What is asthma?

Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing. Many people with asthma have an individual or family history of allergies, such as hay fever (allergic rhinitis) or eczema.

What are the symptoms?

  • Shortness of breath or cough (cough variant asthma) that gets worse with exercise or activity
  • Wheezing
    • Usually begins suddenly
    • Comes in episodes and may go away on its own
    • May be worse at night or in early morning
    • Gets worse when breathing in cold air/exercise
    • Gets better when using drugs that open the airways (bronchodilators)

What causes asthma?

Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swell. This reduces the amount of air that can pass by, and can lead to wheezing sounds. Most people with asthma have wheezing attacks separated by symptom-free periods. Some patients have long-term shortness of breath with episodes of increased shortness of breath. In others, a cough may be the main symptom. Asthma attacks can last minutes to days and can become dangerous if the airflow becomes severely restricted. In sensitive individuals, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).

Common asthma triggers include:

  • Animals (pet hair or dander) mold , pollen, dust
  • Changes in weather (most often cold weather)
  • Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)
  • Exercise
  • Tobacco smoke or perfumes
  • Respiratory infections, such as the common cold

How Is Asthma Recognized?

Medically, asthma is a name assigned to a group of symptoms that includes shortness of breath, wheezing, coughing, and chest tightness. These symptoms can occur in various combinations (one, several, or all) and may range from mild intermittent to severe persisitant. Symptoms are usually intermittent, perhaps happening only on rare occasions or seasonally; some people go for a long period without symptoms and then suddenly have severe episodes for days at a time. Others have weekly or daily asthma attacks, while in the most severe cases, symptoms are present at all times.

The 3 main components of asthma are:

  • Smooth muscle constriction
  • Airway inflammation
  • Mucus production

The most common asthma symptom recognized by both physicians and patients is wheezing, a whistling sound that's created when air passes through the narrowed breathing tubes that mark asthma. Wheezing, which may be very loud or barely audible, is usually most obvious during exhalation. Asthmatics also have difficulty inhaling during an attack, which causes the feeling of shortness of breath (dyspnea). Also, mucus that normally forms in the airways cannot be easily cleared, which triggers coughing. Unfortunately, each of these underlying changes eventually contributes to and aggravates other asthma symptoms, like chest tightening.

Are There Different Types of Asthma?

There are various types of asthma, some of which are difficult to diagnose. Further complicating accurate diagnosis is that in certain individuals, there are very specific, unique patterns of symptoms.

Cough-variant asthma

Coughing can occur alone, without the other symptoms of asthma that are usually present and recognized by the physician or patient. Cough-variant asthma is tough to diagnose because it can be easily confused with other conditions, such as chronic bronchitis and postnasal drip. Coughing can occur day or night. Nighttime coughing may be most disruptive, as it interferes with sleep. Nocturnal asthma When nighttime asthma occurs without any daytime symptoms, It's called "nocturnal asthma." People with the condition may have wheezing or trouble breathing when lying down, or may not notice these symptoms until awoken by them--typically between 2 a.m. and 4 a.m. Nocturnal asthma may occur only once in a blue moon or frequently during the week. Nighttime symptoms are also a common problem for people who have daytime asthma. If this is the case, then nocturnal symptoms are more easily recognized and confirmed. However, when there are no daytime symptoms to suggest asthma is the underlying cause of nighttime woes, this type of asthma will be more difficult to recognize. The cause (or causes) of nocturnal asthma is unknown, although many possibilities are under investigation.

Exercise-induced asthma

Shortness of breath and/or wheezing occurring after strenuous exercise is called exercise-induced asthma. Although this phenomenon happens in up to 80 percent of people with recognized asthma, it is frequently an isolated event, without symptoms at any other time. This complicates any diagnosis of asthma as an underlying cause because it is frequently confused with poor physical conditioning or possible heart problems. Nevertheless, asthma should always be suspected as a possible cause of exercise-induced wheezing or shortness of breath, especially when the person is otherwise healthy and in shape.

