Asthma

Asthma is a common lung disease that can make breathing difficult. Learn more about asthma, including symptoms, causes, types, and treatment options.

Introduction

More than 260 million people worldwide have asthma, according to the World Health Organization (WHO). This includes more than 25 million people in the United States. For many, the lung disease starts during childhood, although it can affect anyone at any age.

If you are among those living with asthma, learning as much as you can about the disease can help you manage it more effectively. Read on to understand the different types of asthma, symptoms to track, and what happens during an asthma attack. Find out what can trigger your symptoms and which asthma treatments and lifestyle strategies can help you prevent and better control your condition. 
 

What is asthma?

Young woman with asthma taking a break during a workout to use her asthma pump

Asthma is a chronic lung disease that affects the bronchial tubes. These airways in your lower respiratory tract allow oxygen (O2) to flow into your lungs when you inhale and they channel waste gases such as carbon dioxide (CO2) out of your lungs when you exhale. This vital process keep your lungs healthy, nourishes your cells and organs, and sustains life.

Asthma causes the lining of these bronchial tubes to become inflamed and swollen. This inflammation and swelling narrows your airways and makes them sensitive, which makes it harder for air to move freely. The muscles surrounding the airways become tighter, which restricts air flow even more. Meanwhile, glands in the airways produce extra mucus, further impeding breathing.

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What are the symptoms of asthma?

Your asthma symptoms—and the severity of those symptoms—may differ from those experienced by other people and can also vary from one episode to the next. You may have mild symptoms that rarely occur or you may experience some that linger and make it difficult for you to get through daily activities.

Common asthma symptoms include:

  • Chest tightness: You may feel pressure as if something’s squeezing or sitting on your chest.
  • Cough: You may cough frequently, with or without phlegm.
  • Shortness of breath: You may feel like you can’t get enough air into your lungs, which can prompt you to take shallow and rapid breaths.
  • Wheezing: You may notice a whistling, squeaky, almost musical sound when you breathe.

Other health conditions can also cause these symptoms. Acid refluxheart attackheart failurepneumonia, and a sinus infection are just a few examples of these. But asthma symptoms tend to follow a pattern:

  • They come and go through the course of your day or over time.
  • Triggers for your symptoms may include allergies, cold air, exercise, or breathing too fast when you laugh or cry.
  • Your symptoms tend to be worse in the morning or at night. (The latter is known as nocturnal asthma.)

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What is an asthma attack?

Woman suffering asthma attack reaching inhaler sitting on a couch in the living room at home

Your symptoms grow worse during an asthma attackalso called an asthma flare-up or flare. Attacks can arrive suddenly or gradually and tend to occur more often if you have severe asthma.

You may sometimes experience warning signs of an impending asthma attack. Although these can differ for each person, some of the common signs include:

  • Itchy neck or skin
  • Lack of energy or feeling weak and tired
  • Nasal congestion or rhinorrhea (runny nose)
  • Producing more sputum or mucus
  • Raised shoulders, slouching, or leaning forward more than usual

What is a severe asthma attack?

All asthma attacks require immediate treatment as instructed by a healthcare provider (HCP). This entails using a short-acting bronchodilator called a rescue or quick-relief inhaler to quickly expand or dilate your airways, allowing you to breathe easier.

Get prompt medical attention after giving yourself this treatment: If your symptoms persist or grow severe even after your asthma attack treatment, it’s crucial to get emergency medical care at a nearby hospital emergency department (ED).

Signs and symptoms of a severe asthma attack in an adult include:

  • Chest pain, tightness, squeezing, or pressure that’s getting worse
  • Persistent or severe shortness of breath, wheezing, or cough
  • Hyperventilation or hypoventilation (breathing that is too shallow, too slow, or otherwise inadequate to meet your body’s needs)
  • Chest expands but doesn’t deflate as you exhale
  • Shallow or hard breathing
  • Intercostal retractions (rare in adults), when the muscles between the ribs pull or suck inward when you inhale
  • Ribs or stomach suck in and push out deeply and rapidly as you breathe
  • Posturing (shoulders hunched over)
  • Cyanosis, a condition that causes the skin of your face, lips, or fingers to turn bluish if you have a lighter skin tone or whitish or grayish if you have a darker skin tone

Having difficulty breathing can lead to a condition called hypercapnia or hypercarbia in which the level of CO2 in your blood rises above normal. This can aggravate ongoing asthma symptoms such as shortness of breath and fatigue and cause other symptoms such as nausea, lightheadedness or dizziness, paranoia, seizures, and heart palpitations.

Severe asthma symptoms in a child, toddler, or infant include:

  • Nasal flaring, when nostrils rapidly widen and narrow. (This symptom is rare in adults.)
  • Labored breathing, which may include nasal flaring, skin sucking in between the ribs or above the sternum, and exaggerated belly breathing or movement
  • Cyanosis

In addition, an infant may:

  • Appear agitated, cranky, irritable, or sluggish
  • Bob their head or have a floppy body
  • Grunt
  • Not recognize and respond to parents or caregivers

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What are the causes and risk factors for asthma?

