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Many people don't think twice about the ability to take a breath. It isn't until someone experiences breathing problems such as shortness of breath, wheezing, or chest tightness that they feel the extent to which easy breathing can be taken for granted. Asthma is a common condition that can cause difficulty breathing, wheezing, chest pain, and cough. It can be frustrating and frightening for some patients, but it's manageable with the right treatment plan.
What is asthma?
Asthma, sometimes referred to as bronchial asthma, is a condition that affects the airways in the lungs and a patient's ability to breathe. Patients with asthma experience airway inflammation, which causes a variety of issues. Asthma is a common condition, with an estimate of over 25 million cases in the United States, according to the Centers for Disease Control and Prevention (CDC). Asthma is not contagious, but it may be hereditary.Many sufferers' condition is triggered or made worse by environmental irritants they may encounter. Asthma triggers may include allergens, dust mites, pet dander, humid weather, smoke (including tobacco), infections, cold air, pollution, mold, food additives, fragrances, and physical activity. Symptoms of asthma include shortness of breath, wheezing, chest tightness or pain, frequent respiratory infections, and a chronic cough.
The treatment of asthma typically involves avoiding asthma triggers, addressing symptoms, and preparing for attacks. Everyone with asthma should have a written action plan.
How is asthma diagnosed?
Often, asthma symptoms lead to a patient's initial diagnosis. These asthma symptoms include wheezing, cough, chest pain, frequent respiratory infections, and difficulty breathing. Airway reactivity and inflammation cause these breathing problems. Asthma diagnoses usually happen in childhood, but the age of diagnosis may vary depending on when the patient's first flare-up occurs.A pediatrician, primary care provider, urgent care healthcare provider, pulmonologist, or allergist are all healthcare providers that can diagnose asthma. During the exam, the healthcare provider will ask the patient about potential risk factors, such as asthma triggers and a history of asthma symptoms, before moving on to a physical exam.
During the physical exam, the doctor will evaluate the patient for signs of allergies and monitor the patient's breathing. The doctor may also perform several diagnostic tests to determine if the patient has asthma. These tests include:
- Peak expiratory flow rate tests (PEFR) measure the amount and rate of air that can be forcefully exhaled from the lungs. The patient usually takes this test home to track measurements over time.
- Pulmonary function tests can help determine the severity of asthma as the patient breathes through a tube connected to a computer, which measures lung volume, capacity, flow rate, and gas exchange.
- Spirometry with a bronchodilator test can determine the efficacy of asthma medication by measuring the force of a patient's inhalation before and after using a bronchodilator medicine.
- Allergy tests identify allergens that the patient can learn to avoid. Avoiding asthma triggers can significantly help with the quality of life.
Asthma classification
Treatment will depend on whether your asthma is intermittent (happens occasionally) or persistent (happens regularly). Asthma may be classified as:- Intermittent asthma: Symptoms occur less than twice per week and wake you up less than twice monthly. People with intermittent asthma use their rescue inhaler (such as albuterol) one or two times per week and have normal lung function, and can perform everyday activities.
- Mild persistent asthma: Symptoms occur two or more days per week and wake you up 3 or 4 nights per month. You use your rescue inhaler more than two days per week. Although lung function is mostly normal and symptoms do not occur daily, this type of asthma affects some everyday activities.
- Moderate persistent asthma: Symptoms occur at least once a day and wake you up one or more nights per week. There is some decrease in lung function, some everyday activities are limited, and you need to use your rescue inhaler every day.
- Severe persistent asthma: With this type of asthma, symptoms occur during the day and wake you up every night. There is a significant decrease in lung function and significant limitations on everyday activities, and you need to use your rescue inhaler several times per day.
Asthma treatment options
There are two categories of asthma medications: control medications and quick-relief medications. Control medications are daily medicines used to prevent symptoms, reduce airway inflammation, and prevent further breathing issues."In maintenance, we recommend inhalers that include anti-inflammatories and bronchodilators," says Amy Darter, MD, an allergist at Oklahoma Institute of Allergy, Asthma, and Immunology. "Asthma sufferers also need to find out what the triggers are, including infections, allergies, exercise, and weather change." Identifying triggers can assist a patient in both the management of asthma and quick-relief treatments.
