Asthma

About Asthma

Asthma is a lung disease that causes the airways to narrow, making it hard to breathe. Asthma is a chronic condition. Once you are diagnosed with it, you will have it for the rest of your life.

You can develop asthma as early as infancy and as late as old age. The good news is that with careful monitoring and management, asthma can be kept under control.

What happens in your body when you have Asthma?

In a healthy lung, the lining of the airways is clear and open, and the muscles surrounding the airways are relaxed. This allows air to flow through freely. With asthma, three things happen—often at the same time—that make it hard to breathe:

  • The lining gets inflamed, which makes it swell and thicken. This swollen lining narrows the opening for air to flow through.
  • The muscles on the outside of the airways tighten, making it harder to push air in and out.
  • Mucus forms another layer inside the airway, which also narrows the opening.
Airway in a normal, healthy lung.
Airway restriction in an asthmatic lung.

Managing Asthma

If uncontrolled, asthma can cause permanent scarring over time or even death, so it’s important that you take action. The goal of asthma management is to find out what causes your airways to act in these ways and find ways to prevent these reactions.

Asthma Action Plan

An Asthma Action Plan is a personalized written plan with steps to help reduce or prevent symptoms.

Download the PDF »


Levels of Asthma

There are 4 levels of asthma severity. The thing to remember is that most patients don’t reach a certain level and stay there. Asthma changes over time in response to triggers. This is why it is important to keep monitoring and managing your asthma—even when it seems to be under control.

Intermittent asthma:

  • Daytime symptoms: Less than 3 times a week
  • Nighttime symptoms: Less than 2 times a month
  • Use of rescue inhaler: 2 or fewer days a week
  • Limitations: No limitations to activities of daily living

Mild persistent asthma:

  • Daytime symptoms: 3-6 times a week
  • Nighttime symptoms: 3-4 times a month
  • Use of rescue inhaler: More than 2 days a week, but not daily
  • Limitations: Minor limitations to activities of daily living

Moderate persistent asthma:

  • Daytime symptoms: Every day
  • Nighttime symptoms: 4 or more times a month, but not each night
  • Use of rescue inhaler: Daily
  • Limitations: Increased limitations to activities of daily living (more than 2 times a week)

Severe persistent asthma:

  • Daytime symptoms: Continuously throughout the day
  • Nighttime symptoms: Every night
  • Use of rescue inhaler: Several times a day
  • Limitations: Extreme limitations to activities of daily living

Asthma Levels Chart

Doctors use these four levels of asthma to discuss symptoms and determine treatments.

Download the PDF »

Key facts about Asthma
  • Almost 20 million American adults have asthma—roughly 1 in 12
  • 1 in 10 children in the United States has asthma—that’s almost 6 million—with higher rates among Black children
  • 8 million adults and 3 million children had an asthma attack in the past year
  • Asthma causes:
    • More than 5 million missed school days for children each year
    • 14.2 lost workdays per adult each year
    • $89 billion in estimated costs in the United States each year

Asthma in children

Asthma can be diagnosed in children as young as infants. Asthma is as serious in children as it is in adults, but it can be harder to diagnose. Asthma in children is often linked to allergies, exposure to tobacco smoke or other air irritants, and obesity. It tends to run in families.

Children’s symptoms are similar to those of respiratory infections such as colds and may include:

  • Coughing spells
  • Wheezing or a whistling sound when the child exhales
  • Shortness of breath
  • Rapid breathing periodically
  • Chest tightness and chest pain
  • Tiredness and/or less energy to play due to poor sleep
  • Coughing and wheezing that worsens with cold or flu

Living Well with Asthma Patient Education Guide

Living Well With Asthma

Our patient education guide has more information about asthma diagnosis, treatments, and more.

Download the PDF »

Asthma life stories

Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. This narrowing can cause episodes of wheezing, chest tightness, shortness of breath, and coughing.  

Asthma symptoms are usually controlled by inhaled medications that treat inflammation in the airways or relax the smooth muscle that tightens the airways. However, some people do not respond adequately to these medications.  

If you are already using high dose medicines, reducing risks, and following your treatment plan yet your asthma remains uncontrolled, this is a sign that you may be suffering from severe asthma. It’s important to consult with your health care provider to determine if you suffer from severe asthma or uncontrolled asthma, as treatment plans may differ.  

Getting diagnosed with severe asthma can stop you in your tracks. It’s normal to feel fearful and concerned—how will this affect your life and those you love? It’s also normal to feel a sense of relief with the diagnosis. With a proper treatment plan, you’ll still be able to better manage your disease. Hear the stories of Amy and April, two women living their best lives in spite of their diagnoses. 

April Fink – A go-getter student who wouldn’t give up on her dreams.

Amy Vasquez – A mom who refused to miss out on time with her family. 


On demand webinars 

In collaboration with GSK, our educational webinars are designed to help you better understand the symptoms of severe asthma. They also will help you navigate your journey through your diagnosis by providing real stories from the people who’ve been there.

When Asthma Isn’t Just Asthma

Learn about the differences between asthma and severe asthma, the causes of the disease, the symptoms you may experience, and the impact it may have on your life. 