The causes of asthma aren’t fully understood by the scientific community, and there may not be an obvious reason why some people develop asthma. What is known is that genetic and environmental factors seem to influence the development of the disease. These factors include:

Air pollution

Being exposed to the main component of smog, called ozone, can raise the risk of asthma. Ozone is highly irritating to the lungs and airways, especially in people with impaired lung function.

Smog, also called haze, is more likely to affect people in urban areas where ozone emissions from factories and motor vehicles such as cars and buses are higher. Low winds and more sunlight also contribute to higher ozone levels in these areas.

Other types of air pollution that raise the risk of asthma include small airborne particles found in airborne dust, haze, and smoke. These small particles can enter your mouth or nose and make their way to your lungs, triggering asthma symptoms or flare-ups.

Allergies

Allergies and asthma have close ties. You’re more likely to develop asthma if you have atopic syndrome, also called atopy. This means you have a higher likelihood of various allergic reactions such as allergic rhinitis (hay fever) and atopic dermatitis, the most common type of the skin disease eczema.

Family history

You’re three to six times more likely to develop asthma if you have a biological parent with the condition. You’re also more likely to have allergies if one or both of your biological parents have them.

Obesity

Children and adults who are overweight or obese are more likely to develop asthma. The reason is not clear, but scientists believe low-grade inflammation that occurs with excess weight likely plays a role.

The connection between asthma and obesity may start as early as the fetal period. Being obese and gaining excess weight during pregnancy can raise the risk of your child developing asthma by 15 to 30 percent, according to a 2023 review of studies published in Pharmacological Research.

Obesity also raises the risk of serious asthma complications, including:

  • Severe impairment in lung function
  • More frequent asthma attacks
  • Poor asthma control
  • Reduced effectiveness of conventional asthma treatments

Occupational exposure

Exposure to certain allergens, chemicals, and irritants in some work environments raises the risk of developing asthma and having your asthma symptoms triggered. These include chemical fumes and vapors, industrial or wood dusts, and molds.

Smoking

The lung irritation caused by smoking tobacco can increase asthma risk. Smoking or being exposed to secondhand smoke during pregnancy can also raise the risk of your child developing the disease.

Childhood respiratory infections and allergen exposure

Having respiratory infections and being exposed to airborne allergens and irritants at an early age can inflame and damage lung tissue. This damage can impair lung function and raise the risk of developing asthma later in life. This is possibly because your immune system is still developing during infancy and early childhood.

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What are common asthma triggers?

Asthma triggers set off or worsen asthma symptoms. Many of these overlap with asthma risk factors. Common asthma triggers include:

  • Air pollution: This includes ozone and emissions from cars, buses, factories, lawn mowers, leaf blowers, and snow blowers.
  • Animals: You may have allergies to dander and saliva from animals with fur or feathers, which can trigger asthma attacks.
  • Exercise: Physical activity can trigger asthma symptoms, especially if it is intense, prolonged, or performed in hot, cold, humid, or windy weather.
  • Food: Allergies to certain foods can trigger asthma attacks. These include peanuts and shellfish, spices such as cinnamon and garlic, and food additives such as sulfites, which are found in many foods and drinks such as wine and canned and dehydrated goods.  
  • Medicines: Taking certain drugs, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), naproxen, and blood pressure medicines such as beta-blockers and angiotensin-converting enzyme inhibitors can lead to asthma flares.
  • Medical conditions: Respiratory infections (such as cold and flurespiratory syncytial virus, and sinus infections) can trigger asthma attacks, as can gastroesophageal reflux disease (GERD), commonly called acid reflux.
  • Mold: This allergen can trigger asthma symptoms.
  • Pests: Droppings, saliva, or body parts of cockroaches, rodents such as mice and rats, and tiny bugs called dust mites can trigger allergy and asthma symptoms.
  • Pollen: Allergies to pollen in the air from weeds, trees, grass, and plants can trigger asthma attacks, especially during the spring and fall months when the pollen count is higher.
  • Smoke: Any type of smoke can trigger asthma symptoms or flare-ups. This includes tobacco smoke, vaping, and burning items such as wood, leaves, or grass. An odorless gas called nitrogen dioxide that’s given off by appliances that burn fuels such as gas, kerosene, and wood can also irritate your eyes, nose, and throat and cause shortness of breath.
  • Stress and strong emotions: Feeling stressed or anxious can cause you to breathe rapidly, triggering asthma symptoms. These include yelling and laughing or crying too hard or being angry or afraid.
  • Strong odors: These include fumes from gas stoves, as well as perfumes and fragrances used in household, personal hygiene, and beauty products.
  • Weather and temperature: These include hot, humid, cold, windy, or stormy weather, as well as sudden or extreme weather fluctuations.

