Topic Overview

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This topic provides information about asthma in teens and adults. If you are looking for information about asthma in children age 12 and younger, see the topic Asthma in Children.

What is asthma?

Asthma causes swelling and inflammation in the airways that lead to your lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for you to breathe. These flare-ups are also called asthma attacks or exacerbations.

Asthma affects people in different ways. Some people only have asthma attacks during allergy season, or when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.

Even if you have few asthma attacks, you still need to treat your asthma. The swelling and inflammation in your airways can lead to permanent changes in your airways and harm your lungs.

Many people with asthma live active, full lives. Even though asthma is a lifelong disease, treatment can control it and keep you healthy.

What causes asthma?

Experts do not know exactly what causes asthma. But there are some things we do know:

• Asthma runs in families.
• Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
• Pollution may cause asthma or make it worse.

What are the symptoms?

Symptoms of asthma can be mild or severe. You may have mild attacks now and then, or you may have severe symptoms every day, or you may have something in between. How often you have symptoms can also change. When you have asthma, you may:

• Wheeze, making a loud or soft whistling noise that occurs when you breathe in and out.
• Cough a lot.
• Feel tightness in your chest.
• Feel short of breath.
• Have trouble sleeping because of coughing or having a hard time breathing.
• Quickly get tired during exercise.

Your symptoms may be worse at night.

Severe asthma attacks can be life-threatening and need emergency treatment.

How is asthma diagnosed?

Along with doing a physical exam and asking about your health, your doctor may order lung function tests. These tests include:

• Spirometry. Doctors use this test to diagnose and keep track of asthma. It measures how quickly you can move air in and out of your lungs and how much air you move.
• Peak expiratory flow (PEF). This shows how fast you can breathe out when you try your hardest.
• An exercise or inhalation challenge. This test measures how quickly you can breathe after exercise or after taking a medicine.
• A chest X-ray, to see if another disease is causing your symptoms.
• Allergy tests, if your doctor thinks your symptoms may be caused by allergies.

You will need routine checkups with your doctor to keep track of your asthma and decide on treatment.

How is it treated?

There are two parts to treating asthma, which are outlined in the asthma action plan. The goals are to:

• Control asthma over the long term. The asthma action plan tells you which medicine to take. It also helps you track your symptoms and know how well the treatment is working. Many people take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps to reduce the swelling of the airways and prevent attacks. Your doctor will show you how to use your inhaler correctly. This is very important so you get the right amount of medicine to help you breathe better.
• Treat asthma attacks when they occur. The asthma action plan tells you what to do when you have an asthma attack. It helps you identify triggers that can cause your attacks. You use quick-relief medicine, such as albuterol, during an attack.

If you need to use the quick-relief inhaler more often than usual, talk to your doctor. This is a sign that your asthma is not controlled and can cause problems.

Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your asthma action plan.

How can you prevent asthma attacks?

You can prevent some asthma attacks by avoiding those things that cause them. These are called triggers. A trigger can be:

• Irritants in the air, such as cigarette smoke or other air pollution. Don't smoke, and try to avoid being around others when they smoke.
• Things you are allergic to, such as pet dander, dust mites, cockroaches, or pollen. When you can, avoid those things you are allergic to. It may also help to take certain kinds of allergy medicine.
• Exercise. Ask your doctor about using a quick-relief inhaler before you exercise if this is a trigger for you.
• Other things like dry, cold air; an infection; or some medicines, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Try not to exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections. And ask about what medicines you should avoid.

Sometimes you don't know what triggers an asthma attack. This is why it is important to have an asthma action plan that tells you what to do during an attack.

Frequently Asked Questions

Cause

The cause of asthma is not known. Health experts believe that inherited, environmental, and immune system factors combine to cause inflammation of the bronchial tubes, which carry air to the lungs. This can lead to asthma and asthma attacks.

• Asthma may run in families (be inherited). If this is the case in your family, you may be more likely than other people to develop long-lasting (chronic) inflammation in the bronchial tubes.
• In some people, immune system cells release chemicals that cause inflammation in response to certain substances (allergens) that cause allergic reactions. Studies show that exposure to allergens such as dust mites, cockroaches, and animal dander may influence asthma's development.¹ Asthma is much more common in people with allergies, although not all those who have allergies develop asthma. And not all people with asthma have allergies.
• Environmental factors and today's germ-conscious lifestyle may play a role in the development of asthma. Some experts believe that there are more cases of asthma because of pollution and less exposure to certain types of bacteria or infections.² As a result, children's immune systems may develop in a way that makes it more likely they will also develop allergies and asthma.

Asthma in adults also can be related to work (occupational asthma). Being around animals, plastic resin, wood dust, grain dust, insecticides, and metals can cause asthma, usually because your immune system reacts to the material. Some people continue to have asthma symptoms even after they are no longer exposed to what caused the symptoms. But for many people, symptoms will get better or go away when they are away from the asthma trigger.

Symptoms

Symptoms of asthma can be mild or severe. You may have no symptoms; severe, daily symptoms; or something in between. How often you have symptoms can also change. Symptoms of asthma may include:

• Wheezing, which is a whistling noise of varying loudness that occurs when the airways of the lungs (bronchial tubes) narrow.
• Coughing, which is the only symptom for some people.
• Chest tightness.
• Shortness of breath, which is rapid, shallow breathing or difficulty breathing.
• Sleep disturbance because of coughing or having a hard time breathing.
• Tiring quickly during exercise.

