Asthma in Teens and Adults

Condition Basics

What is asthma?

Asthma is a lifelong condition that can make it hard to breathe. It causes the airways that lead to the lungs to swell and get inflamed.

Some people have a hard time breathing only at certain times. This may be during allergy season, when they get a cold, or when they exercise. Others have breathing problems a lot of the time.

When asthma symptoms suddenly get worse (or flare up), the airways tighten and become narrower. This makes it hard to breathe, and you may wheeze or cough. These flare-ups are also called asthma attacks or exacerbations (say "ig-ZAS-ur-BAY-shuns").

Even though asthma is a lifelong condition, treatment can help you feel and breathe better and help keep your lungs healthy.

What causes it?

Experts don't know exactly what causes asthma. But we do know that asthma runs in families. And it's much more common in people who have allergies.

What are the symptoms?

When you have asthma, you may wheeze or cough a lot. You may also feel tightness in your chest or feel short of breath.

How is it diagnosed?

To find out if you have asthma, your doctor will do a physical exam and ask you questions about your health. He or she may also have you do breathing tests to find out how well your lungs work.

How is asthma treated?

Asthma is treated with medicine to help you breathe easier. Controller medicines are used to prevent asthma attacks. Quick-relief medicines are used when symptoms need to be treated fast. Treatment also includes things you can do to control your symptoms, like avoiding your triggers and following your asthma action plan.

How can you prevent asthma attacks?

There's no certain way to prevent asthma. But you can reduce your risk of asthma attacks by avoiding things that cause them. For example, don't smoke. Try not to exercise outside when it's cold and dry. And stay inside when pollution levels are high. Using your asthma controller medicine helps prevent asthma attacks.

What Increases Your Risk

You may be more likely to have asthma if:

Someone in your family has asthma.

Asthma may run in families (be inherited). If this is the case in your family, you may be more likely than other people to get long-lasting (chronic) inflammation in the airways.

You or someone in your family has an allergy.

Most children and many adults with asthma have atopic dermatitis, allergies, or both. Asthma is much more common in people who have allergies. But not everyone with allergies gets asthma. And not everyone with asthma has allergies.

You had ongoing (chronic) wheezing when you were a child.

Wheezing is a whistling noise of varying pitch and loudness. It may occur when the small airways of the lungs become narrower. This can happen because of inflammation or a buildup of mucus and dead cells in the airway.

Your airways overreact.

People who inherit a tendency of the airways to overreact often get asthma.

Other things that may put you at risk for asthma include:

Cigarette smoking.

People who smoke are more likely to get asthma than people who don't.

Cigarette smoking during pregnancy.

This raises the risk of wheezing in babies. Babies whose mothers smoked during pregnancy also have worse lung function than those whose mothers didn't smoke.

Pollution.

Environmental factors may play a role in the development of asthma.

Workplace irritants or allergens.

Asthma in adults can be related to exposure to substances at work. This is called occupational asthma. It develops when a person is exposed to a certain inhaled substance in the workplace, such as wood dust, plastics, and chemicals.

Allergens.

Studies show that exposure to allergens such as dust mites, cockroaches, and pet dander may influence asthma's development. Cockroach droppings in a child's home have been linked to a higher risk for asthma.

Obesity.

Being obese raises your risk for asthma. Weight gain may make asthma worse.

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Symptoms

When you have asthma, you may:

• Wheeze, making a loud or soft whistling noise when you breathe in and out.
• Cough a lot. This is the only symptom for some people.
• Feel tightness in your chest.
• Feel short of breath. You may have rapid, shallow breathing or trouble breathing.
• Have trouble sleeping because you're coughing or having a hard time breathing.
• Get tired quickly during exercise.

Symptoms may start soon after you're around things (triggers) that cause your asthma attacks. This is an early phase response. Or they may start several hours after exposure (late phase response). A late phase response can make it harder to figure out what triggers your symptoms.

Symptoms can be mild or severe. You may have symptoms daily or just now and then. Or you may have something in between.

Some people have symptoms that get worse at night, such as a cough and shortness of breath.