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What are the different types of asthma?

Young boy with asthma using his inhaler while sitting in his mother's lap

Asthma is no longer considered a single disease. The different types include:

Pediatric (childhood) asthma

Pediatric (childhood) asthma, also called early onset asthma (EOA), may start when you’re very young. Although EOA is chronic, which means it persists over time, you may experience periods when your symptoms go into remission. They may also resolve altogether, which tends to occur between the ages 14 and 21.

In these cases, once the lungs are fully developed, symptoms may completely go away and never recur in adulthood. In other cases, people might not “outgrow” the disease, especially if they had severe asthma as a child.

Adult-onset asthma

Adult-onset asthma means your condition first developed during adulthood. It’s also called late-onset asthma (LOA).

You may not notice any asthma symptoms until you’re an older adult, too. In fact, a 2022 study published in the Journal of Clinical Medicine noted that 30 to 40 percent of adults experience their first symptoms after age 40. Up to 52 percent of adults are also older than 40 when they have their first asthma attack.

Compared to EOA, the outlook for adults with LOA tends to be worse. Symptoms often persist, unlike children and teens whose symptoms often come and go. Standard asthma treatments also tend to be less effective with LOA.

Allergic asthma

When you have allergic asthma, your allergies bring on your symptoms. Allergies are in fact the most common asthma trigger.

Your body perceives allergens, substances that cause an allergic reaction, as a threat to your health. These allergens contact or enter your body when you inhale, inject, swallow, or touch them.

Your immune system responds by releasing immunoglobulin E (IgE) antibodies. In turn, IgE triggers the release of chemicals that inflame your airways, prompting common asthma symptoms such as coughing, shortness of breath, wheezing, and chest tightness.

Non-allergic asthma

This refers to any type of asthma that isn’t triggered by allergies. These types of asthma produce the same symptoms as the allergic type.

Unlike allergic asthma, non-allergic asthma is triggered by factors other than allergens, such as:

  • Exercise
  • Extreme or fluctuating weather or temperatures
  • Irritants in the air
  • Medicines and certain food additives
  • Stress
  • Viral respiratory infections

Cough variant asthma

Cough-variant asthma (CVA) tends to produce a dry, persistent cough as its main or sole symptom. You may be first misdiagnosed as having a chronic cough since CVA may not cause some of the more common asthma symptoms, such as wheezing.

Over-the-counter cough medicines don’t offer much relief for CVA. Instead, it’s treated with asthma medicines. Without proper treatment, CVA can eventually involve the wider spectrum of asthma symptoms.

Exercise-induced bronchoconstriction (EIB)

Once referred to as exercise-induced asthma, the condition is now called exercise-induced bronchoconstriction (EIB). Physical activity leads to airway narrowing, causing asthma symptoms such as wheezing (often the first EIB symptom in children), shortness of breath, coughing, and chest tightness.

EIB can also decrease your endurance and cause a sore throat and upset stomach. Quickly breathing in dry air dehydrates your bronchial tubes. When this happens, your airways lose water, heat, or both because of reduced moisture in the air. This narrows them, restricting airflow.

Asthma symptoms start to develop within minutes of starting your workout and may persist for 10 to 15 minutes after you stop your activity.

Examples of EIB triggers include:

  • Air pollution while running, cycling, or playing other sports outdoors
  • Dry, hot air during hot yoga
  • Chlorine in swimming pools
  • Cold, dry air while doing winter sports such as ice skating, ice hockey, or cross-country skiing
  • Strong odors from perfumes, cleaners, and paints used at gyms

Eosinophilic asthma (e-asthma)

E-asthma is a severe form of asthma caused by high levels of eosinophils. These white blood cells (WBCs) are part of your body’s immune defenses. But e-asthma causes your immune system to overreact by producing too many of these WBCs. Your airways then become swollen and inflamed as a result.

People with e-asthma often have chronic sinusitis and nasal polyps in addition to asthma. It’s often associated with allergies, but the disease can have allergic and non-allergic triggers.

Aspirin-induced asthma

Aspirin-induced asthma (AIA) is one of the more severe types of e-asthma. It can cause a severe, sometimes fatal, reaction to taking cyclooxygenase-1 (COX-1) inhibitors, such as aspirin, and certain NSAIDs, including ibuprofen and naproxen.

AIA is also called aspirin-exacerbated respiratory disease (AERD), drug-induced asthma, or Samter’s Triad. This triad refers to the co-occurrence of AIA, nasal polyps, and chronic sinusitis, which is when your sinuses are swollen and inflamed for three or more months.

Around 7 to 8 percent of all people with asthma and 15 percent of people with severe asthma develop AIA, according to a 2020 research review published in the World Journal of Otorhinolaryngology-Head and Neck Surgery. It occurs more often in adults than children.