An asthma attack occurs when your symptoms suddenly increase. Factors that can lead to an asthma attack or make it worse include:

• Having a cold or another type of respiratory illness, especially one caused by a virus, such as influenza.
• Exercising (exercise-induced asthma), especially if the air is cold and dry.
• Exposure to triggers, such as cigarette smoke, air pollution, dust mites, or animal dander.
• Being around chemicals or other substances at work (occupational asthma).
• Changes in hormones, such as during the start of a woman's menstrual blood flow or pregnancy.
• Taking medicines, such as aspirin (aspirin-induced asthma) or nonsteroidal anti-inflammatory drugs.

Many people have symptoms that become worse at night (nocturnal asthma). In all people, lung function changes throughout the day and night. In people who have asthma, this often is very noticeable, especially at night, and nighttime cough and shortness of breath frequently occur. In general, waking at night because of shortness of breath or a cough indicates poorly controlled asthma.

Symptoms are used to classify asthma by severity. They are used along with peak expiratory flow to help define the green, yellow, and red zones of your asthma action plan. You use this plan to decide on treatment during an asthma attack.

What Happens

Asthma often begins during infancy or childhood but may start at any age and last throughout your life. It can increase your risk for complications from lung and airway infections, such as acute bronchitis and pneumonia.

At times, the inflammation from asthma causes a narrowing of your airways and mucus production, resulting in asthma symptoms such as shortness of breath.

The airways narrow when they overreact to certain substances. These are known as asthma triggers and may include:

• Substances you are allergic to (allergens, such as dust mites or animal dander). Allergens cause long-term (chronic) inflammation and may cause asthma symptoms.
• Environmental factors that irritate your airways, such as smoke or cold air. Environmental factors may lead to a tightening of the muscles that line the bronchial tubes (bronchospasm), which can trigger asthma symptoms.

What triggers asthma symptoms varies from person to person. When asthma is triggered by an allergen, it is called allergic asthma.

When asthma symptoms suddenly occur, it is called an asthma attack (also called a flare-up or exacerbation). Asthma attacks can occur rarely or frequently and may be mild to severe. Although some asthma attacks occur very suddenly, many become worse gradually over a period of several days. In general, you can take care of symptoms at home by following your asthma action plan, although a severe attack may require emergency treatment and in rare cases can be fatal.

Asthma is classified as intermittent, mild persistent, moderate persistent, and severe persistent.

• People with intermittent asthma often have symptoms only after being around a trigger.
• People with intermittent asthma usually need medicines only during an asthma attack.
• People with mild persistent or moderate persistent asthma may not always have noticeable symptoms. But they need to take medicines daily to control the long-term inflammation in their airways.
• People with severe persistent asthma have symptoms almost all of the time. Their symptoms need to be treated daily. These people are at increased risk for severe, life-threatening asthma attacks known as status asthmaticus.

Asthma—even mild asthma—may result in changes to the airway system (airway remodeling) and may speed up and make worse the natural decrease in lung function that occurs as we age.³ And some experts believe asthma may raise your risk for chronic obstructive pulmonary disease (COPD).⁴

Sometimes asthma does not respond to treatment because people are not taking their medicines, not taking them correctly, not avoiding triggers, or otherwise not following their asthma action plan. Follow your asthma action plan so you can keep your asthma from getting worse and reduce the risk of death from asthma.

Asthma during pregnancy

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

When asthma is properly controlled, a pregnant woman with asthma can have a normal pregnancy with little or no increased risk to herself or her fetus. But if the asthma is not well controlled, there are risks to the pregnant woman and her fetus. The management of asthma in pregnant women and nonpregnant women is basically the same, although a pregnant woman may need to take different medicines and needs to monitor the fetus's health as well as her own.

What Increases Your Risk

Many factors may increase your risk of developing asthma. Some of these are not within your control; others you can control. The main things that put you at risk for developing asthma as an adult are ongoing (chronic) wheezing when you were a child and cigarette smoking.^{5, 6}

Asthma risk factors that you cannot control

The following risk factors are not within your control:

• Gender and age. Women and men seem to have the same risk of developing asthma until they reach their 40s. After 40, women have a higher risk for asthma.
• A family history of allergies and asthma. People who have an allergy and asthma usually have a family history of allergies or asthma.
• Inherited tendency (genetic predisposition) to overreaction of the bronchial tubes. People who inherit a tendency of the bronchial tubes (which carry air to the lungs) to overreact often develop asthma.
• A history of allergy. If you have an allergy, you are more likely than others to develop asthma. Most children and many adults with asthma have atopic dermatitis, allergic rhinitis, or both. Studies show that 40 to 50 out of 100 children with atopic dermatitis develop asthma. Having atopic dermatitis as a child may also increase your risk of having more severe and persistent asthma as an adult than someone who did not have atopic dermatitis.⁷
• Rhinitis. Adults who have inflamed nasal passages (rhinitis) have a higher-than-average risk for asthma.