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What Happens

Asthma often starts when you're a child or teen, or you may get it as an adult. It usually lasts throughout your life.

At times, the inflammation from asthma causes your airways to narrow and mucus to increase. This causes asthma symptoms such as shortness of breath.

You may have symptoms every day or just now and then, or you may have something in between. Sometimes your symptoms may suddenly get worse (or flare up) and cause an asthma attack. Over time, your breathing problems may get more severe, or you may have symptoms more often.

You may have a hard time breathing only at certain times, like during allergy season, or when you get a cold, or when you exercise. Or you may have breathing problems a lot of the time. The things that make your asthma or breathing worse are called triggers.

Even mild asthma may cause long-term changes to your airways and lungs. It may speed up and make worse the natural decrease in lung function that occurs as we age. Asthma can make lung and airway infections like bronchitis and pneumonia worse.

Asthma may raise your risk for chronic obstructive pulmonary disease (COPD).

Asthma can occur for the first time during pregnancy, or it may change during pregnancy.

When asthma is well controlled, there are little or no increased risks to the pregnancy.

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When to Call a Doctor

Call 911 or other emergency services right away if:

• You are having severe trouble breathing. Signs of this include:
  • Breathing very fast. Shortness of breath can interfere with the ability to speak smoothly.
  • Appearing anxious and being unable to eat because it's too hard to breathe.
  • Using the neck, chest, and belly muscles to breathe so that the skin between, above, and under the ribs sinks inward with each breath. Your nostrils may open wide when you breathe in.
  • Taking longer than usual to breathe out and sometimes having a high-pitched, musical sound when breathing in.
  • Sitting up, leaning forward, or sitting with your nose tilted up as if sniffing the air.
  • Having skin color that stays pale, gray, bluish, or mottled, including the tongue, lips, earlobes, and nail beds.

Call your doctor now or seek immediate medical care if:

• Your symptoms do not get better after you have followed your asthma action plan.
• You have new or worse trouble breathing.
• Your coughing and wheezing get worse.
• You cough up dark brown or bloody mucus (sputum).
• You have a new or higher fever.

Call your doctor if:

• You need to use quick-relief medicine on more than 2 days a week within a month (unless it is just for exercise).
• You cough more deeply or more often, especially if you notice more mucus or a change in the color of your mucus.
• You have asthma and your peak flow has been getting worse for 2 to 3 days.

If you have not been diagnosed with asthma but have mild asthma symptoms, call your doctor and make an appointment to be checked.

Watchful waiting

Watchful waiting is a "wait and see" approach. It may be okay as long as you follow your asthma action plan and stay within the green zone. Watch your symptoms, and continue to avoid your asthma triggers.

Exams and Tests

To find out if you have asthma, your doctor will do a physical exam and ask you questions about your health.

Your doctor may also have you do breathing (lung function) tests to find out how well your lungs work. Your doctor may also do other tests to make sure your symptoms aren't caused by another lung or health problem.

Breathing (lung function) tests

Lung function tests can help your doctor diagnose asthma, see how bad it is, and check for problems. These tests may include:

Tests for other diseases

Asthma can be hard to diagnose because the symptoms vary widely. And asthma-like symptoms can also be caused by other conditions, such as a viral lung infection (like pneumonia), a vocal cord problem, or a problem with another organ, like your heart. So your doctor may want to do other tests.

• More lung function tests may be needed if your doctor suspects another lung disease, such as chronic obstructive pulmonary disease (COPD).
• An electrocardiogram (EKG or ECG) might be done to rule out serious conditions with similar symptoms, such as chronic heart failure. This test measures the electrical signals that control the rhythm of your heartbeat.
• A bronchoscopy test can be done to examine the airways for problems such as tumors or foreign bodies. This test uses a long, thin, lighted tube to look at your airways.
• A chest X-ray may be used to look for signs of other lung diseases, such as fibrous tissue caused by chronic inflammation (pulmonary fibrosis).
• Blood tests, such as a complete blood count (CBC), may be done to look for signs of an infection or other condition.

