Symptoms of Asthma; What Does Asthma Feel Like?
Asthma is characterized by inflammation of the bronchial tubes with increased production of sticky secretions inside the tubes. People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. Common asthma symptoms include:
- Coughing, especially at night
- Wheezing
- Shortness of breath
- Chest tightness, pain, or pressure
Still, not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your asthma symptoms may also vary from one asthma attack to the next, being mild during one and severe during another.
Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms called asthma attacks. Others might have asthma symptoms every day. In addition, some people may only have asthma during exercise, or asthma with viral infections like colds.
Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild asthma symptoms to help you prevent severe episodes and keep asthma under better control.
Know the Early Symptoms of Asthma
Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These signs may start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.
In general, these signs are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse. Early warning signs of an asthma attack include:
- Frequent cough, especially at night
- Losing your breath easily or shortness of breath
- Feeling very tired or weak when exercising
- Wheezing or coughing after exercise
- Feeling tired, easily upset, grouchy, or moody
- Decreases or changes in lung function as measured on a peak flow meter
- Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache)
- Trouble sleeping
If you have these warning signs, adjust your medication, as described in your asthma action plan.
Know the Symptoms of an Asthma Attack
An asthma attack is the episode in which bands of muscle surrounding the airways are triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of the airways becomes swollen or inflamed and the cells lining the airways produce more and thicker mucus than normal.
All of these factors — bronchospasm, inflammation, and mucus production — cause symptoms such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack include:
- Severe wheezing when breathing both in and out
- Coughing that won’t stop
- Very rapid breathing
- Chest pain or pressure
- Tightened neck and chest muscles, called retractions
- Difficulty talking
- Feelings of anxiety or panic
- Pale, sweaty face
- Blue lips or fingernails
The severity of an asthma attack can escalate rapidly, so it’s important to treat these asthma symptoms immediately once you recognize them.
Without immediate treatment, such as with your asthma inhaler or bronchodilator, your breathing will become more labored. If you use a peak flow meter at this time, the reading will probably be less than 50%. Many asthma action plans suggest interventions starting at 80% of normal.
As your lungs continue to tighten, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so there is not enough air movement to produce wheezing. You need to be transported to a hospital immediately. Unfortunately, some people interpret the disappearance of wheezing as a sign of improvement and fail to get prompt emergency care.
If you do not receive adequate asthma treatment, you may eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as cyanosis, means you have less and less oxygen in your blood. Without aggressive treatment for this asthma emergency, you may lose consciousness and eventually die.
If you are experiencing an asthma attack, follow the “Red Zone” or emergency instructions in your asthma action plan immediately. These symptoms occur in life-threatening asthma attacks. You need medical attention right away.
Know the Asthma Symptoms in Children
Asthma affects as many as 10% to 12% of children in the United States and is the leading cause of chronic illness in children. For unknown reasons, the incidence of asthma in children is steadily increasing. While asthma symptoms can begin at any age, most children have their first asthma symptoms by age 5.
Not all children with asthma wheeze. Chronic coughing with asthma may be the only obvious sign, and a child’s asthma may go unrecognized if the cough is attributed to recurrent bronchitis.
Know About Unusual Asthma Symptoms
Not everyone with asthma has the usual symptoms of cough, wheezing, and shortness of breath. Sometimes individuals have unusual asthma symptoms that may not appear to be related to asthma. Some “unusual” asthma symptoms may include the following:
- rapid breathing
- sighing
- fatigue
- inability to exercise properly (called exercise-induced asthma)
- difficulty sleeping or nighttime asthma
- anxiety
- chronic cough without wheezing
Also, asthma symptoms can be mimicked by other conditions such as bronchitis, vocal cord dysfunction, and even heart failure.
It’s important to understand your body. Talk with your asthma doctor and others with asthma. Be aware that asthma may not always have the same symptoms in every person.
Know Why Infections Trigger Asthma Symptoms
Sometimes a virus or bacterial infection is an asthma trigger. For instance, you might have a cold virus that triggers your asthma symptoms. Or your asthma can be triggered by a bacterial sinus infection. Sinusitis with asthma is common.
