Mild Asthma

Asthma is a long-term lung condition that causes swelling and narrowing of the tubes responsible for bringing air in and out of your lungs. Both inflammation and the contracting of muscles surrounding your airways make it difficult to breathe during an asthma attack. Without proper airflow to your lungs, the cells in your body will not receive needed oxygen. Asthma looks different from person to person and can range from a mild annoyance to dangerous and life-altering.  

If you suspect you have asthma or are recently diagnosed, you are not alone. There are 25.7 million Americans who have been told by a doctor they have asthma. Children, women, and those living below the poverty level have an increased risk of receiving a diagnosis.1This may be partly due to lower quality housing with more exposure to common triggers like chemicals, mold, and pollutants. 

Asthma comes in three main varieties (allergic, non-allergic, and exercise-induced) and four classifications which range from mild to severe. If you receive an asthma diagnosis, your doctor will tell you the type and category of your asthma. Knowing the kind you have will help determine your treatment plan. Regardless of whether you have allergic, non-allergic, or exercise-induced, most cases fall into the mild category. Although an asthma diagnosis can leave you uncertain about your health, most who have it live symptom-free with treatment. 

Asthma symptoms vary. You may have only a few of the listed symptoms or all of them. You can also experience them multiple times per day or just once per week, depending on the severity of your asthma. 

Asthma symptoms include:  

• Shortness of breath 

• Chest tightness 

• Wheezing upon exhalation 

• Coughing 

• Coughing or wheezing that's exasperated by respiratory infections 

• Mucous in the airways 

• Disrupted sleep due to breathing difficulties 

There are four classifications of asthma categorized by severity and frequency of symptoms.i The mildest classification is the most common form of asthma.  

Mild Intermittent 

Mild intermittent asthma is the least severe type but still requires treatment. If you have mild intermittent asthma, you will have asthma attacks no more than two days per week, and your sleep will be disrupted by symptoms no more than twice per month.  

Mild Persistent 

Mild persistent asthma means you have symptoms more than twice per week and experience asthma-related sleep disturbances three to four nights per month.  

Moderate Persistent 

If you have moderate persistent asthma, you will live with daily asthma symptoms and are woken up by asthma symptoms one or more nights per week.  

Severe Persistent 

Severe persistent asthma is the most severe category. If you have severe persistent asthma, you have symptoms every day and are woken up every night due to your asthma.  

Most asthma cases are either an allergic response or induced by exercise. If your asthma is not caused by one of those two, you have non-allergic asthma. It is essential to understand the type of asthma you have so your doctor can develop an individualized treatment plan specific to you. Managing your asthma starts with understanding its source.  

Exercise-Induced Asthma 

If strenuous physical activity triggers your asthma, you have exercise-induced asthma, also known as exercise-induced bronchoconstriction. Symptoms start during or soon after exercise and can worsen with exposure to specific triggers. Each patient can have individual triggers, but dry air and pollution often exacerbate exercise-induced asthma.ii 

Because dry air can aggravate symptoms of exercise-induced asthma, many with this condition swim as their physical activity. The moist air at swimming pools reduces the severity of symptoms in some patients. Additionally, it may be easier to tolerate sports with periods of inactivity versus sustained periods of strenuous effort. Sports like golf, baseball, short distance track, skateboarding, or gymnastics are less likely to activate asthma attacks.  

In addition to choosing sports more conducive to your condition, you can use your asthma medications before exercising and take breaks when you feel your asthma ramping up. Avoid demanding activities on high pollution days or dryer months. With medicines and minor modifications, people with exercise-induced bronchoconstriction are able to remain active and fit.  

Allergic Asthma 

If you have allergic asthma, your airways swell and tighten when exposed to an allergen. In addition to the muscles surrounding your airways constricting, your airways begin to produce mucous and become inflamed. Because your airways are responsible for transporting air to and from your lungs, it becomes difficult to breathe. Common allergens may result in sneezing and itchy eyes in one person while triggering an asthma attack in another. Why some people respond to pollen with asthma symptoms and others do not is unknown.  

In nearly 90 percent of children and 50 percent of adults with asthma, it is diagnosed as allergic asthma, making it the most common type.iii Anything that initiates hay fever and other allergic symptoms can cause allergic asthma. With allergic asthma, the physiological response to an allergen involves the airways instead of the standard runny nose and itchy eyes seen with common allergies.  

Knowing your triggers and avoiding them, if possible, can help reduce asthma symptoms. Common triggers are pollen, mold spores, or animal dander. You may also notice that you react to smoke, pollution, chemical fumes, or perfume. Avoiding triggers is not always possible or even desirable. For this reason, avoidance should not be your default strategy for asthma management. In addition to avoidance, medications that treat allergies can be a crucial part of your asthma action plan. 

