When you have asthma, your
airways narrow and swell. They produce extra mucus, and breathing
becomes difficult. The most common asthma signs and symptoms are
coughing, wheezing and shortness of breath. For some people, asthma
symptoms are a minor nuisance. For others, they're a major problem that
interferes with daily activities. If you have severe asthma, you may be
at risk of a life-threatening asthma attack.
Asthma can't be cured, but its symptoms can be controlled. Treatments
include taking steps to avoid your particular asthma triggers, using
long-term control medications to prevent flare-ups and using a
quick-relief inhaler to control symptoms once they start. Because asthma
changes over time, you'll work with your doctor to track your signs and
symptoms and adjust treatment as needed.
Asthma symptoms range from minor to severe and vary from person to
person. You may have mild symptoms and asthma attacks may be infrequent.
Between asthma flare-ups you may feel normal and have no trouble
breathing. You may have symptoms primarily at night, during exercise or
when you're exposed to specific triggers. Or you may have asthma
symptoms all the time. Asthma signs and symptoms include:
* Shortness of breath
* Chest tightness or pain
* Trouble sleeping caused by shortness of breath, coughing or wheezing
* An audible whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
* Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu
Signs that your asthma is probably getting worse include:
* More frequent and bothersome asthma signs and symptoms
* Increasing difficulty breathing (this can be measured by a peak
flow meter, a simple device used to check how well your lungs are
* An increasingly frequent need to use a quick-relief inhaler
For some people, asthma symptoms flare up in certain situations:
* Exercise-induced asthma occurs during exercise. For many people,
exercise-induced asthma is worse when the air is cold and dry.
* Occupational asthma is asthma that's caused or worsened by
breathing in a workplace irritant such as chemical fumes, gases or dust.
* Allergy-induced asthma. Some people have asthma symptoms that are
triggered by particular allergens, such as pet dander, cockroaches or
When to see a doctor
These key circumstances may lead you to talk to your doctor about asthma:
* If you think you have asthma. If you have frequent coughing that
lasts more than a few days or any other signs or symptoms of asthma, see
your doctor. Treating asthma early, especially in children, may prevent
long-term lung damage and help keep the condition from worsening over
* To monitor your asthma after diagnosis. If you know you have
asthma, work with your doctor to keep it under control. Good long-term
asthma control not only helps you feel better on a daily basis, but also
can prevent a life-threatening asthma attack.
* If your asthma symptoms get worse. Contact your doctor right away
if your medication doesn't seem to ease your symptoms or you need to use
your quick-relief inhaler more and more often. Don't try to solve the
problem by taking more medication without consulting your doctor.
Overusing asthma medication can cause side effects and may even make
your asthma worse.
* To review your treatment. Asthma changes over time. Meet with your
doctor on a regular basis to discuss your symptoms and make any needed
adjustments to your treatment.
When to seek emergency treatment
Severe asthma attacks can be life-threatening. Work with your doctor
ahead of time to determine what to do when your signs and symptoms
worsen — and when you need emergency treatment. If your quick-relief
medications don't relieve symptoms of a severe asthma attack, seek
emergency help right away. Signs of an asthma emergency include:
* Rapid worsening of shortness of breath or wheezing
* No improvement even after using a quick-relief inhaler such as albuterol
* Shortness of breath when you are doing minimal physical activity
It isn't clear why some people get asthma and others don't, but it's
probably due to a combination of environmental and genetic (inherited)
Asthma triggers are different from person to person. Exposure to a
number of different allergens and irritants can trigger signs and
symptoms of asthma, including:
* Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
* Respiratory infections, such as the common cold
* Physical activity (exercise-induced asthma)
* Cold air
* Air pollutants and irritants, such as smoke
* Certain medications, including beta blockers, aspirin and other nonsteroidal anti-inflammatory drugs
* Strong emotions and stress
* Sulfites, preservatives added to some types of foods and beverages
* Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat
* Menstrual cycle in some women
* Allergic reactions to some foods, such as peanuts or shellfish
Asthma is common, affecting millions of adults and children. A growing
number of people are diagnosed with the condition each year, but it
isn't clear why. A number of factors are thought to increase your
chances of developing asthma. These include:
* Having a blood relative (such as a parent or sibling) with asthma
* Having an allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)
* Being overweight
* Being a smoker
* Exposure to secondhand smoke
* Having a mother who smoked while pregnant
* Exposure to exhaust fumes or other types of pollution
* Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing
* Low birth weight
Exposure to allergens, exposure to certain germs, and having some types
of bacterial or viral infections may also be risk factors. However, more
research is needed to determine what role they may play in developing
Asthma may cause a number of complications, including:
* Symptoms that interfere with sleep, work or recreational activities
* Sick days from work or school during asthma flare-ups
* Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe
* Emergency room visits and hospitalizations for severe asthma attacks
* Side effects from long-term use of some medications used to stabilize severe asthma
Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general
practitioner. However, when you call to set up an appointment, you may
be referred immediately to an allergist, pulmonologist or other
Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared. Here's some
information to help you get ready for your appointment, and what to
expect from your doctor.
