Asthma is a common, long-term inflammatory disease that affects the airways of the lungs, making breathing difficult. It can impact people of all ages and is the most common chronic disease among children. While there is no cure for asthma, it can be effectively managed with proper treatment and lifestyle adjustments.  

How Asthma Affects Your Airways

In individuals with asthma, the airways become inflamed and swollen. The muscles around the airways can also tighten, and the lining of the airways may produce excess mucus. These factors cause the airways to narrow, making it harder for air to flow in and out of the lungs. This can lead to a variety of respiratory symptoms.  

Common Symptoms of Asthma

Asthma symptoms can vary from person to person and may change over time. They are often worse at night or in the early morning and can sometimes worsen significantly, leading to an "asthma attack." Common symptoms include:  

• Wheezing: A whistling or squeaky sound when breathing, especially when exhaling.  

• Coughing: Persistent coughing, which may be worse at night, during exercise, or when exposed to triggers.  

• Shortness of breath (dyspnea): Difficulty breathing or feeling like you can't get enough air.  

• Chest tightness or pain: A feeling of pressure or squeezing in the chest.  

What Causes Asthma?

The exact cause of asthma isn't fully understood, but it's believed to be a combination of genetic and environmental factors.  

• Genetic Predisposition: Having a family history of asthma or allergies (like eczema or hay fever) increases the likelihood of developing asthma. If a parent has asthma, their child is three to six times more likely to develop it.  

• Environmental Factors: Exposure to certain substances and conditions can contribute to the development of asthma, especially early in life. These include:  

  • Allergens (e.g., pollen, dust mites, mold spores, pet dander, cockroach waste)  

  • Air pollution (indoor and outdoor)  

  • Tobacco smoke (including secondhand and thirdhand smoke, and maternal smoking during pregnancy)  

  • Occupational irritants (e.g., chemical fumes, gases, dust)  

  • Respiratory infections in early childhood (e.g., Respiratory Syncytial Virus - RSV)  

  • Premature birth or low birth weight.  

Common Asthma Triggers

For individuals with asthma, exposure to certain triggers can provoke or worsen symptoms. Triggers can vary widely among individuals and may include:  

• Allergens: Such as pollen, dust mites, mold, pet dander, and cockroach particles.  

• Irritants in the air: Smoke (tobacco, wood fires), chemical fumes, strong odors (perfumes, cleaning products), and air pollution.  

• Respiratory infections: Colds, flu, sinusitis, and COVID-19.  

• Exercise: Especially in cold, dry air (known as exercise-induced bronchoconstriction or EIB).  

• Weather changes: Cold air, dry wind, sudden temperature changes, thunderstorms, and high humidity.  

• Strong emotions and stress: Laughter, crying, yelling, anxiety.  

• Medications: Some medications, like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs e.g., ibuprofen), and beta-blockers, can trigger asthma in susceptible individuals.  

• Food additives: Such as sulfites found in some foods and beverages.  

• Gastroesophageal reflux disease (GERD): Stomach acids backing up into the esophagus can irritate the airways.  

Risk Factors for Developing Asthma

Several factors can increase a person's risk of developing asthma:

• Family history of asthma or allergies.

• Personal history of allergic conditions: Such as eczema or hay fever (allergic rhinitis).  

• Viral respiratory infections: Especially during infancy and early childhood.  

• Occupational exposures: To dust, chemical fumes, or other irritants.  

• Smoking or exposure to secondhand smoke.  

• Exposure to air pollution.

• Obesity: Being overweight or obese is linked to a higher risk of developing asthma and having more severe symptoms.  

• Race or ethnicity: Certain groups, such as Puerto Rican individuals and Black or African American people, have a higher risk.  

• Sex: Asthma is more common in boys during childhood, but more common in women during adulthood.  

How Asthma is Diagnosed

Diagnosing asthma involves several steps, and a doctor will consider your medical history, symptoms, and test results.  

• Medical History and Symptom Review: Your doctor will ask about your symptoms, their frequency and severity, family history of asthma or allergies, and potential triggers. Keeping a diary of symptoms can be helpful.

• Physical Examination: The doctor will listen to your breathing with a stethoscope for wheezing and examine your nose, throat, and upper airways. They may also check for signs of allergic conditions like eczema.  

• Lung Function Tests (Spirometry): This is the main test used to diagnose asthma in individuals aged 5 and older. You'll breathe into a device called a spirometer that measures how much air you can exhale and how quickly. The test may be repeated after you inhale a medication (bronchodilator) that opens airways; significant improvement after the medication can indicate asthma.  

• FeNO Test (Fractional exhaled Nitric Oxide): This test measures the level of nitric oxide in your breath, which can be a sign of inflammation in your lungs.  

• Challenge Test (Bronchoprovocation Test): If your spirometry results are normal but asthma is still suspected, a challenge test may be done. This involves inhaling a substance (like methacholine) or undergoing exercise to see if it triggers airway narrowing, followed by a spirometry test.

• Diagnosing in Young Children (under 5): Diagnosis can be more challenging in young children as they often can't perform lung function tests reliably. Doctors may rely on parental reports of symptoms, family history, and sometimes a trial of asthma medication to see if it improves symptoms.  

• Ruling out other conditions: Your doctor may order other tests like chest X-rays, CT scans, blood tests, or assessments for GERD to rule out other conditions that could be causing similar symptoms.  

Treating and Managing Asthma

While asthma can't be cured, it can be effectively managed. Treatment aims to control symptoms, prevent asthma attacks, and maintain normal lung function. This usually involves a combination of medication and lifestyle strategies.  

Asthma Medications:

There are two main types of asthma medications:

Long-Term Control Medications (Preventers): Taken daily on an ongoing basis to reduce airway inflammation and prevent symptoms. These are the cornerstone of asthma treatment.  

Quick-Relief Medications (Relievers or Rescue Medications): Used as needed for rapid, short-term relief of asthma symptoms during an attack or before exercise if recommended.  

In addition to this, there are other medications such as pills or injectable medications aimed at reducing the allergic inflammation caused by asthma.