Symptoms Of Asthma You Shouldn't Ignore

We've all had moments — maybe after a strenuous workout or while battling a cold — when it feels hard to take a deep breath. But for individuals with asthma, not being able to breathe properly is a chronic (and serious) concern. According to WebMD, "Asthma is a long-term disease of the lungs. It causes your airways to get inflamed and narrow, and it makes it hard to breathe." For some, asthma is only a minor nuisance that occasionally flares up because of exposure to certain triggers; for others, it's a daily battle that negatively impacts their ability to perform everyday activities or get a good night's sleep. 

Severe asthma attacks can send a person to the ER and even put their life in danger. There's no cure for asthma, but symptoms can be managed with a variety of medications and by avoiding asthma triggers.

As the Asthma and Allergy Foundation of America noted, asthma is extremely common in the United States. About 8% of adults and 7% of children — roughly 25 million Americans — have asthma. It's the most common chronic condition in children. Interestingly, boys are more likely than girls to have asthma, but in adulthood, women are more likely than men to have the condition. Each year, asthma attacks lead to 1.6 million ER visits, and it's estimated that asthma costs individuals approximately $3,266 annually.

There are a variety of symptoms that may indicate you have asthma or that your condition is getting worse, and you should never ignore them.

Shortness of breath

Experiencing shortness of breath is perhaps the quintessential asthma symptom. According to survey data reported on by asthma.net, shortness of breath is an early sign that asthma is worsening for about 40% of children, and 100% of patients visiting an ER because of an acute asthma attack experienced shortness of breath. People describe shortness of breath (also known as dyspnea) as "air hunger" or as if they're running out of air and unable to breathe deep or fast enough.

Every time you take a breath, air moves from your nose or mouth down the trachea (windpipe). As it reaches your lungs, the trachea divides into two bronchial tubes. The bronchial tubes then divide into smaller passages called bronchioles. At the end of each bronchiole are alveoli, tiny balloon-like sacs where oxygen enters the bloodstream and carbon dioxide leaves. There are tiny muscles surrounding your airways that control their expansion and constriction as you breathe in and out (via the Asthma and Allergy Foundation of America).

According to WebMD, "People with asthma have sensitive airways that tend to overreact and narrow when they come into contact with even slight triggers." When a person with asthma has an asthma attack, the bronchial tubes become inflamed, which causes swelling and makes it harder for air to pass through. The muscles surrounding the tubes also tighten, further restricting airflow. Airflow is also hampered by increased mucus production inside the tubes. These changes cause shortness of breath and other asthma symptoms.

Coughing

As Healthline explained, a productive cough is one in which phlegm is expelled. This type of cough is one of the body's natural defense mechanisms against pathogens and foreign particles in the lungs. While coughing is a common symptom of asthma, in most cases it's nonproductive (dry). This cough is the result of the swelling and inflammation of the airways that's characteristic of asthma.

Asthma is classified based on frequency and severity of symptoms rather than the symptoms themselves. According to Medscape, in intermittent asthma, symptoms are present less than twice a week and nighttime symptoms occur less than twice a month. Lung function (as measured with specialized medical equipment) is close to normal. In mild persistent asthma, symptoms are present three to six times a week and nighttime symptoms occur three to four times a month. Flare-ups may affect daily activities, but lung function is close to normal. 

In moderate persistent asthma, symptoms occur daily and nighttime symptoms are present five or more times a month. Lung function is farther from normal. In severe persistent asthma, symptoms are continuous and frequently cause problems at night. Lung function is significantly affected. Asthma can also be categorized based on how easy it is to control. Mild asthma can be managed with medication on an as-needed basis when symptoms arise or with low-dose daily medication. Moderate asthma requires more powerful medications, but at a low dose. Severe asthma either requires higher doses of these medications or can't be controlled at all.

Wheezing

Wheezing is another common symptom of asthma. According to the National Library of Medicine, a wheeze is a high-pitched, almost musical, breathing noise that results from narrowed airways or external compression on the airways. When airways are narrowed and the walls of the passages are very close together, they may vibrate as air travels through them, causing the wheezing sound. Wheezing is more commonly heard when someone with asthma is exhaling, because the airways naturally narrow when a person breathes out. If wheezing is also audible when someone breathes in, that may be a sign that their airways are even more severely constricted. 

Although the disappearance of wheezing may mean that asthma medications are expanding an individual's airways, it can also mean that the narrowing of particular airways has gotten so severe that air can no longer pass through and trigger the vibrations that cause the wheezing sound.

Just because someone with asthma sometimes wheezes during an asthma attack doesn't mean they always will. As WebMD noted, even in the same individual, symptoms can vary from one asthma attack to another or evolve gradually over time. Symptoms may be mild during some attacks but severe during others. Mild asthma attacks are more common and the airways usually open within a few minutes to a few hours. Severe asthma attacks last longer and require medical intervention. But it's important to recognize and adequately address even mild attacks.

