Asthma – signs and symptoms

“More adult women than adult men have asthma, and they can have to deal with more serious symptoms and risks. Hormonal changes are thought to play a part in this.”

The good news is, there are effective treatments – including inhalers and medications – that can cut your risk of getting symptoms and of having an ‘asthma attack’ (where your symptoms get worse very quickly).

So here’s your guide to understanding asthma symptoms and who gets them, as well as the different types of asthma and common triggers.

What is asthma?

Asthma is a very common condition that affects about 25 million Americans – 20 million adults and 5 million children.

It’s caused by swelling (inflammation) in your airways – the passages between your mouth and nose and your lungs.

When your airways are inflamed, they’re narrower, which can make it harder to breathe.

The inflammation also makes your airways more sensitive, and they can react to ‘triggers’ – such as pollution, allergies, and even emotions – by narrowing even more.

Asthma symptoms

When your airways are inflamed and narrowed, it causes symptoms such as:

• breathing problems
• coughing
• wheezing
• chest tightness
• pain

It’s also common to feel tired – asthma can often be worse at night, so your sleep can be interrupted by coughing and wheezing.

What does asthma feel like?

“Asthma feels different depending on how severe your symptoms are,” says Dr Ann. “Some people don’t have symptoms all the time, but people with uncontrolled or severe asthma may do.

Words people use to describe what an asthma flare-up or attack feels like include:

• “tight chest”
• “itchy lungs“
• “struggling to breathe”
• “gasping for breath”
• “fighting for air”
• “breathing through a straw”
• “like having someone grabbing you around the chest“
• “heavy weight on your chest”
• “confused”
• “rising panic”

“In most cases, you can relieve your symptoms in a few minutes by using your quick-relief inhaler,” says Dr Ann. “And prevent them from happening in the first place by using your preventer inhaler as prescribed.”

Watch this video to learn more about the early warning signs of an asthma attack.

Can you die from asthma?

“Yes, you can – but be reassured that the number of people who die from asthma attacks is a small percentage of the people with asthma,” says Dr Ann.

“And most asthma deaths are preventable. That means if you take your medicines as prescribed, use an asthma action plan and see your doctor for regular checks, your risks go right down. And knowing how to deal with an asthma attack, if you have one, is crucial – it’s a medical emergency.” (Read about

.)

Asthma deaths in the US: the facts

• an average of 11 people a day die from asthma
• in 2020, 4,145 people died from asthma attacks
• this is a small percentage of the 25 million people who have asthma
• nearly all these deaths would have been preventable with the right treatment
• women are more likely to die from asthma than men
• black people are more likely to die from asthma than white people
• black women are nearly 4 times more likely to die from asthma than white men

Who is most likely to get asthma?

There are several things that can increase your risk of getting asthma, including:

• being a woman – about 9.8% of adult women are affected, compared with 6.1% of adult men
• having another allergy-related condition – known as an ‘atopic condition’ – such as
  eczema
  ,
  hay fever
  or a
  food allergy
• having a family history of asthma or atopic conditions
• having a lung infection called
  bronchiolitis
  as a child
• having exposure to tobacco smoke as a child, or a mother who smoked during pregnancy
• being born preterm (before 37 weeks) or with a low birth weight
• occupational risks at work

Family allergy and asthma

Asthma can run in families, along with atopic conditions such as eczema, hay fever and certain food allergies. You’re more likely to get asthma if members of your close family have it, such as parents, brothers or sisters.

Experts say this is likely to be due to a mixture of your genes and your shared home environment – such as how clean your home is, ventilation, infections and the foods you eat.

But having a family allergy and asthma doesn’t mean your children will definitely get it. And lots of people get asthma when there’s no family history.

Some people are genetically more likely to get asthma (predisposed), then something in their environment triggers the symptoms.

Women and asthma – the hormone factor

“Women seem to have a much harder time than men when it comes to asthma,” says Dr Ann.

Research shows that adult women:

• get asthma more often than men – in children, around 65% of asthma cases are seen in boys, but in adults, the statistics are reversed
• can have worse symptoms, more often
• are more at risk of having asthma attacks and being admitted to hospital

What’s more, women who get asthma for the first time after the

are more likely to have symptoms that are difficult to control, and to need specialist care. Women over 65 with asthma are also at risk of more life-threatening attacks.

