The wheezing. The coughing. The extreme and sudden shortness of breath. These are symptoms that are attached to asthma, which is a surprisingly common condition. According to the Asthma and Allergy Foundation of America, 1 in 13, or 8%, of Americans have asthma, and this includes adults and children.
But what is asthma exactly? Is it hereditary? How is it diagnosed? Can it be cured? Whether you or someone you love has recently been diagnosed with asthma, you may understandably have a lot of questions. That’s why we’ve called upon the expertise of two medical experts to share their insights on asthma: Dr. Terrell Smith, MD MPH, a founding physician with Spora Health, a healthcare provider for people of color, and Caroline Sokol, MD, PhD, an assistant physician at Massachusetts General Hospital and assistant professor at Harvard Medical School.
Dr. Smith explains that asthma is a disease of the lungs caused by inflammation, or swelling, of the breathing airway. This swelling can be caused by different irritating agents, such as smoke, chemicals, and some infections of the lungs.
When someone has asthma, Dr. Sokol says that the inflamed hyper-reactive airways can “clamp down” in response to different stimuli. Chronic inflammation can lead to long-term changes to the lungs, which result in narrow airways and worsening shortness of breath.
Asthma is accompanied by asthma attacks, which typically occur when someone has a trigger. These triggers can include viral infections, allergens, increased physical activity, or exposure to environmental irritants. Dr. Smith says, “The asthma attack itself is caused by inflammation of the airways due to irritation that leads to the symptoms of wheezing, coughing, and difficulty breathing.” They can come on very suddenly and it can be quite difficult to get a breath out.
Contrary to popular belief, asthma isn’t something that a person is born with. In fact, it’s a disorder that many people develop when they’re young—oftentimes, toddlers first display symptoms. It can come about as a result of increased risks, such as family members who also have the disease.
“It tends to develop as the body develops and is exposed to different aspects of the environment,” Dr. Smith notes.
Although it frequently shows up in children, less commonly, adults can experience adult-onset asthma. Dr. Sokol says that it’s incredibly rare by middle age, or in one’s 50s, to be first diagnosed with asthma.
Asthma is also more common in certain groups of people. For instance, the AAFA says that women are more likely to have asthma than men.
Dr. Smith adds that people of color are at a higher risk of asthma overall than their white counterparts, saying that it was reported in 2018 that non-Hispanic African Americans were 40 percent more likely to have asthma than non-Hispanic whites. In addition, non-Hispanic blacks are almost three times more likely to die from asthma-related causes than the non-Hispanic white population.
He explains, “There are several factors that come into play here, like poorer living conditions, increased exposure to cigarette smoke, and other environmental irritants, and less access to proper medical treatment.”
Yes, there are indeed different types of asthma. Dr. Smith says that these include occupational asthma, exercise-induced asthma, allergic asthma, adult-onset asthma, and several others. He adds that although the reaction within the body ultimately leads to the same symptoms, the cause of the asthma is important, as this will guide a doctor in how it should be treated and the types of activities and chemicals that should be avoided.
According to Dr. Sokol, asthma can also be classified by whether it’s caused by outside triggers, like allergens and irritants, or whether it’s an ever-present trigger that’s always present in a person’s life.
The severity can also differ from person to person. While some can have mild, intermittent asthma that only requires occasional symptomatic relief, others have chronic symptoms with frequent attacks. If left untreated, the severity of asthma can increase over time.
Although asthma symptoms can vary between people, Dr. Smith says that the most common symptoms he has encountered are coughing and wheezing. Other common symptoms include difficulty breathing with activity, chest tightness, difficulty taking a deep breath, and shortness of breath.
Dr. Sokol adds that patients can also experience nighttime symptoms that lead them to wake up short of breath.
Dr. Sokol explains that asthma can be diagnosed with an in-depth discussion about the history of one’s symptoms and triggers, along with a thorough physical exam.
“Asthma specialists will often be able to perform spirometry in their office,” she says. “Spirometry is a breathing test that measures your lung sizes and amount of air you can quickly breathe out.”
Dr. Smith says that asthma isn’t curable—instead, it’s treatable. He says, “Management of symptoms is very important, as well as avoidance of chemicals or environmental factors that increase the frequency of asthma attacks.”
Even though some children “grow out” of asthma, as Dr. Sokol says, in general, asthma is not curable.
She adds that in cases where asthma is caused only by allergic triggers, it’s possible to use allergy shots or allergen immunotherapy to prevent reactions to the culprit allergen. This could lead to a “cure” for asthma, although in the vast majority of cases, allergic asthmatics have multiple triggers.
Fortunately, asthma can be treated and well-controlled in most people. However, without proper treatment and attention, Dr. Smith says that when the lungs are exposed to constant inflammation, it can cause lasting damage.
He shares, “Over time, this might make it difficult to do strenuous activities that you might enjoy, like hiking and biking. If severe lung disease is also present, oxygen may be needed.”
Dr. Sokol says that these chronic changes in the lungs are called “remodeling.” The uncontrolled lung inflammation leads to a narrowing of the airways, and eventually, loss of lung function.
“Asthma attacks and exacerbations can require hospitalization, and in rare cases, can result in death,” Dr. Sokol says.
As someone who has asthma, Dr. Smith highly recommends staying on top of the treatment recommended by your provider. He adds, “I have asthma and it is now under excellent control. But when I was younger and did not follow recommendations, I certainly had a lot of emergency room visits with asthma attacks.”
Luckily, if you or your child has been diagnosed with asthma, there are many treatment options available today. But the first line of defense is avoiding anything that worsens your symptoms.
Dr. Smith observes, “As someone who has asthma, I have come to learn that this is the easiest way. For example, if I’m on a hike and it becomes difficult to breathe, I will slow down. If I am near a fire and it becomes a bit tougher to breathe, I make sure I stay away from the smoke. Trust your body and your judgment—that is the best way to avoid asthma attacks.”
He says that asthma treatment tends to fall into two major categories: rescue medications that dilate the airway during an asthma attack and maintenance medications that reduce or even prevent inflammation. Acute attacks benefit from beta-agonist inhalers like albuterol to relax the muscles around the airways, and for chronic symptoms, inhaled steroids can prevent attacks.
“There are many different inhalers that come in different combinations, but these are the basic ideas for reducing asthma symptoms,” Dr. Smith says. “In severe cases, oral or even intravenous steroids are given, but again, this is reserved for only the most severe cases.”
Apart from traditional treatments, Dr. Smith suggests a healthy diet filled with fruits and vegetables, which can be helpful in the long run.