Asthma risk factors that you can control

You may be able to change some factors to reduce your or your teen's risk for asthma. These include:

• Cigarette smoking. People who smoke are more likely to get asthma. If you already have asthma and you smoke, it may make your symptoms worse.
• Cigarette smoking during pregnancy. Women who smoke during pregnancy increase the risk of wheezing in their babies. Babies whose mothers smoked during pregnancy also have worse lung function than those whose mothers did not smoke.
• Workplace exposure to irritants.Occupational asthma may develop after exposure to a specific inhaled irritant or allergen in the workplace. Such substances also can make symptoms worse in people with existing asthma.
• Dust mites. Exposure to dust mites is another thing that puts people at risk for asthma.⁸
• Cockroaches. In one study, children who had high levels of cockroach droppings in their homes were 4 times more likely to have a new diagnosis of asthma than children whose homes had low levels.⁸
• Obesity. Studies have found that obese children may be more likely to have asthma. But the reason for this is unclear. Experts don't know whether one condition contributes to the other or whether some unknown mechanism contributes to both.⁹ Some people who are obese and who lose weight may have fewer asthma symptoms. And sometimes symptoms caused by obesity are thought to be asthma symptoms.

No one is sure if breast-feeding affects a child's risk of getting asthma. Some studies show that breast-feeding protects a child from getting asthma.^{10, 11} Other studies show that breast-feeding, especially when mothers with asthma breast-feed, may actually raise a child's risk of getting asthma.¹² A large study following children until 14 years of age found that breast-feeding had no effect on the development of asthma.¹³ Mothers are encouraged to breast-feed their children for all the other proven health benefits that come from breast-feeding.

Experts are also not sure about the effect that pets in the home have on getting asthma. Some research shows that having cats or dogs in the home raises an adult's risk of getting asthma.¹⁴ But other research has seemed to show that being around pets early in life might actually protect a child against getting asthma.¹⁵ If your child already has asthma and allergies to pets, having a pet in the home will make his or her asthma worse.

Risk factors that may make asthma worse (triggers)

Triggers that may make asthma worse and may lead to asthma attacks include:

• Infections, such as severe upper respiratory infections (URIs), sinusitis, and influenza (flu). URIs cause more than half of the asthma attacks in adults.^{16, 17}
• Allergens, such as dust mites, mold, or pet dander, in people allergic to them.⁸

When to Call a Doctor

Call 911 or other emergency services immediately if:

• You are having severe trouble breathing.

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 (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 PEF 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 for an evaluation.

If your teenager has symptoms of asthma, it is important to see a doctor. A large portion of teens with frequent wheezing may have asthma but are not diagnosed with the disease. Teens who have asthma but are less likely to be diagnosed are most often:¹⁸

• Girls.
• Smokers, or teens who are exposed to household cigarette smoke.
• Those with low socioeconomic status.
• Those who have allergies.
• African Americans, Native Americans, or Mexican Americans.

Watchful waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting may be appropriate if you follow your asthma action plan and stay within the green zone. Watch your symptoms and continue to avoid your asthma triggers.

If you have been getting treatment for 1 to 3 months but are not improving, ask your doctor whether you need to see an asthma specialist.

Who to see

Doctors who can diagnose and treat asthma include:

• Pediatricians.
• Family medicine physicians.
• Nurse practitioners.
• Physician assistants.
• Internists.

You may need to see a specialist (allergist or pulmonologist) if you have:

• Severe persistent asthma.
• Other medical conditions that make it hard to treat asthma.
• A need for additional education or have difficulty following your asthma action plan.
• Not met the goals of treatment after several months of therapy.
• Had a life-threatening asthma attack.
• Skin testing for allergies or you get allergy shots.
• Occupational asthma.

Exams and Tests

A diagnosis of asthma is based on your medical history, a physical exam, and lung function tests. If you developed asthma in adulthood, your doctor will ask about your job to figure out whether you have occupational asthma.

Lung function tests can diagnose asthma, determine its severity, and check for complications.

• Spirometry is the most common test used to diagnose asthma. It measures how quickly you can move air in and out of your lungs and how much air is moved. The test helps your doctor decide whether airflow is decreased because of inflammation in the bronchial tubes and whether the tubes can return to their usual size in a short time after using medicine. Doctors also recommend the test at least every 1 to 2 years after asthma treatment has begun.
• Testing of daytime changes in peak expiratory flow (PEF) is done over 1 to 2 weeks. This test is needed when you have symptoms off and on but have normal spirometry test results.
• An exercise or inhalation challenge may be used if the spirometry test results have been normal or near normal but asthma is still suspected. These tests measure how quickly you can breathe in and out after exercise or after using a medicine. An inhalation challenge also may be done using a specific irritant or allergen if your doctor suspects occupational asthma.

Regular checkups

You need to monitor your condition and have regular checkups to keep asthma under control and to review and possibly update your asthma action plan. Checkups are recommended every 1 to 6 months, depending on how well your asthma is controlled.

During checkups, your doctor will ask whether your symptoms and peak expiratory flow have held steady, improved, or become worse and will ask about asthma attacks during exercise or at night. You track this information in an asthma diary. You may be asked to bring your peak expiratory flow meter to an appointment so your doctor can see how you use it. Based on the results, your asthma category may change, and your doctor may change the medicines you use or how much medicine you use.

