What is Asthma? Causes, Symptoms, and Treatment
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 8, 2020.
What is Asthma?
Catching one’s breath is not always an easy task.
In fact, roughly 19.2 million adults and 5.5 million children in the U.S. have asthma. This equates to about 7.7% of adults and 7.8% of children under 18 years of age, according to the CDC.
- What is asthma? Asthma is a lung disease caused by inflammation (swelling) that leads to wheezing, shortness of breath, chest tightness, and coughing.
- Who has asthma? Many people with asthma also have a family history of allergies, such as hay fever or pet allergies. It's a common ailment and reason for a doctor visit.
- How is it treated? Although asthma cannot be cured, it can usually be well-controlled with medications. Many patients can live an active and normal lifestyle.
Follow along for tips and treatment options for this common but long-term illness.
What Happens During an Asthma Attack?
An asthma attack is exactly that - the muscles around the airways and the lining of the air passages quickly tighten and restrict breathing.
- Swelling reduces the amount of air that can pass through the airways and leads to a high-pitched, wheezing sound.
- Asthma attacks can become life-threatening if the airflow in the lungs becomes severely blocked.
- Quick-relief asthma inhalers like albuterol (brand name examples: ProAir HFA, ProAir RespiClick, ProAir Digihaler, Proventil HFA, Ventolin HFA) are often used to treat sudden asthma attacks.
What Causes Asthma?
The exact reason why people get asthma is not fully known. A family history and the environment seem to play a role for most (but not all) people.
In sensitive people, breathing in allergy-causing substances (called "allergens" or "triggers") can start the onset of asthma symptoms.
Triggers might include:
- pet dander
- dust mites
- cockroach allergens
- molds, or pollens
- respiratory infections
- cold air
- food sulfites
- tobacco smoke
- other air pollutants.
What are the Symptoms of Asthma?
Asthma symptoms may persist regularly or come and go with the season or asthma triggers. In the fall or spring, asthma symptoms may worsen, especially in patients with mold or pollen allergies.
Asthma symptoms can include:
- Shortness of breath
- Chest tightness
- Difficulty sleeping due to coughing or wheezing
- A whistling or wheezing sound when exhaling (a frequent sign in children)
- Symptoms are worsened by a cold or the flu
Your asthma may be worsening if you notice frequent symptoms, more difficult breathing as measured by your peak flow meter, or you are increasing the use of your fast-acting inhaler.
How is Asthma Diagnosed?
A doctor visit is in order if you have asthma symptoms.
Asthma is diagnosed based on:
- Your medical and family history of asthma and allergies
- A physical exam
- Asthma test results.
The doctor will use a stethoscope to listen to your lungs and look for signs of asthma such as wheezing, swollen nasal passages, and runny nose.
Asthma tests may include a lung function test called spirometry that measures how much and how fast you can blow air in and out. Your doctor might recommend allergy testing, too.
How is Asthma Treated and Controlled?
Asthma treatment is aimed at controlling airway inflammation and avoiding known allergy triggers, like pet dander and pollen. The main goals are to restore normal breathing, prevent asthma attacks and restore daily activities.
Daily asthma treatment helps to prevent symptoms, and asthma inhalers are the preferred method because the drug can be delivered directly into the lungs in smaller doses with less side effects. Some agents are given by injection or in pill form, too.
There's only one over-the-counter (OTC) inhaler for asthma. In November 2018, the FDA announced that Primatene Mist inhaler would return as the only FDA-approved asthma inhaler available without a prescription in the U.S. Primatene Mist is used to temporarily relieve mild symptoms of intermittent asthma in people ages 12 and older.
- You can view the new step-by-step directions for the new Primatene Mist.
- See your doctor for advice about use of any asthma treatment.
What Are Some Common Medications Used to Treat Asthma?
Asthma is treated and controlled primarily with two types of medications:
- Inhaled corticosteroids (examples: Flovent HFA, Pulmicort Flexhaler) are used to control lung swelling over the long-term
- Quick-relief beta2-agonists like albuterol (examples: ProAir HFA, Proventil HFA) are used as "rescue" inhalers when symptoms occur.
Quick-relief inhalers don't reduce lung swelling (inflammation) and should not be used in place of long-term, inhaled corticosteroid ("steroid") treatment.
- A long-acting beta2-agonist (LABA) bronchodilator and corticosteroid combination, such as Advair (fluticasone and salmeterol), may be needed in more severe asthma. Bronchodilators help your breathing by relaxing the smooth muscle around the lung airways.
- Other brands of fluticasone and salmeterol include AirDuo Digihaler, AirDuo Respiclick, and Wixela Inhub.
- Warning: The use of long-acting beta-2 agonists (LABAs) (like salmeterol or others) without a corticosteroid is associated with an increased risk of asthma-related deaths.