What you can do
These steps can help you make the most of your appointment:
* Write down any symptoms you're having, including any that may seem
unrelated to the reason for which you scheduled the appointment.
* Note when your symptoms bother you most — for example, if your
symptoms tend to get worse at certain times of the day; during certain
seasons; or when you're exposed to cold air, pollen or other triggers.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, vitamins and supplements that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
asthma, some basic questions to ask your doctor include:
* Is asthma the most likely cause of my breathing problems?
* Other than the most likely cause, what are other possible causes for my symptoms?
* What kinds of tests do I need?
* Is my condition likely temporary or chronic?
* What's the best treatment?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:
* What exactly are your symptoms?
* When did you first notice your symptoms?
* How severe are your symptoms?
* Do you have breathing problems most of the time, or only at certain times or in certain situations?
* Do you have allergies, such as atopic dermatitis or hay fever?
* What, if anything, appears to worsen your symptoms?
* What, if anything, seems to improve your symptoms?
* Do allergies or asthma run in your family?
* Do you have any chronic health problems?
Tests and diagnosis
Diagnosing asthma can be difficult. Signs and symptoms can range from
mild to severe and are often similar to those of other conditions,
including emphysema, early congestive heart failure or vocal cord
problems. Children often develop temporary breathing conditions that
have symptoms similar to asthma. For example, it can be hard to tell
asthma from wheezy bronchitis, pneumonia or reactive airway disease.
In order to rule out other possible conditions, your doctor will do a
physical exam and ask you questions about your signs and symptoms and
about any other health problems. You may also be given lung (pulmonary)
function tests to determine how much air moves in and out as you
Tests to measure lung function include:
* Spirometry. This test measures the narrowing of your bronchial
tubes by checking how much air you can exhale after a deep breath and
how fast you can breathe out.
* Peak flow. A peak flow meter is a simple device that measures how
hard you can breathe out. Lower than usual peak flow readings are a sign
your lungs may not be working as well and that your asthma may be
getting worse. Your doctor will give you instructions on how to track
and deal with low peak flow readings.
Lung function tests often are done before and after taking a
bronchodilator (brong-koh-DIE-lay-tur) such as albuterol to open your
airways. If your lung function improves with use of a bronchodilator,
it's likely you have asthma.
Other tests to diagnose asthma include:
* Methacholine challenge. If you have asthma, inhaling a known
asthma trigger called methacholine will cause mild constriction of your
airways. If you react to the trigger, you likely have asthma. This test
may be used if your initial lung function test is normal.
* Nitric oxide test. This test is sometimes used to diagnose and
monitor asthma. It measures the amount of a gas called nitric oxide you
have in your breath. If your airways are inflamed — a sign of asthma —
you may have higher than normal nitric oxide levels. This test isn't
How asthma is classified
To classify your asthma severity, your doctor will consider your answers
to questions about symptoms (such as how often you have asthma attacks
and how bad they are), along with the results of your physical exam and
diagnostic tests. Determining the severity level of your asthma will
help your doctor choose the best treatment for you. Asthma severity
often changes over time, requiring an adjustment to treatment.
Asthma is classified into four general categories:
Asthma classification Signs and symptoms
Mild intermittent Mild symptoms up to two days a week and up to two nights a month
Mild persistent Symptoms more than twice a week, but no more than once in a single day
Moderate persistent Symptoms once a day and more than one night a week
Severe persistent Symptoms throughout the day on most days and frequently at night
Treatments and drugs
Prevention and long-term control is the key to preventing asthma
attacks. Treatment usually involves learning to recognize your triggers
and taking steps to avoid them, and tracking your breathing to make sure
your daily asthma medications are keeping symptoms under control. In
case of an asthma flare-up, you may need to use a quick-relief inhaler
such as albuterol.