Chest pain

According to Healthline, chest tightness and pain are common symptoms before or during an asthma attack. After an asthma attack, chest pain from coughing or struggling to breathe during the attack can linger after the airways have reopened.

But what exactly brings on attacks of chest pain and other asthma symptoms in the first place? As the Asthma and Allergy Foundation of America explained, for those with asthma, the lungs overreact to things that usually don't bother other people's lungs (or at least not to the same degree). Everyone's asthma triggers are different. Some people may only have one, while others may have many. It's important that people with asthma figure out their triggers so they can avoid them. Allergies are a major trigger for asthma. Common allergens include pollen, pet dander, mold, and dust mites. 

But it's important to note that not all people with asthma have allergies, and not everyone with allergies has asthma. Airborne irritants such as cigarette smoke, wood smoke, smog, dust, chemical fumes, and strong fragrances can also trigger an asthma attack. Crying, yelling, laughing, and experiencing other strong emotions can bring on symptoms. 

Certain medications, including aspirin, NSAIDs, and blood pressure drugs known as beta blockers, can be triggering for some. In addition, a number of medical conditions can worsen asthma. These include respiratory infections, food allergies, sleep apnea, nasal polyps, and pregnancy. The weather — particularly cold air, dry wind, sudden changes in temperature, and even thunderstorms — can bring on symptoms.

Difficulty breathing during or after exercise

While feeling a bit winded during your workout is usually a sign that you're putting in plenty of effort, experiencing true shortness of breath, wheezing, coughing, or other asthma symptoms during or immediately following exercise could indicate you have exercise-induced asthma. As the Cleveland Clinic explained, for those with exercise-induced asthma, physical activity can trigger airway inflammation and tightening. An estimated 90% of people with asthma will experience symptoms during or after exercise. But exercise-induced asthma is also prevalent among individuals with no other asthma triggers and affects about 10% of the general population. Exercise-induced asthma is more common among elite athletes than "weekend warrior" types.

Exercise-induced asthma is most likely to occur when the air is cold and dry. Exercising when pollen counts are high or there's a lot of pollution in the air is also a recipe for disaster. Symptoms may appear within a few minutes of starting exercise or they may not show up until after you've finished a workout. Symptoms usually resolve after about 30 minutes of rest, but some individuals may have symptoms that return up to 12 hours after exercising. These delayed effects are known as "late phase" symptoms and can take up to a day to go away. The sports most likely to trigger asthma are those in which there's sustained, high levels of exertion (such as distance running and soccer) and those that are played in cold environments (such as skiing or ice hockey).

Fast or slow breathing

According to the Asthma and Allergy Foundation of America, abnormally rapid or slow breathing is a common symptom of an asthma attack. When experienced in conjunction with other symptoms, the organization considers this a "red flag" symptom that indicates a person is having an asthma emergency and needs to take medication immediately to open their airways. If, after taking the medication, breathing doesn't improve quickly, emergency medical treatment should be sought.

While experts have identified plenty of triggers that can spark a flare-up of asthma symptoms, the root cause of asthma remains a mystery. Why do some people's lungs overreact so strongly to things that are generally benign? According to the American Lung Association, asthma is likely the result of multiple factors working together. Certain respiratory infections early in life may increase an individual's chances of getting asthma. If a lung infection in infancy or early childhood causes inflammation and damage to the still-developing lung tissue, it "can impact lung function long-term."

Other infections early in life, as well as certain genetic factors and exposure to certain allergens and irritants, also make it more likely that a person will develop asthma. When you're young, your immune system is still maturing and figuring out how to properly recognize and respond to threats. If it mistakenly overreacts to something it encounters when it's still learning about the world, it may create a dangerous precedent that it continues to follow.

A drop in your peak flow

One tool to help diagnose and monitor asthma is peak flow. As Johns Hopkins Medicine explained, "Peak flow measurement can show the amount and rate of air that can be forcefully breathed out of the lungs." Also known as peak expiratory flow rate (PEFR) or peak expiratory flow (PEF), peak flow is most often measured by breathing forcefully into a small handheld device known as a peak flow meter (PFM). PFMs are small and light enough to be carried anywhere and can be an excellent tool for individuals who want to check their lung function. 

In a healthcare setting, a similar but larger device known as a spirometer may be used to gauge peak flow. Peak flow is most often used as a subjective measure, with readings compared to an individual's personal "best." Readings of 50% to 80% of a person's "best" indicate mild airway narrowing, while readings below 50% indicate severe narrowing.