Tests for other diseases

Asthma sometimes is hard to diagnose, because symptoms vary widely from person to person and within each person over time. Symptoms may be the same as those of other conditions, such as influenza or other viral respiratory infections or vocal cord dysfunction. Tests done to determine whether diseases other than asthma are causing your symptoms include the following:

• Additional lung function tests may be needed if other lung diseases, such as chronic obstructive pulmonary disease (COPD), are suspected.
• An electrocardiogram (EKG, ECG) measures the electrical signals that control the rhythm of your heartbeat. This test might be done to rule out serious conditions with similar symptoms, such as chronic heart failure.
• A bronchoscopy test involves using a flexible scope called a bronchoscope to examine the airways. Sometimes airway problems such as tumors or foreign bodies will create symptoms that mimic those of asthma. The test might be done if you have unequal wheezing in the lungs or a poor response to asthma therapy. Biopsies of the airways can be done to look for changes that point to asthma.
• A chest X-ray may be used to see whether other lung diseases, such as fibrous tissue caused by chronic inflammation (pulmonary fibrosis), are causing symptoms.
• Blood tests may be done. For example, a complete blood count (CBC) may be done to look for signs of an infection or other condition.

Tests to identify triggers

If you have persistent asthma and take medicine every day, your doctor may ask about your exposure to substances (allergens) that cause an allergic reaction. For more information about the following tests, see the topic Allergic Rhinitis.

Allergy tests include:

• Skin tests. The skin on the back or arms is pricked with one or more small doses of allergens that might cause an allergy. The amount of swelling and redness at the sites of the skin pricks is measured to see which allergens cause a reaction. Skin tests are quick, simple, and relatively safe. Skin tests are needed if you are interested in allergy shots (immunotherapy).
• Enzyme-linked immunosorbent assay (ELISA). A blood sample is taken from a vein and tested for immunoglobulin E (IgE) antibodies, which are produced in response to particular allergens.

Other tests may be done to see whether other conditions such as sinusitis, nasal polyps, or gastroesophageal reflux disease (GERD) are present.

Treatment Overview

Although asthma cannot be cured, you can manage the symptoms with medicines, especially inhaled corticosteroids and beta2-agonists. You will probably work with your doctor to develop an asthma action plan. This plan will help you meet treatment goals and get your asthma under control. The goals of asthma treatment are to:¹⁹

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

For more information, see:

Asthma: Taking Charge of Your Asthma.

Emergency treatment

If you have a severe asthma attack (the red zone of your asthma action plan), use medicine based on your action plan and talk with a doctor immediately about what to do next. This is especially important if your peak expiratory flow (PEF) does not return to the green zone or stays within the yellow zone after you take medicine. You may have to go to the hospital or an emergency room for treatment. Be sure to tell the emergency staff if you are pregnant.

At the hospital, you will probably receive inhaled beta2-agonists and corticosteroids. You may be given oxygen therapy. Your lung function and condition will be assessed. Depending on your response, further treatment in the emergency room or a stay in the hospital may be needed.

Some people are at increased risk of death from asthma, such as people who have been admitted to an intensive care unit for asthma or who have needed a breathing tube (intubation) for asthma. These people need to seek medical care early when they have symptoms.

Medical checkups

You need to monitor your asthma and have regular checkups to keep it under control and to ensure correct treatment. Checkups are recommended every 1 to 6 months, depending on how well your asthma is controlled.

During checkups, your doctor will ask whether your symptoms and peak expiratory flow have held steady, improved, or become worse and will ask about asthma attacks during exercise or at night. You track this information in an asthma diary. You may be asked to bring your inhaler and peak expiratory flow meter to an appointment so your doctor can see how you use them.

Initial treatment

There are many components to managing asthma. After your diagnosis, your doctor may only discuss what you need to know immediately. These include:

• Oral or injected corticosteroids (systemic corticosteroids). These medicines may be used to get your asthma under control before you start taking daily medicine. In the future, you also may take oral or injected corticosteroids to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and methylprednisolone.
• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce the inflammation of your airways, and you take them every day to keep asthma under control and to prevent asthma attacks. Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
• Short-acting beta2-agonists. These medicines are used for asthma attacks. They relax the airways, which allows you to breathe easier. Short-acting beta2-agonists include albuterol and pirbuterol.
• A combination of an inhaled corticosteroid and long-acting beta2-agonist. This combination is often used to treat persistent asthma.
• Basic education about asthma. The more you know about asthma, the more likely it is you will control symptoms and reduce the risk of asthma attacks. Keep in mind that even severe asthma can be controlled. And cases where the condition cannot be controlled are unusual.
• Instruction on how to use a metered-dose inhaler (MDI) or dry powder inhaler (DPI). Inhalers deliver medicine directly to the lungs. If you use your inhaler correctly, you can control your symptoms and avoid asthma attacks that can send you to the emergency room. Most doctors recommend using a spacer with an MDI. For more information, see:

  Asthma: Using a Metered-Dose Inhaler.

  Asthma: Using a Dry Powder Inhaler.

