Asthma is a chronic disease of the airways that transport air to and from the lungs.

No
full cure is available, but management methods can help a person with asthma lead a full and
active life.
In a person with asthma, the inside walls of the airways, known as bronchial tubes, become
swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to
irritations and increases their susceptibility to an allergic reaction.
In an allergic reaction, the airways swell, and the muscles around the airway tighten, making
it difficult for air to move in and out of the lungs.
In the United States, around 8.3 percent of people have a form of asthma. There are many
types of asthma, as well as a range of factors that can cause the disease.
In this article, we provide an overview of this complex respiratory condition, as well as
exploring the different types and causes and how a doctor might diagnose the condition.P
What is asthma?
Asthma is an incurable illness of the airways. The disease causes inflammation and
narrowing inside the lung, restricting air supply.
The symptoms of asthma often present in periodic attacks or episodes of tightness in the
chest, wheezing, breathlessness, and coughing.
During the development of asthma, the airways swell and become extremely sensitive to
some of the substances a person might inhale.
When this increased sensitivity causes a reaction, the muscles that control the airways
tighten. In doing so, they might restrict the airways even further and trigger an
overproduction of mucus.
Asthma attacks
The set of inflammatory events in the respiratory system can lead to the severe
symptoms of an asthma attack.
Worldwide, around 250,000 people die every year as a result of asthma.
Asthma attacks occur when symptoms are at their peak. They might begin suddenly and can
range from mild to severe.
In some asthma attacks, swelling in the airways can completely prevent oxygen from
reaching the lungs, which also stops it entering the bloodstream and traveling to vital organs.
This type of asthma attack can be fatal and requires urgent hospitalization.
At the start of an asthma attack, the airways allow enough air into the lungs, but it does not
let the carbon dioxide leave the lungs at a fast enough rate. Carbon dioxide is poisonous if the
body does not expel the gas, and a prolonged asthma attack might lead to a build-up of the
gas in the lungs.
This might further reduce the amount of oxygen entering the bloodstream.
People with clear symptoms of asthma should visit a doctor. They will provide treatments
and advise on management techniques, as well as identifying potential triggers for asthma
symptoms and how to avoid them. The doctor will also prescribe medications to help reduce
the frequency of attacks asthma.
Effective asthma control reduces the impact of the condition on everyday living.
Types
As many different factors come together to cause asthma, there are many different
types of the disease, separated by age and severity.
Adults and children share the same triggers for symptoms that set off an allergic response in
the airways, including airborne pollutants, mold, mildew, and cigarette smoke.
Childhood asthma
Children are more likely to have an intermittent form of asthma that presents in severe
attacks. Some children might experience daily symptoms, but the common characteristic
among children with asthma is a heightened sensitivity to substances that cause allergy.
Second-hand tobacco smoke causes severe problems for children with asthma. Between
400,000 and 1 million children experience worsening asthma symptoms as a result of second-
hand smoke, according to the American Lung Association.
The Centers for Disease Control and Prevention (CDC) advise that children experience more
emergency visits and admissions for asthma than adults.
Mild asthma might resolve without treatment during childhood. However, there is still a risk
that the condition might return later on, especially if symptoms are moderate or severe.
Adult-onset asthma
Asthma in adults is often persistent and requires the daily management of flare-ups
and preventing symptoms. Asthma can begin at any age.
Allergies lead to at least 30 percent of adult presentations of asthma. Obesity is a strong risk
factor for adult-onset asthma, and women are more likely to develop the condition after the
age of 20 years.
People over 65 years of age make up a large number of deaths from asthma.
Occupational asthma
This is a type of asthma that occurs as a direct result of a job or profession.
Symptoms will become apparent after attending a particular workplace. Industries with
regular associations to occupational asthma include baking, laboratory work, or
manufacturing.
In this type, the work environment leads to the return of childhood asthma or the start of
adult-onset asthma.
Other symptoms might include a runny nose and red eyes.
Difficult-to-control and severe asthma
These types involve consistent, debilitating asthma symptoms and breathing
difficulties. Around 12 percent of people with asthma have difficult-to-control or severe
asthma.
With the correct medication and effective trigger avoidance, those in this category can bring
asthma symptoms back under control.
Roughly 5 percent of people with asthma do not see improvements after using the standard
asthma medications. These people have severe asthma, and there are several types of severe
asthma depending on the cause.
Newer medications are becoming available to address the different forms of severe asthma,
such as eosinophilic asthma that does not link to any allergic reactions.
Seasonal asthma
This type occurs in response to allergens that are only in the surrounding environment
at certain times of year, such as cold air in the winter or pollen during hay fever season.
People still have asthma for the rest of the year but do not experience symptoms.
Causes
Many different aspects of a person's environment and genetic makeup can contribute
to the development of asthma.
Asthma is the most common chronic disease among children. The first symptoms become
clear at around 5 years of age in the form of wheezing and regular infections in the
respiratory tracts.
The following are the primary causes of asthma.
Allergies
A strong link exists between allergies and asthma. One 2013 study in the Annals of
Asthma, Allergy, and Immunology suggests that over 65 percent of adults with asthma over
the age of 55 years also have an allergy, and the figure is closer to 75 percent for adults
between the ages of 20 and 40 years.
 Common sources of indoor allergens include animal proteins, mostly from cat and dog
dander, dust mites, cockroaches, and fungi.
Smoking tobacco
Research has linked tobacco smoke to an increased risk of asthma, wheezing,
respiratory infections, and death from asthma. In addition, the children of parents who smoke
have a higher risk of developing asthma.