When to Consider a Specialist

Hear from two patients who describe their journey to diagnosis, including their decisions to see specialists, and the impact that had on their health and well-being. 


Severe Asthma: Infographic

Managing Your Asthma

Questions to Ask Your Doctor  

This educational campaign on the burden of disease is funded by GSK and developed in collaboration with CHEST.

Infographic References:

  • Varricchi G, Bagnasco D, Borriello F, Heffler E, Canonica GW. Interleukin-5 pathway inhibition in the treatment of eosinophilic respiratory disorders: evidence and unmet needs. Curr Opin Allergy Clin Immunol. 2016 Apr; 16(2):186-200. 
  • Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, Adcock IM, Bateman ED, Bel EH, Bleecker ER, Boulet LP, Brightling C, Chanez P, Dahlen SE, Djukanovic R, Frey U, Gaga M, Gibson P, Hamid Q, Jajour NN, Mauad T, Sorkness RL, Teague WG. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014 Feb;43(2):343-73. 
  • Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma. 2019 Update. https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdf  

Mythbuster References:

About Severe Asthma

About 5% to 10% of people with asthma have severe asthma. Despite various treatments, their asthma is not controlled. If you have severe asthma, you might experience more:

  • Daytime and nighttime symptoms
  • Flare-ups
  • Hospital visits
  • Serious damage to the lungs

Identifying Severe Asthma

New research has identified four molecular markers in the type 2 inflammation pathways that show how specific cells react and lead to greater inflammation. Identifying molecular targets can help your provider determine the best treatment for your severe asthma.

The molecular targets in your body vary depending on the type of asthma you have. An increase in these biomarkers is associated with more asthma flare-ups and limited asthma control:

  • IgE (immunoglobulin E): IgE is normally found in small amounts in the body, but sometimes it increases dramatically when exposed to allergens that trigger a reaction in your body. IgE can also stimulate other cells to behave in ways that increase inflammation.
  • IL-4/IL-4Rɑ (interleukin 4/interleukin 4 receptor alpha): IL-4 does three things: It signals other harmful cells to begin production. It sends eosinophils (white blood cells that cause inflammation in high amounts) to the inflammatory areas. And it causes the smooth muscles around the airway to contract.
  • IL-5/IL-5R (interleukin 5/interleukin 5 receptor):IL-5 activates eosinophils and directs them to circulate to the sites of inflammation.
  • TSLP/IL-33 (thymic stromal lymphopoietin/interleukin 33): TSLP activates different cells that stimulate an allergic response in the lungs, which increases eosinophil levels and leads to smooth-muscle contraction.

Type 2 inflammation pathways

Medical illustration of allergens and airway response
Asthma inflammation caused by allergens

Medical illustration showing Eosinophilic response to asthma triggers
Eosinophilic Asthma inflammation

Symptoms and triggers

Asthma is a disease that involves two body reactions: swelling and tightening of the airway. These two factors cause your airway passages to be sensitive to the environment.

You can be symptom free for years by using medications and limiting your exposure to triggers. The most common asthma symptoms are:

Common Asthma triggers

Anything that causes the airway to be inflamed, swollen, or tighten is an asthma trigger. Reducing exposure to your asthma triggers is the first important step in keeping your airways open and managing your asthma.

House dust

House dust contains both dust mites (tiny bugs too small to see) and a combination of dirt and allergens from mold, animal dander, insects, or pests. Breathing dust particles can irritate inflamed airways and set off allergic reactions. House dust is unavoidable, so it is important to keep your home clean.

Molds

Molds thrive on moisture. They live both indoors and outdoors. Manage molds indoors by reducing moisture throughout your home.

Cockroaches

Cockroaches leave droppings behind that contain potent allergens. Cockroach allergies are a particular concern for people living in big cities. If you live in a building with cockroaches, keep your house clean and your food in tight containers.

Rodents

Mice and rats are linked to increased asthma symptoms. To reduce exposure to rodents, use traps or have your home professionally treated by a pest control service.

Smoking

Smoking cigarettes, pipes, cigars, and e-cigarettes (vaping) has a severe effect on asthma. Children who live in homes with adults who smoke are far more likely to have asthma problems and ear infections.

If you or someone in your family has asthma, the best solution is not to smoke at all. Never allow anyone to smoke in your home, in your car, or around people with asthma.

Weather

Weather conditions can affect airways of people with asthma. Usually, this happens when the temperature is very hot, very humid, or very cold and dry. Avoid outdoor activity when the weather is very hot, very cold, or very humid.

Infections

Respiratory viruses and sinus infections can make asthma worse. Viral infections, such as a cold or the flu, are the most common triggers in young children. They can be just as dangerous for adults. Steps to take:

  • Get a flu shot every year. Ask your health-care provider about whether you should get a pneumonia vaccine.
  • Wash hands frequently.
  • See your health-care provider for immediate treatment if you suspect you have an infection.

Outdoor triggers

Tree, grass, and weed pollens and outdoor mold are common asthma triggers. Poor air quality from air pollution, smoke, car exhaust, and chemicals can also trigger asthma. To prevent exposure, keep the doors and windows to your house shut, and avoid outdoor activities when pollen or ozone levels are high.