If your doctor thinks your symptoms may be caused by allergies, your doctor may order allergy tests.

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Treatment Overview

Asthma is treated with medicine to help you breathe easier, along with self-care.

It's important to treat asthma, because even mild asthma can damage your airways. By following your treatment plan, you can meet your goals to:

• Prevent symptoms.
• Keep your lung function as close to normal as you can.
• Be able to do your normal daily activities. This includes work, school, exercise, and recreation.
• Prevent asthma attacks.
• Have few or no side effects from medicine.

Medicines

Most medicines for asthma are inhaled. These types of medicines go straight to your airways, where the problem is.

The main medicines used to treat asthma include:

Controller medicines.

These medicines prevent asthma attacks, stop problems before they happen, and reduce inflammation in your lungs. These things help you control your asthma.

If you have symptoms often, you will likely need to take your controller medicine daily. Inhaled corticosteroids are the preferred controller medicines. Your controller inhaler may also include a long-acting medicine that relaxes the airways to help you breathe.

Quick-relief medicines.

These medicines are used when you can't prevent symptoms and need to treat them fast.

These help relax the airways and allow you to breathe easier. Albuterol is a quick-relief medicine that is often used. In some cases, a certain type of controller inhaler is used as a quick-relief medicine. Ask your doctor what to use for quick relief.

Oral or injected corticosteroids.

These medicines may be used to treat asthma attacks.

Other medicines may be given in some cases.

Self-care

There are things you can do to help manage your asthma. You can follow your asthma action plan and try to avoid things that trigger your symptoms.

Other treatments

Immunotherapy.

If you have asthma symptoms that are triggered by allergens, your doctor may recommend immunotherapy. For this treatment, you get allergy shots that have a small amount of certain allergens in them. Your body "gets used to" the allergen, so you react less to it over time. This kind of treatment may help prevent or reduce some allergy symptoms.

For some people, allergy shots reduce asthma symptoms and the need for medicines. But allergy shots don't work equally well for all allergens. Allergy shots should not be given when asthma is not well-controlled.

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Self-Care

There are things you can do to control your asthma.

Taking medicines

• Take your controller medicine to treat inflammation. If you have symptoms often, you will likely need to take your controller medicine daily. Controller medicine usually includes an inhaled corticosteroid. The goal is to prevent problems before they occur.
• Use your quick-relief medicine when you have symptoms of an asthma attack. Some people need to use quick-relief medicine before they exercise to prevent asthma symptoms. Albuterol is a quick-relief medicine that is often used. In some cases, a certain type of controller inhaler is used as a quick-relief medicine. Ask your doctor what to use for quick relief.
• If your doctor prescribed corticosteroid pills to use during an asthma attack, take them as directed. They may take hours to work, but they may shorten the attack and help you breathe better.
• Keep your quick-relief medicine with you at all times.
• Learn how to use your inhalers the right way. Ask your doctor or pharmacist for help.

Avoiding triggers

Common triggers include colds, smoke, air pollution, dust or dust mites, pollen, mold, pet dander, cockroaches, stress, and cold dry air. Here are some ways to avoid triggers:

• Don't smoke, and don't let others smoke around you. Smoking makes asthma worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Avoid infections such as COVID-19, colds, and the flu. Get the flu vaccine every year, and ask your doctor about getting the pneumococcal shot. Stay up to date on your COVID-19 vaccines.
• Wash your hands often to prevent infections.

Following an asthma action plan

An asthma action plan is a written plan that will help you control your asthma every day and know what to do during an asthma attack. If you don't have an action plan, work with your doctor to make one. An asthma action plan usually includes:

• An outline of which medicines you take daily for asthma control and when to take them.
• Steps to take and medicines to use to treat an asthma attack early, before it becomes severe.
• What to do if an asthma attack becomes an emergency, and where to get medical treatment.
• An asthma diary where you record peak expiratory flow and the triggers that cause asthma symptoms.
• Treatment goals, which include your personal goals about your asthma.

