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What Is Asthma?

It is important to understand what asthma is, what its symptoms are, and what is happening in the airways of your lungs. Asthma is a disease in which the airways of the lungs can become inflamed, narrowed, and full of mucus. This makes it difficult to breathe, causing symptoms such as:

  • Wheezing
  • Coughing
  • Chest tightness
  • Shortness of breath

Asthma is a long-term disease

If you have asthma, you will always have it. But you can learn to control it by avoiding things that trigger your symptoms and following your doctor’s instructions.

Asthma symptoms can be different for each person. You may have symptoms frequently, or not very often, or only in certain situations.

Asthma affects people of all ages, but it most often begins during childhood.

What Happens in Asthmatic Airways?

Every time you breathe, you bring air into your lungs through the airways and let it back out through the same airways.

If you have asthma, your airways can become inflamed, swollen, and sensitive. This makes them more likely to overreact to certain triggers.

When the airways react to a trigger, it causes two more things to happen:

  • The muscles around the airways tighten, which causes the airways to become narrower.
  • Cells in the lining of the airways may produce excess mucus, making the narrowing even worse.

Then you might begin to experience asthma symptoms because it is more difficult to breathe through narrow, mucus-filled airways.

Sometimes the symptoms are mild and go away after taking a quick-relief asthma medicine, but at other times the symptoms may get worse (asthma attack) and require additional treatment.

Inflammation in Large and Small Airways

The airways look a lot like the branches of a tree – larger near the base and smaller at the tips.

Asthma may cause inflammation in any or all of those branches.

Why is this important?

Most of the lung’s surface area is in the smaller airways, but the small diameters of those airways make it difficult for medication to reach those inflamed surfaces.

As a result, the small airways are a common place for asthma symptoms to arise.


  1. Centers for Disease Control and Prevention (CDC). Learn How to Control Asthma. Accessed October 10, 2017.
  2. Hamid Q. Pathogenesis of Small Airways in Asthma. Respiration. 2012;84:4–11.
  3. Mayo Clinic. Asthma. Accessed October 18, 2017.
  4. National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). What is Asthma? Accessed Oct 17, 2017.
  5. van der Wiel E, ten Hacken NHT, Postma DS, van den Berge M. Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review. J Allergy Clin Immunol.

Signs and Symptoms of Asthma

Asthma symptoms can range from mild to severe and be different from person to person. Some people may experience symptoms infrequently, while others may have symptoms all the time.

If something irritates your airways, your symptoms can flare up in what is called an “asthma attack.”

Common Signs and Symptoms

  • Coughing—typically worse at night or early in the morning, making it hard to sleep
  • Wheezing—a whistling or squeaky sound that occurs when breathing
  • Chest tightness—feeling like something is squeezing or sitting on your chest
  • Shortness of breath—feeling out of breath or like air isn’t leaving the lungs
  • Coughing or wheezing that gets worse during a respiratory infection (e.g., cold or flu)

Not everyone with asthma has all of these symptoms, and not everyone with these symptoms has asthma. Asthma needs to be diagnosed by a doctor, who will perform certain tests of your lung function.

No matter what asthma symptoms you experience, talk with your doctor about beginning treatment to control your symptoms and prevent them from worsening.


If you have not yet been diagnosed with asthma, but experience some of these symptoms, make an appointment with your doctor as soon as possible. Early treatment has been shown to control daily asthma symptoms and prevent asthma attacks.