Food and medicine allergies

Avoid eating foods that contain preservatives called sulfites. Sulfites are found in beer, wine, shrimp, and processed potatoes. Some medicines can also cause problems, especially aspirin and beta-blockers. Talk with your provider or pharmacist about all prescription and over-the-counter medications you take, including vitamins and herbal supplements.

Stress and emotions

You may be surprised to learn that stress and strong emotions are common asthma triggers. Some people find that laughing or crying can set off symptoms. Research also indicates that stress, especially long-term or chronic stress, can increase inflammation. Take steps to reduce stress wherever possible:

  • Use stress management techniques, such as deep breathing, meditation, and yoga.
  • Develop a regular exercise program and healthy eating habits.
  • Healthy social interaction reduces stress, so spend time with friends and family.

Animals

All warm-blooded animals produce dander (shedding skin, fur, and feathers), urine, saliva, and droppings. All of this material contains allergens that can trigger allergy and asthma symptoms.

Don’t keep furry pets in your home. If you do have a pet, keep it out of your bedroom and off upholstered furniture.

Exercise

Exercise is important, but it can trigger asthma symptoms for some. Work with your health-care provider to develop a safe and healthy exercise program.

Strong smells

Strong smells from paints, sprays, cleaning fluids, garden chemicals, scented candles, perfumes, lotions, hair sprays, and deodorants can trigger asthma problems. Avoid these scents whenever possible.

Reflux and heartburn

Heartburn or GERD (gastroesophageal reflux disease) causes a burning sensation in the chest. Reflux can trigger asthma and may make it difficult to control your asthma. To reduce reflux or heartburn:

  • Avoid certain foods, alcohol, or tobacco.
  • Lose weight.
  • Sleep with your head slightly elevated.
  • Don’t eat or drink 3 hours before lying down to sleep.
  • Talk with your health-care provider about medications that control stomach acid.

Illnesses that can affect Asthma

Sometimes other illnesses may masquerade as or trigger asthma. Ask your health-care providers whether you have any conditions that contribute to or may trigger asthma.

Other lung diseases, such as COPD (chronic obstructive pulmonary disease), have symptoms that are similar to those for asthma. This similarity can make diagnosing asthma harder. Other illnesses contribute to airway constriction, which can make asthma worse. They include:  

  • Hay fever (allergic rhinitis)
  • Sinusitis
  • Obesity
  • Vocal cord dysfunction

Asthma Triggers

Find out what you need to know about air quality triggers and asthma.

Download the PDF »

Living Well with Asthma Patient Education Guide

Living Well With Asthma

Our patient education guide has more information about asthma diagnosis, treatments and more.

Download the PDF »

Diagnosis

You should find an asthma specialist to get an accurate diagnosis. To determine whether you have asthma, your health-care provider will typically perform these tests:

  • Physical exam and health history: Your provider will do a physical examination and ask about your health history and your family’s health history (family history).
  • Spirometry: This lung function test measures how much air you can move in and out of your lungs and how fast you can do it. You will be asked to blow into the mouthpiece of a handheld device (called a spirometer) as fast and hard as you can a few times.
  • Methacholine challenge: During this test, you are exposed to small and increasing doses of a medication called methacholine, which causes your airways to narrow. When your airways narrow by 20% compared with your baseline reading, the test is over and you get medication to open your airways again.
  • Allergy tests: These tests can help your provider discover what allergens might trigger your asthma.
  • Fractional exhaled nitric oxide (FeNO) test: This test helps your health-care provider determine how much inflammation you have in your airways.
  • Eosinophil test: This test determines the eosinophil cell count in your blood.

Examining Asthma with phenotypes

Not long ago, it was believed that asthma was experienced the same way by all people. Today, science has shown that people react very differently to asthma triggers. By identifying your unique physical reactions in your cells, your treatment can be tailored to your specific biological changes.

Today, asthma is examined through phenotypes, which are observable traits or characteristics that are a result of how your genes interact with your environment.

A classification system groups asthma based on clinical, genetic, and environmental responses called biomarkers. The advantage of using this system is that it can help predict how your body will respond to specific treatments. The major phenotypes associated with asthma are based on the type of inflammation that is the cause.

Type 2 inflammation

This includes all forms of asthma that are driven by inflammation. The most common causes are allergic asthma and asthma.

  • Allergic asthma often starts in childhood andis caused by allergic reactions to triggers such as dust mites, pets, pollens, molds, cockroaches, and rodents. It can also be caused by allergic diseases, like allergic rhinitis and atopic dermatitis.
  • Eosinophilic asthma (e-asthma) occurs because of an abnormal increase in eosinophils in the bloodstream. Eosinophils are white blood cells that naturally promote inflammation to fight disease. A high amount of eosinophils increases inflammation in the airways.

Treatment for type 2 inflammation relies on biomarker testing. Biomarkers are observable biological, physiological, and molecular signals that indicate what is happening in the cells of the body. Biomarker testing shows exactly how your body reacts to inflammatory triggers and can help your provider recommend targeted therapies tailored to treat your physical response.