Your short-term goal is to control your current symptoms. Long-term, your goal is to prevent symptoms so that asthma does not impact your daily activities.

Special considerations in treating asthma include:

• Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may get better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medicines that can make asthma symptoms worse.
• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before you exercise.
• Managing asthma before surgery. People who have moderate to severe asthma are at higher risk of having problems during and after surgery than people who do not have asthma.
• Managing asthma symptoms at night. Sometimes allergens that get in the airway can cause problems up to 8 hours later. This is called a late allergic response (LAR). Or your controller medicine may wear off during sleep, causing you to wake up. Your doctor may be able to change the dose or timing of medicine to make sure it lasts through the night.

Ongoing treatment

After your initial treatment for asthma, it is important to learn more about the condition and develop an overall plan to manage the disease. You and your doctor will work together to do this. Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, no one management plan is effective for everyone.

Asthma management consists of:

• An asthma action plan. An asthma action plan tells you which medicines to take every day and how to treat asthma attacks. It also may include an asthma diary where you record your peak expiratory flow (PEF), symptoms, and triggers. This helps you identify triggers that can be changed or avoided, be aware of your symptoms, and know how to make quick decisions about medicine and treatment. See an example of an asthma action plan(What is a PDF document?). For more information, see:

  Asthma: Using an Asthma Action Plan.

• Monitoring peak expiratory flow. It is easy to underestimate the severity of your symptoms. You may not notice them until your lungs are functioning at 50% of your personal best peak expiratory flow (PEF). Measuring PEF is a way to keep track of asthma symptoms at home. It can help you know when your lung function is becoming worse before it drops to a dangerously low level. You can do this with a peak flow meter. For more information, see:

  Asthma: Measuring Peak Flow.

• A plan to deal with factors that can make asthma worse (triggers). Being around triggers increases symptoms. Try to avoid situations that expose you to irritants (such as smoke or air pollution) or to substances (such as animal dander) to which you may be allergic. If substances at work are causing your asthma or making it worse (occupational asthma), you may have to change jobs. See information on:

  Asthma: Identifying Your Triggers.

• A plan to treat other health problems. If you also have other health problems, such as inflammation and infection of the sinuses (sinusitis) or gastroesophageal reflux disease (GERD), you will need treatment for those conditions.

• Using your prescribed medicines correctly. Your doctor may adjust your medicines depending on how well your asthma is controlled. Medicines include:
  • Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
  • Long-acting beta2-agonists (such as salmeterol and formoterol), which are used along with inhaled corticosteroids.
  • Oral or injected corticosteroids (systemic corticosteroids) to treat any sudden and severe symptoms (asthma attacks), such as shortness of breath. Oral corticosteroids are used more than injected corticosteroids. Oral corticosteroids include prednisone and methylprednisolone.
  • Quick-relief medicine, such as short-acting beta2-agonists and anticholinergics (ipratropium) for asthma attacks. If you are using quick-relief medicine on more than 2 days a week (except for exercise), you probably need to add or change controller medicine treatment. Overuse of quick-relief medicine can be harmful.
  • Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Education. Continue to learn about asthma. This questionnaire can help you find out what you already know about asthma and what you may need to discuss with your doctor.

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful. For more information, see:

Allergies: Should I Take Allergy Shots?

You can expect to live a normal life if you control symptoms by following your asthma action plan. Control of your asthma symptoms can help keep your lungs as healthy as possible.

Special considerations in treating asthma include:

• Managing asthma during pregnancy. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Managing asthma in older adults. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or be taking other medicines that can make asthma symptoms worse.
• Managing exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before you exercise.
• Managing asthma before surgery. People who have moderate to severe asthma are at higher risk of having problems during and after surgery than people who do not have asthma.

Treatment if the condition gets worse

If your asthma is not improving, make an appointment with your doctor to:

• Review your asthma diary to see if you have a new or previously unidentified trigger, such as animal dander. Talk to your doctor about how best to avoid triggers.
• Review your medicines, to be sure you are using the right ones and are using them correctly.
• Review your asthma action plan, to be sure it is still suitable for your condition.
• Determine whether you have a condition with symptoms similar to asthma, such as sinusitis.
• Make sure you are using your inhaler correctly.

If your medicine is not working to control airway inflammation, your doctor will first check to see whether you are using the inhaler correctly. If you are using it correctly, your doctor may increase the dosage, switch to another medicine, or add a medicine to the existing treatment.

Your doctor may suggest other medicines, such as leukotriene pathway modifiers (zafirlukast, zileuton, or montelukast). Less commonly, your doctor may recommend mast cell stabilizers (cromolyn) or theophylline.

If your asthma does not improve, you may require more intensive treatment, including larger doses of corticosteroids or other medicine. An asthma specialist typically prescribes these medicines. For severe asthma that cannot be controlled with medicines, a newer treatment called bronchial thermoplasty may be used. For this therapy, heat is applied to the airways to reduce the thickness of the airways and improve the ability to breathe.^{20, 21}

If you have persistent asthma and react to allergens, you may need to have skin testing for allergies. Allergy shots (immunotherapy) may be helpful.