It’s important to know the signs and symptoms of respiratory tract infections and to call your health care provider immediately for diagnosis and treatment. For instance, you might have symptoms of increased shortness of breath, difficulty breathing, or wheezing with a bronchial infection. In people who don’t have asthma, the bronchial infection may not trigger the same debilitating symptoms. Know your body and understand warning signs that an infection might be starting. Then take the proper medications as prescribed to eliminate the infection and regain control of your asthma and health.
Asthma Risk Factors
There are usually reasons or risk factors that predispose you to asthma and respiratory problems. Asthma can happen to anyone without any risk factors, but it is less likely if there are no risk factors present.
Let’s look at some asthma risk factors and see how they increase the chance that a person will have the asthma symptoms of cough, wheezing, and shortness of breath associated with the disease. After determining your personal risk factors for asthma, decide on the ones you can control and try to make some lifestyle changes. Avoidance of the risk factors you can control is crucial in preventing asthma symptoms. While you cannot change your gender or family history, you can avoid smoking with asthma, breathing polluted air, allergens, and taking care of your general health so you don’t become overweight. Take control of your asthma — by controlling your asthma risk factors. By understanding all the risk factors, you may be able to prevent or control your asthma.
Gender and Asthma
Childhood asthma occurs more frequently in boys than in girls. It’s unknown why this occurs, although some experts find a young male’s airway size is smaller when compared to the female’s airway, which may contribute to increased risk of wheezing after a cold or other viral infection. Around age 20, the ratio of asthma between men and women is the same. At age 40, more females than males have adult asthma.
Family History of Asthma
Blame Mom or Dad or both for your asthma. Your inherited genetic makeup predisposes you to having asthma. In fact, it’s thought that three-fifths of all asthma cases are hereditary. According to a CDC report, if a person has a parent with asthma, they are three to six times more likely to develop asthma than someone who does not have a parent with asthma.
Atopy and Asthma
Atopy refers to a genetic tendency to develop eczema (atopic dermatitis), allergic rhinitis, allergic conjunctivitis, and asthma. Atopy causes a heightened sensitivity to common allergens, especially those that are in food and in the air.
Some children with eczema or atopic dermatitis develop asthma. Some findings indicate that children with atopic dermatitis may have more severe and persistent asthma as adults.
Allergies Linked to Asthma
Allergies and asthma often coexist. Indoor allergies are a predictor of who might be at risk for an asthma diagnosis. One nationwide study showed levels of bacterial toxins called endotoxins in house dust were directly related to asthma symptoms.
Sources of other indoor allergens include animal proteins (particularly cat and dog allergens), dust mites, cockroaches, fungi, and mold. Changes that have made houses more “energy-efficient” over the years are thought to increase exposure to these causes of asthma.
Environmental Factors and Asthma
Indoor air pollution such as cigarette smoke, mold, and noxious fumes from household cleaners and paints can cause allergic reactions and asthma. Environmental factors such as pollution, sulfur dioxide, nitrogen oxide, ozone, cold temperatures, and high humidity are all known to trigger asthma in susceptible individuals. In fact, asthma symptoms and hospital admissions are greatly increased during periods of heavy air pollution. Ozone is the major destructive ingredient in smog. It causes coughing, shortness of breath, and even chest pain — and can boost the susceptibility to infection. Sulfur dioxide, another component of smog, also irritates the airways and constricts the air passages, resulting in asthma attacks.
Gas stoves are the primary source of indoor nitrogen dioxide, a common indoor pollutant. Studies show that people who cook with gas are more likely to have wheezing, breathlessness, asthma attacks, and hay fever than those who cook with other methods. It is estimated that more than half of the households in the U.S. use gas stoves.
Weather changes can also result in asthma attacks in some people. For instance, cold air causes airway congestion and an increase in mucus production. Increases in humidity may also cause breathing difficulty in a certain population.
Cigarette Smoke Is an Asthma Risk Factor
Several studies confirm that cigarette smoking is linked with an increased risk for developing asthma. There’s also evidence that cigarette smoking among adolescents increases the risk of asthma. Even more findings link secondhand smoke exposure with the development of asthma in early life.
The Link Between Obesity and Asthma
Some studies show that asthma is more common in overweight adults and children. Overweight asthmatics seem to have more uncontrolled asthma and more days on medications for asthma.
Pregnancy and Asthma
Maternal smoking during pregnancy appears to result in lower lung function in infants compared to those whose mothers did not smoke. Premature birth is also a risk factor for developing asthma.