The right medications for you depend on a number of things, including
your age, your symptoms, your asthma triggers and what seems to work
best to keep your asthma under control. Preventive, long-term control
medications reduce the inflammation in your airways that leads to
symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen
airways that are limiting breathing. In some cases, medications to treat
specific allergies are needed.
Long-term control medications
In most cases, these medications need to be taken every day. Types of long-term control medications include:
* Inhaled corticosteroids. These medications include fluticasone
(Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler),
mometasone (Asmanex), flunisolide (Aerobid), beclomethasone (Qvar) and
others. They are the most commonly prescribed type of long-term asthma
medication. You may need to use these medications for several days to
weeks before they reach their maximum benefit. Unlike oral
corticosteroids, these corticosteroid medications have a relatively low
risk of side effects and are generally safe for long-term use.
* Leukotriene modifiers. These oral medications include montelukast
(Singulair), zafirlukast (Accolate) and zileuton (Zyflo, Zyflo CR). They
help prevent asthma symptoms for up to 24 hours. In rare cases, these
medications have been linked to psychological reactions such as
agitation, aggression, hallucinations, depression and suicidal thinking.
Seek medical advice right away for any unusual reaction.
* Long-acting beta agonists (LABAs). These inhaled medications
include salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer).
LABAs open the airways and reduce inflammation. However, they've been
linked to severe asthma attacks. LABAs should be taken only in
combination with an inhaled corticosteroid.
* Combination inhalers such as fluticasone and salmeterol (Advair
Diskus) and budesonide and formoterol (Symbicort). These medications
contain a LABA along with a corticosteroid. Like other LABA medications,
these medications may increase your risk of having a severe asthma
* Theophylline. This is a daily pill that helps keep the airways
open (bronchodilator). Theophylline (Theo-24, Elixophyllin, others)
relaxes the muscles around the airways to make breathing easier. It's
not used as often now as in past years.
Quick-relief (rescue) medications are used as needed for rapid,
short-term symptom relief during an asthma attack — or before exercise
if your doctor recommends it. Types of quick-relief medications include:
* Short-acting beta agonists. These inhaled, quick-relief
bronchodilators can rapidly ease symptoms during an asthma attack. They
include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol
(Xopenex HFA) and pirbuterol (Maxair Autohaler). These medications act
within minutes, and effects last several hours.
* Ipratropium (Atrovent). Your doctor might prescribe this inhaled
medication for immediate relief of your symptoms. Like other
bronchodilators, ipratropium relaxes the airways, making it easier to
breathe. Ipratropium is mostly used for emphysema and chronic
bronchitis, but it's sometimes used to treat asthma attacks.
* Oral and intravenous corticosteroids. These medications relieve
airway inflammation caused by severe asthma. Examples include prednisone
and methylprednisolone. They can cause serious side effects when used
long term, so they're used only on a short-term basis to treat severe
Treatment for allergy-induced asthma
If your asthma is triggered or worsened by allergies, you may benefit
from allergy treatment as well. Allergy treatments include:
* Allergy shots (immunotherapy). Immunotherapy injections are
generally given once a week for a few months, then once a month for a
period of three to five years. Over time, they gradually reduce your
immune system reaction to specific allergens.
* Omalizumab (Xolair). This medication is specifically for people
who have allergies and severe asthma. It acts by altering the immune
system. Omalizumab is delivered by injection every two to four weeks.
* Allergy medications. These include oral and nasal spray
antihistamines and decongestants as well as corticosteroid, cromolyn and
ipratropium nasal sprays.
Don't rely on quick-relief medications
Long-term asthma control medications — such as inhaled corticosteroids —
are the cornerstone of asthma treatment. These medications keep asthma
under control on a day-to-day basis and make it less likely you'll have
an asthma attack.