If you have already been diagnosed with asthma, the following situations may warrant another visit to the doctor:

  • Frequent, intermittent coughing
  • Coughing that seems to be connected to physical activity
  • Wheezing or whistling sounds during exhalations
  • Rapid breathing or shortness of breath
  • Complaints of chest tightness
  • Repeated episodes, even if only suspected, of bronchitis or pneumonia


Your doctor can help you better gauge when an ER trip or visit to an urgent care facility is necessary. The following are signs that immediate medical attention may be needed for an asthma attack:

  • Coughing or wheezing without stopping, especially at night or early in the morning
  • Fast heartbeat, sweating, and chest pain
  • Needing to catch breath mid-sentence
  • Using abdominal muscles to breath
  • Widening of nostrils while inhaling
  • Breathing so hard that the stomach is sucked under the ribs while inhaling
  • Low peak flow meter readings
  • Symptoms that do not resolve after using a quick-relief inhaler


  1. Centers for Disease Control and Prevention (CDC). Learn How to Control Asthma. Accessed October 10, 2017.
  2. Mayo Clinic. Asthma. Accessed October 18, 2017.
  3. Mayo Clinic. Asthma Attack. Accessed October 12, 2017.
  4. Mayo Clinic. Childhood Asthma. Accessed October 11, 2017.
  5. National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI).What are the Signs and Symptoms of Asthma? Accessed Oct 17, 2017.

Diagnosing Asthma

Asthma needs to be diagnosed by a medical professional. But before your appointment, you can fill out the following Asthma Symptoms Checklist, and bring it with you to help review your symptoms with your doctor.

Asthma Symptoms Checklist

This checklist is based on the guidelines from the National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health.

Place a check mark in the box next to any symptom that you have had:

Do any of these asthma triggers make your symptoms worse?

Do your symptoms get worse at night or wake you up?


Click the "Print" button to print this checklist and use it to talk with your healthcare provider about your symptoms.

At Your Doctor's Appointment

To determine whether your symptoms are due to asthma or something else, your doctor will ask about your:

  • asthma symptoms
  • triggers for your asthma symptoms
  • medical history
  • family members who may also have asthma symptoms

Then the doctor will perform a physical examination and certain tests to measure your lung function.

Tests to evaluate lung function


  • Measures the amount of air you can exhale after a deep breath
  • Also measures how fast you breathe out
  • Used to estimate how much your airways may be narrowing

The doctor may use a spirometry test before and after giving you a fast-acting asthma medicine. If your results are much better after receiving the medicine, that is a sign that you may have asthma.

Peak Flow

  • Measures how forcefully you can breathe out

A low peak flow reading may mean that your lungs are not working as well as they could and/or that asthma may be worsening.

Imaging Tests

  • Chest X-ray and/or CT scan of lungs and sinuses
  • Identifies structural abnormalities or infections that may cause breathing problems

Provocative Testing

  • Measures how sensitive your airways are
  • The doctor gives you something known to trigger asthma symptoms, such as:
    • breathing cold air
    • performing vigorous activity
    • breathing in a chemical called methacholine
    and tests whether your lung function is affected by any of those triggers

Nitric Oxide Test

  • Measures the amount of nitric oxide in your breath, an indicator of inflammation in the airways

How Asthma Is Classified

Your doctor will determine the severity of your asthma based on the information gathered from your medical and family history, your physical examination, and your lung function test results. There are four categories that are used to classify asthma severity:

  • Mild Intermittent — Mild symptoms up to 2 days each week and up to 2 nights each month.
  • Mild Persistent — Symptoms more than 2 times each week, but no more than 1 time on a single day.
  • Moderate Persistent — Symptoms at least 1 time each day and more than 1 night a week.
  • Severe Persistent — Symptoms, on most days, throughout the day and frequently at night.


  1. Mayo Clinic. Asthma. Accessed October 18, 2017.
  2. National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). How is Asthma Diagnosed? Accessed Oct 17, 2017.
  3. National Asthma Education and Prevention Program (NAEPP). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma–Full Report 2007. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, Lung, and Blood Institute; August 2007. Accessed October 14, 2017.

Treating Asthma

Although asthma has no cure, treatments can be used to keep it under control. Asthma that is well controlled can:

  • prevent troublesome symptoms, such as coughing and shortness of breath
  • reduce your need for quick-relief medicines
  • help you maintain good lung function
  • allow you to maintain your normal activity level and sleep through the night
  • prevent asthma attacks that could result in an emergency room visit or hospital stay

Managing asthma involves following your doctor’s treatment advice and avoiding your asthma triggers.

