoring and treatment. Your doctor will provide you with a detailed plan for taking your medications and managing potential triggers, as well as advise on lifestyle changes you can most benefit from (diet and nutrition and, fitness and exercise). Your condition will be erratic and your treatment plan flexible, but you must always take your medications as prescribed. It is highly advisable not to change your medication dosage without your doctor having directed you to. You can also monitor your breathing and lung function. Your doctor will help you to learn how to measure and record your peak air flow at home with a peak flow metre. Sometimes your lung function may decrease before you’re even aware of any obvious symptoms (coughing or wheezing).
- Get vaccinations: Viral and bacterial infections can worsen asthma symptoms. You can help prevent bouts of flu, colds and pneumonia by getting yourself vaccinated during high infection seasons (autumn, winter, spring).
- Identify and treat an asthma attack swiftly: If you are able to act quickly, you can help to prevent a severe asthma attack by taking your medications for rapid-acting relief as directed by your doctor. Stop any activity immediately and ensure that you are seen by a medical professional as soon as possible.
Coping with asthma
Any kind of health condition diagnosis can be a stressful experience. Coping can sometimes be challenging and frustrating, leaving you feeling limited when it comes to your quality of life. Coping with asthma doesn’t have to be a frustrating experience, forcing you to lead a limited life. The best way to cope with this type of condition is to understand it. In this way, you assume control over your day-to-day life.
It is important to be mindful of your activity and pace yourself. When you need a break between tasks or activities, allow yourself a breather. Overdoing things will contribute to worsening your condition.
Take your doctor’s advice seriously. He or she will have supplied you with informative guidelines as part of your treatment plan to help you live your best life and avoid stimulating triggers. Getting into mindful habits will help prevent attacks and ensure that you can best manage your symptoms comfortably.
As with many other conditions that can bring on emotional responses such as despair, frustration or anxiety, talking to others helps. As human beings, we naturally take comfort in being able to share challenges with others facing similar obstacles. If it helps, make use of support groups or talk to others known to you who are also coping with asthma.
A child learning to cope with asthma is often a challenge within itself. An adult may be able to understand the nature of his / her condition a lot quicker than a child might. Children suffering from asthma may become fearful as a result of not being able to understand the reasons behind their symptoms, especially if they experience frequent attacks. Be encouraging and help to focus a child’s attention on the things they can do instead of those he or she can’t.
It is just as important for an adult to focus on the positives too. Living and coping with asthma is going to be as limiting as you make it. In just the same light, by focussing on what best benefits you instead of what holds you back, your quality of life will certainly improve.
What is an acute asthma attack?
In short, a sudden and severe asthma attack. Usual medications and the use of inhaled bronchodilators do not easily alleviate symptoms of an attack. Symptoms are severe and life-threatening and are often associated with signs of a potential respiratory failure (status asthmaticus). An acute attack is an emergency and requires immediate medical attention.
How long does an asthma attack last?
The length of an attack will vary and largely depends on the trigger responsible for causing it, as well as how long the airways have been inflamed. An attack can range from a few minutes to more than an hour. A mild attack can be spontaneously resolved with medication and a quick-acting inhaler. More severe attacks require emergency medical intervention.
Why does my asthma worsen at night?
When lying down, nasal secretions accumulate in the airways. This can make it more difficult for an asthmatic person to breathe. Other nasal secretion culprits causing discomfort or irritation include sinus infections, postnasal drip and allergies to pet dander. All of these can contribute to worsening symptoms of asthma at night-time.
Can you ever ‘outgrow’ asthma?
A person can appear to become asymptomatic at some stage, but it doesn’t necessarily mean their asthma has gone into remission. To determine whether the condition is completely gone a biopsy of lung tissue would need to be tested and examined. The condition is a complex one in that many different factors and triggers contribute to a person’s illness. As such, there is no clear-cut answer to this question.
The majority of children diagnosed (correctly) appear to have symptoms before the age of five. It is a difficult diagnosis to make at such a young age as the lung function tests that most accurately determine the condition are fairly difficult for many little children to perform.