Non–type 2 inflammation

This includes all types of asthma not caused by noneosinophilic inflammation. The most noteworthy of these types is nonallergic asthma, which can be triggered by poor air quality, food preservatives, tobacco smoking, stress, strong emotions, smoke in the air, or obesity. Nonallergic asthma often begins in adulthood.

Treatment for non–type 2 inflammation relies on the use of antibiotics and lifestyle and behavior changes, such as staying indoors when the outdoor air quality is poor or losing weight, if recommended by your doctor.

When to see a health-care provider for Asthma

Contact your health-care provider if you experience:

  • Shortness of breathcoughing, or wheezing that affect activities of daily living
  • Daytime asthma symptoms two or more days per week
  • Shortness of breath that is not helped by a rescue inhaler
  • Symptoms that cause you to miss school or work
  • Symptoms that result in urgent care or emergency department visits
  • Side effects from medication
  • Oral infections, such as thrush

Treatment

There are many medications used to treat asthma. Some focus on reducing inflammation, some work on relaxing the muscles that surround the airways, and some help reduce mucus production. The most important thing to remember about asthma medications is that they work only if you take them as prescribed.

Most medications used to treat adults and older children with asthma can also be used for younger children. Parents need to work closely with their health-care providers to keep their child’s asthma well controlled as their bodies change and grow.

Asthma treatments

Asthma treatments target inflammation or bronchospasm:

  • Inflammation causes the lining of the airways to swell and thicken. This narrows the space available for air to flow through. The goal of medication (usually anti-inflammatory drugs) and treatment is to reduce or eliminate the underlying inflammation.
  • Bronchospasm is tightening of the muscles that surround the outside of the airways. This also narrows the space available for air to flow through. The goal of medication (usually bronchodilators) and treatment is to prevent muscle tightening or to cause the muscles to relax so the airways can open up.


Some of the most frequently prescribed medications for adults and children include the following treatments.

Inhalers

Inhalers are the most common type of asthma medication. The two types of inhalers are:

Rescue inhalers

Also known as quick-relief inhalers, rescue inhalers provide quick, short-term relief during a flare-up (asthma attack). This form of treatment contains a medication (called a bronchodilator) that rapidly widens your airway. It works by relaxing the outer muscles surrounding the airways to prevent the tightening that narrows the airways and limits air flow.

Examples of rescue inhalers include:

  • Albuterol (ProAir® HFA, ProAir® Respiclick, Proventil® HFA, Ventolin® HFA)
  • Levalbuterol (Xopenex HFA®)

Control inhalers

Also known as long-term control, maintenance, or preventer inhalers, this form of medication usually contains a steroid that reduces inflammation. Daily use of a control inhaler, even when you feel well, is important to prevent asthma from worsening. If your asthma is mild, you might be able to use this type of inhaler only when you have symptoms.

Examples of control inhalers with steroids include:

  • Budesonide (Pulmicort Flexhaler®)
  • Beclomethasone dipropionate (Qvar RediHaler® HFA)
  • Fluticasone furoate (Arnuity®, Ellipta®)
  • Fluticasone propionate (Flovent Diskus or HFA)
  • Mometasone furoate (Asmanex® HFA or Twisthaler®)
  • Ciclesonide (Alvesco®)

Long-acting bronchodilator

Another type of controller medication includes a long-acting bronchodilator (LABA), which works to relax the muscles continuously over time. This type of medication should be used with corticosteroids in the inhaler.

Examples of inhaled corticosteroids (ICSs) and LABAs include:

  • Advair Diskus® or HFA
  • Breo® Ellipta®
  • Dulera®
  • Symbicort®
  • Wixela™
  • AirDuo RespiClick®

Single maintenance and reliever therapy (SMART) inhalers

Some medications act as both a rescue inhaler (because they are fast acting) and a control inhaler (because they are long lasting). Examples include:

  • Budesonide and formoterol fumarate dihydrate (Symbicort® HFA)
  • Mometasone furoate and formoterol fumarate dihydrate (Dulera®)

Other medication options

When your asthma is not controlled by using rescue or control inhalers, you may need other medications.

Long-acting muscarinic antagonists (LAMAs)

These medications reduce mucus and widen airways. This allows more air to flow through.

Oral corticosteroids

Oral corticosteroids are a kind of anti-inflammatory medication that reduces swelling and mucus inside the airway. This medication is used for asthma flare-ups and for severe asthma.

Leukotriene modifiers

Leukotrienes are chemicals that cause inflammation and excess mucus production in the lungs. The body releases leukotrienes when it comes into contact with an allergic trigger. Leukotriene modifiers are medications that reduce the number of leukotrienes the body releases. This prevents them from causing greater inflammation and increased mucus.

