Asthma: causes and symptoms

If you’ve ever experienced an asthma attack, you know how overwhelming and frightening it can be. But understanding asthma can help with learning how to manage it. This article will cover the causes, symptoms and treatments for asthma, offering practical knowledge to help better understand this chronic condition. 

In this article:

What is asthma? 

Asthma is a chronic or long-term lung disease affecting millions of people worldwide. It affects the airways, known as bronchial tubes, which bring air in and out of the lungs. When a person has asthma, their airways become narrowed and inflamed. The condition can cause chest pain, chest tightness, coughing, difficulty breathing and wheezing.

Asthma has no single underlying cause, but genetics and environmental factors may play a role. Asthma usually develops in early childhood and can flare up or cause an “attack” due to several triggers: weather, exercise, allergens or other health conditions.

These flare-ups can result in missed school or work, or in serious cases, hospitalization. While there is no cure, asthma can be controlled with prescribed medication and some lifestyle adjustments.

Causes and risk factors

Asthma can affect any individual depending on their inherited genetic risk and exposure to certain environmental triggers. These include:

• Exposure to secondhand smoke as a young child or in the womb
• Exposure to chemicals in the workplace, including irritants and dust
• Genetics and family history, especially if a person’s mother also has the condition
• In children, boys are more likely to get asthma, and in teens and adults, it’s more common in women 
• Race or ethnicity; in particular, Black people and people of Puerto Rican heritage

Common symptoms of asthma 

Asthma can be difficult to diagnose and manage, as many of its symptoms are similar to other health conditions, like rhinitis, gastroesophageal reflux disease (GERD), nasal polyps and obstructive sleep apnea. Understanding these common symptoms can help a health care provider prescribe a treatment plan. 

Early symptoms of asthma

The initial symptoms of asthma can include:

• Tightness in the chest
• Coughing, especially at night, also known as nocturnal asthma 
• Wheezing, often with a whistling sound
• Shortness of breath 
• Waking at night due to symptoms

Early warning signs of an asthma attack

Sometimes, there may be early warning signs that an asthma episode is coming, and they may begin before more obvious asthma symptoms. Identifying warning signs and taking steps to prevent asthma episodes can help keep asthma well controlled. Early warning signs may be different for each person, but some common warning signs can include the following:

• A congested, runny or stuffy nose
• Feelings of fatigue or weakness
• Hunched posture or raised shoulders 
• Increased mucus or sputum

Asthma attack symptoms

An asthma attack can be a frightening experience. Many people describe it as trying to breathe with a heavy weight on their chest or as if their lungs are filled with thick fog.

This is known as the “red” or “danger zone.” In this zone, seek emergency help if breathing does not quickly improve with medication. Symptoms include:

• Asthma symptoms are worsening
• Breathing becomes more shallow
• Experiencing chest tightness or pain
• Having severe shortness of breath
• Noticing raised ribs or expanding belly breathing
• Quick-relief medicines aren’t working
• Trouble walking or talking due to difficulty breathing

The length of an asthma attack is usually determined by its trigger and how long the airways have been inflamed or restricted. An asthma attack can vary in duration, lasting a few minutes to a few hours or even days in severe cases.

Severe attacks can be shortened with the right treatment.

Types of asthma

• Allergic asthma: Caused by allergens. These are substances that cause an allergic reaction: 
  • Dust mites
  • Mold
  • Pet hair (dander)
  • Pollen
  • Waste from pests (including cockroaches and mice)
• Exercise-induced asthma: When asthma is brought on by physical activity, especially in dry conditions
• Nonallergic asthma: Caused by environmental and physical factors. These might be:
  • A cold or flu infection
  • Air pollution
  • Breathing in chemicals like household cleaners, perfumes and solvents
  • Breathing in cold air
  • Certain medications 
  • Smoke from tobacco or open wood fires
• Occupational asthma: Caused by breathing in industrial chemicals or residues in the workplace

Asthma symptoms in children

Asthma is one of the most common chronic childhood diseases. It usually develops before age 5 and can often be confused with other respiratory conditions. While childhood asthma is more common in boys than girls, it is more commonly seen in girls during their teens.