While peak flow can be useful for diagnosing asthma, there's no single test that definitively indicates the condition. Usually a diagnosis begins with an individual visiting their doctor because they have persistent symptoms. The first step is a thorough medical history, during which the doctor asks the person about their symptoms, family history of asthma, possible environmental exposures, and other medical conditions. A physical exam, including listening to the lungs with a stethoscope, is also essential for diagnosing asthma and ruling out other possible conditions (via the Mayo Clinic).

Elevated nitric oxide levels

According to the American Lung Association, another sign that you have asthma, or that your asthma medication isn't working, is elevated nitric oxide levels in your lungs. While this isn't a symptom you'd notice on your own, it can be measured in a doctor's office using the exhaled nitric oxide test. This test is performed similarly to a peak flow test: An individual breathes into a small device that measures the nitric oxide content of the exhaled air. Higher than normal results indicate that there's swelling in the airways. In addition to helping diagnose new cases of asthma, the exhaled nitric oxide test can be used to check if asthma medications are working and if an individual is following their treatment plan as directed. 

Nitric oxide is produced naturally in the body, especially in the presence of inflammation. Results of the exhaled nitric oxide test (sometimes also referred to as a fractional exhaled nitric oxide test), are given in parts per billion (ppb). Anything above 40 ppb is considered elevated and indicates airway inflammation (via Asthma+Lung UK).

When diagnosing asthma, if the doctor has done a peak flow test and an exhaled nitric oxide test but wants to rule out other possible reasons for symptoms — or suspects that an individual may have other medical conditions that may be making asthma symptoms worse — a variety of blood tests or imaging of the chest or sinuses may also be done (via the Mayo Clinic).

Difficulty breathing while asleep

Although it's unclear exactly why, shortness of breath, wheezing, and other asthma symptoms are often worse during sleep. While many people with asthma experience symptoms at night, these symptoms shouldn't be dismissed just because they're common. In addition to making it difficult to get a good night's rest, nocturnal asthma symptoms are serious and indicate a person's asthma isn't well controlled. In fact, most deaths from asthma happen at night (via WebMD).

According to the Cleveland Clinic, "Asthma can't be cured, but it can be managed." The goal is to adequately control the condition so that a person experiences no (or only minimal) symptoms and rarely needs to use a rescue inhaler. Well-controlled asthma means a person can do the things they want to do during the day and their sleep isn't interrupted by asthma symptoms. Managing asthma requires making (and sticking to) an action plan developed with healthcare professionals. The action plan spells out how and when asthma medication should be used and what to do if asthma symptoms seem to be getting worse and when emergency care is necessary.

An individual's action plan also includes identifying their unique triggers and avoiding them as much as possible or taking measures to minimize their impact if they can't be avoided. Individuals with asthma may also be asked to track their symptoms in a symptom diary for better long-term monitoring of how well their asthma is being controlled (via the Mayo Clinic).

Hard, shallow breathing

According to the Asthma and Allergy Foundation of America, hard, shallow breathing is an indicator that someone has asthma that's rapidly worsening. When experienced alongside other asthma symptoms, this type of breathing indicates that asthma medication needs to be taken immediately.

As the Mayo Clinic explained, quick-relief medications, also known as rescue medications, are used on an as-needed basis to prevent an imminent asthma attack or treat one that's already underway. If an individual with asthma is exposed to one of their triggers, they may use a quick-relief inhaler to prevent a flare-up. These medications open the airways by relaxing the small muscles around the bronchial tubes. They take effect within minutes but only last four to six hours. 

The most commonly used quick-relief medications are short-acting beta agonists such as albuterol and levalbuterol. Ipratropium is a bronchodilator that's usually prescribed for emphysema or chronic bronchitis, but is also sometimes used with asthma patients. For particularly severe asthma attacks, individuals may need to go to the ER, where they'll often receive oral or IV corticosteroids such as prednisone and methylprednisolone.

If an asthma attack is life-threatening, ER doctors may need to intubate. In this process, a tube is placed down the throat into the upper airway. A machine pumps oxygen into the lungs and removes carbon dioxide. This gives doctors time to bring the asthma under control using quick-relief drugs (via the Mayo Clinic).

Skin retraction around the chest

In some cases of a severe asthma attack, the skin around the neck, breastbone, and in between the ribs may retract and "suck in" around these bones, making them more noticeable. This symptom is more commonly seen in children, but adults may also experience it (per the Asthma and Allergy Foundation of America).

Although quick-relief medications are lifesaving interventions, effectively managing asthma is best accomplished with long-term control medications. They're taken daily, even if an individual isn't experiencing any active symptoms. Inhaled corticosteroids are the most commonly used long-term control medication. These anti-inflammatory drugs reduce swelling and constriction in the airways. Leukotriene modifiers are another option for long-term control. They block the action of leukotrienes, immune system chemicals that trigger the symptoms of asthma. 