Biologics

Biologics take asthma treatment to a new level. They target a specific cell or protein in the body to prevent inflammation in the airways. Biologics are delivered via a shot or intravenous infusion given every 2 to 4 weeks. Your provider may recommend a biologic if:

  • Your asthma is not controlled with standard inhalers
  • You have frequent asthma flare-ups
  • You use oral steroids frequently

Five biologics are available:

  • Benralizumab (Fasenra®)
  • Dupilumab (Dupixent®)
  • Mepolizumab (Nucala®)
  • Omalizumab (Xolair®)
  • Reslizumab (Cinqair®)

How to take your Asthma medications

Most asthma medications come as sprays or powders delivered using an inhaler. When you inhale the medication, it goes into the airways of the lungs, right where it is needed.

The most familiar type of asthma inhaler is the metered-dose inhaler (MDI). This pressurized device releases medication in a fine spray for you to inhale. Small children and others may also use a nebulizer to deliver their medication. This machine turns liquid medicine into a mist that can be inhaled slowly over 10 to 15 minutes.

Ask your health-care provider or pharmacist to show you how to use your inhaler. Also read the instructions that came with the inhaler and follow the priming and cleaning directions carefully.

Using a metered-dose inhaler

Each brand of MDI operates and needs to be maintained differently. Check the patient instruction sheet that came with your inhaler for details.

Priming and counting doses

When an MDI is new or hasn’t been used in a while, the ingredients may separate. Priming (releasing one or more sprays into the air before using it as treatment) helps ensure the dose you inhale has the right amount of medication.

Even the most perfectly timed inhalation won’t help if there’s no medicine left in the inhaler. You need to count each dose and each priming spray. By keeping count, you will know when to replace your inhaler. Many MDIs now have dose counters built in to make it easy for you to keep track of how much of your inhaler you have used.

How to inhale properly

You must inhale the spray quickly enough to prevent it from landing on your tongue or inside your cheek, but slowly enough to let it get deep into your lungs.

Many people, especially children, have trouble inhaling from an MDI. A common solution is a valved holding chamber (VHC) or spacer. These devices are easy to use and improve the delivery of the medication to the lower airways. They also decrease two common side effects of medication delivery: thrush (candidiasis) and hoarseness (dysphonia).

  • VHC: A VHC attaches to the MDI and has a one-way valve that allows you to spray the medication into the chamber and inhale it when you are ready or over several breaths. It can also be used with a mask attachment for young children and others.
  • Spacer: A spacer is an open tube placed on the mouthpiece of the MDI. It increases the distance between the MDI and the patient’s mouth and directs the medicine into the chamber. Patients must still coordinate breathing with the release of spray from the inhaler.

Instructions for using inhalers

Use these instructions to help you troubleshoot your inhaler:


Living Well with Asthma Patient Education Guide

Living Well With Asthma

Our patient education guide has more information about asthma diagnosis, treatments, and more.

Download the PDF »

Managing Asthma

Asthma tends to change a lot over time, with symptoms that come and go. This can lead to changes in your asthma severity.

To manage symptoms, you’ll need to work with your health-care provider. That means keeping regular appointments even when you feel fine. Well visits help you keep your asthma under control and identify problems early on. Having a team who knows you also makes it easier to maintain effective treatment plans and deal with emergencies.

Your Asthma Action Plan

An important part of your asthma management is a written Asthma Action Plan. Your health-care provider will work with you to create an Asthma Action Plan that tells you:

  • What medicines to take and when to take them
  • Things you should do to prevent symptoms and deal with flare-ups

Your Asthma Action Plan outlines treatment according to colored zones:

  • Green Zone: Means you are doing well
  • Yellow Zone: Means your asthma is getting worse
  • Red Zone: Means you need immediate medical attention

Controlling your asthma may seem like a lot of work at first, but turning these steps into daily habits now can help you live a normal life. Remember to:

  • Take action to control or avoid your individual asthma triggers.
  • Keep a daily diary of your asthma symptoms to share with your health-care provider.
  • Take your long-term control medicines daily or as prescribed.
  • Always carry your quick-relief medicine with you.

Asthma Action Plan

Take this fillable Asthma Action Plan to your next appointment.

Download the PDF »

Questions to ask your health-care provider

Asthma Action Plan

  • What is an Asthma Action Plan?
  • How do I know that my asthma is controlled?
  • How is a peak flow meter used? What are my green, yellow, and red zone measurements?

Colds and allergies

  • When I catch a cold, will it always worsen my asthma?
  • What can I do to keep my asthma under control if I have allergies?

Inhalers

  • What is the difference between a controller inhaler and a rescue inhaler?
  • Do I have to take my controller inhaler every day if my asthma is under control?
  • What is the difference between a spacer and a holding chamber? How does it work with my inhalers?
  • What mouth care is required when using my controller inhalers?
  • What is the difference between hydrofluoroalkane (HFA) inhalers, metered-dose inhalers, and dry-powder inhalers?
  • How many times can I use my rescue inhaler or nebulizer in a 24-hour period?
  • Will the use of a controller inhaler that contains steroids affect my glaucoma?
  • Will the use of a controller inhaler that contains steroids affect my blood pressure or heart rate?
  • Do I have to prime or shake my inhaler with each use?
  • When should I use my rescue inhaler?

