The warning signs of asthma
Lorene Alba is director of education for the Asthma and Allergy Foundation of America (AAFA), and like 25 million other Americans, she lives with asthma.
Alba first noticed symptoms during a case of bronchitis at 16 years old. While the infection cleared up, she felt like she never fully recovered.
“I continued to cough and feel short of breath most of the time,” she says. “I didn’t know any better, so it became my new normal. I just stopped doing things that made it harder to breathe, like climbing stairs and hiking.”
Yet breathing difficulties are never normal, says Mitchell Grayson, MD, chair of the AFAA’s Medical Scientific Council and director of the division of allergy and immunology at The Ohio State University.
“Anything that interferes with daily activities should be evaluated right away,” he says.
Alba’s asthma is under control today, thanks to working with her doctor to identify her triggers and the right combination of asthma treatments. But her experience is what motivated her to become a certified asthma educator. She wanted to help others understand what asthma feels like, what’s not normal, and how to get symptoms under control.
What causes asthma?
“We don’t really know why asthma develops,” Dr. Grayson says. “That makes it hard to prevent.”
But he emphasizes that with proper care and medication, it’s possible to treat the disease effectively and live a normal life.
People with asthma are sensitive to some kind of trigger. When exposed to that trigger, the airways in their lungs inflame and narrow. The muscles around those airways also tighten up, further narrowing the tubes that provide air to our lungs.
“What ends up happening is that people can’t breathe air out,” he says. “The air gets stuck behind these constrictions—and it’s old air with no oxygen in it.”
According to Dr. Grayson, most people can recognize what sets off their asthma symptoms. Common triggers include things like:
Exercise: You might have persistent trouble breathing while working out, even if you get physically fitter.
Allergens: Symptoms may worsen at different times of the year, or a specific allergy, like pet hair or mold, may trigger symptoms
Colds or infections: If asthma symptoms emerge or continue after you start to feel better, this can signal that respiratory infections drive your asthma.
Weather: Cold air and high humidity can trigger an attack.
“I am always thinking about what triggers I may encounter during the day and figuring out how to avoid them,” Alba says.
For example, she makes sure to avoid fresh flowers on display at the grocery store and stays indoors on days with bad air quality or high pollen counts.
“Having to plan your life around avoiding asthma triggers can certainly feel overwhelming,” she says. “But the good news is that it is manageable, and you can lead a healthy and full lifestyle when your asthma is well-controlled.”
What does asthma feel like?
For Alba, an emergency room visit in her mid-20s led to her asthma diagnosis. As a culinary arts graduate, her work environment was provoking asthma symptoms. Poor ventilation in hot kitchens, the stress of a fast-paced schedule, and harsh cleaning chemicals all acted as triggers.
During this time—before her asthma was under control—she’d experience coughing fits so severe they caused stomach and back muscle soreness. The simple act of breathing made it feel like her lungs were on fire.
Taking short, shallow breaths was the only way for Alba to breathe through one of these episodes. Because asthma symptoms often occur suddenly, she also says the resulting anxiety can make it even harder to breathe.
But people may experience their symptoms in different ways. Dr. Grayson says there’s a physiological element at play with asthma—some people might have more airway constriction or mucus production than others, for example.
“There’s also the fact that everybody perceives things differently,” he says.
In her work, Alba has heard descriptions that asthma feels like breathing through a narrow straw or cotton cloth. Others say it feels like an elephant is sitting on their chest.
“The [description] I relate to the most is the feeling of ‘air hunger,’” she says. “The sensation of not being able to get enough air into your lungs.”
While there are plenty of variations, most asthma accounts circle back to this high-pressure sensation.
“For me, asthma feels like a massive balloon swelling in my chest,” explains Tommy Pederson, an emergency medical technician from Minneapolis. “I keep trying to breathe in, I hear that wheezing noise whistling through my mouth, and it just feels like I’m not taking any air in at all.”
Is all asthma the same?
Asthma varies widely from person to person, Dr. Grayson says. The condition’s symptoms and severity depend on a range of individual factors, like someone’s level of airway sensitivity and exposure to triggers.
“For some people, an attack will last a couple of hours and then go away, while for others, symptoms could last for days,” he says, referring to individuals with uncontrolled asthma.
According to the AAFA, while most cases of asthma are entirely controllable, the disease causes about 3,500 deaths per year in the United States.
That why Dr. Grayson says it’s so critically important to treat an attack when it starts—and to take medication that can prevent symptoms from occurring in the first place.
How is asthma treated?
While there’s no cure for asthma, the medications available today work well to control it—if used properly.
When Alba first started taking asthma medication, she says she was still visiting the emergency room often. After her third visit in one month, a respiratory therapist asked her to demonstrate her inhaler technique.
“He explained that I was using it incorrectly—which meant I wasn’t getting a full dose of the medicine,” she says. “That five minutes of education made such a positive impact on my health.”
But she’s not alone in struggling with an inhaler.
Studies suggest that up to 94 percent of people with asthma do not use their inhalers correctly. If you start asthma treatment or think your medication isn’t working effectively, make sure to ask your doctor for complete instructions, and follow your prescribed plan.
If you’re really struggling to use an inhaler, your doctor might prescribe a nebulizer, an easier-to-use tool that delivers a mist of medication.
Asthma medications fall into two broad categories: controller medications and rescue medications.
Controller medications aim to manage airway inflammation on a day-to-day basis. People are less likely to experience severe asthma symptoms with this inflammation consistently kept at bay, Dr. Grayson explains.
Rescue medications for asthma include drugs like albuterol that open up the airways quickly when symptoms occur.
But treatments continue to advance.
Biologics are one promising therapy for people with severe asthma and asthma that doesn’t respond to standard treatments. This injectable—and Food and Drug Administration (FDA)-approved—medication works to stop the processes in the body that contribute to lung inflammation.
Other medications combine the effects of controller and rescue medications in a single dose. This newer approach, called single maintenance and reliever therapy (SMART), makes treatment protocols more flexible, Dr. Grayson says.
It also reduces the amount of medication someone needs to take. And that may make people with asthma more likely to take these lifesaving meds.
Getting asthma under control
“Breathing is just such an easy, natural thing to do for most people,” Alba says. “Imagine struggling to do what others can do so easily. Having to constantly worry if you will be able to breathe can certainly take a toll on your physical and emotional health.”
People with asthma may isolate themselves to avoid their asthma triggers, she explains. Symptoms can also impact sleep—so having headaches and feeling tired and moody can be asthma warning signs.
If you suspect you might have asthma, your doctor can confirm a diagnosis and work with you to design your asthma action plan.
This personalized program includes steps you can take to manage your condition—like medication adherence, trigger avoidance, lifestyle changes and home remedies, and check-ins with your doctor.
Once you have a plan in place, it’s essential to stick with it—even if you don’t experience any more symptoms.
Asthma is a long-term condition, Dr. Grayson says, and there are things happening in your lungs that you can’t feel or sense. While you may not need to take medication for life, only your doctor can determine the right treatment plan for you.
But if you are taking your asthma medication as directed and still having flare-ups, make sure to check in with your doctor right away. Your treatment protocol or management plan may need adjusting.
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