What is Asthma? Causes, Symptoms, & Treatment
Medically reviewed by L. Anderson, PharmD. Last updated on Nov 23, 2018.
What is Asthma?
Catching one’s breath is not always an easy task.
In fact, roughly 26.5 million adults and children in the U.S. have asthma, according to the CDC.
- Asthma is a lung disease caused by inflammation (swelling) that leads to wheezing, shortness of breath, chest tightness, and coughing.
- Many people with asthma also have a family history of allergies, such as hay fever or pet allergies. It's a common ailment and complaint.
- Although asthma cannot be cured, it can be controlled with medications and patients can live an active and normal lifestyle.
Follow along for tips and treatment options for this common and chronic 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 tighten, often quickly, restricting 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 (ProAir HFA, ProAir RespiClick, 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 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 shortness of breath, 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 worseing 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.
When needed, acute asthma symptoms are often treated with a fast-acting bronchodilator inhaler such as albuterol (ProAir, others).
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 asthma medicines are given in pill or injection form, too.
What Are Some Common Medications Used to Treat Asthma?
Asthma is treated and controlled primarily with two types of medications:
- Inhaled corticosteroids (examples: Flovent, Pulmicort) are used to control lung swelling over the long-term
- quick-relief beta2-agonists like Albuterol (examples: ProAir, Proventil) are used as "rescue" inhalers when symptoms occur.
Quick-relief inhalers like albuterol don't reduce lung swelling and should not be used in place of long-term, inhaled corticosteroid treatment. A long-acting beta2-agonist, such as Advair, may needed in more severe asthma.
What Other Treatments Are Used to Treat Asthma?
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.
- Montelukast is also approved for allergy treatment and exercise-induced asthma.
- These drugs are taken in a pill form by mouth, not by inhalation.
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.
- In 2011, OTC Primatene Mist was removed from the market to phase out products worldwide containing ozone-depleting chlorofluorocarbons (CFCs) propellants.
- The new inhalation delivery system no longer includes CFC, provides a built-in spray indicator and a metal canister, which replaces the original glass container.
- 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 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 a medication change. 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. Be sure a caregiver or a child's school understands the 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 a spacer device or use of a nebulizer to help with breathing in their asthma medication.
- 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. BUt 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 shakiness, nervousness, difficulty sleeping or a fast heartbeat.
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, with asthma triggers, 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).
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 or 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 reformulated to be more safe for the environment, like ProAir HFA (albuterol), are costly.
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.
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 cost information, too.
Latest 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 injection in your doctor's office.
- Common side effects included anaphylaxis, cancer, and muscle pain.
- Nucala blocks interleukin-5 and reduces inflammatory-producing white blood cell accumulation in the lungs.
- Like Cinqair, Nucala is given by injection every 4 weeks.
- Common side effects may include headache, injection site reactions, back pain, and weakness.
Latest Asthma Approvals: AirDuo RespiClick and ArmonAir RespiClick
In February 2017, Teva's AirDuo RespiClick (fluticasone propionate and salmeterol) and ArmonAir RespiClick (fluticasone propionate) were both FDA-approved for adolescent and adult patients with asthma.
- AirDuo is a combination corticosteroid and long-acting beta2-adrenergic agonist, while ArmonAir is the single corticosteroid.
- Both products are breath-activated, dry powder inhaler formulations.
- AirDuo RespiClick contains the same active ingredients as Advair while ArmonAir RespiClick contains the same active ingredient as Flovent.
- The most common side effects for both of these asthma products were nasopharyngitis (common cold), headache, cough, and oral candidiasis (thrush). Back pain was also reported for AirDuo RespiClick, and upper respiratory tract infections were seen in the ArmonAir RespiClick group.
- The available strengths of AirDuo RespiClick are: 55/14 mcg, 113/14 mcg and 232/14 mcg administered as one inhalation twice daily. ArmonAir RespiClick is available as 55 mcg, 113 mcg, and 232 mcg also taken as one inhalation twice daily.
Latest Asthma Approvals: Fasenra
In November 2017, AstraZeneca's Fasenra (benralizumab) was approved for severe eosinophilic asthma.
- Fasenra is an interleukin-5 receptor monoclonal antibody used as an add-on maintenance treatment.
- 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.
Eosinophilic asthma patients have limited treatment options and often rely on oral steroids to manage their symptoms, which can lead to serious side effects. 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.
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.
Latest 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 the 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 injection (under the skin) every other week at different sites after an initial loading dose.
- It is also approved to treat moderate-to-severe atopic dermatitis, the most common type of eczema.
Finished: What is Asthma? Causes, Symptoms, and Treatment
- FDA Approves Dupixent (dupilumab) for Moderate-to-Severe Asthma. Drugs.com. Accessed Nov. 23, 2018 at https://www.drugs.com/newdrugs/fda-approves-dupixent-dupilumab-moderate-severe-asthma-4848.html
- Fasenra Prescribing Information and Patient Information. AstraZenenca. Nov. 2017. Accessed Nov 27, 2017 at https://www.azpicentral.com/fasenra/fasenra_pi.pdf#page=1
- American Academy of Allergy Asthma and Immunology (AAAAI). Asthma overview. Accessed 03/07/2017. http://www.aaaai.org/conditions-and-treatments/asthma.aspx
- Fanta CH, M.D. Asthma. N Engl J Med 2009; 360:1002-14
- Centers for Disease Control and Prevention (CDC). Asthma Fast Stats. Accessed 11/23/2018. https://www.cdc.gov/nchs/fastats/asthma.htm