Health

  • Can I outgrow asthma?
  • Can I exercise or play sports with asthma?
  • How does smoking or secondhand smoke affect my asthma?
  • How often should I have my pneumonia and flu vaccination?
  • Can I pass asthma on to my children?

When to see an Asthma specialist

You may need to see a specialist (an allergist or pulmonologist) if you continue to have symptoms that disrupt your sleep or everyday activities, even after following your management plan. The National Institutes of Health asthma guidelines recommend seeing a specialist if you:

  • Have had a life-threatening asthma episode
  • Are not responding to treatment after 2 to 4 weeks
  • Have persistent asthma symptoms, limited physical activity, and frequent flare-ups
  • Need continuous high-dose ICSs or more than two courses of oral corticosteroids in 1 year
  • Need additional testing, such as allergy tests, complete spirometry breathing tests, rhinoscopy, or bronchoscopy
  • Are being considered for immunotherapy
  • Have conditions that complicate your asthma, such as severe hay fever, sinusitis, GERD, or exercise-related breathing problems
  • Need more education on complications of therapy or allergen avoidance at home, school, or work

Coping with an Asthma attack

Know the danger signs of a serious asthma attack:

  • Severe shortness of breath (gasping for air)
  • Inability to talk well (not being able to speak in a full sentence)
  • Difficulty walking
  • Lips or fingernails turning blue

If you experience these danger signs, you are having a major asthma attack. Go to the emergency room or call 911 immediately!


Signs of less severe asthma attacks:

  • Coughing, sneezing, itchy throat
  • Tight chest, wheezing
  • Shortness of breath
  • Waking up at night
  • Fast heartbeat

When you feel an attack coming, follow these three steps:

  • Get away from the trigger that started your attack.
  • Take your quick-relief medicine as soon as you notice symptoms and then follow your Asthma Action Plan, which may advise you to take your controller medicine as well.
  • If you still have wheezing and shortness of breath, contact your health-care provider or get emergency help.

Women with Asthma

Asthma is particularly challenging for women. Compared with men, women are more likely to have asthma, their asthma is more severe, and they have worse outcomes. Female hormones are thought to be the main contributor to higher rates of asthma in women.

Differences in Asthma for Women
  • Adult women are more likely to have asthma than adult men—9.8% of women in the United States have asthma, compared with 6.1% of men.
  • Adult women visit the doctor for asthma twice as much as men do each year and go to the emergency department for asthma problems more often than men.
  • Women are more likely than men to have uncontrolled asthma.
  • Women are more likely to be hospitalized for asthma than men.
  • Women have a higher death rate than men due to asthma.

Part of the problem is that female biology makes breathing harder—normally and at all ages—than does male biology. Women have smaller lungs, smaller airways, and smaller breathing muscles. They also have smaller rib cages, which limits the amount of air that can enter the lungs, and smaller chest wall muscles. These differences affect air flow, lung volume, and the amount of effort required to breathe.

Risk factors

Although the risk factors for women are the same as those for men, three asthma risk factors occur more often for women.

Obesity

Being overweight increases the likelihood of getting asthma for both men and women, but can make control particularly difficult for women

Environmental triggers

Poor air quality in the home or the workplace, particularly in cities, increases the likelihood of women developing asthma.

Smoking

Tobacco smoke, secondhand smoke, and vaping all contribute to higher incidence of asthma in women.

Girls and Asthma

Before age 18, boys are more likely to have asthma than girls. In fact, boys are twice as likely as girls to be hospitalized for an asthma exacerbation. But as puberty begins and male and female hormones kick in, the numbers shift—more women have asthma than men.

This difference is likely associated with the male and female hormones. As boys reach puberty, testosterone increases, which reduces asthma reactions that lead to inflammation and mucus production in the lungs. Conversely, estrogen and progesterone (the primary female hormones) have been shown to increase airway inflammation, leading to more asthma symptoms.

It’s not the female hormones themselves that trigger asthma symptoms. It’s the fluctuation—the ups and downs—of these hormones that affects asthma at key points in a woman’s life—puberty, periods, pregnancy, and perimenopause.

Periods and Asthma

For about half of women who have asthma, asthma symptoms worsen right before (4 to 5 days) and during their periods. That’s because estrogen and progesterone levels decrease to their lowest levels in the reproductive cycle the final week before your period.

The decline in female hormones narrows the airways or affects cells in the immune system, which can cause an asthma attack. This is called premenstrual asthma. Most hospitalizations for women with asthma happen in the days before their periods begin.

For most women with asthma, paying close attention to your triggers before your period can help you avoid increases in symptoms. For women who experience severe asthma symptoms around their periods, hormone therapy may be recommended, such as birth control pills, patches, or injections.

Pregnancy and Asthma

Controlling asthma is very important if you are pregnant. Healthy baby development relies on oxygen delivered to the fetus from the mother’s bloodstream. That means women with asthma who are pregnant need to keep their airways open and their breathing clear to ensure that the fetus gets plenty of oxygen. Fortunately, asthma affects only about 4% to 8% of pregnant women.