Children most at risk of developing asthma may:

• Be of Black or Puerto Rican heritage
• Have a parent with asthma
• Have been exposed to secondhand smoke 
• Have other conditions, such as allergies or obesity
• Live in an area with air pollution

Typical symptoms of asthma in children include:

• Chest tightness
• Coughing, especially in the evening (nocturnal asthma) or early morning
• Dark circles under the eyes
• Difficulty breathing, including gasping for air or rapid breathing 
• Feeling tired
• Trouble eating or suckling (in infants) 
• Wheezing, causing a whistling sound with every outwards breath

It can be difficult for a child to explain how they are feeling, so try to pay attention to when a child’s symptoms begin. This will help a health care provider make a diagnosis and create an asthma action plan. This could be in certain seasons, in the evening or early morning, during or after intense physical activity and play or after laughing or crying.

“Most commonly asthma in children is diagnosed after a viral infection, such as that caused by RSV (respiratory syncytial virus),” says board-certified allergist and immunologist Sairaman Nagarajan, MD, MPH. “It causes airway spasming and narrowing and puts children at risk of developing asthma. RSV and influenza (the flu) are also triggers of asthma in adults.” There are now FDA approved vaccines that are available for adults and children.

When a child has an asthma attack, it can come on gradually or without warning and become serious or life-threatening very quickly. Seek emergency medical assistance immediately if a child is:

• Coughing severely
• Develops blue lips or fingernails
• Displaying distress, such as head bobbing, grunting, nasal flaring, exaggerated belly breathing or uncharacteristic behavior changes
• Failing to respond or recognize you 
• Struggling to breathe
• Turning pale

Triggers that worsen symptoms

It’s important to note that triggers — factors that bring on an asthma attack, episode or flare-up — are different for everyone and can change over time. With Americans spending up to 90% of their time indoors, indoor irritants and allergens are the most common triggers for asthma.

A person may experience asthma from any number of these common triggers:

• Air pollutants
• Allergens like pollen, dust mites, mold and waste from pests and rodents
• Anxiety and stress 
• Chemical irritants
• Medications 
• Respiratory infections and sinusitis
• Smoke from tobacco or wood fires
• Strenuous exercise and physical activity
• Weather conditions

Heartburn and asthma

Heartburn, or acid reflux, can cause asthma, and asthma can cause heartburn. Similarly, asthma and the more severe acid reflux condition, GERD, can “exacerbate each other.” Children with asthma are more likely to experience GERD than those without.

It is still unclear why this happens, but researchers suggest a few reasons. Different types of medication used in asthma management may promote reflux, such as theophylline and corticosteroids. Coughing, internal pressure and the extra effort required to breathe in asthmatic patients may also make GERD worse.

GERD could also be the cause of asthma in adults who experience sudden onset of the condition, especially if they don’t have a family history, show no signs of allergies or notice their symptoms getting worse after eating.

Treating both conditions is considered the most effective way to reduce these symptoms. Avoiding heartburn triggers like acidic and fatty foods, alcohol and tobacco may help. Over-the-counter (OTC) heartburn medications can also provide relief support when used as directed.

Some options to consider for heartburn include CVS Health^® chewable antacid tablets, Pepcid AC original strength for heartburn prevention and relief and Prilosec OTC 20mg delayed-release acid reducer tablets for frequent heartburn.

If OTC medicines don’t help or asthma lingers, a health care provider can prescribe a more suitable alternative that won’t interfere with either condition. Always speak to a health care provider before starting or stopping any medication or supplement.

Smoking and asthma

People who smoke are more likely to have asthma, though there is no exact evidence that smoking causes it. Currently, one in four asthma patients are also smokers.

Exposure to second-hand smoke, especially during pregnancy and early childhood, is also linked to asthma. Smoking and vaping can lead to faster lung decline and permanent breathing problems, making it difficult to distinguish asthma from other conditions like chronic obstructive pulmonary disease (COPD).

The good news is quitting smoking and avoiding second-hand smoke can improve lung function and reduce asthma severity quickly. If someone needs help to quit smoking, talk to a health care provider about treatments.

Infections and asthma

People with asthma are more likely to get respiratory infections, which can worsen the symptoms of these chronic conditions. Having asthma can also make managing respiratory infections and diseases more complicated. To stay protected against contracting COVID-19, influenza, pneumococcal pneumonia and RSV:

• Avoid close contact with people who are ill
• Clean and disinfect frequently touched surfaces
• Keep up to date with vaccinations for respiratory diseases
• Wear a surgical-grade face mask when in crowded or indoor environments
• Wash hands regularly with soap

Practicing good hygiene habits can help protect a person’s health and keep their asthma in check.