Smoking makes the effects of asthma on the airways worse by adding coughing and
breathlessness to its symptoms, as well as increasing the risk of infections from the
overproduction of mucus.
Environmental factors
Air pollution both in and out of the home can impact the development and triggers of
asthma.
Allergic reactions and asthma symptoms often occur because of indoor air pollution from
mold or noxious fumes from household cleaners and paints.
Other asthma triggers in the home and environment include:
 pollution
 sulphur dioxide
 nitrogen oxide
 ozone
 cold temperatures
 high humidity
Heavy air pollution tends to cause a higher recurrence of asthma symptoms and hospital
admissions.
Smoggy conditions release the destructive ingredient known as ozone, causing coughing,
shortness of breath, and even chest pain. These same conditions emit sulfur dioxide, which
also results in asthma attacks by constricting the airways.
Changes in the weather might also stimulate attacks. Cold air can lead to airway congestion,
constricted airway, extra secretions of mucus, and a reduced ability to clear that mucus.
Humidity might also lead to breathing difficulties for populations in some areas.
Obesity
Some studies, such as this report from 2014, suggest a link between obesity and
asthma, although the American Academy of Asthma, Allergies, and Immunology does not
recognize obesity as a formal risk factor for asthma.
However, the report in question suggests that the inflammatory mechanisms that drive asthma
also link to obesity.
Pregnancy
If a woman smokes tobacco or illicit substanes while pregnant, an unborn child might
grow less in the womb, experience complications during labor and delivery, and have a low
birth weight.These newborns might be more prone to medical problems, including asthma.
Stress
People who undergo stress have higher asthma rates. Increases in asthma-related
behaviors during stressful times, such as smoking, might explain these increased rates.
Emotional responses, including laughter and grief, might trigger asthma attacks.
Genetics
A parent can pass asthma on to their child. If one parent has asthma, there is a 25
percent chance that a child will develop asthma. Having two parents with asthma increase the
risk to 50 percent.
Many genes are involved in passing on asthma. These genes can interact with the
environment to become active, although confirming these findings may require further
research.
Atopy
Atopy is a general class of allergic hypersensitivity that leads to allergic reactions in
different parts of the body that do not come in contact with an allergen. Examples include
eczema, hay fever, and an eye condition called allergic conjunctivitis.
During atopy, the body produces more immunoglobin (IgE) antibodies than usual in response
to common allergens.
The most common type of asthma is atopic asthma, and atopy plays a key role in its
development. Environmental allergens lead to overproduction of IgE antibodies and trigger
asthmatic reactions.
The menstrual cycle
One type of asthma, known as perimenstrual asthma (PMA), leads to acute symptoms
during the menstrual cycle and a particular sensitivity to aspirin.
The sex hormones that circulate during menstruation, such as luteinizing hormone (LH) and
follicle-stimulating hormone (FSH), impact immune activity. This increased immune action
can cause hypersensitivity in the airways.

Diagnosis
 Three main components comprise an accurate asthma diagnosis: Medical history,
observations during a physical exam, and results from breathing tests.
A primary care physician will administer these tests and determine the level of asthma as
mild, intermittent, moderate, or severe in people who show signs of the condition, as well as
identifying the type.
A detailed family history of asthma and allergies can help a doctor make an accurate
diagnosis. A personal history of allergies is also important to mention, as many share
mechanisms with asthma and increase the risk.
Keep a note of any potential triggers of asthma symptoms to help guide treatment, including
information about any potential irritants in the workplace.
Be sure to identify any health conditions that can interfere with asthma management, such as:
 a runny nose
 sinus infections
 acid reflux
 psychological stress
 sleep apnea
Young children who develop asthma symptoms before the age of 5 years find it more
difficult to receive a clear diagnosis. Doctors might confuse asthma symptoms with those of
other childhood conditions.
If children experience wheezing episodes during colds or respiratory infections in early life,
they are likely to develop asthma after 6 years of age.
Physical exam
A physical examination will generally focus on the upper respiratory tract, chest, and
skin. A doctor will listen for signs of wheezing, or a high-pitched whistle on breathing out, in
the lungs during a breath using a stethoscope. Wheezing is a key sign of both an obstructed
airway and asthma.
Physicians will also check for a runny nose, swollen nasal passages, and soft growths on the
inside of the nose and check for skin conditions including eczema and hives. These are
allergic conditions that link to asthma and suggest heightened immune activity that could be
causing any wheezing.
People with asthma do not always show physical symptoms, and it is possible to have asthma
without presenting any physical maladies during an examination.
 Asthma tests
Lung function tests are another component of an asthma diagnosis. They measure
how much air a person inhales and exhales and the speed with which a person can expel air
from the lungs.
A spirometry test can provide an indication of lung function.
Spirometry is a non-invasive test that requires deep breaths and forceful exhalation into a
hose. The hose links to a machine called a spirometer that displays two key measurements:
 forced vital capacity (FVC), or the maximum amount of air a person can inhale and
exhale
 forced expiratory volume (FEV-1), the maximum amount of air a person can exhale in
one second
The doctor then compares these measurements against what would be normal for another
person of the same age. Measurements below normal indicate obstructed airways and
probable asthma.
A doctor will often administer a bronchodilator drug to open air passages before retesting
with the spirometer to confirm the diagnosis. If results improve after using the drug, the risk
of an asthma diagnosis increases.
Children under 5 years of age are difficult to test using spirometry, so asthma diagnoses will
rely mostly on symptoms, medical histories, and other parts of the physical examination
process.
In younger children, doctors commonly prescribe asthma medicines for 4 to 6 weeks to gauge
physical response.