A common lung disorder called asthma can occasionally make breathing difficult because of swelling (inflammation) in the airways. It can affect people of all ages and generally begins in childhood. However, it can also appear in adulthood for the first time.
Asthma is a chronic disease. In other words, you will have it every day for your entire life. If left untreated, it can be dangerous, even fatal.
Although there is no known cure for asthma, there are easy-to-use therapies that can help manage symptoms and minimise their impact on your everyday life.
Causes of Asthma
A person is more likely to acquire asthma if:
- They have an asthmatic parent.
- They had a serious viral respiratory ailment in childhood.
- They currently have allergies.
- They have been exposed to chemical pollutants or industrial dusts (through smoking, living in an area with air pollution, or working around certain toxic gases, dusts, fumes, and vapours).
- They are overweight or obese.
Symptoms of Asthma
General symptoms of asthma disorder are:
- Wheezing when you breathe
- Tightness in the chest
The temporarily worsen during an asthma attack or a flare-up. The walls of your airways enlarge significantly more and may generate more mucus when you have an asthma attack. This reduces the amount of room available for air to enter and exit the lungs. Breathing may become more difficult due to tightening of the muscles that surround your airways.
The concept of asthma disorder as a singular disease has changed over time. It is frequently classified into several categories. The recognised asthma types are:
Allergic asthma: Also known as atopic or extrinsic asthma, it is caused by allergens such as pollen, pet dander, mould, and dust mites. Allergens are chemicals that elicit an allergic response. There are different ways that allergens can enter the body, and that can trigger an allergic reaction because your body perceives these outsiders as dangerous. Your immune system reacts by producing an antibody known as immunoglobulin E (or IgE). Excess IgE can cause inflammation of the airways, which triggers an asthma attack and hinders your breathing. In allergic rhinitis (or “hay fever”), a similar mechanism occurs in the nose and sinuses.
You can check if you have allergic asthma by visiting a doctor, who will inquire about your family and medical history. They will then order an allergy panel (skin or blood tests) and check your lung function. The allergy tests can help find the triggers behind your asthma flare-ups.
Usually, asthma medicines (inhaled or oral corticosteroids) and allergy medicines are helpful in bringing relief. You will also be given quick-relief medicines, like a rescue inhaler, to bring down your symptoms so you can breathe freely. Your doctor will also advice you on how to manage or limit exposure to allergens. In some cases, allergy immunotherapy may also be prescribed.
Occupational asthma: Among the different types of asthma is occupational asthma, which happens because of consistent workplace exposure to certain irritants. The good news is that occupational asthma is potentially reversible, and the symptoms can go away if the triggers are avoided. But if the person is exposed for an extended period, irreparable damage can occur.
You may develop occupational asthma if your symptoms began as an adult and are better on days when you are not at work.
Determining whether you have occupational asthma requires knowing about your family and medical history, any known allergies, whether you already have asthma, what your job conditions are like, and how often and when your asthma attacks occur. Lung function tests may also be done to measure airflow to and from your airways. Besides this, your doctor may recommend allergy tests and a chest X-ray.
Managing occupational asthma includes avoiding triggers if possible, taking asthma and allergy medicines, and getting regular medical check-ups. If it’s completely possible to avoid the irritants, then that will fully favour your recovery.
Non-allergic asthma: Also known as non-atopic or intrinsic asthma, it is not caused by allergens like pollen or dust. The common signs of this asthma type include coughing after a workout or laughing too hard, difficulty breathing, wheezing, and tightness in the chest.
This asthma type may also get triggered during extreme weather like when it’s too chilly or too hot outside. Other triggers can include stress, anxiety, strenuous exercise, respiratory infections, hormonal changes, certain medicines, fragrances, air pollution, and irritants like smoke.
Non-allergic asthma frequently manifests in adulthood and is more prevalent in women. The fundamental causes of non-allergic asthma are not fully known. Researchers are still looking into the interaction between environmental and genetic factors that can lead to asthma.
This type of asthma in adults is usually treated in the same way as allergic asthma. Lifestyle changes, taking asthma medication, and avoiding triggers are useful for management. Going to an allergist and ruling out any allergies will also be helpful.
Exercise-induced asthma: Also known as exercise-induced bronchoconstriction (EIB), it causes the airways to tighten and swell during exercise or physical activity. People who already have asthma typically also have EIB. However, you can have EIB if you do not have asthma.