If you do have an asthma flare-up, a quick-relief inhaler can ease your
symptoms right away. But if your long-term control medications are
working properly, you shouldn't need to use your quick-relief inhaler
very often. Keep a record of how many puffs you use each week. If you
need to use your quick-relief inhaler more often than your doctor
recommends, see your doctor. You probably need to adjust your long-term
This treatment is used for severe asthma that doesn't improve with
inhaled corticosteroids or other long-term asthma medications. Generally
done in three outpatient visits, bronchial thermoplasty heats the
insides of the airways in the lungs with an electrode, reducing the
smooth muscle inside the airways. This limits the ability of the airways
to tighten, making breathing easier and may reduce asthma attacks.
Bronchial thermoplasty isn't widely available. More research is needed
to determine whether the benefits of this treatment outweigh the
possible risks and potential side effects.
Treatment by severity for better control: A stepwise approach
Treatment based on asthma control can help you manage your asthma.
Asthma treatment should be flexible and based on changes in symptoms,
which should be assessed thoroughly each time you see your doctor. Then,
treatment can be adjusted accordingly. For example, if your asthma is
well controlled, your doctor may prescribe less medicine. If your asthma
is not well controlled or getting worse, your doctor may increase your
medication and recommend more frequent visits.
Asthma action plan
Work with your doctor to create an asthma action plan that outlines in
writing when to take certain medications, or when to increase or
decrease the dose of your medications based on your symptoms. Your
asthma action plan should also list your triggers and the steps you need
to take to avoid them. Your asthma plan may also involve tracking your
asthma symptoms or using a peak flow meter on a regular basis to monitor
how well your treatment is controlling your asthma.
Lifestyle and home remedies
Although many people with asthma rely on medications to prevent and
relieve symptoms, you can do several things on your own to maintain your
health and lessen the possibility of asthma attacks.
Avoid your triggers
Taking steps to reduce your exposure to things that trigger asthma
symptoms is a key part of asthma control. Here are some things that may
* Use your air conditioner. Air conditioning reduces the amount of
airborne pollen from trees, grasses and weeds that finds its way
indoors. Air conditioning also lowers indoor humidity and can reduce
your exposure to dust mites. If you don't have air conditioning, try to
keep your windows closed during pollen season.
* Decontaminate your decor. Minimize dust that may worsen nighttime
symptoms by replacing certain items in your bedroom. For example, encase
pillows, mattresses and box springs in dust-proof covers. Remove
carpeting and install hardwood or linoleum flooring. Use washable
curtains and blinds.
* Maintain optimal humidity. If you live in a damp climate, talk to your doctor about using a dehumidifier.
* Keep indoor air clean. Have a utility company check your air
conditioner and furnace once a year. Change the filters in your furnace
and air conditioner according to the manufacturer's instructions. Also
consider installing a small-particle filter in your ventilation system.
If you use a humidifier, change the water daily.
* Reduce pet dander. If you're allergic to dander, avoid pets with
fur or feathers. Having pets regularly bathed or groomed also may reduce
the amount of dander in your surroundings.
* Clean regularly. Clean your home at least once a week. If you're
likely to stir up dust, wear a mask or have someone else do the
* If it's cold out, cover your face. If your asthma is worsened by cold, dry air, wearing a face mask can help.
Taking care of yourself and treating other conditions linked to asthma
will help keep your symptoms under control. A few things you can do
* Get regular exercise. Having asthma doesn't mean you have to be
less active. Treatment can prevent asthma attacks and control symptoms
during activity. Regular exercise can strengthen your heart and lungs,
which helps relieve asthma symptoms. Keep in mind that exercising in
cold weather may trigger asthma symptoms. If you do exercise in cold
temperatures, wear a face mask to warm the air you breathe.
* Maintain a healthy weight. Being overweight can worsen asthma
symptoms, and it puts you at higher risk of other health problems.
* Eat fruits and vegetables. Eating plenty of fruits and vegetables
may increase lung function and reduce asthma symptoms. These foods are
rich in protective nutrients (antioxidants) that boost the immune
* Control heartburn and gastroesophageal reflux disease (GERD). It's
possible that the acid reflux that causes heartburn may damage lung
airways and worsen asthma symptoms. If you have frequent or constant
heartburn, talk to your doctor about treatment options. You may need
treatment for GERD before your asthma symptoms improve.