Types of Asthma
Allergies and Asthma
Allergies and asthma often go hand-in-hand. Allergic rhinitis (also called hay fever) is inflammation of the lining of the nose and is the single most common chronic allergic disease. In those with allergic rhinitis, increased sensitivity (allergy) to a substance causes your body’s immune cells to release histamines in response to contact with the allergens. Histamines, along with other chemicals, lead to allergy symptoms. The most common allergens enter the body through the airway.
With allergic rhinitis, you may feel a constant runny nose, ongoing sneezing, swollen nasal passages, excess mucus, weepy eyes, and a scratchy throat. A cough may result from the constant postnasal drip. Many times, asthma symptoms are triggered by allergic rhinitis. Your doctor may prescribe medications to control the allergies and, in doing so, the cough and other asthma symptoms may subside.
Exercise-Induced Asthma
Exercise-induced asthma is triggered by exercise or physical exertion. Many people with asthma have some symptoms with exercise. But there are many people without asthma, including Olympic athletes, who get symptoms only during exercise.
With exercise-induced asthma, airway narrowing peaks 5 to 20 minutes after exercise begins, making it difficult to catch your breath. The symptoms begin within a few minutes of starting exercise and peak or worsen a few minutes after stopping exercise. You may have symptoms of an asthma attack, with wheezing and coughing. Your doctor can tell you if you need to use an asthma inhaler (bronchodilator) before exercise to prevent these uncomfortable asthma symptoms.
Cough-Variant Asthma
In cough-variant asthma, severe coughing is the main symptom. There can be other causes of coughing, such as postnasal drip, chronic rhinitis, sinusitis, or gastroesophageal reflux disease (GERD or heartburn). Coughing because of sinusitis with asthma is common.
Cough-variant asthma is vastly underdiagnosed and undertreated. Asthma triggers for cough-variant asthma are usually respiratory infections and exercise.
For any persistent cough, contact your doctor. They may order specific asthma tests, such as lung function tests, to show how well your lungs work. You might need to see a lung specialist for further tests before an asthma diagnosis is made.
Occupational Asthma
Occupational asthma results from workplace triggers. The list of known triggers is long and varied, but they are usually things that you breathe in (or inhale). With this type of asthma, you might have trouble breathing and asthma symptoms just on the days you’re on the job.
Many people with this type of asthma have a runny nose and congestion, eye irritation, or a cough instead of the typical asthma wheezing.
Occupational asthma can happen in almost any line of work or any work environment, including offices, stores, hospitals, and medical facilities.
Some common jobs that are tied to occupational asthma include animal breeders, farmers, hairdressers, nurses, painters, and woodworkers.
Occupational asthma triggers include:
- Contaminants in the air such as smoke, chemicals, vapors (gases), fumes, or dust
- Respiratory infections, such as colds and flu (viruses)
- Allergens in the air, such as molds, animal dander, and pollen
Two types of occupational asthma attacks happen:
- Aggravation of preexisting asthma. This is by far the most common type. Over time, with regular contact, you become very sensitive to the trigger. With this asthma, continued exposure to the trigger causes attacks.
- Irritant asthma. Contact with certain things or conditions in the workplace irritates the airways, causing symptoms right away. Although this is not an allergic-type reaction, the irritation may cause allergy-like or asthma-like symptoms.
Once the attack is triggered, the airways begin to swell and tighten (bronchospasm) and make mucus. The swelling and extra mucus partially block, or obstruct, the airways. This makes it harder to push air out of your lungs (exhale).
Occupational asthma is the most common work-related lung disease in developed countries. In up to 15% of people with disabling asthma in the United States, the condition is at least partly related to their work.
Nighttime (Nocturnal) Asthma
Nighttime asthma, also called nocturnal asthma, is a common type of the disease. If you have asthma, the chances of having symptoms are much higher during sleep because asthma is powerfully influenced by the sleep-wake cycle (circadian rhythms). Your asthma symptoms of wheezing, coughing, and trouble breathing are common and dangerous, particularly at night.
Thunderstorm Asthma
Thunderstorm asthma can happen when heavy storms hit on a day with a very high pollen count, usually during the spring, and cause symptoms of an asthma attack.