AIA doesn’t occur because of allergies to COX-1 inhibitors or NSAIDs. Rather, it happens because your body has developed an intolerance or hypersensitivity to them, which can lead to an asthma attack and other symptoms such as:

  • Chest pain
  • Facial flushing
  • Nasal congestion and discharge
  • Red eyes

For some people with AIA, these problems can be triggered by drinking alcohol.

Nocturnal (nighttime) asthma

Nocturnal asthma produces the same symptoms as many other asthma types, but these tend to get worse at night. Your asthma symptoms may wake you up during the night or cause you to wake up earlier in the morning. You may sleep less as result and your sleep quality may be poor.

Why this happens isn’t fully understood, but scientists believe it has to do with fluctuations in lung function and hormones that occur throughout the day and night. Nighttime asthma has also been associated with other health conditions such as GERDobesity, and the sleep-breathing disorder sleep apnea.

Occupational asthma

Occupational asthma (OA) is caused by substances found in the workplace. More than 250 substances used in various work settings can trigger asthma symptoms, according to the American College of Allergy, Asthma, & Immunology. Up to 15 percent of people with the asthma type experience disabling symptoms.

The risk of developing occupational asthma tends to go up if you smoke tobacco or if you or your close blood relatives (parents or siblings) have allergies or asthma. Triggers may include irritants or sensitizers.

Irritant-induced asthma occurs as a result of exposure to high concentrations of a certain substance just once or multiple times. Sensitizer-induced asthma involves a latency period, which means you’re not allergic to the substances at first but instead develop an allergic reaction with repeated exposure over time. This process may take months or years of being exposed to the substance before you develop OA. Around 90 percent of the time, OA is sensitizer-induced.

Common OA triggers include:

  • Chemicals used for manufacturing products
  • Cleaning products
  • Droppings, saliva, and body parts from insects and animals
  • Dusts from wood, grain, and flour
  • Latex gloves
  • Molds
  • Paints

Asthma-COPD overlap syndrome (ACOS)

Your HCP may diagnose you with ACOS when you have asthma and chronic obstructive pulmonary disease (COPD) symptoms. COPD is an umbrella term for a group of conditions that include emphysema and chronic bronchitis. The syndrome isn’t a separate disease, but rather a way for your HCP to recommend a more effective treatment plan based on the mix of symptoms common to asthma and COPD.

Asthma symptoms that are also common COPD symptoms include:

  • Breathing issues such as shortness of breath and wheezing
  • Frequent coughing
  • Excess mucus
  • Fatigue

ACOS tends to produce more symptoms than either asthma or COPD alone. You may also experience more severe attacks, which can result in more ED visits and hospital admissions.

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How is asthma diagnosed?

To diagnose asthma, your HCP will assess your symptoms, discuss your personal and family medical history, and perform a physical exam. During the exam, they will likely:

  • Listen to your lung and heart sounds, because issues with your heart may be the cause of your wheezing
  • Look inside your mouth, nose, and ears for signs of inflammation, irritation, or infection
  • Examine your skin for rashes, which may point to atopic dermatitis

For children younger than 5 years old, these tests may be sufficient to diagnose asthma. For adults and children older than 5 years old, your HCP may also conduct or order additional tests to confirm or rule out asthma. These might include the following:

  • Imaging test: This may include an X-ray or computerized tomography (CT) scan of your lungs and sinuses to look for signs of infection or other abnormalities.
  • Blood test: This includes checking your eosinophil and IgE levels.
  • Allergy test: Your HCP may refer you to a provider who specializes in diagnosing and treating allergies, asthma, and immunologic conditions to test for allergies, which may be causing your asthma symptoms and attacks.
  • Tests to confirm or rule out other health conditions: Your HCP may consider testing for other conditions that can aggravate or cause symptoms similar to asthma, such as GERD, chronic sinusitis, or sleep apnea.
  • Pulmonary function tests (PFTs): These noninvasive tests measure how well your lungs are working before and after inhaling a bronchodilator medicine to open your airways.

Pulmonary function tests (PFTs) for asthma

Your HCP may order or perform one or more of these tests to measure your lung function:

Spirometry

This is the most basic and common PFT used to diagnose asthma. It involves breathing into a mouthpiece connected to a device called a spirometer. The device measures the amount of air you can inhale and exhale, and how quickly and easily you can blow the air out of your lungs.

Peak flow meter

peak flow meter is a small, handheld device that measures the maximum force of air you can blow from your lungs. You’ll be asked to inhale deeply just before you blow into the meter as hard and as fast as you can.

Although the test isn’t used to diagnose asthma, it may help detect narrowing of the airways. If you’re diagnosed with asthma, your HCP will recommend you use a peak flow meter at home to monitor your condition and the effectiveness of your asthma treatment plan.