Some theories, when it comes to children potentially outgrowing their condition, indicate that sometimes, children merely have asthma-like symptoms when exposed to sensitive triggers such as viral or bacterial infections or other allergens. Their airways to the lungs become “twitchy” and inflamed as a result, but they may never have actually had full-blown asthma.
Very few studies have monitored changes in children diagnosed with asthma well into their adult years. As such, ‘outgrowing’ the condition mostly remains a question mark. What is evident in those studies that have taken place is that asthma symptoms change (which is a normal pattern of this condition). Some individuals will have occasional symptoms, some may have more frequent flare-ups, and others will appear to be free from symptoms altogether as adults.
Children who experience symptoms of wheezing triggered by upper respiratory infections have been noted to improve over time as they grow. But those who are particularly sensitive to allergens from a young age typically show little improvement at all. A family history of asthma has also been noted to play a role, and generally those with blood relatives with the condition tend to have lasting asthma symptoms.
The general rule of thumb for adults with asthma is that it is a long-term disease that cannot be outgrown or cured. Many adult asthmatics may go for long periods (sometimes a few years) without experiencing any symptoms. For the most part, the more severe the classification of asthma past the age of the five, the likelier symptoms will continue, whether a person’s condition is triggered by allergens or not.
It is best to never assume your condition ‘has gone away’. If you have been diagnosed and treated for asthma at any stage of your life, it is advisable to work closely with your doctor (periodically) to ensure that you are in your best condition throughout your life.
Is it possible to improve symptoms of asthma with exercise?
The key to finding a healthy balance with exercise when you are asthmatic is in understanding the healthy benefits, getting your symptoms under proper control and being mindful of overdoing things or exposing yourself to triggers. If you are adhering to your treatment plan and taking your medications as directed, your asthma should be under control. This then allows you better control over your physical activity. A healthy fitness routine can help to reduce your symptoms, improve your breathing capacity, strengthen your heart and alleviate any levels of stress and anxiety – all good reasons to exercise, and even more so when you suffer from asthma.
It is easy to be put off or become fearful of exercise when you have asthma. Increased activity can bring on an attack, and for many, this is a frightful experience. It has been likened to feeling as if “you’re drowning in air”.
An asthma condition merely means your lungs are more sensitive to certain things, such as cold and hot temperatures, pollution and even dry air. During exercise, you are likely to breathe differently than when you’re not all that physically active.
Understanding this is important. When you’re not exercising you typically breathe more comfortably through your nose. When this happens, your nose moistens, warms and filters this air before it reaches your lungs. When you exercise, you can easily breathe more through your mouth which forces your lungs to work harder. This is what can trigger asthma symptoms into a full-blown attack. For this reason, many sufferers are encouraged to be mindful of their breathing during exercise – breathe in through your nose and breathe out through your mouth.
An important thing for an asthmatic person to remember is that you CAN exercise. The best form of activity is one that causes you to be just slightly out of breath. Some of the best activities for an asthmatic person are swimming, yoga, walking, biking, hiking, or even golf.
Activities which you may want to steer clear of include cold-weather sports, such as ice skating or ice hockey, and endurance activities, such as long-distance running. Choose an activity that you can enjoy and that is not too difficult for you. If you are able to do the activity 4 or 5 times a week in 30 minute sessions without pushing yourself, chances are you should be able to exercise safely. If you notice any symptom flare-ups when you work-out, consult your doctor for advice about the best ways to adjust your medication dosages and treatment plan, or for assistance with choosing a better suited activity.
Top tips for exercising include:
- Always carrying an asthma inhaler with you
- Including a good warm-up before a work-out
- Breathing through your nose as much as possible
- Avoiding potential triggers, such as cold weather or areas where pollen counts are high
- Allowing yourself rest and recuperation when sick or feeling unwell (do not push yourself to exercise)
- Knowing your exercise limits and stopping when you’ve reached them
- Including a cool-down routine following a work-out session