Asthma in pregnant women is unpredictable. For about one-third of this group, asthma symptoms worsen. In another third, asthma symptoms stay the same. For another third, asthma symptoms improve. Almost half of pregnant women with asthma have an asthma attack during their pregnancy. If asthma control gets worse during pregnancy, the symptoms tend to increase during weeks 24 to 34.

Poorly controlled asthma during pregnancy carries risks. Mothers with uncontrolled asthma are more likely to develop complications, including:

  • Pre-eclampsia (dangerously high blood pressure)
  • High blood pressure
  • Higher rate of C-section (cesarean delivery)
  • Preterm or premature birth
  • Low birth weight for the baby
  • Bleeding during pregnancy
  • Bleeding after giving birth
  • Anemia
  • Blood clots to the lungs

Keeping asthma controlled during pregnancy requires careful monitoring. Make sure your obstetrician is aware of your asthma and that your asthma specialist knows about your pregnancy as early as possible. Most asthma medications are safe to take during pregnancy. Meet with your asthma specialist to review your medications and Asthma Action Plan for your pregnancy.

You’ll also need to have your medications on hand during labor and delivery. About 10% of women with asthma have symptoms during labor and delivery, but an asthma attack is very rare.

Women who experience changes in their asthma during pregnancy—either worsening or improving—generally go back to their prepregnancy asthma levels within 3 months of birth. It is safe to use both quick-relief and controller inhalers while breastfeeding.

Perimenopause or menopause and Asthma

The transition to menopause—called perimenopause—begins around age 45. During this time, women experience changes in the length, frequency, and severity of their periods. Because of fluctuations in estrogen and progesterone levels, women with asthma often see an increase in asthma symptoms and severity. The changing peaks and valleys in women’s hormones can trigger inflammation in the lungs. The good news is that once menopause takes place, the reduction in female hormone levels often leads to fewer and less severe asthma symptoms.

Taking hormone replacement therapy (HRT) to reduce the symptoms of menopause is a mixed bag for women. If you have a history of asthma and begin HRT at menopause, you may still see a reduction in your asthma. But some women who have not had asthma and begin taking HRT when they reach menopause may be likely to develop new asthma than women who do not take HRT, and their asthma is often more severe and difficult to treat. Talk to your doctor before beginning HRT to determine whether this treatment will be beneficial for you.

Older women and Asthma

Many women experience asthma symptoms for the first time around age 50 or older. Asthma tends to be more severe in women with asthma who are over age 65, and they have higher death rates than the general population. Women in this age group are also twice as likely as men to visit emergency departments, and they have the highest rate of hospitalizations for asthma of any group.

Older women are at risk for negative effects from inhaled corticosteroids (ICSs). ICSs can contribute to low bone density and increase the risk of fractures. Older women also have a higher rate of obesity (42.3%) than the general population (35.7%). Asthma occurs more often in women who are obese than in those who are not.

Depression can be a challenge for older women with asthma. Depression can contribute to worse asthma control, lower quality of life, and less adherence taking controller medications.

The best defense is to stick to your Asthma Action Plan and see your health-care provider regularly to prevent worsening symptoms.

Understanding how asthma is treated and how to live well with it will improve your quality of life. Use the CHEST Foundation’s resources to learn more about asthma.


Living Well with Asthma Patient Education Guide

Living Well With Asthma

Our patient education guide has more information about asthma diagnosis, treatments, and more.

Download the PDF »

Resources

Use this information to get answers and support.

Asthma support groups and education

Look for local asthma support groups in your area or online support groups. You can also ask your health care-provider about support groups in your area. Your insurance provider may also have asthma educators who provide education and resources.

Asthma Severity Assessment Tool

Do You Need an Asthma Specialist?

Use this checklist to find out.

Asthma assessment tool »

Asthma Diary

This asthma diary will help you record your medicines, triggers, and peak flow.

Download the PDF »

Living Well with Asthma Patient Education Guide

Living Well With Asthma

Our patient education guide has more information about asthma diagnosis, treatments, and more.

Download the PDF »


Asthma glossary

Being able to talk about your asthma is a big part of managing your asthma. Here are some terms you might hear from your health-care provider:

Adult-onset asthma: Asthma that develops during adulthood

Allergen: Anything that causes an allergic reaction, such as pollen, pet dander, and dust mites

Allergic asthma: Asthma triggered by allergic reactions or allergic diseases; often starts in childhood

Allergy test: Any of various tests that help your asthma specialist determine what allergens might be triggering your asthma

Antibiotic: A type of medication your doctor may prescribe to treat non–type 2 inflammation

Anti-inflammatory: In asthma, anything that reduces or prevents swelling or thickening of the airways; a type of medication that reduces inflammation

Asthma: A chronic lung disease that makes it hard to breathe. There are 4 levels: intermittent, mild persistent, moderate persistent, and severe persistent.

Asthma trigger: Anything that causes the airway to be inflamed or swollen, or to tighten

Biologic: A type of medication that targets a specific cell or protein in the body to prevent inflammation in the airways.