Exhaled nitric oxide

Asthma causes lung inflammation. In turn, your lungs produce nitric oxide.

Also called a fractional exhaled nitric oxide (FeNO), this test involves exhaling into a small, handheld device at a steady pace for 10 seconds. An FeNO test measures the amount of nitric oxide in your breath. Higher nitric oxide levels may indicate a greater amount of inflammation caused by asthma.

Bronchoprovocation (trigger) test

This test evaluates how your lungs react or respond when you breathe in controlled doses of the drug methacholine (mannitol), which is known to cause airway narrowing. As such, the test is also called the methacholine challenge test.

You’ll start by inhaling a very small dose of methacholine then take a breathing test to measure your lung function. Depending on how your lungs respond, these steps will be repeated until your breathing ability drops by 20 percent or you reach the maximum dose with no change in lung function. The test is considered positive if your breathing ability drops by 20 percent or more compared to your baseline reading.

Asthma severity

As part of the diagnostic process, your HCP will also assess the severity of your asthma to help determine the appropriate treatment plan. The Asthma and Allergy Foundation of America classifies these severity levels as follows:

Intermittent asthma

This means you:

  • Experience symptoms fewer than two times a week
  • Wake up fewer than two nights a month due to asthma symptoms
  • Use quick-relief asthma medicine no more than two days a week
  • Have normal lung function and are able to do all your normal activities

Mild persistent asthma

This means you:

  • Experience symptoms two or more days a week, although you don’t have daily symptoms
  • Wake up three to four nights a month due to asthma symptoms
  • Use quick-relief asthma medicine more than two days a week
  • Have mostly normal lung function but your symptoms affect some of your daily activities

Moderate persistent asthma

This means you:

  • Experience symptoms at least every day
  • Wake up at least once a week due to asthma symptoms
  • Need to use your quick-relief asthma medicine daily
  • Have some decrease in lung function and symptoms that limit some of your daily activities

Severe persistent asthma

This means you:

  • Experience symptoms every day
  • Wake up each night because of asthma symptoms
  • Need to use your quick-relief asthma medicine several times a day
  • Have marked reduction in lung function and symptoms that greatly limit your daily activities

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How is asthma treated?

Man with asthma monitoring peak expiratory flow rate with a peak flow meter

Your asthma treatment plan depends on the type and severity of your asthma. The main types of asthma medicines provide quick relief and long-term control of symptoms.

Quick-relief asthma treatments

Quick-relief medicines are used at the first sign of an asthma attack. They are medicines called bronchodilators that dilate or expand your airway. This allows more air to get into and out of your lungs, helping you breathe more easily. Mucus also moves through these passageways more freely, making it easier for you to cough it out.

Quick-relief medicines include:

Short-acting inhaled beta2-agonists (SABAs) for asthma attacks

SABAs are the first choice for quick relief of asthma attacks. They work within 15 to 20 minutes and can relieve symptoms for about four to six hours. Your HCP may also recommend you use this quick-relief medicine 15 to 20 minutes before exercising, especially if you have EIB. SABAs are typically delivered through inhalers.

Inhalers (also called puffers) are small, handheld devices that you pump or that propel medicine so that you can inhale the medicine directly into your lungs. SABA inhalers include:

  • Albuterol
  • Levalbuterol
  • Combination albuterol and ipratropium bromide

Anticholinergics for asthma attacks

Anticholinergics are another class of inhalable bronchodilators. They can be used either for quick relief of asthma symptoms or long-term control. These asthma treatments block the neurotransmitter acetylcholine from causing involuntary muscle movements in your lungs, which helps keep your airway muscles from constricting or tightening.

They come as inhaler or nebulizer solutions. Nebulizer devices turn liquid asthma medicines into a soft mist that you slowly inhale while wearing a mouthpiece or facemask. Unlike inhalers, you must plug in or use batteries to operate nebulizers.

Ipratropium bromide (either in inhaler or nebulizer form) is a quick-relief anticholinergic asthma treatment.

Corticosteroids for asthma attacks

Your HCP might also prescribe corticosteroids, also called glucocorticoids or steroids, to treat severe asthma attacks when other medicines fail to help. You’ll be given a short course of steroid pills, or the medicine will be given via intravenous (IV) infusion in a hospital setting.

These drugs mimic the effects of the steroid hormone cortisol to reduce inflammation.

Corticosteroids are only used short-term on an as-needed basis because they can raise your risk of infections and cause loss of bone density or thickness, raising your risk of fractures due to brittle and weak bones.

Long-term asthma control medications

These asthma treatments help prevent asthma symptoms and flare-ups, although they don’t treat asthma attacks. Long-term asthma control medications reduce airway inflammation, helping to make these passageways less sensitive to your asthma triggers. They’re usually taken daily, even if you don’t have symptoms currently.

