What is Asthma? Causes, Symptoms, & Treatment
Medically reviewed on Nov 27, 2017 by L. Anderson, PharmD.
What is Asthma?
Catching one’s breath is not always an easy task.
In fact, roughly 30 million Americans have asthma. 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.
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. 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 include pet dander, dust mites, cockroach allergens, molds, or pollens. Respiratory infections, exercise, cold air, stress, food sulfites, tobacco smoke, and other air pollutants can also trigger asthma symptoms.
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 prevention is the mainstay of therapy - using inhaled corticosteroids like fluticasone (Arnuity Ellipta, Flovent Diskus, Flovent HFA), and adding a long-acting beta2-agonist like salmeterol (Advair, Serevent) for more severe or poorly controlled asthma. Acute asthma symptoms are often treated with a fast-acting bronchodilator inhaler such as albuterol (ProAir).
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, and 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, and 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.
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 inhaler, 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 nebulizer to help with breathing in asthma medication. Spacer devices have a chamber that receives the aerosol before it is inhaled. Nebulizers convert 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 who has trouble with an inhaler. Your doctor can order these for you. Learn more about how to use a nebulizer here and about spacers here. If you still aren't sure, ask your pharmacist.
What Are Common Side Effects with Asthma Medications?
Inhaled asthma medications are usually well-tolerated with few side effects when used as prescribed.
Inhaled corticosteroids can cause 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 thrush.
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 like coughing, wheezing, fatigue, chest tightness, or headache may occur. 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? Should I Use One If I have Asthma?
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 doctor 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, but ProAir is expected to be available generically in Dec. 2016. Patients should talk with their doctor when getting their prescription to be sure they can afford their medications; less costly alternatives may be available.
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
In March, 2016, Teva Pharmaceuticals' Cinqair (reslizumab) was approved as an add-on maintenance treatment of severe asthma in adults not well-controlled on their current asthma medications. 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 (mepolizumab) is GlaxoSmithkline's IL-5 antagonist FDA-approved in November 2015 for the add-on maintenance treatment of severe eosinophilic asthma. 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 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 will be 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. Fasenra is given initially as a subcutaneous 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.
Finished: What is Asthma? Causes, Symptoms, and Treatment
- 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. Basic Information. Accessed 03/07/2017. http://www.cdc.gov/asthma/faqs.htm