What to think about

If you have been diagnosed with asthma, it is important that you treat it. You may feel good most of the time—so much so that you find it hard to believe you have a long-lasting condition. But all asthma—even mild asthma—may result in changes to your airways that speed up and make worse the natural decrease in lung function that occurs as we age.³

Prevention

Although there is no certain way to prevent asthma, you can take steps to reduce airway inflammation and the likelihood of asthma attacks.

Preventing asthma attacks

The main focus of prevention is to reduce the number, length, and severity of asthma attacks. By avoiding triggers, you may be able to prevent or reduce the severity of symptoms. For more information on identifying your triggers, see:

Asthma: Identifying Your Triggers.

If you can predict or often have asthma attacks when you exercise, use your inhaler 10 minutes before you start the activity so you can avoid an attack.

The following is information about specific triggers. If you know that any of these cause your symptoms to become worse, you should avoid or limit your exposure to them.

Irritants in the air

Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma attacks in some people.

Controlling tobacco smoke is important because it is a major cause of asthma symptoms in children and adults. If you have asthma, try to avoid being around others who are smoking, and ask people not to smoke in your house.

• Pregnant women who smoke cigarettes during pregnancy increase the risk of wheezing in their newborn babies.
• Exposing young children to secondhand tobacco smoke increases the likelihood that they will develop asthma and increases the severity of symptoms if they already have the disease.

Some household cleaning products cause asthma symptoms or make them worse. If a cleaning product seems to trigger your asthma, stop using it or use another product that does not cause symptoms.

Consider staying inside when air pollution levels are high. Other irritants in the air (such as fumes from gas, oil, or kerosene or wood-burning stoves) can sometimes irritate the bronchial tubes, which carry air to the lungs. Avoiding these may decrease your asthma symptoms.

Allergens

If you are allergic to certain substances (allergens), you may decrease your asthma symptoms by limiting exposure to these substances.

To help reduce your exposure to allergens:

• Control cockroaches, especially if you live in an area where cockroaches are common.
• Control dust mites. House dust mites have been linked with the development of asthma in children.¹
• Control animal dander and pet allergens. If you know your pet is a trigger, you may need to think about giving it away. If that is too hard, taking steps such as keeping your pet out of your bedroom and dusting and vacuuming often may help your asthma.
• Control indoor mold, especially if you live in an area with high humidity.

You may also need to avoid exposure to other types of triggers that cause asthma symptoms.

• Get a flu vaccine every year. Have your family members get one too.
• Get the pneumococcal vaccine. The vaccine may not prevent pneumonia, but it can prevent some of the serious complications of pneumonia.
• Control your exposure to pollens in the air if you are allergic to them. Check your local weather report or newspaper for pollen counts in your area.
• Avoid exercising outdoors in cold weather. The air may irritate your airways. If you are outdoors in cold weather, wear a scarf around your face and breathe through your nose.
• Avoid foods that may cause asthma symptoms. Some people have symptoms after eating processed potatoes, shrimp, nuts, and dried fruit, or after drinking beer or wine. These foods and liquids contain sulfites, which may cause asthma symptoms.
• Avoid taking aspirin, ibuprofen, or other similar medicines if they increase asthma symptoms. Consider using acetaminophen (Tylenol) instead. (Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome.)

Living With Asthma

You can control the impact asthma has on your life by following your asthma action plan consistently. A management plan can help you reduce inflammation to decrease the severity, frequency, and duration of asthma attacks. Following your action plan may be hard because of the many different factors involved.

To help yourself remain consistent in following your asthma action plan:

• Educate yourself about asthma. By doing so, you can learn to control symptoms and reduce the risk of asthma attacks. This questionnaire can help you find out what you already know about asthma and what you may need to discuss with your doctor.
• Understand your barriers and the solutions to overcome them. What may prevent you from following your plans? These may be physical barriers, such as living far from your doctor or pharmacy, or emotional barriers, such as having undiscussed fears about the condition or unrealistic expectations. Discuss your barriers with your doctor, and work to find solutions.
• Develop goals that relate to your quality of life. Being able to measure your success gives you greater motivation to follow asthma plans consistently. Decide what you want to be able to do. Have nights free of symptoms? Be able to exercise on a regular basis? Feel secure in knowing you can deal with an asthma attack? Work with your doctor to see if your goals are realistic and how to meet them.

Your asthma action plan generally consists of the following:

• Seeing your doctor regularly to monitor your asthma. The frequency of checkups depends on how well your asthma is controlled. Checkups are recommended every 1 to 6 months. Bring your asthma plan to appointments.
• Following your asthma action plan. The plan describes which medicines to take every day to help delay the long-term effects of asthma. The action plan also contains the steps to treat asthma attacks. It helps you better control your asthma attacks by keeping you aware of symptoms and of how to make quick decisions about medicine and treatment. See an example of an asthma action plan(What is a PDF document?). You may also have an asthma diary where you record your peak expiratory flow, symptoms, and triggers of asthma attacks. This tool can help you manage your asthma too.

For more information on how to monitor and treat asthma, see:

Asthma: Taking Charge of Your Asthma.

Asthma: Using an Asthma Action Plan.

To effectively manage your asthma and use your asthma action plan, you will have to know how to monitor your peak airflow, identify asthma triggers, and take your asthma medicine correctly.

