When you’re diagnosed with asthma, your doctor will evaluate the severity of your condition — for some people symptoms show up only on occasion in response to very specific triggers; and for other people, asthma symptoms are present much more often. Beyond differences in severity, there are also a variety of types of asthma with differing symptoms and triggers that can lead to discomfort (even though asthma is considered a single condition). Knowing what triggers your asthma is important in helping you identify which type you have, so you can get proper treatment for your asthma. Also, several types of asthma overlap — meaning two or more of the categories detailed here may apply to your condition. Allergens are substances that cause an allergic reaction. They enter the body through inhalation, swallowing, touching, or injection. Allergic asthma occurs because the immune system identifies the allergen as a threat. When someone with allergy-induced asthma comes in contact with a trigger substance, the body responds by releasing antibodies called immunoglobulin E. Immunoglobulin E causes immune system cells to release chemicals that produce inflammation in the lungs. Common allergenic substances include:
CockroachesHousehold dust mitesMoldPet dander (skin flakes), urine, feces, saliva, and hairFungiPollen
A skin or blood test performed by a doctor may determine your specific trigger(s) and whether or not your allergy-induced asthma is seasonal or year-round. RELATED: Everything You Need to Know About Pollen Allergies When airflow is obstructed as a result of exercise, it’s known as exercise-induced bronchoconstriction (EIB), which is a subcategory of asthma. EIB was previously known as exercise-induced asthma; however, exercise-induced asthma incorrectly implies that exercise is the underlying cause of asthma, when it is actually its trigger, not the cause. (4) It’s worth noting that some cases of allergy-induced asthma also fall under the subcategory of EIB because allergens and exercise can trigger symptoms. Exercising in cold, dry air is more likely to cause EIB than exercising in warm, humid air. RELATED: Tips for Exercising Outside in Cold Winter Weather Pollution, pollen, cigarette smoke, and other airborne irritants — as well as the common cold or a recent asthma attack — can also raise your risk of experiencing EIB. Symptoms from EIB can occur within a few minutes after you start exercising. They can also:
Worsen 5 to 10 minutes after you stop exercising and disappear within 20 to 30 minutesReturn as a “second wave” or “late phase” 4 to 12 hours after exercisePersist for up to 24 hours
Those suffering from EIB should not avoid exercise to avoid an asthmatic flare-up. In fact, according to Thomas Chacko, MD, an allergist based in Atlanta, it can worsen your case of asthma to avoid exercise. RELATED: How to Start Working Out and Stick With It “Fat cells, particularly in those who are classified as obese, sit on the lungs and prevent them from growing,” says Dr. Chacko. In addition, “obesity fat cells make the topical medications for asthma less effective, so you have to use more." If you have EIB, it’s important to be familiar with your asthma treatment plan so that you know how to handle symptoms and potential attacks if and when you experience them during exercise. It’s also important to know your limits, so you don’t overexert yourself during exercise in a way that will trigger a flare up of symptoms. (4) And it’s important to know that research does suggest that over time, exercise has been found to reduce asthma symptoms. (4) Though a means to help your body get better, a persistent cough can be extremely irritating. The way to eliminate a cough is by identifying the cause. Unfortunately, those suffering from cough-variant asthma (CVA) experience a dry, nonproductive cough — and symptoms tend to present only with cough. (5) Cough-variant asthma is often misdiagnosed as chronic cough because it has some nontraditional asthmatic symptoms. Symptoms and complications of cough-variant asthma may include:
Persistent coughDifficulty breathing or shortness of breathChest tightnessWheezingAsthma attacksSleep disruptionExhaustionLightheadednessVomiting
Unless adequately treated, 30 to 40 percent of adults with CVA may progress to classic asthma or develop more serious complications. (5) Those suffering from cough-variant asthma may also be at risk for:
Permanent narrowing of the bronchial tubesPneumoniaCollapsed lungLung failureFractured ribAsthma attacks that don’t respond to treatment
Proper management with inhaled corticosteroids are the mainstay of treatments and help ensure cough-variant asthma doesn’t progress to a more severe type of asthma. (5) Occupational factors are associated with up to 15 percent of disabling asthma cases in the United States. An estimated 11 million workers in a wide range of industries are exposed to at least one of the numerous agents known to be associated with occupational asthma. (6) More than 250 manufacturing substances have been known to exacerbate occupational asthma, such as:
PaintsCleaning productsDust from wood, grain, and flourLatex glovesMolds
Once you’re exposed, the length of time before you experience symptoms may vary. Exposure to a high concentration of irritants can cause asthma within 24 hours. In other cases, it can take months to develop. According to the National Institutes of Health, the following workers have a high risk for developing occupational asthma: (7)
BakersDetergent manufacturersDrug manufacturersFarmersGrain elevator workersLaboratory workersMetal workersMillersPlastics workersWoodworkers
Workers have the right to a safe workplace. If you suspect unsafe work conditions and wish to issue a complaint, check out resources (and the On-Site Consultation Program) from the U.S. Department of Labor’s Occupational Safety and Health Administration. (8) Classified as nocturnal asthma, this type involves the same symptoms as other types of asthma, but they are exacerbated during the evening hours: (9)
CoughingWheezingShortness of breath or difficulty breathingInflammation of airway
In a series of surveys of asthmatic patients from different countries, nocturnal asthmatic symptoms were reported in 47 to 75 percent of cases. No matter which type of asthma you have, you may experience difficulties breathing at night. (9) It’s unclear whether or not there is a circadian rhythm factor or an additional aspect of sleep that makes asthmatic symptoms worse. Some triggers that may make asthmatic symptoms worse in the evening include:
Having a cold, flu, or virusDust or other allergensSmokingAcid refluxAnti-inflammatory drugs or pain relievers or beta-blockers
Nocturnal asthma has been shown to negatively affect mental performance in children. A study published in the Archives of Diseases in Children found that children whose sleep was disturbed by nocturnal asthma also exhibited signs of psychological problems and impaired functioning in school. (10) Fortunately, researchers found that mental function improved when asthma symptoms were treated. Treatments for nocturnal asthma are much the same as those for other forms of asthma — inhalers and other medications. It can be helpful for your asthma to control any sleep disturbances you have, such as sleep apnea. Some common triggers in people with nonallergic asthma include: (12)
InfectionsExercise (see EIB section above)StressChanging weather conditions
The treatments for nonallergic asthma are often the same as those for allergic asthma, although the formulations of some inhaled or oral medications may differ. “The symptoms of severe asthma are similar to those of mild asthma, they’re just more frequent and more severe, and require more medications to keep them under control,” says Emily Pennington, MD, a pulmonologist and asthma specialist at the Cleveland Clinic in Ohio. Often, if someone’s symptoms require a combination of asthma medications — such as high-dose inhaled corticosteroids as well as longer-acting drugs — that person’s asthma is termed “severe.” The same term applies to people who don’t respond well to treatment. (13) “We don’t entirely understand why some people don’t respond as well to medication,” Dr. Pennington says. Genetic and underlying “molecular” factors are likely explanations, she says, but the exact causes of severe asthma are complex and likely vary from one person to the next. There’s also an informal term, “uncontrolled asthma,” that refers to people whose asthma symptoms are not well managed. This can happen for a number of reasons: (14)
Other conditions, such as heart disease, that make asthma hard to manageLifestyle choices, such as the decision to smoke cigarettes, that exacerbate asthma symptomsNot following a doctor’s advice or guidelines when taking medications
These people may need a combination of medications, including oral steroids, to manage their symptoms. (13) Additional reporting by Markham Heid.