Many asthma medicines can be used for long-term control of asthma medicines. These include:

Long-acting beta-2 agonists (LABAs) for asthma control

LABAs are usually taken twice daily to control your asthma symptoms and maintain the health of your airways. They can also be used to treat EIB. LABAs include formoterol and salmeterol

and are typically combined with a corticosteroid (see below).

Anticholinergics for long-term asthma control

Several anticholinergics can also be used for long-term asthma management. They come in inhaler or nebulizer forms. These include:

  • Aclidinium
  • Glycopyrrolate
  • Glycopyrronium
  • Revefenacin
  • Tiotropium
  • Umeclidinium

Inhaled corticosteroids for long-term asthma control

Inhaled corticosteroids (ICS), also referred to as anti-inflammatories, are among the most effective long-term treatments for asthma. As such, they’re often regarded as a standard treatment for long-term control of symptoms.

ICS medications include:

  • Beclomethasone
  • Budesonide
  • Ciclesonide
  • Flunisolide
  • Fluticasone
  • Mometasone
  • Triamcinolone

Inhaled corticosteroids are often combined with other medications for long-term control of asthma symptoms. Combinations of LABAs and inhaled corticosteroids include:

  • Formoterol and mometasone
  • Formoterol and beclomethasone
  • Budesonide and formoterol
  • Fluticasone and salmeterol
  • Fluticasone and vilanterol

ICS medications may also be combined with both LABAs and anticholinergics. These include:

  • Vilanterol, umeclidinium, and fluticasone
  • Formoterol, glycopyrrolate, and budesonide

Biologics (monoclonal antibodies) for severe asthma

Biologics are injectable medicines that help block your body’s response to asthma triggers. They are made from cells extracted from living organisms to target molecules in your body that cause asthma symptoms, such as those that trigger inflammation.

These are injected every two to eight weeks, depending on which biologic has been prescribed. They can be self-administered, injected by an HCP in a clinic, or via IV infusion at a clinic or hospital.

Examples include:

  • Benralizumab
  • Dupilumab
  • Mepolizumab
  • Omalizumab
  • Resulizumab
  • Tezepelumab-ekko

Leukotriene modifiers for asthma

These long-term asthma treatments block the effect of chemicals in your body called leukotrienes or stop your body from making them. These chemicals cause bronchial constriction and boost inflammation and mucus production in your lungs.

Leukotriene modifiers—also called leukotriene receptor antagonists or leukotriene synthesis inhibitors—come in pill form. They’re often taken daily to prevent or lessen the symptoms of allergic asthma, EIB, or allergic rhinitis, although the dose frequency depends on which one you take.

Examples include:

  • Montelukast
  • Zafirlukast
  • Zileuton

Allergy immunotherapy for asthma control

Allergy immunotherapy (AIT) is a disease-modifying treatment (DMT) that helps make your body less sensitive to allergens that trigger asthma. It involves giving you incremental doses of the allergen over time. The goal is to slowly build up your body’s ability to tolerate allergens so they no longer trigger an allergic reaction such as inflammation in your airways.

AITs have been shown to reduce:

Asthma symptoms
Asthma medication use and the doses of ICS necessary for asthma control
Bronchial hyperactivity
Number of asthma attacks
Asthma incidence

These DMTs have also been shown to increase forced expiratory volume in one second (FEV1). This is the maximum amount of air you can forcefully exhale in one second using a spirometer.
The measure is used to describe the degree of airway obstruction caused by asthma. The higher the FEV1, the lower the degree of airway obstruction.

AITs include:

Subcutaneous immunotherapy (SCIT): These are allergy shots injected under your skin.
Sublingual immunotherapy (SLT): These are pills or liquids that dissolve under the tongue.

Bronchial thermoplasty (BT) for asthma

BT is an outpatient procedure that uses radiofrequency (RF) energy to mildly heat and reduce (or thin out) smooth muscle tissue in your airways. Three of these RF treatments are often needed to reduce bronchial smooth muscle tissue.

Having less smooth muscle tissue constricting your airways may make it easier for you to breathe. Asthma attacks may also occur less often.

BT is usually reserved for adults with severe asthma who:

Have asthma that is not well-controlled with ICS or other long-acting bronchodilators
Use oral corticosteroids more than twice a year to manage asthma attacks
Take an oral corticosteroid for daily maintenance
Don’t have other health conditions besides asthma

Asthma action plan

An individualized asthma action plan can help you control and manage your condition more effectively. This written document that you create with help from an HCP will list:

  • Your asthma triggers
  • Specific names of medicines you take for quick- and long-term relief of asthma symptoms and flare-ups
  • Symptoms and peak flow measurements (if used) that would indicate your lung condition is getting worse
  • Medicines to take based on symptoms and signs of asthma, as well as peak flow measurements (if used)
  • Severe symptoms and peak flow measurements (if used) that would point to the need for urgent or emergency medical care

Your tailored action plan provides guidance on treating and managing your asthma when you find yourself in certain situations described in your action plan as “zones”:

Green zone

Being in the green zone means you’re feeling fine and your symptoms are well-controlled. This part of your plan lets you know the type, dose, and frequency of medicines to take for long-term control of your condition. It also provides instructions on how to take each.