Help your teen manage asthma

Teens who have asthma may see the illness as cutting into their freedom. They may feel that it sets them apart from their friends.

But there are ways you can help your teen manage their asthma care.

• Help your teen remember that asthma is only one part of life.
• Let your teen meet with the doctor alone.
• Work out a daily asthma plan that lets your teen keep doing daily activities like sports.
• Help your teen understand that asthma doesn't have to hold them back and that taking the asthma medicine will help your teen lead an active life.
• Talk with your teen about the dangers of smoking and drug use.
• Help your teen meet others who have asthma so they can support each other.

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Medicines

Medicine helps you breathe easier and control your asthma. It doesn't cure asthma. But it's an important part of managing it. Medicines for asthma treatment are used to:

• Prevent and control airway inflammation. This is so you have fewer asthma symptoms.
• Reduce how many asthma attacks you have, how long they last, and how bad they get.
• Treat the attacks as they occur.

Medicine choices

Most medicines for asthma are inhaled. They allow a specific dose to be given directly to the airways.

The main medicines used to treat asthma include:

Controller medicines.

These medicines prevent asthma attacks, stop problems before they happen, and reduce inflammation in your lungs. These things help you control your asthma.

If you have symptoms often, you will likely need to take your controller medicine daily. Inhaled corticosteroids are the preferred controller medicines. They include budesonide, fluticasone and mometasone. Your controller medicine may also include a long-acting medicine that relaxes the airways to help you breathe.

Quick-relief medicines.

These medicines are used when you can't prevent symptoms and need to treat them fast.

Quick-relief medicines, such as beta2-agonists, help relax the airways and allow you to breathe easier. Albuterol is a quick-relief medicine that is often used. In some cases, a certain type of controller inhaler is used as a quick-relief medicine. Ask your doctor what to use for quick relief.

Oral or injected corticosteroids (systemic corticosteroids).

These medicines may be used to treat asthma attacks. The oral form is used much more than the injected form. They include methylprednisolone and prednisone.

There are other long-term medicines that are sometimes used alone or with other medicines. They include:

• Anticholinergics (such as tiotropium). They treat asthma that's not well-controlled.
• Leukotriene pathway modifiers. Examples are montelukast, zafirlukast, and zileuton.
• Long-acting beta2-agonists. They are always used with an inhaled corticosteroid as a single medicine combination. They include formoterol and salmeterol.

Other medicines may be given in some cases.

• Magnesium sulfate may be used if asthma doesn't improve with standard treatment.
• Anticholinergics (such as ipratropium) are sometimes used for severe asthma attacks.
• Your doctor may recommend other medicines if you have severe allergic asthma and the symptoms aren't relieved by avoiding allergens or by taking standard medicines. Examples include mepolizumab and omalizumab.

How your doctor prescribes asthma medicines

Medicine treatment for asthma depends on your age and type of asthma. It also depends on how well the treatment controls your asthma symptoms. Your doctor may use a different approach for your situation. The goal is to use the least amount of medicine you can to control asthma symptoms.

• Your doctor may start you at a higher dose of medicine. Doing this can control the inflammation right away.
• After the asthma has been controlled for several months, the dose of the last medicine added is reduced to the lowest possible dose that prevents symptoms. This is known as step-down care. It's thought to be a better way to control inflammation in the airways than starting at lower doses of medicine and raising the dose if it isn't enough.

You may also be started at the lowest dose that helps you.

• The amount of medicine and number of medicines are increased in steps. So if asthma isn't controlled at a low dose of one controller medicine, the dose may be raised. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
• Quick-relief medicine is used to treat asthma attacks. But if you need to use it a lot, the amount and number of controller medicines may be changed.

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Complementary Medicine

Complementary medicine is a term used for a wide range of health care practices that may be used along with standard medical treatment.

Some people have found that mind and body practices such as acupuncture, breathing exercises, and yoga have been helpful for their asthma. But there is not evidence to say if these practices help.

Talk with your doctor if you are using complementary health practices or would like to. Your doctor can help you manage your health better if he or she knows all the treatments you use.

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