How Does Asthma Start?

Asthma is a chronic lung disease characterized by inflammation and narrowing of the airways with increased mucus production.

According to the Centers for Disease Control and Prevention (CDC), it is estimated that more than 26 million Americans have asthma, including 6.1 million children.

1. Difficult to control asthma: Symptoms that do not go away, even with high doses of asthma medicines and add-on treatments.
2. Severe asthma:
   • Allergic asthma: Caused by exposure to allergens, such as pollen, pet dander, and molds.
   • Eosinophilic asthma: Characterized by having an increase in eosinophils, a type of white blood cells that are involved in inflammatory reactions.
   • Noneosinophilic asthma: Includes an increase in airway inflammation with the absence of eosinophils and triggering of other inflammatory pathways.
3. Occupational asthma: Caused directly by the work, such as a baker might be allergic to flour dust or a healthcare provider to latex gloves.

Other types include:

• Seasonal asthma: People get asthma flare-ups at certain times of the year, such as during hay fever season or when it is cold.
• Exercise-induced asthma: People get asthma-like symptoms triggered only by strenuous exercise.

Some people with asthma may have extended periods without having any symptoms, interrupted by periodic worsening of their symptoms called asthma attacks.

• An asthma attack (asthma flare-up) is an acute episode where the respiratory muscles (surrounding the airways) are triggered to tighten, a process called bronchospasm.
• The lining of the airways becomes swollen or inflamed and the cells lining the airways produce excessive mucus secretions, which are thicker than normal, leading to a reduction in the space for air movement.
• All these factors combined (bronchospasm, inflammation, and excessive mucus production) cause symptoms, such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities.
• Other symptoms of an acute asthma attack include:
  • Severe wheezing
  • Coughing that does not stop
  • Rapid breathing
  • Chest pain or pressure
  • Tightened neck and chest muscles (retractions)
  • Difficulty talking
  • Feelings of anxiety or panic
  • Pale, sweaty face
  • Blue lips or fingernails

The exact cause of asthma is not known, but it tends to run in families and may be inherited. Environmental factors also play a key role.

Certain factors that could play an important role in the development of asthma include:

1. Genetics: A person is more likely to be asthmatic if their parents or grandparents were asthmatic.
2. Environment: Contact with allergens, certain irritants, or exposure to viral infections as an infant or in early childhood (immature immune system) has been linked to developing asthma. Exposure to certain chemicals and dust in the workplace may play a significant role in adult-onset asthma (occupational asthma).
3. Respiratory infections: Certain respiratory infections have been shown to cause inflammation and damage the lung tissue during infancy and early childhood, impacting lung function in the long term.
4. Ethnicity: African Americans and Puerto Ricans are at higher risk of asthma than people of other ethnicities.
5. Having other diseases or conditions: Obesity and allergies.

Certain factors may trigger an asthma attack in susceptible individuals.

• A viral or bacterial infection, such as common cold, bacterial sinusitis, and flu
• Stress
• Weather changes
• Heavy exercise
• Allergic rhinitis
• Dust mites
• Pollen from grass, trees, and weeds
• Hay fever
• Exposure to chemicals, smoke, and pet dander
• Smoking (active or passive)

Symptoms can range from mild to severe and may include:

• Coughing, especially at night
• Wheezing
• Shortness of breath
• Chest tightness, pain, or pressure

To confirm asthma diagnosis, the pulmonologist (chest specialist) or an allergist (allergy specialist) will review the medical history, and current asthma symptoms and do a physical examination to assess the present situation.

Additional testing to determine the specific type includes:

• Biomarkers: Taking a blood sample or analyzing a mucus sample (sputum) or taking a breathing test that measures substances in the breath droplets are commonly used tests to analyze biomarkers, such as immunoglobulin E, eosinophil, and neutrophil.
• Lung function tests: Spirometry and peak flow tests help understand the flow of air through the airways during breathing.
• Fractional exhaled nitric oxide tests: Measure the levels of nitric oxide in the breath when breathing out. High levels of nitric oxide may mean that the lungs are inflamed.

There is no cure for asthma, but it can be managed so that a person with asthma can live an active and healthy life. It is important to recognize and treat even mild asthma symptoms to help prevent severe episodes and keep asthma under control.

Mild asthma attacks are more common. Usually, the airways open within a few minutes to a few hours, whereas severe attacks are less common, last longer, and require immediate medical help.

A combination of quick-relief and long-term medicines is required to treat severe and uncontrolled asthma, including oral corticosteroids, long-acting beta II agonists, montelukast, or theophylline, inhaled corticosteroids (asthma inhaler), and bronchodilators.