There are many other long-term asthma control drugs available, including: cromolyn inhalation, oral theophylline, tiotropium (Spiriva Respimat), fluticasone and vilanterol (Breo Ellipta) and omalizumab (Xolair injectable).
Singulair and Related Medications
Other treatments include:
- Leukotriene modifiers, such as montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR).
- These drugs block chemicals that cause inflammation and airway narrowing in asthma. They are taken in a pill form by mouth, not by inhalation.
Montelukast is also approved for allergy treatment (allergic rhinitis) and prevention of exercise-induced asthma.
- However, the FDA added a Boxed Warning to montelukast in March 2020 warning about the risk of neuropsychiatric events (such as agitation, depression, sleeping problems, and suicidal thoughts and actions) with montelukast (Singulair).
- The boxed warning advises health care providers to avoid prescribing montelukast for patients with mild symptoms, particularly those with allergic rhinitis.
In November 2018, the FDA announced that Primatene Mist inhaler would return as the only FDA-approved asthma inhaler available without a prescription in the U.S. Primatene Mist is used to temporarily relieve mild symptoms of intermittent asthma in people ages 12 and older.
- You can view the new step-by-step directions for the new Primatene Mist.
- If your symptoms are ongoing or worsen, you should see your doctor for prescription asthma medications.
How Should I Use My Rescue Inhaler?
Work with your doctor and pharmacist to develop an asthma action plan, particularly for when you have an asthma attack.
- Be sure you are using your quick-relief inhaler correctly and keep it with you at all times.
- If you use the rescue inhaler more than two times a week, contact your prescriber; your asthma may not be well-controlled and you might need to add or change a medication.
- If you aren't sure how to use your metered dose inhaler (MDI), ask your pharmacist or learn more here.
You should be able to sleep at night without symptoms, like coughing or wheezing. Be sure a caregiver or your child's school nurse understands your asthma action plan and inhaler use, too.
My Child is Having Trouble Using an Inhaler, What Should I Do?
Children, especially those under 5 years of age, may need to use a spacer device or nebulizer to help with the process of breathing in their asthma medication. The technique of using a metered-dose inhaler can be hard for small children to master.
- Spacer devices have a chamber that receives the aerosol before it is inhaled.
- Nebulizers are an electronic machine that converts liquid medication into a fine mist breathing treatment to ease inhalation.
- Spacers are portable, while nebulizers are available for home (electric) or portable (battery) use.
- Spacers and nebulizers are also useful for anyone (not just a young child) who prefers to use these tools to ease inhalations.
- Your doctor, nurse or pharmacist can order these for you or let you know how to access one.
What Are Common Side Effects with Asthma Medications?
Inhaled asthma medications are usually well-tolerated with few side effects when used as prescribed; however, there are a few precautions.
- Inhaled corticosteroids can cause oral thrush, a fungal infection of the mouth.
- Rinsing your mouth with water after using the inhaler or using a spacer device might help prevent thrush.
- Contact your doctor if you notice white patches in your mouth, which could be the beginning of a thrush infection.
Inhaled quick-acting medicines like albuterol can also cause side effects like: shakiness, nervousness, difficulty sleeping or a fast heartbeat, among others.
How is Exercise-Induced Asthma Different From Regular Asthma?
Exercise-induced asthma (EIA) is a swelling of the airways during exercise. EIA can occur in people with or without asthma. EIA may happen during or after physical activity, especially in cold weather, when exposed to an asthma trigger, and during an illness.
Symptoms of EIA may include:
- fatigue (tiredness)
- chest tightness
To treat EIA, you may need to avoid triggers and take medicine before you exercise or on a daily basis.
Many of the same drugs used for asthma can be used for EIA, such as albuterol and montelukast (Singulair). However, the FDA now includes a Boxed Warning for montelukast warning of psychiatric side effects, and does not advise it be used for mild symptoms.
What is a Peak Flow Meter?
A peak flow meter is a small handheld device you can keep at home that measures how well your lungs are working.
- It measures how much and how fast you exhale after taking a deep breath in and blowing out hard.
- The numbers tell you and your healthcare provider if your asthma action plan is working.
- Your peak flow number can help you predict times when your asthma may worsen; the numbers may decrease a few hours or days before an asthma attack.
- Your healthcare provider can show you how to use a peak flow meter and you can read about it here.
Are Asthma Medicines Expensive?
Many asthma treatments are available generically and can save money; however, some asthma treatments are expensive. Inhaler medications have been reformulated to be more safe for the environment and some brands can be very expensive
However, generic albuterol inhalers are now available at the pharmacy, and can save you money. On average, a generic albuterol inhaler using an online coupon costs roughly $25 to $35 cash, per inhaler. It may be even more affordable if you have Medicare, Medicaid, or private health insurance.