Medications and asthma

Certain medications can trigger asthma in some people, including:

• Aspirin
• Beta-blockers, used in treating blood pressure and heart conditions and migraines
• Nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen

While not a direct cause, angiotensin-converting enzyme (ACE) inhibitors, used to treat heart disease, can cause a dry cough that may be mistaken for asthma.

People should speak to their health care provider if they begin taking medications and notice the onset of asthma symptoms. They can work to find an asthma treatment plan or different medication better suited to their needs. 

If someone has already been diagnosed with asthma, it’s also crucial to mention the condition to their health care provider first before taking any new medications.

Monitoring and recognizing symptoms

Keeping an asthma symptom diary (ASD) helps to work out triggers and common symptoms. Anytime they begin to experience symptoms, they can note it in the diary or a chart.

They should check the ASD regularly to see if they notice any patterns emerging and discuss these with a health care provider. They can work on an asthma action plan to better understand asthma triggers and typical symptoms and be prepared in case of an asthma attack.

If someone has been formally diagnosed with asthma, their health care provider can work with them to create an asthma action plan to follow at home. These written plans can include the following:

• A list of triggers and how to avoid them
• Details of prescribed medications and dosage instructions
• Health care provider details and emergency telephone numbers
• Information on what to do during an asthma attack
• Instructions on when to seek medical attention

This treatment plan also helps others be able to take action if someone with asthma suffers an attack. For children, it is recommended their school or daycare have a copy of their action plan. They should be updated at least once a year.

A peak flow meter is a handheld device that measures the ability to push air out of the lungs.

Regular use can give a person and their health care provider more information about the causes of asthma and how wide or narrow the airways in their lungs are. With one large, fast blast, a health care provider can measure peak flow rate to determine how fast a person can exhale. It is useful if someone has asthma or long-term chronic lung problems to determine whether:

• Adjustments need to be made to prescribed medications
• An asthma action plan is working
• Certain triggers are causing symptoms
• The patient needs to use an inhaler
• The patient requires emergency medical assistance

When to seek medical attention

For people with asthma, it’s recommended they carry any prescribed medication with them in case they experience symptoms when they’re not at home. If they feel their symptoms are getting worse, they should seek medical assistance as soon as possible.

A health care provider can diagnose the condition by looking at medical history, doing a physical exam and testing lung function. This is often done using a spirometry test before and after a bronchodilator — a type of medication used to relieve the symptoms of asthma by relaxing the muscles in the lungs and increasing airflow.

This test is done with a spirometer, a diagnostic device that records the rate of air a person is able to breathe in and out over a period of time.

Treatment includes ongoing education, regular symptom monitoring, and access to fast-acting inhalers and the appropriate long-term medications based on the severity of the condition. A health care provider will also explain how to properly use an inhaler.

If someone experiences severe or frequent asthma attacks, a health care provider may prescribe inhaled corticosteroids or the regular use of a nebulizer as part of their long-term care plan.

What is a nebulizer? Also known as a “breathing machine,” a nebulizer turns liquid asthma medicine into a mist that a person breathes in via a mask or mouthpiece.

Generally, someone’s asthma is under control if:

• Are able to sleep comfortably throughout the night
• Are able to undertake physical activity and exercise with few to no symptoms
• Need their quick-relief inhaler less than three times per week

Steps toward better asthma management

Living with asthma can be challenging, but it doesn’t have to limit someone from enjoying life. By understanding the condition, the triggers and how to avoid them, and working closely with a health care provider, a person can manage their symptoms and lead a full, active life.

Frequently asked questions

What does asthma feel like? 

Asthma can feel like someone heavy sitting on a person’s chest or the air is being sucked out of their chest. Others suggest it feels like being forced to breathe in a thick fog. It can feel very uncomfortable and, depending on the severity of an asthma attack, overwhelming and frightening. 

What are 5 signs of asthma? 

Chest tightness, difficulty breathing, wheezing, shortness of breath and coughing, especially at night or during exercise.

What are silent asthma symptoms? 

Silent asthma symptoms include subtle signs like a persistent cough, especially at night, fatigue, or body weakness. These symptoms can be easy to overlook but may indicate worsening asthma that needs medical attention.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.