Yellow zone

Being in the yellow zone means asthma symptoms have started to develop. Addressing your symptoms when they first start helps you get them under control quickly and keep them from getting worse. This part of your action plan notes the type, dose, and frequency of medicines to take when asthma symptoms first arise, as well as how to take them.

Red zone

Being in the red zone means your asthma symptoms have grown severe or you’re having an asthma attack. This portion of your plan includes the type, dose, and frequency of your quick-relief medicines along with how to take them.

It will also instruct you on what to do after you’ve taken your quick-relief medicine and how and when to get prompt medical care if your symptoms don’t improve. You’ll also find phone numbers for your HCP, hospital ED, rapid transportation, and caregivers who can support you should these situations occur.

When to see a healthcare provider

Be sure to speak with your HCP if you:

  • Haven’t been diagnosed with asthma, but believe your symptoms might be due to the condition
  • Notice your medicines aren’t easing your asthma symptoms effectively or you need to use your quick-relief inhaler more often than usual
  • Need to review or revise your asthma treatment plan, which must be done regularly as your condition can change over time and your plan may need to be adjusted.

Remember to get emergency medical care right away if you experience a severe asthma attack. Call 911 or have the designated caregiver on your action plan take you to the nearest ED.

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How to live well with asthma and prevent asthma attacks

Young woman with asthma exhaling a breath on the beach at sunset

Although you may not be able to prevent or cure the lung condition, you can take steps to help prevent flare-ups and gain better control of your asthma. This goes beyond just taking asthma medicines.

Living well with asthma means taking a holistic approach to caring for yourself and your condition. This includes:

Actively manage your asthma

That means following your asthma treatment plan, taking your medicines as prescribed, and working with your HCP to change your medicines or any part of your plan, as needed. It also involves keeping regularly scheduled follow-up appointments with your HCP and getting and staying current with your vaccinations, especially for flu and pneumonia, as respiratory infections can trigger flare-ups. It’s also crucial to understand and stay away from your asthma triggers and treat asthma attacks early before symptoms grow severe.

Monitor your breathing

You’ll want to be mindful of how you’re breathing, which can help you spot early signs of an asthma attack. Tracking your peak airflow with a peak flow meter on a regular basis also helps you monitor your lung function, which may decrease before you notice any asthma signs or symptoms.

Eat well, exercise, and maintain a healthy weight

Eating mostly whole, nutrient-rich foods such as fruits, vegetables, lean meats, poultry, and fish while limiting or avoiding processed and refined foods and added sugars can help reduce inflammation in your body and help you achieve and stay within a healthy weight range for you. This goes hand in hand with being physically active per your asthma action plan and as discussed with your HCP. Swimming, walking, and yoga are a few activities you can try.

Get adequate rest

Prioritize restful and restorative sleep on a regular basis by developing good sleep habits and following a calming bedtime routine. Be sure to talk with your HCP if you’re having trouble sleeping because of asthma symptoms.

Manage stress

Keep stress under control with  relaxation techniques such as meditation or sound healing to slow down your breathing and heartbeat and help clear and center your mind. If needed, seek help from a licensed mental health provider for stress, anxiety, and depression related to your condition or to life in general.

Quit or never smoke tobacco

That includes vaping or using e-cigarettes. It’s also important to steer clear of secondhand smoke and vapor as much as possible.

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Featured asthma articles

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American College of Allergy, Asthma, & Immunology. Asthma Cough. Accessed April 3, 2023.

American College of Allergy, Asthma, & Immunology. Exercise-Induced Bronchoconstriction (EIB). Accessed April 3, 2023.

American College of Allergy, Asthma, & Immunology. Medication. Accessed April 4, 2023.

American College of Allergy, Asthma, & Immunology. Non-Allergic Asthma. Accessed April 3, 2023.

American College of Allergy, Asthma, & Immunology. Occupational Asthma. Accessed April 3, 2023.

American College of Allergy, Asthma, & Immunology. Types of Asthma. Accessed April 3, 2023.

American Lung Association. Learn About Asthma. Last updated January 25, 2023.

American Lung Association. Assess and Monitor Your Asthma Control. Last updated December 7, 2022.

American Lung Association. Asthma and Pregnancy. Last updated November 28, 2022.

American Lung Association. Asthma at Work. Accessed March 31, 2023.

American Lung Association. Asthma Causes and Risk Factors. Last updated February 28, 2022.

American Lung Association. Asthma-COPD Overlap Syndrome (ACOS). Last updated November 17, 2022.