Why more women get asthma than men

It’s thought that hormones are involved:

• female hormones can trigger asthma symptoms around times of hormonal change – such as in
  puberty
  , certain points in the
  menstrual cycle
  , pregnancy, and the time leading up to the menopause (
  perimenopause
  )
• symptoms can also be affected by hormonal medication, such as birth control (
  contraception
  ) and
  hormone replacement therapy (HRT)
• another theory is that the male hormone testosterone protects men against asthma, by stopping inflammation in the lungs after puberty

Why women have worse asthma experiences

As well as hormonal triggers, other reasons women can have worse asthma experiences than men include:

• worse reactions to common triggers – cigarette smoke can affect women more than men, and women are also more likely to have food allergies
• more need for pain relief – women are more likely to have pain conditions than men, and anti-inflammatory painkillers such as ibuprofen and aspirin can trigger asthma in some people
• more need for hospital treatment – rates of hospital admissions for asthma are three times higher in women aged 20-50 years than men of the same age group. Having more frequent and severe symptoms means asthma can create a greater burden for women, leading to a poorer quality of life

What are the different types of asthma?

Allergic asthma

This type of asthma is triggered by ‘allergens’ – such as pet dander, pollen and dust mites, mold, and cockroaches.

About 8 in 10 people who have allergic asthma have another atopic condition, such as eczema, hay fever, or food allergies.

Treatment will involve managing your allergies, as well as your asthma. Read advice from the Asthma and Allergy Foundation of America (AAFA) about

.

Seasonal asthma

For some people, seasonal changes in temperature and the weather can trigger asthma, including:

• cold weather – reasons for this include dry, cold air irritating your lungs and making you produce more mucus, more colds and flu in winter, and more exposure to indoor allergens (read more about how to manage asthma and other conditions this winter with our
  complete guide to winter health
  )
• hot weather – breathing in hot air can also cause your airways to narrow
• thunderstorms – humid air before a storm can make your chest feel tight, while windy conditions can blow pollen (a common allergen) up into the air

Occupational asthma

Asthma can be triggered by allergens related to your job – for example, if you handle flour in a bakery, or use latex gloves in healthcare. Other triggers include chemicals, fumes, paint and animal fur.

Your symptoms begin when you start the job and improve on days when you’re not at work.

Read more from Asthma & Lung UK about

.

Exercise-induced asthma

Also known as

, this affects up to 90% of people with asthma:

• exercise makes you breathe harder, faster and deeper, especially in cold air, and this is a frequent trigger
• you’ll usually inhale through your mouth, causing the air to be cooler and dryer – this is the main trigger for the narrowing of the airways
• the most common symptom is usually a cough, which starts 5 to 10 minutes after starting exercise and usually goes away within half an hour

Adult onset asthma and childhood asthma

Asthma can start in childhood or in later life. Some children find their asthma gets better or goes away completely as they get older.

Triggers for adult asthma starting include occupational hazards, smoking, obesity, hormones and stressful life events.

Non-allergic asthma

This type of asthma doesn’t appear to be triggered by any allergens. It’s poorly understood, and can be difficult to manage. It tends to develop later in life and can be quite severe.

Severe asthma

About 4% of people have severe asthma, where their symptoms aren’t under control, despite taking

. In the past, this was sometimes called brittle asthma.

If you have severe asthma, you may:

• have uncontrolled asthma despite using the highest dose of steroid inhaler, other medication and following your treatment plan
• have to use a quick-relief inhaler 3 or more times a week
• have 2 or more asthma attacks a year

If you have severe asthma, you may also need to take

or other medication to dampen down the inflammation in your lungs.

When to see a doctor

If you have

, or if you’ve been diagnosed and your symptoms get worse or you’re concerned, see your doctor.

How to get an asthma diagnosis

Your doctor will diagnose asthma based on your symptoms and your medical and family history.

As well as asking about your symptoms and how frequent they are, they’ll do a lung function test to see how well you breathe in and out.

They may also do

, or .

Lung function tests

Lung function tests are often done before and after breathing in a medicine called a bronchodilator, which opens up your airways. They include:

• peak flow test
  – a portable, hand-held device measures the air you can blow out in one go. It can also be used for home monitoring, at a check up, or if you have a flare-up
• spirometry
  – this test measures both how well and how fast you breathe in and out

Read more about

from the AAFA.

Been diagnosed and want to know more about managing your condition? Read

.