Biomarker: Molecular signal that helps your health-care provider know what is happening in the cells of the body

Biomarker testing: A test that tells your health-care provider exactly how your body is reacting to inflammatory triggers

Bronchodilator: A medication that relaxes airway muscles or prevents them from tightening. Long-term bronchodilators work to relax the muscles continuously over time; short-acting bronchodilators are used for quick relief when a flare-up occurs.

Bronchospasm: Tightening of the muscles around the outside of the airways; this causes narrowing of the airways

Chronic obstructive pulmonary disease (COPD): This term refers to a group of diseases that cause inflammation and airway obstruction in the lungs.

Control inhaler: Also known as long-term control, maintenance, or preventer inhalers, this form of medication, which is taken daily, usually contains a steroid that reduces inflammation.

Dry powder inhaler (DPI): A device that delivers asthma medication in a very fine powder that can be inhaled with a deep, strong breath

Eosinophilic asthma (e-asthma): Type of asthma in which an abnormal increase in eosinophils (a type of blood cell) causes inflammation in the airways; pronounced EE-oh-SIN-oh-FIL-ik

Family history: Your family’s health history

Fractional exhaled nitric oxide (FeNO) testing: A test that helps your health-care provider determine how much inflammation you have in your airways by measuring the amount of nitric oxide (NO) you exhale. Higher NO levels may indicate swelling of the airways in your lungs.

Gastroesophageal reflux disease (GERD): A digestive-tract disease caused by stomach acids or foods coming up into the esophagus. Eventually the acids reach the throat and airways, causing a burning sensation (heartburn) in the chest.

Heterogeneity: Variability or diverseness; in terms of asthma, this refers to each person’s individual biological reactions to asthma

High-efficiency particulate air (HEPA): A HEPA filter can remove at least 99.97% of dust, pollen, and other airborne particles as small as 0.3 microns.

Immunoglobulin E (IgE): IgE is normally found in small amounts in the body, but levels sometimes can increase dramatically when exposed to the allergens that trigger a reaction in your body. IgE can also stimulate other cells to behave in ways that increase inflammation.

Interleukin 4/interleukin 4 receptor alpha (IL-4/IL-4Rα): IL-4 signals other harmful cells to begin production, sends eosinophils to the inflammatory areas, and causes the smooth muscles around the airway to contract.

Interleukin 5/interleukin 5 receptor (IL-5/IL-5R): IL-5 activates eosinophils and directs them to circulate to the sites of inflammation. Likewise, the IL-5R is involved in the immune response.

Interleukin-33 (IL-33): Another type of immune system molecule whose levels may be higher in people experiencing an allergic response

Inflammation: Swelling and thickening of the airways; a hallmark of asthma

Long-acting muscarinic antagonist (LAMA): A type of medication that reduces mucus in and widens airways

Lifestyle and behavior changes: Steps your doctor may recommend to reduce your exposure to asthma triggers, such as staying indoors when the outdoor air quality is poor, or losing weight

Metered-dose inhaler (MDI): A pressurized device that releases medication in a fine spray for you to inhale

Methacholine challenge: A test your health-care provider administers to help determine if you have asthma

Nebulizer: A machine that turns liquid medicine into a mist that can be inhaled slowly through a mask or mouthpiece

Nonallergic asthma: A type of asthma that can be triggered by a variety of causes not related to an allergic reaction; often begins in adulthood

Non–type 2 inflammation: An asthma category that includes all types of asthma not caused by eosinophilic inflammation

Phenotype: Observable traits or characteristics that are the result of how your genes interact with your environment

Physical examination: Your asthma specialist will listen to your lungs and check your ears, nose, throat, and eyes for indications of allergy, such as inflammation. They also will examine your skin for eczema (atopic dermatitis).

Priming: Releasing one or more sprays from your inhaler into the air to help ensure the dose you inhale has the right amount of medication

Rescue inhaler: Also known as quick-relief inhalers, this type of treatment contains a bronchodilator that rapidly widens your airways, providing quick, short-term relief during a flare-up (asthma attack).

Single maintenance and reliever therapy (SMART) inhaler: A type of inhaled medicine that acts as both a rescue inhaler (because it is fast acting) and a control inhaler (because it is long lasting)

Spacer: A device that attaches to your inhaler; it improves the delivery of inhaled medication to the lower airways

Spirometer: A handheld device with a tube you blow into that helps your health-care provider determine your lung capacity

Spirometry: A lung function test of how much air you can move in and out of your lungs and how fast you can do it

Sulfite: A type of preservative found in some foods (eg, beer, wine, shrimp, processed potatoes) that can trigger an allergic asthma response

Targeted therapy: Treatment tailored to your individual physical response

Thymic stromal lymphopoietin (TSLP/IL-33): TSLP activates different cells that stimulate an allergic response in the lungs, which increases eosinophil levels and leads to smooth muscle contraction.

Type 2 inflammation: An asthma category that includes all forms of asthma that are driven by inflammation

Valved holding chamber (VHC): A type of spacer that is one-way, allowing the patient to breathe air in only from the chamber, not out into the chamber

Zone: Your Asthma Action Plan outlines treatment according to colored zones: green zone means you are doing well, yellow zone means your asthma is getting worse, and red zone means you need immediate medical attention