Quick-relief medications, like rescue inhalers, are used to alleviate symptoms during an asthma attack. They are also known as rescue inhalers and include medications such as albuterol or levalbuterol.
If a patient has a severe asthma attack or needs emergency treatment, they may be given quick-relief medications before heading to a hospital to be treated with a nebulizer or receive oxygen therapy. Additionally, patients with severe asthma may undergo a procedure called bronchial thermoplasty. During this procedure, the doctor applies heat in the airways in an attempt to shrink the muscles in the lungs that cause the constricting (bronchoconstriction).
Asthma action plan
Patients with asthma will have an asthma action plan, or management plan. The plan lists the patient’s medications and instructions. It also describes what to do when certain symptoms occur, and when to contact the healthcare provider or seek emergency medical attention. If you or your child do not have an action plan, you can download and print one and bring it to your healthcare provider to discuss and fill out together.Asthma medications
Beta agonists
There are two types of beta agonists (also called beta 2-agonists). Beta agonists often come in the form of inhalers and work by relaxing the muscles in the airways and allowing the lungs to breathe more easily.Long-acting beta agonists are used for long-term control of asthma. Also known as LABAs, these medications should always be prescribed in combination with an inhaled corticosteroid, either as a combination inhaler or as two separate products.
Short-acting beta agonists are quick-relief medicines (often referred to as rescue inhalers). One of the most commonly prescribed short-acting beta-agonists is called albuterol.
Corticosteroids
Corticosteroids (also called steroids) are effective at preventing and maintaining asthma symptoms over time. They can be taken by pill or liquid, inhaled, or injected. They work by reducing the body's inflammatory response, leading to more manageable asthma symptoms. Commonly prescribed corticosteroids include fluticasone (inhaled), beclomethasone (inhaled), and prednisone (oral). After using an inhaled steroid, rinse your mouth with water (and spit—do not swallow) to help prevent the chance of a yeast infection of the mouth or throat.Long-acting muscarinic antagonists (LAMAs)
LAMAs, such as Spiriva Respimat, are bronchodilators. They help open up the airways and can be used for long-term control of symptoms. They are not used as rescue inhalers.Combination inhalers
There are many combination inhalers that combine two or three ingredients to help control asthma symptoms. One example is Advair, which contains two ingredients: fluticasone (inhaled corticosteroid) and salmeterol (LABA).Leukotriene modifiers
These long-term medications control the effects of leukotrienes (inflammation chemicals) that cells release in asthma. Commonly prescribed leukotriene modifiers include Accolate (zafirlukast) and Singulair (montelukast).Mast cell stabilizers
Another popular class of drugs for controlling asthma is mast cell stabilizers. These medications can help to prevent inflammation of the airways caused by allergens or asthma triggers. The most commonly prescribed mast cell stabilizer is cromolyn.Theophylline
Theophylline is an oral bronchodilator medication that is sometimes prescribed to treat asthma or other breathing problems.Monoclonal antibodies
These asthma medications can be used as control medicines and injected in a doctor’s office or at home, or infused by a healthcare provider. Also referred to as biologics, this drug class blocks the body's responses to allergens. These medications are only prescribed to patients with severe asthma that is not controlled by other medications. Commonly prescribed monoclonal antibodies include mepolizumab and omalizumab.RELATED: How much do inhalers cost?
What is the best medication for asthma?
There is no one best medication for asthma. Your healthcare provider will determine what medications are needed for acute attacks as well as for long-term control. Consult your healthcare provider for more information about your treatment plan.Commonly prescribed asthma medications
| Drug name | Learn more | See SingleCare price |
|---|---|---|
| Accolate | accolate details | Get free coupon |
| Zafirlukast | zafirlukast details | Get free coupon |
| Advair Diskus | advair-diskus details | Get free coupon |
| Breo Ellipta | breo-ellipta details | Get free coupon |
| Flovent Hfa | flovent-hfa details | Get free coupon |
| Nucala | nucala details | Get free coupon |
| Prednisone | prednisone details | Get free coupon |
| Qvar Redihaler | qvar-redihaler details | Get free coupon |
| Serevent Diskus | serevent-diskus details | Get free coupon |
| Singulair | singulair details | Get free coupon |
| Ventolin Hfa | ventolin-hfa details | Get free coupon |
| Xolair | xolair details | Get free coupon |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and other factors. Other possible side effects exist. This is not a complete list.
