Asthma

Asthma is a chronic respiratory condition that causes inflammation and narrowing of the airways in the lungs. This can lead to difficulty breathing, and for some, it is a minor issue, but for others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. While there is no cure, symptoms can be controlled with proper management. 

Signs and symptoms

Asthma symptoms can vary widely among individuals and often appear suddenly or are triggered by certain factors. 

Common signs and symptoms include:

  • Wheezing: A whistling or squeaky sound, especially when breathing out, which is caused by narrowed airways.

  • Shortness of breath: A feeling that you can't get enough air. This can occur with activity or even at rest.

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

  • Coughing: A persistent cough, which can be worse at night or with exercise.

  • Trouble sleeping: Symptoms often worsen at night, waking you up with coughing, wheezing, or shortness of breath. 

Asthma attacks

A severe worsening of symptoms is known as an asthma attack. Signs of a life-threatening emergency include: 

  • Rapidly worsening shortness of breath or wheezing.

  • No improvement after using a quick-relief inhaler.

  • Bluish color to the lips or face.

  • Extreme difficulty talking or walking.

  • Severe anxiety due to shortness of breath. 

Diagnosis

To diagnose asthma, a doctor will evaluate your symptoms, medical history, and risk factors. There is no single test for asthma, so the diagnosis is based on a combination of factors. 

  • Physical exam: The doctor will ask about your symptoms and listen to your breathing with a stethoscope to check for wheezing or other abnormal sounds.

  • Spirometry: The most common test for diagnosing asthma in those over 5 years old. You will blow into a tube attached to a machine (spirometer) to measure how much and how quickly you can breathe out. A test performed before and after using a bronchodilator (a medicine to open the airways) helps determine if your breathing improves with treatment.

  • Methacholine challenge: If your initial spirometry test is normal, a doctor may have you inhale a substance called methacholine, which can trigger mild airway narrowing in those with asthma. Lung function is then tested again.

  • Allergy testing: Since allergies can be a major trigger, tests can identify specific allergens like dust mites, pollen, or pet dander that may cause or worsen your symptoms.

  • For children under 5: Diagnosis can be more challenging. Doctors often rely on a child's medical history, family history of asthma, and observation of symptoms rather than lung function tests. 

Treatment

The goal of asthma treatment is to control symptoms, prevent attacks, and allow you to live a normal, active life. Treatment often includes a combination of medications and lifestyle changes. 

Medications

  • Quick-relief (rescue) medications: These inhalers, like albuterol, provide fast-acting relief by opening the airways. They should be used at the first sign of symptoms or before exercise if your doctor recommends it.

  • Long-term control medications: These are taken daily to reduce airway inflammation and prevent symptoms. They do not provide immediate relief.

    • Inhaled corticosteroids: Reduce swelling and mucus in the airways.

    • Long-acting bronchodilators: Relax the muscles around the airways.

    • Combination inhalers: Some inhalers combine both a corticosteroid and a long-acting bronchodilator.

  • Biologics: These injectable medications are used for severe asthma that doesn't respond to standard treatments.

  • Oral corticosteroids: Taken as pills for a short period to treat severe asthma attacks. 

Lifestyle changes and management

  • Identify and avoid triggers: Common triggers include allergens, cold air, smoke, air pollution, and respiratory infections.

  • Asthma action plan: Work with your doctor to create a personalized plan that outlines your daily medications and what to do during an asthma attack.

  • Monitor your breathing: Use a peak flow meter at home to track your lung function and recognize early warning signs.

  • Maintain a healthy weight: Being overweight can worsen asthma symptoms.

  • Vaccinations: Get flu and pneumonia shots to prevent infections that can trigger asthma attacks.

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