Grains of pollen get sucked into the storm clouds. Once those grains take in a certain amount of water, they pop, making even smaller grains. Those smaller grains get into the wind at ground level. There, they can be breathed in easily. That can lead to asthma attacks.
You can’t control pollen counts or thunderstorms, but you can control how you’re affected if they come together. If you have asthma or hay fever or are allergic to grass, the best thing to do is keep your condition under control and know how to handle an asthma attack if you have one.
If you have hay fever or allergies, see a specialist to figure out your triggers. If you’re allergic to pollen and your doctor wants you to have treatment for it, be sure to start taking your meds at least 6 weeks before high-pollen season begins.
Keep an eye on the weather, too. On high-pollen days, especially if thunderstorms are expected, try to stay indoors and keep your windows closed. It’s especially important to stay out of the high winds that come just before thunderstorms.
Health Conditions That May Mimic Asthma
A variety of illnesses can cause some of the same symptoms as asthma. For example, cardiac asthma is a form of heart failure in which the symptoms mimic some of the symptoms of regular asthma.
Vocal cord dysfunction is another asthma mimic. Many recent reports have drawn attention to a peculiar syndrome in which abnormal vocal cords cause wheezing that is frequently misdiagnosed as asthma. This is most common in girls and young women who have loud and dramatic episodes of wheezing that do not respond to medications that open the airways.
Treatments of Asthma
Asthma Medications
You might need to use fast-acting rescue medicines, long-term treatments, or both.
Rescue inhalers (or quick-relief inhalers)
You use these medications to ease asthma symptoms. They relax the muscles that tighten around your airways. This helps open them up so you can breathe easier. If you’re using this type of medication more than 2 days a week, see your doctor.
- Short-acting beta-agonists are the first choice for quick relief of asthma symptoms. They include albuterol (ProAir HFA, Proventil HFA, Ventolin HFA), epinephrine (Asthmanefrin, Primatene Mist), and levalbuterol (Xopenex HFA).
- Anticholinergics such as ipratropium (Atrovent) lessen mucus in addition to opening your airways. They take longer to work than short-acting beta-agonists.
- Oral corticosteroids such as methylprednisolone ands prednisone lower swelling in your airways.
- Combination quick-relief medicines have both an anticholinergic and a short-acting beta-agonist.
- Inhaled corticosteroids are the most effective long-term control medicines. These aren’t the same as anabolic steroids that people use to grow muscle. They include beclomethasone (Qvar RediHaler), budesonide (Pulmicort Flexhaler), ciclesonide (Alvesco), fluticasone (Flovent HFA), and mometasone (Asmanex Twisthaler).
- Inhaled long-acting beta-agonists open your airways by relaxing the smooth muscles around them. You’ll take this medication along with an inhaled corticosteroid. They include formoterol, salmeterol, and vilanterol.
- Combination inhaled medicines have an inhaled corticosteroid along with a long-acting beta-agonist. This is an easy way to take them together. They include Advair, Breo, Dulera, and Symbicort.
- Biologics target a cell or protein in your body to prevent airway inflammation. They may be shots or infusions you get every few weeks. They can be expensive, so you usually get them if other medications don’t work. Biologics include benralizumab (Fasenra), dupilumab (Dupixent), mepolizumab (Nucala), omalizumab (Xolair), and reslizumab (Cinqair).
- Leukotriene modifiers relax the smooth muscles around your airways and ease swelling. You can take them as pills or liquids. These include montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo).
- Cromolyn prevents your airways from swelling when they come into contact with an asthma trigger. It’s a non-steroid medicine that comes in an inhaler.
- Theophylline (Theo-24, Theo-Dur) relaxes the smooth muscles that narrow your airways. It comes as a tablet, capsule, solution, or syrup.
- Tezepelumab-ekko (Tezspire) injection is a first-in-class medicine indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older.
- Long-acting bronchodilators. You might use tiotropium (Spiriva) along with corticosteroids if you have ongoing asthma symptoms even though you take a daily inhaled steroid. Never use long-acting bronchodilators alone as a long-term asthma treatment.
- Corticosteroids. If no other medicine can get your asthma attacks under control, your doctor might have you take these medications for a couple of weeks. They come in pills or liquids.
How Do You Take Asthma Medications?