What are the common side effects of asthma medication?
All asthma medications can cause side effects that vary in type and severity. However, it is important to remember that every patient is different and may experience different side effects for their specific asthma treatment. All patients should consult their primary healthcare provider before starting asthma medication and if they experience side effects. Side effects of asthma medicine can include, but are not limited to:- Headache
- Stuffy or runny nose
- Hoarseness
- Fast heart rate
- Sore throat
- Nausea
- Joint pain
- Dizziness
Living with asthma
It’s important to take care of yourself—as a whole. Talk to your healthcare provider about what steps you can take to stay healthy, such as:- Getting enough quality sleep.
- Practicing mindfulness or relaxation.
- Maintaining a healthy diet, focusing on fresh fruits, vegetables, lean protein, and whole grains.
- Exercising as tolerated. Ask your healthcare provider before beginning any new exercise program.
- Keeping doctor’s appointments. Make sure you understand your asthma action plan. Keep track of your symptoms.
- Taking medications as prescribed, and calling in refills a few days before you run out of medication.
- Getting all necessary vaccines. Ask your doctor or pharmacist which vaccines you need to stay up to date.
- Closing doors and windows (including car windows) on days where air quality is poor or pollen counts are high. Identify and limit other triggers when you can.
Frequently asked questions about asthma
What is the main cause of asthma?
Asthma is caused by hyperactivity of the muscles in the airways and airway inflammation. This leads to breathing problems and other respiratory symptoms. Asthma triggers can vary depending on the patient, as different triggers affect different patients in different ways.What are the types of asthma?
There are various types of asthma, including:- Adult-onset asthma develops in adulthood.
- Allergic asthma causes a respiratory reaction when exposed to specific triggers like mold or pollen.
- Asthma-COPD overlap (ACO) happens when someone presents symptoms of asthma and chronic obstructive pulmonary disease (COPD).
- Cough-variant asthma is a type of asthma where the main symptom is a chronic cough.
- Eosinophilic asthma is caused by high levels of eosinophils, a type of white blood cell. This type of asthma is generally severe.
- Exercise-induced bronchoconstriction (EIB) causes difficulty breathing during or after physical activity. Breathing in cold, dry air often triggers EIB.
- Nonallergic asthma is often caused by recurrent respiratory infections.
- Occupational asthma is caused by exposure to allergens, chemicals, and irritants as part of your job. For example, car mechanics breathe in gasoline and other fumes daily.
Can asthma kill you?
Unfortunately, asthma can lead to death if untreated. Asthma attacks constrict the airways, sometimes severely, and can keep a patient from breathing. Asthma can be a life-threatening health condition that almost always requires treatment. However, the good news is that asthma deaths are very rare and thought of as preventable since early treatment and patient education can be very effective.What foods trigger asthma?
The eight most common food allergens are:- Cow's milk
- Eggs
- Tree nuts (nuts that grow on trees, such as almonds, Brazil nuts, cashews, hazelnuts, pecans, pistachios, and walnuts)
- Peanuts
- Shellfish
- Soybeans
- Wheat
- Fish
What is the best medicine for asthma?
Every patient is different and will have different needs for their lifestyle and type of asthma. There is not one universal treatment for every person living with asthma. Some patients find relief with certain medicines, while others respond better to different ones. Using a nebulizer machine could be a convenient way to give children their asthma medication. Most people with asthma require a rescue inhaler such as albuterol. Many people will also need preventive treatment with other medications, such as inhaled steroids or combination inhalers, or other treatment.Are asthma inhalers bad for you?
There are two types of inhalers: metered-dose inhalers (MDI) and dry powder inhalers (DPI). People with a milk protein allergy should check with their healthcare provider before using a DPI, as most contain lactose. There are no side effects associated with the inhaler itself, but rather the medication it dispenses. Overuse of any drug can lead to adverse side effects. Additionally, all medications do have the potential for side effects. Patients should check with their prescribing healthcare professional about any concerns they may have about their inhaler.RELATED: How to properly administer an inhaler to your child