Medicines for Treating Asthma

There are two types of medicines for treating asthma:

  • long-term control medicines, which reduce airway inflammation to help prevent symptoms
  • quick-relief medicines, which help relieve acute symptoms when they occur

Most people with asthma need to use both kinds of medicine.

Long-term Control Medicines – These should be taken every day, whether or not you feel symptoms, because they are intended to reduce the inflammation and therefore prevent symptoms from starting.

Quick-relief Medicines – These are essential for every asthma patient to carry with them, to relieve acute symptoms if a flare-up happens. Quick-relief medicines help with immediate symptoms, but they do not treat the inflammation at all, which is why long-term control medicines are still necessary.

Your doctor will choose an initial treatment plan based on the severity of your asthma, but the treatment plan may be adjusted over time in order to optimize your asthma control.


National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). How is Asthma Treated and Controlled? Accessed Oct 17, 2017.

Managing Asthma

Life shouldn’t be controlled by asthma symptoms. Fortunately, there are ways to help manage them:

  • Follow an Asthma Action Plan (specifying your medications, when to take them, and when to call your doctor or go to the Emergency Department), including taking your medications daily
    • See a sample plan here
  • Avoid your asthma triggers
  • Record your asthma symptoms to determine whether your asthma is controlled
  • Use a peak flow meter to monitor your lung function
  • Visit your doctor regularly for asthma checkups

Avoiding Triggers

Asthma symptoms can be “triggered” by various irritants or situations, so it is important to learn what your specific triggers are so you can avoid them as much as possible.

For example, if pollen makes your asthma symptoms start or get worse, try to avoid going outside on days when the pollen count is high.

Common triggers include:

  • Pollen (from trees, grass, and/or weeds)
  • Air pollution
  • Cold weather
  • Pet fur or dander
  • Dust mites
  • Cockroaches
  • Mold spores
  • Cigarette or cigar smoke
  • Smoke from burning wood or grass
  • Strongly scented products
  • Certain medications
  • Certain foods
  • Preservatives in foods and drinks
  • Respiratory infections (cold/flu)
  • Strong emotions or stress
  • Physical activity

Note: Although physical activity can be a trigger for asthma in some people, you should not avoid it entirely, because physical activity is important for a healthy lifestyle. Talk with your doctor about types of physical activity you could do that would be less likely to trigger your asthma symptoms.

Keeping your asthma well controlled involves both avoiding your triggers and taking your long-term control medication every day, whether or not you feel symptoms.


Here are some asthma-related resources to help you connect and find more information and support:


  1. Centers for Disease Control and Prevention (CDC). Learn How to Control Asthma. Accessed October 10, 2017.
  2. Mayo Clinic. Asthma. Accessed October 18, 2017.
  3. National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). How is Asthma Treated and Controlled? Accessed Oct 17, 2017.

Adolescents with Asthma

Of the nearly 25 million Americans who have been diagnosed with asthma (as of 2015), approximately 6 million are under the age of 18.

Tips for Managing Asthma in Teens:

  • Help your teenager learn how to control their asthma by avoiding triggers and taking a long-term control medicine daily.
  • Encourage your adolescent to play an active role in creating and following his/her Asthma Action Plan to help manage asthma symptoms.
  • Provide a copy of the Asthma Action Plan to the school nurse.

Did you know?

Daily treatment routines are especially important for adolescents, who are generally more likely to skip medication doses, deny the severity of their symptoms, and take risks that may expose them to asthma triggers.


  1. Centers for Disease Control and Prevention (CDC). Most Recent Asthma Data. Accessed Oct 17, 2017.
  2. Mayo Clinic. Childhood Asthma. Accessed October 11, 2017.
  3. National Institutes of Health (NIH). National Heart, Lung, and Blood Institute (NHLBI). How is Asthma Treated and Controlled? Accessed Oct 17, 2017.
  4. Sadof M, Kaslovsky R. Adolescent asthma: a developmental approach. Current Opinion in Pediatrics. 2011;23:373–378.