Monitoring peak expiratory flow

People often underestimate the severity of their symptoms. They may not notice symptoms until their lungs are functioning at 50% of their personal best measurement. Measuring peak expiratory flow (PEF) is a way to keep track of asthma symptoms at home. Doing this can help you know when your lung function is becoming worse before it drops to a dangerously low level. You can do this with a peak flow meter. For more information, see:

Asthma: Measuring Peak Flow.

Identifying asthma triggers

A trigger is anything that can lead to an asthma attack. A trigger can be:

• Irritants in the air, such as tobacco smoke or air pollution.
• Substances to which you are allergic (allergens), such as pollen or animal dander.
• Other factors, such as a viral infection, exercise, stress, or dry, cold air.

Avoiding triggers will help decrease the chance of having an asthma attack and, in the case of allergens, will help control inflammation in the bronchial tubes, which carry air to the lungs. For more information, see:

Asthma: Identifying Your Triggers.

If you have asthma triggered by an allergen, taking antihistamine medicine may help you manage the allergy and thus limit its effect on your asthma.

Taking your asthma medicine

Taking medicines is an important part of asthma treatment. But because you may need to take more than one medicine, it can be hard to remember to take them. To help yourself remember, understand the reasons people don't take their asthma medicines, and then find ways to overcome those obstacles, such as taping a note to your refrigerator.

Most medicines for asthma are inhaled. Inhaled medicines give a specific dose of the medicine directly to the bronchial tubes, avoiding or decreasing the effects of the medicine on the rest of the body. Delivery systems for inhaled medicines include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Sometimes doctors recommend the use of a spacer with a metered-dose inhaler (MDI). The spacer is attached to the MDI. A spacer may deliver the medicine to your lungs better than an inhaler alone, and for many people it is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and the need for oral corticosteroids.

It is important to keep track of the inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medicine, but it also prevents you from inhaling only propellant after the medicine has run out. Some metered-dose inhalers and dry powder inhalers have counters that let you know how much medicine is left. For more information, see:

Asthma: Using a Metered-Dose Inhaler.

Asthma: Using a Dry Powder Inhaler.

Travel

Most people with asthma can travel freely. But if you travel to remote areas and participate in intensive physical activity, such as long hikes, you may be at increased risk for an asthma attack in an area where emergency help may be difficult to find.

When traveling, always bring your medicine with you, carry the prescription for it, and use it as prescribed. Also carry your asthma action plan so you know what medicines to take every day and what to do if you have an asthma attack.

Give teens extra attention

Teens who have asthma may view the disease as cutting into their independence and setting them apart from their peers. Parents and other adults should offer support and encouragement to help teens stick with a treatment program. It's important to:

• Help your teen remember that asthma is only one part of life.
• Allow your teen to meet with the doctor alone. This will encourage your teen to become involved in his or her care.
• Work out a daily management plan that allows a teen to continue daily activities, especially sports. Exercise is important for maintaining strong lungs and overall health.
• Talk to your teen about the dangers of smoking and drug use.
• Encourage your teen to meet others who have asthma so they can support each other.

Medications

Medicine does not cure asthma. But it is an important part of managing the condition. Medicines for asthma treatment are used to:

• Prevent and control airway inflammation, to minimize asthma symptoms.
• Decrease the severity, frequency, and duration of asthma attacks.
• Treat the attacks as they occur.

Asthma medicines are divided into two groups: those for prevention and long-term control of inflammation and those that provide quick relief for asthma attacks. Most people with persistent asthma need to use long-term medicines daily. Quick-relief medicines are used as needed and provide rapid relief of symptoms during asthma attacks.

Because asthma develops from a complex interaction of genetics, environmental factors, and the reaction of the immune system, different people may use different medicines and doses of medicines. Special consideration may be needed if you:

• Are pregnant. If a woman had asthma before becoming pregnant, her symptoms may become better or worse during pregnancy. Pregnant women whose asthma is not well controlled may be at risk for a number of complications.
• Are an older adult. Older adults tend to have worse asthma symptoms and a higher risk of death from asthma than younger people. They may also have one or more other health conditions or take other medicines that can make asthma symptoms worse.
• Have exercise-induced asthma. Exercise often causes asthma symptoms. Steps you can take to reduce the risk of this include using medicine immediately before you exercise.
• Need surgery. People with moderate to severe asthma are at higher risk than people who do not have asthma of developing problems during and after surgery.

Medicine delivery

Most medicines for asthma are inhaled. Inhaled medicines are used because a specific dose of the medicine can be given directly to the bronchial tubes. Different types of delivery systems may be used to do this, and one type may be more suitable for certain people or age groups than another. Delivery systems include metered-dose and dry powder inhalers and nebulizers. A metered-dose inhaler is used most often.

Sometimes doctors recommend the use of a spacer with a metered-dose inhaler (MDI). The spacer is attached to the MDI. A spacer may deliver the medicine to your lungs better than an inhaler alone. And for many people it is easier to use than an MDI alone. Using a spacer with inhaled corticosteroids can help reduce their side effects and the need for oral corticosteroids.