The symptoms of EIB are typical of the general symptoms, which can range from mild to severe. Coughing, however, is more prevalent and can sometimes be the only symptom as well. EIB symptoms will show when you just start an exercise, peak when you are in the middle of it (around 10 to 15 minutes in), and go away around an hour after you are done exercising.
Paradoxically, EIB symptoms have been known to improve through exercise. Early detection and diagnosis of this issue can help manage symptoms effectively through a solid treatment plan. Your doctor might test your lung function, make you do exercise challenge tests, and prescribe a quick-relief medicine to take 15-20 minutes before an exercise.
Other ways to address EIB include being in ventilated spaces, including warm-up exercises before you start your actual workout, and protecting your airways from cold and dry or humid air. The main treatment objective is to keep exercising rather than avoid it.
Difficult-to-treat asthma: This asthma type is uncontrolled even after using inhaled corticosteroids in combination with oral asthma meds. The typical pattern of difficult asthma is experiencing symptoms around 3-4 times a week, using your inhaler 3-4 times a week, waking up in the middle of the night with symptoms more than once or twice a week.
If you have severe asthma, your doctor will work with you to discover a combination of asthma medications that works for you. You may need to consult an asthma specialist (pulmonologist) to determine why your asthma is difficult to manage and to explore other medication options.
Severe asthma: Every asthma patient has some level of underlying airway inflammation, which is typically manageable with a mix of medications for both short-term relief and long-term control.
However, some patients do not respond positively to inhaled corticosteroids, even in high doses, or other long-term controller drugs, which could indicate that they have severe asthma. The root cause of this inflammation must be determined through testing because it may be more difficult to cure. Together with your doctor, you should be able to design a personalised asthma treatment plan. This may include the use of long-term steroids or biologics.
Severe asthma has two sub-types:
- Eosinophilic asthma (E-asthma) where there is an increase in eosinophiles, a type of white blood cell. A large rise in the number of these white blood cells can have the opposite of a healing effect on the body. This increase can cause inflamed airways and trigger an asthma flare-up. An increase in eosinophiles can be due to a parasitic infection or an allergic reaction to certain medications.
- Non-eosinophilic asthma happens when there is a presence of neutrophils (the most common type of white blood cells that fight off infection), but few or no eosinophiles. This asthma type responds poorly to inhaled corticosteroid treatment.
- Neutrophilic asthma is a sub-type of non-eosinophilic asthma where there is an increase in the number of neutrophils. Inhaled corticosteroids do not effectively treat this kind of asthma, and their use may raise neutrophil levels. Chronic bacterial or viral infections, obesity, smoking, and abnormalities of the smooth muscles of the airways are all linked to neutrophilic asthma.
- Childhood asthma: Children with asthma display the typical symptoms like wheezing, coughing, and shortness of breath. However, some children may just have a chronic cough. Adequate diagnosis can help confirm the presence of asthma and help decide the right management and treatment plan.
There is no guaranteed way to foretell which kids will get asthma, but studies have identified a few indicators that can increase vulnerability to this condition:
- Known allergies, such as allergic rhinitis, skin allergies, or food allergies
- Asthma or allergy symptoms run in the family
- Tobacco smoke exposure during pregnancy and after birth
- Residing in an area with high air pollution levels
Adult-onset asthma: Although asthma commonly develops in childhood, some people only get diagnosed with it as adults. This is referred to as adult-onset asthma or late-onset asthma. Although the exact cause of adult-onset asthma is unknown, it can be triggered by smoke, mould, and other irritants.
The fatality rate for adult-onset asthma is significantly greater than the death rate for childhood asthma, owing to adults’ tendency to disregard their symptoms or ascribe them to weight gain and age.
Types of asthma FAQs
How many main types of asthma are there?
There are different types of asthma classified according to the triggers and intensities. Some of the types are non-allergic asthma, allergic asthma, occupational asthma, exercise-induced asthma, difficult-to-treat asthma, and severe asthma. Asthma can also be adult-onset or paediatric (childhood asthma).
What type of asthma does not respond to treatment?
Neutrophilic asthma and non-eosinophilic asthma are known to not respond well to inhaled asthma medication. However, there are other treatment plans that your doctor will create to suit your needs.
What type of asthma is considered the most life threatening?
Any type of asthma can be fatal if it is not addressed. However, severe asthma is known to be the most life-threatening because its symptoms are harder to control, even with high dosage of asthma medication.
What type of asthma is most common?
The most common type of asthma is allergic asthma, which affects around 16 million individuals worldwide. Individuals who have allergic asthma will not have an asthma attack until they come into touch with anything to which they are allergic, such as dust, pet dander, mould, or pollen.