There's some evidence that certain alternative treatments may help with
asthma symptoms. However, keep in mind that these treatments are not a
replacement for medical treatment — especially if you have severe
asthma. Talk to your doctor before taking any herbs or supplements, as
some may interact with medications you take. While some alternative
remedies are used for asthma, in most cases more research is needed to
see how well they work and to measure the extent of possible side
effects. Alternative asthma treatments include:
* Breathing techniques. Examples include the Buteyko breathing
technique, the Papworth method, and yoga breathing (pranayama). These
exercises may reduce the amount of medication you need to keep your
asthma symptoms under control. Yoga classes increase fitness and reduce
stress, which may help with asthma as well.
* Acupuncture. This technique involves placing very thin needles at
strategic points on your body. It's safe and generally painless.
* Relaxation techniques. Techniques such as meditation, biofeedback,
hypnosis and progressive muscle relaxation may help with asthma by
reducing tension and stress.
* Herbal remedies. A few herbal remedies that have shown some
promise in treating asthma symptoms include butterbur, dried ivy and
ginkgo extract. Blends of different types of herbs are commonly used in
traditional Chinese, Indian and Japanese medicine. However, more studies
are needed to determine how well herbal remedies and preparations work
* Omega-3 fatty acids. Found in fish, flaxseed and other foods,
these healthy oils may reduce the inflammation that leads to asthma
symptoms. They also appear to have a number of other health benefits.
* Homeopathy. Homeopathy aims to stimulate the body's self-healing
response using very small doses of substances that cause symptoms. In
the case of asthma, homeopathic remedies are made from substances that
generally trigger an asthmatic reaction, such as pollen or weeds.
There's still not enough clear evidence to determine if homeopathy helps
treat asthma caused by allergies.
Coping and support
Asthma can be challenging and stressful. You may sometimes become
frustrated, angry or depressed because you need to cut back on your
usual activities to avoid environmental triggers. You may also feel
hampered or embarrassed by the symptoms of the disease and by
complicated management routines. Children in particular may be reluctant
to use an inhaler in front of their peers.
But asthma doesn't have to be a limiting condition. The best way to
overcome anxiety and a feeling of helplessness is to understand your
condition and take control of your treatment. Here are some suggestions
that may help:
* Pace yourself. Take breaks between tasks and avoid activities that make your symptoms worse.
* Make a daily to-do list. This may help you avoid feeling overwhelmed. Reward yourself for accomplishing simple goals.
* Talk to others with your condition. Chat rooms and message boards
on the Internet or support groups in your area can connect you with
people facing similar challenges and let you know you're not alone.
* If your child has asthma, be encouraging. Focus attention on the
things your child can do, not on the things he or she can't. Involve
teachers, school nurses, coaches, friends and relatives in helping your
child manage asthma.
Working together, you and your doctor can design a step-by-step plan for
living with your condition and preventing asthma attacks.
* Follow your asthma action plan. With your doctor and health care
team, write a detailed plan for taking medications and managing an
asthma attack. Then be sure to follow your plan. Asthma is an ongoing
condition that needs regular monitoring and treatment. Taking control of
your treatment can make you feel more in control of your life in
* Identify and avoid asthma triggers. A number of outdoor allergens
and irritants — ranging from pollen and mold to cold air and air
pollution — can trigger asthma attacks. Find out what causes or worsens
your asthma, and take steps to avoid those triggers.
* Monitor your breathing. You may learn to recognize warning signs
of an impending attack, such as slight coughing, wheezing or shortness
of breath. But because your lung function may decrease before you notice
any signs or symptoms, regularly measure and record your peak airflow
with a home peak flow meter.
* Identify and treat attacks early. If you act quickly, you're less
likely to have a severe attack. You also won't need as much medication
to control your symptoms. When your peak flow measurements decrease and
alert you to an impending attack, take your medication as instructed and
immediately stop any activity that may have triggered the attack. If
your symptoms don't improve, get medical help as directed in your action
* Take your medication as prescribed. Just because your asthma seems
to be improving, don't change anything without first talking to your
doctor. It's a good idea to bring your medications with you to each
doctor visit, so your doctor can double-check that you're using your
medications correctly and taking the right dose.
* Pay attention to increasing quick-relief inhaler use. If you find
yourself relying on your quick-relief inhaler such as albuterol, your
asthma isn't under control. See your doctor about adjusting your