What Causes Asthma?

Asthma symptoms were once thought to arise solely from spasms of the bronchial tubes (airways). But in the 1980s, experts began to recognize bronchial tube inflammation as the basic underlying problem. Inflammation is part of the immune system's response to injury or harmful foreign substances that enter the body. Inflammation is caused by the arrival of blood cells and other immune system sentries into the area involved. In people with allergies, this defense system reacts against normally benign substances like pollen from weeds and trees.

Is asthma an "allergic" condition?

Not always, but certain allergens (any substance that can spur an allergic reaction) are common triggers of asthma symptoms. These include dust mites, cockroaches, molds and pollens.

With asthma, the allergen triggers an unwanted inflammatory reaction in the airways. Certain immune cells release chemicals called mediators that attack the allergen and, along the way, set off asthma symptoms.

During this defensive act, some damage and changes occur in the tissues of the bronchial tubes, which can cause them to become easily irritated, or "hyper-responsive." In this state, the lungs become excessively "twitchy" and may react (or overreact) to previously non-stimulating irritants, such as cold weather, pollution, dry air, and chemical odors.

This entire process is possibly reversible if caught early and addressed with preventive measures, like avoidance or appropriate medication. If left untreated these changes in the lungs and airways can lead to long-term, irreversible damage. Numerous scientific studies have shown that avoidance of specific allergens will result in less severe asthma symptoms and less medicine.

In summary, we now recognize asthma as a disease that involves inflammation and eventual hyper-reactivity in the bronchial tubes, all of which manifests in the wheezing, coughing and breathlessness of an asthma attack. By learning to recognize the underlying factors and symptoms of asthma, we as physicians and patients can more adequately control and better treat both the causes and effects of asthma.

Tests & Diagnosis

Allergy testing may be helpful in identifying allergens in patients with persistent asthma. Common allergens include pet dander, dust mites, cockroach allergens, molds, and pollens. Common respiratory irritants include tobacco smoke, pollution, and fumes from burning wood or gas.

What are my treatment options?

The goal of treatment is to avoid the substances that trigger your symptoms and to control airway inflammation. Different medications can be prescribed depending on the severity and frequency of your asthma symptoms. We can perform allergy testing to determine if allergies are contributing to your asthma symptoms. We will then work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms.


Asthma symptoms can be substantially reduced by avoiding known triggers and substances that irritate the airways. Bedding can be covered with "allergy proof" casings to reduce exposure to dust mites. Removing carpets from bedrooms and vacuuming regularly is also helpful. Detergents and cleaning materials in the home should be unscented. Keeping humidity levels low and fixing leaks can reduce growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms -- this helps reduce the possibility of cockroaches, which can trigger asthma attacks in some people. If a person is allergic to an animal that cannot be removed from the home, the animal should be kept out of the patient's bedroom. If these measures do not work or cannot be implemented, allergy immunotherapy may be offered.

What is Immunotherapy?

Immunotherapy is a process in which an allergic patient can become desensitized to those pollens and inhalants that trigger allergic rhinitis (nasal congestion), allergic conjunctivitis, asthma and insect reactions. Small doses of the actual allergic substance are injected weekly. Each week the dose is increased. Gradually a protective antibody, also known as Immunoglobulin G, is formed to block the allergic reaction. When someone has allergy, they have high levels of the allergic antibody, Immunoglobulin E (IgE), in their blood. This IgE is activated by the allergen (dust mites, ragweed, cat, etc), and it attaches itself to “mast” cells that release histamine. The histamine causes a release of a fluid that causes swelling and congestion. It can cause a tightening of the airways to create asthma.

The change induced by immunotherapy is gradual. Many patients notice an improvement within six (6) months at which time the patient should schedule a 6-month evaluation appointment. Progress is evaluated every six (6) months to one (1) year.

Read more about Immunotherapy »