- Patients should talk with their doctor when getting their prescription to be sure they can afford their medications; less costly alternatives may be available.
- Online coupons may help to lessen the sticker shock, too.
- Use generics when you can to save money.
Drugs to control asthma are usually taken every day, so it is important to work with your prescriber and pharmacist to find treatments you can afford. Check with your insurance carrier for their cost information.
Asthma Approvals: Cinqair and Nucala
- Cinqair reduces eosinophils, a type of white blood cell that contributes to asthma development.
- It is classified as an interleukin 5 antagonist monoclonal antibody (IgG4 kappa).
- Cinqair is given once every four weeks by intravenous (IV) infusion in your doctor's office. It take about 20 to 50 minutes to receive the infusion.
- Common side effects included anaphylaxis (severe allergy), cancer, and muscle pain.
- Nucala blocks interleukin-5 and reduces inflammatory-producing white blood cell accumulation in the lungs.
- Nucala is given by subcutaneous (under the skin) injection every 4 weeks. Nucala can be given at home by self-injection using a prefilled syringe or autoinjector if approved by your doctor. It is given into the upper arm, thigh, or abdomen.
- Common side effects may include headache, injection site reactions, back pain, and weakness.
Teva's Approvals: AirDuo and ArmonAir
- AirDuo Respiclick is a combination corticosteroid and long-acting beta2-adrenergic agonist. It is a breath-activated, dry powder inhaler formulations. AirDuo contains the same active ingredients as Advair Diskus.
- AirDuo RespiClick or Digihaler are available in three different strengths and are administered as one inhalation twice daily.
- AirDuo Digihaler, which can be used with a mobile app, contains a built-in electronic module that records data about inhaler events. It detects when the inhaler is used and measures inspiratory flow rates. AirDuo Digihaler does not need to be connected to the app in order to use the medicine.
- The most common side effects for AirDuo includes nasopharyngitis (common cold), headache, cough, back pain, and oral candidiasis (thrush).
ArmonAir RespiClick has been discontinued by the manufacturer, but ArmonAir Digihaler was approved in February 2020 to take it's place. This Digihaler works similar to the AirDuo product.
- ArmonAir Digihaler contains only the corticosteroid fluticasone, the same active ingredient as Flovent.
- ArmonAir Digihaler is also available in three strengths and it is taken as one inhalation twice daily.
- The most common side effects for ArmonAir Digihaler includes nasopharyngitis (common cold), headache, cough, upper respiratory tract infections, back pain, and oral candidiasis (thrush).
Asthma Approvals: Fasenra
- Elevated levels of eosinophils, a type of white blood cell, are seen in about half of severe asthma patients and results in inflammation, increased asthma severity, decreased lung function and increased risk of exacerbations.
- These patients often rely on oral steroids to manage their symptoms, which can lead to serious side effects.
Fasenra is an interleukin-5 receptor monoclonal antibody. It is given initially as a subcutaneous (under the skin) injection once every 4 weeks for the first 3 doses, then once every 8 weeks. It is available in a prefilled syringe and single-use auto-injector pen.
In studies, Fasenra reduced the annual asthma exacerbation rate by up to 51% compared to placebo. Other results included a significant improvement in lung function (FEV1), a 75% median reduction in use of oral steroids, a 52% discontinuation rate of oral steroids, and a favorable side effect profile.
Asthma Approvals: Dupixent
In October 2018, Sanofi and Regeneron’s Dupixent (dupilumab) was FDA-approved for add-on therapy in uncontrolled asthma. Dupixent is an interleukin inhibitor (IL-4 and IL-13) immunosuppressive agent that helps to control inflammation.
- Dupixent is used as an add-on maintenance therapy in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma.
- In clinical studies, Dupixent improved lung function, lowered the use of oral corticosteroids, and reduced asthma exacerbations.
- For people with asthma, Dupixent comes in two doses (200 mg and 300 mg) given by subcutaneous (under the skin) injection every other week at different sites (after an initial loading dose). It's available as a prefilled syringe or auto-injector.
- It is also approved to treat moderate-to-severe atopic dermatitis, the most common type of eczema, and chronic rhinosinusitis (long-term sinus inflammation) with nasal polyps in adults.
Finished: What is Asthma? Causes, Symptoms, and Treatment
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- American Academy of Allergy Asthma and Immunology (AAAAI). Asthma overview. Accessed Sept. 8, 2020 at http://www.aaaai.org/conditions-and-treatments/asthma.aspx
- Fanta CH, M.D. Asthma. N Engl J Med 2009; 360:1002-14. Sept. 8, 2020.
- Centers for Disease Control and Prevention (CDC). Asthma Fast Stats. Accessed Sept. 8, 2020 at https://www.cdc.gov/nchs/fastats/asthma.htm