It is important to keep track of the inhaler doses and discard the inhaler when you have used the number of doses specified on the package labeling. This not only prevents you from having an empty inhaler when you need medicine, but it also prevents you from inhaling only propellant after the medicine has run out. Some metered-dose inhalers and dry powder inhalers have counters that let you know how much medicine is left. For more information, see:

Asthma: Using a Metered-Dose Inhaler.

Asthma: Using a Dry Powder Inhaler.

Medication choices

The most important asthma medicines are:

• Inhaled corticosteroids. These are the preferred medicines for long-term treatment of asthma. They reduce inflammation of your airways and are taken every day to keep asthma under control and to prevent sudden and severe symptoms (asthma attacks). Inhaled corticosteroids include mometasone, triamcinolone, fluticasone, budesonide, and ciclesonide.
• Oral or injected corticosteroids (systemic corticosteroids) to get your asthma under control before you start taking daily medicine. You may also need these medicines to treat asthma attacks. Oral corticosteroids are used much more than injected corticosteroids. Oral corticosteroids include prednisone and methylprednisolone.
• Short-acting beta2-agonists for asthma attacks. They relax the airways, allowing you to breathe easier. These medicines include albuterol and pirbuterol.

Other long-term medicines for daily treatment include:

• Leukotriene pathway modifiers (such as zafirlukast, zileuton, or montelukast).
• Long-acting beta2-agonists (such as salmeterol and formoterol). These medicines are combined with inhaled corticosteroids as a single medicine.
• Less commonly, your doctor may recommend mast cell stabilizers (such as cromolyn) or theophylline.

Other medicines may be given in some cases.

• Anticholinergics (such as ipratropium) are usually used for severe asthma attacks.
• Other medicine such as omalizumab may be used if asthma does not improve with treatment. An asthma specialist typically prescribes this medicine.

Medicine treatment for asthma depends on a person's age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• The least amount of medicine that controls the asthma symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose of medicine, 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 or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your doctor will work with you to help find the number and dose of medicines that work best.

What to think about

At the start of asthma treatment, the number and dosage of medicines are chosen to get the asthma under control. Your doctor may start you at a higher dose within your asthma classification so that the inflammation is immediately controlled. 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. Step-down care is believed to be a better way to control inflammation in the bronchial tubes than starting at lower doses of medicine and increasing the dose if it is not enough.²²

Because quick-relief medicine quickly reduces symptoms, people sometimes overuse these medicines instead of using the slower-acting long-term medicines. But overuse of quick-relief medicines may have harmful effects, such as reducing the future effectiveness of these medicines.²³ Overuse of quick-relief medicine is also an sign that asthma symptoms are not being controlled. Be sure to talk with your doctor immediately.

You may have to take more than one medicine daily to manage your asthma. It can be hard to remember when to take your medicine and which medicine to take. To help yourself remember, understand the reasons people don't take their asthma medicines, and then find ways to overcome those obstacles, such as taping a note to your refrigerator to remind yourself.

Using the fewest medicines possible is important for older people, because they may be taking medicines for other conditions. Tell your doctor about all the medicines you are taking, so he or she can select asthma medicines that won't interfere with other medicines.

Some people only have symptoms during certain times of the year (seasonal asthma). If you know when you will most likely have symptoms, start using a medicine to decrease inflammation before the symptoms start.

Other Treatment

A new treatment called bronchial thermoplasty is available for adults with severe asthma. For this therapy, bronchoscopy is used to apply heat to the airways. This reduces the thickness of the airways and improves the ability to breathe.^{20, 21}

Allergy shots (immunotherapy) may be recommended for people who have asthma symptoms when they are around substances to which they are allergic (allergens). In some people, allergy shots have been shown to reduce asthma symptoms and the need for medicines.²⁴ But allergy shots are not equally effective for all allergens. Allergy shots should not be given when asthma is poorly controlled. For more information, see:

Allergies: Should I Take Allergy Shots?

Allergy shots contain small doses of one or more substances to which you are allergic so that your body can become less responsive to them over time.

Complementary medicine

Alternative treatments such as homeopathy, acupuncture, and breathing exercises have been used to treat asthma. The research on these treatments is limited. Reviews of research show:^{25, 26}

• No evidence to support using homeopathy, air ionizers, manual therapy, or acupuncture for asthma.
• A possible but not clearly established role for using antioxidants.
• Breathing exercises practiced in yoga may improve lung function.

Some people have used ephedra—a stimulant sold for weight loss and sports performance—to try to treat asthma symptoms. But the U.S. Food and Drug Administration (FDA) has banned the sale of this dietary supplement because of concerns about safety. Ephedra, also called ma huang, has been linked to heart attacks, strokes, and some deaths.

A review of complementary and alternative treatments for treating asthma in children concluded that none have been proved to reduce asthma symptoms and some may have harmful side effects.²⁷ Some of these studies included teenagers and adults. The therapies reviewed include:

• Herbal products such as ivy leaf, butterbur, and Tylophora indica (T. indica).
• Dietary supplements such as fatty acids and probiotics.
• Homeopathy.
• Procedures such as acupuncture, massage therapy, chiropractic, osteopathy, hypnosis, and biofeedback.

Talk to your doctor before trying a complementary or alternative treatment.

For more information on alternative treatments, see the topic Complementary Medicine.