Non-Allergic Asthma 

If you have asthma that cannot be classified as allergic or exercise-induced, you have non-allergic asthma. Non-allergic asthma covers all other asthma cases that are not linked to an allergic reaction or elicited by strenuous activity. This type of asthma usually develops later in life.  

Asthma Triggers Versus Asthma Causes 

Not to be confused with asthma causes, asthma triggers are things like pollen or animal dander that can prompt an asthma attack. Cold or dry air, mold, and exercise are also on the list of triggers. However, the cause of asthma is not fully understood, but doctors and scientists can point to certain risk factors.  

Asthma runs in families. If your mom or dad has asthma, you are more likely to get the same diagnosis. There is also evidence that suggests certain viral respiratory infections during infancy increase the risk of an asthma diagnosis later. It is likely asthma is caused by a combination of both genetics and environmental factors.  

Respiratory infections can aggravate asthma and trigger attacks, but some data shows they can actually cause asthma. Respiratory Syncytial Virus (RSV) in early childhood has been linked to an increased risk of receiving an asthma diagnosis. Doctors and scientists have known this for a while, but they have questioned whether RSV directly caused it or just revealed the children already predisposed. Although both scenarios are likely factual, more and more data support a causal relationship between asthma and RSV.

If you suspect you or your child has asthma, the first step is to make an appointment with a healthcare provider. They will start by covering your medical and family history. Your doctor wants to know if any family members have had an asthma diagnosis or if you have had asthma symptoms in the past.  

Depending on your medical history, your doctor may choose to perform specific diagnostic testing. If they move forward, they will perform a physical exam, including images of your lungs. Lung x-rays allow your doctor to rule out non-asthma conditions that could be causing your symptoms, like a lung infection. Your physician may also want to perform allergy testing, which can be done as a skin test, blood draw, or both. Finally, they will likely check the function of your lungs through pulmonary function tests.  

Your doctor may choose more than one lung function test for you to undergo. These noninvasive tests measure lung volume, capacity, and other parameters that tell your doctor how well your lungs work. Some tests are designed to monitor your condition after you have already received a diagnosis. Your doctor will choose the best tools to provide them with the information they need to diagnose and treat you.  

Spirometry 

During the spirometry test, your doctor will ask you to breathe into a mouthpiece that is connected to a device called a spirometer. The spirometer measures the amount of air you can inhale and exhale and the flow rate. Your doctor may have you do the test before and after taking a bronchodilator medication that expands your airways.  

FeNO Test 

The FeNO test measures the amount of nitric oxide you exhale and provides information to your doctor about your lung inflammation status. Doctors often use this test for patients with allergic asthma to see how well inhaled steroid medication is suppressing their inflammation. Your physician can use data from your FeNO test results to assist them in adjusting your medication dosage.  

Peak Flow Meter 

The peak flow meter measures your peak expiratory flow rate, or how well you exhale or push air from your lungs. It is a small, inexpensive plastic device that you can easily use at home to track the degree of your asthma symptoms. There are usually three zones: green, yellow, and red. Green indicates your asthma symptoms are under control, and red signals you need to improve your airflow right away. The peak flow meter may show signs of worsening asthma even before symptoms are present and can be particularly useful in children who are not always good communicators.  

Pulmonary Challenge Tests 

Challenge tests give your doctor information about what triggers your asthma, what type of asthma you have, and how reactive your lungs are. Depending on the information gathered from your exam, your doctor may want to perform an exercise, irritant, or a methacholine challenge test. Each test challenges your lungs in unique ways.  

An exercise challenge test lets your doctor know if exercise triggers your asthma. Depending on your physical capabilities, you will ride a stationary bike or run on a treadmill while your doctor monitors your heart rate and oxygen levels. If you have exercise-induced asthma, you will have a decrease in lung function during the test. You may not be a candidate for this test if you have physical or health limitations that prevent you from strenuous exercise.  

During an irritant challenge test, your doctor exposes you to potential triggers and evaluates how your lungs respond. After each exposure, your doctor performs a breathing test to establish lung reactivity. Decreased lung function after an exposure indicates greater reactivity. Your doctor may challenge your lungs against chemicals, perfumes, smoke, and other common allergens to see which factors cause your asthma.   

A methacholine challenge test helps diagnose asthma by checking how reactive your lungs are. Methacholine is a drug that causes narrowing of the airways. During a methacholine challenge, your doctor will start by giving you a small initial dose, slowly upping the quantity until you have maxed out the dosage or reached a 20 percent decrease in lung function. At the test's completion, you will take a medication to reverse the effects of methacholine. Because this test is contraindicated in patients with certain conditions, your doctor will provide a thorough evaluation to ensure you are a good candidate before starting.  