Long-acting beta agonists (LABAs) can open airways and reduce swelling for at least 12 hours and are most commonly used at night. However, because of safety concerns they're now only prescribed in a combination inhaler that also contains a corticosteroid. Theophylline is another bronchodilator (airway opener), but this one is taken in pill form and generally used for more mild asthma (via the Mayo Clinic).

The most common delivery method for inhaled long-term and quick-relief medications is a metered-dose inhaler (MDI). An MDI delivers a set amount of aerosolized medication that is inhaled into the lungs. Dry powder or rotary inhalers contain the medication in powder form and are activated by a person's breath (per Johns Hopkins Medicine).

Hunched shoulders

According to the Asthma and Allergy Foundation of America, hunched shoulders can be a symptom of asthma. How are the two connected? As a 2013 paper published in Clinics explained, "Patients with asthma and other chronic respiratory diseases tend to develop changes in posture and balance." To compensate for airway restriction, the muscles that control breathing have to work harder. Over time, this makes them shorter and less flexible. This muscle imbalance at the front of the chest can have widespread repercussions elsewhere in the body.

Although asthma medications unquestionably save lives and improve quality of life for millions of people, they can cause unpleasant symptoms and dangerous side effects of their own. As Verywell Health explained, inhaled corticosteroids can cause hoarseness, a sore mouth or throat, and reflex coughs or windpipe spasms. They can also cause thrush, a fungal infection in the mouth. When used long-term, they may cause cataracts or glaucoma, lead to easy bruising, and decreased bone density. Oral corticosteroids can cause a host of issues, including those side effects seen with the inhaled versions. 

In addition, long-term use of oral corticosteroids may lead to weight gain, fluid retention, elevated blood sugar and blood pressure, and type 2 diabetes. Long-acting beta agonists (LABAs) can cause similar side effects, including increased heart rate, headache, dizziness, anxiety, tremors, and a rash. LABAs can, paradoxically, cause severe, life-threatening asthma attacks. Leukotriene modifiers may cause stomach upset, headache, flu-like symptoms, nasal congestion, rash, nausea, and vomiting.

Increased mucus production and staying healthy

Since one of asthma's hallmark characteristics is thick mucus that obstructs airways, it's not surprising that a noticeable increase in mucus or phlegm production is an early warning sign of an impending asthma attack for some individuals (via the Asthma and Allergy Foundation of America).

Although asthma medications are the cornerstone of asthma control for most people, the Mayo Clinic noted that here are a number of things individuals can do to help their asthma. Most importantly, people with asthma should do their best to avoid their triggers. For those with allergy-induced asthma, taking allergy medication, using an air conditioner, and cleaning regularly can help. Maintaining an optimal humidity level by using either a humidifier or dehumidifier, as well as covering your nose and mouth when it's cold outside, can help those with certain weather triggers. 

Animal lovers with pet dander allergies should choose hypoallergenic breeds and make sure pets are regularly bathed and groomed. Breathing exercises can increase awareness of and control over breathing and may reduce the amount of medication an individual needs to take. It's also important individuals with asthma stay as healthy as possible. This includes getting regular exercise and choosing exercise that doesn't aggravate exercise-induced asthma. Individuals should take extra precautions to avoid respiratory illnesses and manage heartburn, as both may worsen asthma. Maintaining a healthy weight is also critical, as being overweight or obese can also make asthma worse.

Cyanosis

According to AsthmaSymptoms.org, "Cyanosis is a medical condition wherein patients have a blue or blue-gray tint to their skin color and their mucous membranes." The blue tint occurs when tissues don't receive enough oxygen. Although cyanosis can happen as the result of a variety of conditions, asthma is perhaps the most common. When airways are swollen and filled with mucus, they can't deliver the oxygen your body needs. Cyanosis is considered a serious asthma symptom, and anyone experiencing it should seek immediate medical help.

Severe asthma that doesn't respond well to treatment can lead to long-term complications. One of the most serious is airway remodeling. As Healthgrades explained, airway remodeling is the result of years of chronic inflammation in the lungs and "is a process that changes the structure of the airways. It leads to bronchial wall thickening, narrowing of the air passages, and other physical changes that can be permanent." These structural changes make it harder to breathe.

If asthma is severe or not adequately controlled, it can be deadly. According to the Asthma and Allergy Foundation of America, more than 3,500 people a year die from asthma in the United States. In many cases, these deaths could have been avoided with proper treatment. "Adults are five times more likely to die from asthma than children," noted the foundation. And adult women are more likely to die of asthma than adult men (though in childhood boys are more likely to die than girls).