American Lung Association. Asthma Symptoms. Last updated November 28, 2022.

American Lung Association. Being Active With Asthma. Last updated November 28, 2022.

American Lung Association. Create an Asthma Action Plan. Last updated March 8, 2023.

American Lung Association. Finding support to Help You Manage Asthma. Last updated January 31, 2023.

American Lung Association. For Parents of Children With Asthma. Last updated December 7, 2022.

American Lung Association. How Is Asthma Diagnosed. Last updated December 7, 2022.

American Lung Association. Managing Asthma. Last updated December 7, 2022.

American Lung Association. Reduce Asthma Triggers. Last updated March 21, 2023.

American Lung Association. Types of Asthma. Last updated December 7, 2022.

American Lung Association. Understand Your Asthma Medication. Last updated November 28, 2022.

American Lung Association. Severe Asthma. Accessed March 31, 2023.

American Lung Association. The Health Effects of Smoking With Asthma. Last updated November 17, 2022.

American Lung Association. Types of Asthma. Last updated December 7, 2022.

American Lung Association. What Is Asthma? Last updated February 17, 2023.

Ankermann T, Brehler R. Allergic asthma: An indication for allergen immunotherapy. Allergol Select. 2023;7:33-38.

Asthma and Allergy Foundation of America. Allergens and Allergic Asthma. Last updated July 2022.

Asthma and Allergy Foundation of America. Asthma Diagnosis. Last reviewed June 2022.

Asthma and Allergy Foundation of America. Asthma in Adults. Last reviewed June 2022.

Asthma and Allergy Foundation of America. Asthma Symptoms. Last reviewed January 2022.

Asthma and Allergy Foundation of America. Understanding Eosinophilic Asthma. Published May 19, 2022.

Badrani JH, Doherty TA. Cellular interactions in aspirin-exacerbated respiratory disease. Curr Opin Allergy Clin Immunol. 2021;21(1):65-70.

Centers for Disease Control and Prevention. Asthma. Most Recent National Asthma Data. Last reviewed December 13, 2022.

Cleveland Clinic. Bronchodilators. Last reviewed August 9, 2022.

Di Cicco M, Ghezzi M, Kantar A, et al. Pediatric obesity and severe asthma: Targeting pathways driving inflammation. Pharmacol Res. 2023;188:106658.

Farzan S, Coyle T, Coscia G, Rebaza A, Santiago M. Clinical characteristics and management strategies for adult obese asthma patients. J Asthma Allergy. 2022;15:673-689.

Hashmi MF, Tariq M, Cataletto ME. Asthma. StatPearls [Internet]. Last updated February 19, 2023.

Li X, Zhang Y, Zhang R, Chen F, Shao L, Zhang L. Association between e-cigarettes and asthma in adolescents: A systematic review and meta-analysis. Am J Prev Med. 2022;62(6):953-960.

Mayo Clinic. Asthma. Last updated March 5, 2022.

Mayo Clinic. Asthma Attack. Last updated March 5, 2022.

Miyake K, Kushima M, Shinohara R, et al. Maternal smoking status before and during pregnancy and bronchial asthma at 3 years of age: A prospective cohort study. Sci Rep. 2023;13:3234.

Mount Sinai. Hyperventilation. Accessed March 31, 2023.

National Heart, Lung, and Blood Institute. Asthma Attack. Last updated March 24, 2022.

National Heart, Lung, and Blood Institute. Asthma Diagnosis. Last update March 24, 2022.

National Heart, Lung, and Blood Institute. Asthma Symptoms. Last updated March 24, 2022.

National Heart, Lung, and Blood Institute. Asthma Treatment and Action Plan. Last updated March 24, 2022.

National Heart, Lung, and Blood Institute. Managing Asthma. Last updated March 24, 2022.

National Heart, Lung, and Blood Institute. What Is Asthma? Last updated March 24, 2022.

Rawat D, Modi P, Sharma S. Hypercapnea. StatPearls [Internet]. Last updated 25, 2022.

Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. J Allergy Clin Immunol Pract. 2022;10(1S):S1-S18.

Robijn AL, Bokern MP, Jensen ME, Barker D, Baines KJ, Murphy VE. Risk factors for asthma exacerbations during pregnancy: A systematic review and meta-analysis. Eur Respir Rev. 2022;31(164):220039.

Roio LCD, Mizutani RF, Pinto RC, Terra-Filho M, Santos UP. Work-related asthma. J Bras Pneumol. 2021;47(4):e20200577.

Sehanobish E, Asad M, Jerschow E. New concepts for the pathogenesis and management of aspirin-exacerbated respiratory disease. Curr Opin Allergy Clin Immunol. 2022;22(1):42-48.

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American Academy of Allergy, Asthma & Immunology. Drug Guide Overview. Accessed April 20, 2023.

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