Asthma

What is asthma?

Asthma is a lung condition that makes it hard to breathe.

If you have asthma, the breathing tubes in your lungs (your airways) are extra sensitive to things in the environment. This results in your airways becoming swollen (or inflamed) and tight, and they often have extra mucus. Because of this, the lungs aren’t able to get air in and out very easily. When this happens suddenly and severely, it’s called an asthma attack. 

In the U.S., 25 million people are affected by asthma. That’s about 8% of adults and children.

Asthma usually starts in childhood or early adulthood, and for most people, it’s lifelong (chronic). Some people grow out of the condition, while others may develop it as they get older. Asthma tends to run in families, along with allergies and eczema. 

Everyone’s asthma is different. If you have asthma, you’ll know — or you’ll soon learn — what’s normal for you, what triggers your symptoms, and what works best to treat them so you can live a healthy life.

What causes asthma?

Asthma is caused by complex interactions between:

• Your genetics: genes that are passed on from your parents

• Your immune system: your defense system against outside threats, such as germs

• Your environment: exposure to pollutants, irritants, viruses, and allergens (substances, like pollen, that cause allergies in certain people)

In other words, asthma is caused by a combination of your genetics, how you react to your environment, and the actual environment that you live in both now and in the past. 

Certain risk factors make you more likely to have asthma in the first place, for example: 

• A parent or sibling with asthma, allergies, hay fever (allergic rhinitis), or eczema

• Excess body weight

• Antibiotic use

• Smoking, or past exposure to passive smoking 

• Air pollution

Is Asthma Hereditary? Here’s How Your Genes and the Environment Affect Your Risk

Written by Brian Clista, MD

Asthma triggers

Triggers are substances in the environment that can make symptoms worse if you have asthma. 

Triggers aren’t the same for everyone, but common ones include: 

• Pollen

• Dust mites

• Pet dander

• Respiratory infections, such as the common cold and COVID-19

• Exercise

• Cold air

• Air pollutants, such as smoke and smog

• Some medications

• Stress 

Knowing your triggers can help you avoid asthma attacks and minimize your symptoms.

Common Triggers for Asthma and Tips for Avoiding Them

Written by Mandy Armitage, MD

Asthma symptoms

Asthma symptoms are often worse at night or first thing in the morning. They’re usually worsened by certain triggers. But they completely go away at other times. The most common symptoms of asthma are: 

• Breathlessness

• Wheezing (noisy breathing)

• Chest tightness

• Cough 

Asthma symptoms can be intermittent (comes and goes) or persistent. For people with persistent asthma, symptoms can be mild, moderate, or severe. The severity of a person’s asthma determines which treatment plan is best for them. 

Symptoms can be predictable. But they can also come on suddenly. An asthma attack is when the airways in the lungs suddenly become tight and swollen. Although rare, asthma attacks can sometimes be deadly. 

The medical community doesn’t yet fully understand why some people get mild asthma whereas others get a more severe version of the disease.

Wondering If You Have Allergies or Asthma? It Could Be Allergic Asthma

Written by Fonda Jiang, MD

Quiz: Could I have asthma?

How is asthma diagnosed?

If you think you have asthma, the first step is to get tested. This involves a visit to a healthcare professional. Most likely, they’ll ask you about your: 

• Symptoms

• Medical history

• Smoking history

• Work history 

You’ll get a physical examination and some breathing tests to see how your lungs are working. Some breathing tests can be done right there in the office. For others, you’ll have to get them done in a specialized lab. You may also need a lung X-ray. 

If the healthcare professional thinks allergies might be making your asthma worse, they might also suggest allergy testing. This can include skin or blood tests.

Breathlessness, wheezing, and a cough can also be symptoms of a different condition called chronic obstructive pulmonary disease (COPD). A specialist physician can help figure out what‘s causing your symptoms.

COPD vs. Asthma: What’s the Difference?

Written by Christine Giordano, MD

Medications for asthma

Inhalers are by far the most common treatment for asthma. These contain medications that are inhaled through the mouth, straight into the lungs. They come in all shapes and sizes. But the most important difference is the medicine inside them. Below, we go into each medication type in more detail.

Corticosteroids

Inhaled corticosteroids (ICSs) reduce airway inflammation and keep the airways calm. Examples are budesonide (Pulmicort) or beclomethasone (Qvar). The dose you take will depend on how severe your asthma is.

Bronchodilators

Inhaled bronchodilators relax the muscles around the airways to open them up and allow more air to pass through. These can be short-acting beta agonists (SABAs), such as albuterol (Proair, Ventolin, Proventil). Or they can be long-acting beta agonists (LABAs), such as salmeterol (Serevent). 

Combination inhalers

Combination inhalers contain corticosteroids plus one or two LABAs. One example is budesonide / formoterol (Symbicort). Combination inhalers come in different doses: The LABA dose is always the same, but the ICS dose can vary depending on how severe your asthma symptoms are.

Rescue vs. maintenance inhalers

Some asthma medications work quickly and are useful when you need to quickly stop your symptoms. These are called rescue, or reliever, inhalers. 

The 2024 guidelines from the Global Initiative for Asthma recommend that everyone with asthma have a SABA for quick relief of asthma symptoms. Most people use these once or twice per week, or less. When your asthma symptoms worsen, you might need more doses.

Other asthma medications work more slowly to keep asthma symptoms controlled long term. 

These are called preventive, controller, or maintenance inhalers. They’re usually taken once or twice per day, every day — even when you’re feeling well. 

Guidelines recommend that anyone with asthma be prescribed an ICS. This is usually given in combination with a LABA. But it can also be given alone too. 

Knowing which medication to take and when, and how to take it properly, is key. It may sound simple, but it isn’t always easy. Your healthcare team can help. And there are also great videos online on how to use different inhalers and spacer devices, and much more.

Can Asthma Be Cured?

Written by Karen Hovav, MD, FAAP

Asthma action plan

Most people with asthma need an action plan. This is a written, personalized plan for what to do when your asthma symptoms worsen. It has a list of step-by-step instructions for how to best treat your symptoms, depending on how severe they are. It also tells you when you need to call your healthcare team or get emergency help. 

The plan helps you manage asthma symptoms when they start to worsen. Hopefully, it’ll also help prevent them from getting worse or turning into a full-blown attack. 

As part of your action plan, you might need to use a device called a peak flow meter. This measures how powerful your exhale is. It helps to objectively monitor how severe your asthma currently is. Most people with asthma know what their normal peak flow reading is. It’s also a good idea to know your own personal “best ever” and “worst ever” values.

Understanding and Treating Your Asthma: What to Ask Your Doctor

Written by Mandy Armitage, MD

How can you prevent asthma attacks?

If you have asthma, there are steps you can take to prevent attacks and keep your symptoms from worsening. They include the following:

• Avoid smoking and places where people smoke. If you smoke, get help to quit. 

• Avoid triggers and irritants that make your asthma worse. Remember that individual triggers are different for each person. 

• Make sure you’re up-to-date with vaccinations. These include the yearly flu shot, as well as vaccines for respiratory syncytial virus (RSV) and COVID. Some people may need a vaccine to protect against some types of pneumonia. The exact schedule for this will depend on your age.

• Be careful about the medications you take. Some people experience worsening asthma symptoms when they take certain medications like beta blockers and NSAIDs (nonsteroidal anti-inflammatory drugs).

Your healthcare team can help you figure out which steps to take and when. So be sure to reach out if you’re unsure about anything. 

Will Quitting Smoking Cure My Asthma?

Written by Bianca Palushaj, MD