Asthma inhalers
Asthma inhalers are the most common and effective way to deliver asthma medicine to your lungs. They’re available in several types that work in different ways. Some deliver one medication. Others contain two medications. Your doctor might give you:
- A metered-dose inhaler, which uses a small aerosol canister to push out a short burst of medication through a plastic mouthpiece
- A dry powder inhaler, which releases the medicine only when you take a deep breath
Asthma nebulizer
If you’re having trouble using small inhalers, your doctor may recommend a nebulizer. This machine changes asthma medications from a liquid to a mist so it’s easier to get the medicine into your lungs. It also has a mouthpiece or mask that makes it a good option for infants, small children, older adults, or anyone who has trouble using inhalers with spacers. It takes a few more minutes to use than an inhaler.
Side Effects of Asthma Medications
Many medications have side effects. For example, inhaled steroids can cause mild problems, such as thrush infections and a sore throat, or more serious ones including eye disorders and bone loss. Keep your doctor up to date with how well your treatment is working and whether you have side effects. They’ll work with you to keep your asthma under control with as little medicine as possible.
Other Asthma Treatments
Medications aren’t the only way to control asthma. Your doctor might also try a condition called bronchial thermoplasty.
People with asthma often have extra smooth muscle in their airway walls. In this procedure, your doctor uses a small tube called a bronchoscope to send heat to the walls and reduce the smooth muscle. You’ll get the treatment over three visits about 2 or 3 weeks apart.
Asthma Action Plan
You and your doctor will work together to create an action plan. It can be on paper or online. Either way, it will boost your efforts to control your condition with information and directions on:
- How to know if your symptoms get worse
- Medicines to take when you’re doing well and when symptoms get worse
- What to do in an emergency
- Doctor contact info for an emergency
- How to control asthma triggers
- Green. You don’t notice any symptoms, or you have them under control. You can use your regular medications.
- Yellow. Your symptoms happen more often or are worse. You might need to change treatments or use more medicine.
- Red. You have severe symptoms that need treatment right away, usually with several medicines.
Asthma Lifestyle Home Remedies
In addition to following your treatment plan, you can try:
- Breathing exercises. These can lower the amount of medication you need to control your symptoms.
- Herbal and natural remedies. Things that may help improve asthma symptoms include:
- Black seed oil (Nigella sativa). Some studies have shown that it can help open airways.
- Caffeine. It’s a mild bronchodilator, meaning it can open your airways, but it doesn’t work as fast as medications. Avoid caffeine for several hours before any medical appointment that might include a lung function test.
- Choline. This helps your body work the way it should. You can get it in meat, liver, eggs, poultry, fish, shellfish, peanuts, and cauliflower, or from a supplement.
- Pycnogenol. You can get this pine bark extract as a supplement.
Avoid Asthma Triggers
Many things in the world around you can set off an asthma attack. By keeping them under control, you can lower your chances of problems. Common triggers include:
- Pet dander. If you can’t live without a pet, at least keep them out of your bedroom.
- Dust mites. Wash your bedding in hot water, vacuum your furniture, and get rid of carpets if you can. Get someone else to vacuum if you can. Use a dust mask if you do it.
- Pollen and outdoor mold. Keep windows closed. Stay inside from late morning to afternoon.
- Tobacco smoke. If you smoke, get help to quit. Don’t let others smoke in your home or car.
- Cockroaches. Keep food and garbage in closed containers, and treat your house for pests. Stay out of the room until fumes go away.
- Cold air. Cover your mouth and nose in cold weather.
- Indoor mold. Fix leaky pipes, and clean moldy surfaces with bleach.
Treatment for Allergy-Induced Asthma
If allergies trigger your asthma, your doctor might give you medications such as:
- Omalizumab (Xolair). It targets proteins in your body that increase when you come into contact with something you’re allergic to. You get it as a shot every 2 to 4 weeks.
- Immunotherapy. These allergy shots or drops that you hold under your tongue build up your tolerance to allergy triggers over time. They might even get rid of the allergy.
Talk to Your Asthma Specialist
If you’ve been diagnosed with asthma but your treatment doesn’t seem to work anymore, it’s time to see your doctor again. Likewise, if you’re having to use your rescue inhaler too often, see your doctor. You may need to change your asthma treatment for better control.
Though asthma is common, it’s a serious condition that needs a diagnosis and treatment. Talk to your doctor for asthma support, and find the medications that work best for you.