The goal of treatment is to prevent asthma attacks and reduce symptoms. There are several types of medications doctors may choose to treat your asthma. Long-acting medications are usually taken daily and prevent asthma attacks from occurring. Short-acting drugs, often called rescue medication, are used during an asthma attack and offer immediate relief. If you have allergy-induced asthma, allergy medications may provide adequate symptom reduction. For many who are diagnosed with asthma, lifestyle adjustments will also become an essential component of their treatment plan.  

Long-Acting Asthma Control Medications 

If you take long-acting medications, you will take a consistent and regular daily dose to manage your asthma symptoms. Long-acting control is the ideal treatment for most asthmatics. These medications control asthma attacks before they start so that you can avoid them altogether. Long-acting asthma control allows you to live everyday life without as many interruptions from troublesome asthma symptoms. The ongoing symptom reduction may also ease the anxiety associated with anticipating future asthma attacks.  

Your doctor can prescribe oral or inhaled medications called corticosteroids (cortisone-like) that reduce inflammation in your airways. Inhaled corticosteroids are generally the better choice because they are equally as effective as their oral counterparts but with fewer side effects.v Inhaled corticosteroids may also be combined with a beta-agonist that acts by relaxing the muscles surrounding your airways.  

Short-Acting Asthma Control 

Short-acting asthma inhalers are often referred to as rescue inhalers and are used during acute asthma attacks for quick symptom relief. If you have mild asthma with minimal symptoms, a short-acting inhaler may be sufficient to manage your asthma. The rapid symptom reduction received from fast-acting medications is also helpful during breakthrough attacks that can occasionally occur with patients on daily long-acting medications. If your asthma is triggered by exercise, you can preemptively use a short-acting inhaler before starting physical activity.  

Allergy Medications 

When you have allergic asthma, your airways become reactive when exposed to allergens such as pollen or animal dander. Allergy medications designed to treat asthma reduce your airways' allergic reaction, or reactivity, in response to a trigger. Your doctor can prescribe these drugs to take as needed or as a daily preventative treatment.  

In some instances, your doctor may suggest allergen immunotherapy, also known as allergy shots. For this treatment, you will first go through a procedure to determine your allergic triggers. Once your triggers allergist identifies your triggers, they will expose you to small, controlled doses of the known allergens until your immune system no longer sees them as a threat.  

Lifestyle Adjustments 

Most asthma treatment plans include evaluating lifestyle changes that may improve your symptoms. You should avoid secondhand smoke and quit if you are a smoker. Other general health maintenance like losing weight and getting an annual flu shot may improve your asthma and safeguard against future asthma attacks. Some patients find it worthwhile to keep an asthma journal to help identify their triggers and determine which ones they can easily avoid. Trigger avoidance may or may not be possible depending on what aggravates your asthma.  

Asthma Action Plan 

The best way to prevent asthma from interfering with your life is by working alongside a doctor, taking your medication, and following an asthma action plan. An asthma action plan is a documented worksheet unique to your medical needs. It provides the necessary steps to manage your asthma and reduce symptoms. Your asthma plan may include triggers to avoid, prescribed medications and when to take them, self-monitoring instructions, and when to see a doctor. If the asthma action plan is for your child, you can share it with a daycare provider or school teacher.  

Asthma action plans have a green, yellow, and red zone. In each zone, you will document your peak flow rate, mediations you have taken that day, how much, and if your activities are limited because of your asthma. Ideally, you will remain in the green zone, but if you slip into the yellow or red zone, your asthma action plan will have instructions on how to move forward. Moving into the yellow or red zone often requires you to contact your asthma care provider to determine if you need additional care.  

It can be scary to watch someone you care about having an asthma attack and even more frightening to have one yourself, but you are not alone. Asthma affects millions of Americans, most of whom continue to live normal and active lives once they commence treatment. Mild asthma cases resulting from allergies or exercise are the most common types of asthma and are generally easy to treat. As you learn more about your chronic lung condition, the uncertainty of your diagnosis will diminish. 

Treatment options allow for prevention and, if needed, provide immediate relief from breakthrough asthma symptoms. You may need to change your lifestyle or health habits and adjust medications now and again but remaining free of asthma symptoms is a reality for most asthmatic individuals. Connect with a doctor you trust and be proactive so you can ensure asthma does not disrupt your plans to live life to the fullest. Asthma won't control your life, but you will control your asthma.