You might think you know the signs of asthma because hey, it seems like one of those health conditions that is absolutely unmistakeable. It’s kind of obvious if you just…can’t really breathe, right? Sure, but asthma symptoms can present with a lot more complexity and subtlety than that. “Many people do not realize they have asthma and deal with daily symptoms,” Purvi Parikh, M.D., an allergist and immunologist with Allergy & Asthma Network, tells SELF. Because of that, you should be aware of the signs of asthma so you don’t write them off for months or even years without realizing you have this persistent—and ultimately treatable—health condition.
What is asthma, anyway?
First up, a little anatomy refresher: Your airways, which extend between your nose and mouth and your lungs, have the very important job of carrying air in and out of your body, according to the National Heart, Lung, and Blood Institute (NHLBI). When you have asthma, triggers like animal fur, pollen, mold, cold air, cigarette smoke, exercise, and respiratory infections like colds cause your airways to get inflamed, according to the NHLBI. That inflammation can cause swelling, which in turn can prompt the muscles around your airways to tighten, making it hard to get air in and out. At the same time, your airways might also expel more mucus than they usually do, making it even harder to breathe.
Experts don’t know exactly what causes some people to get asthma when others don’t, but it’s pretty safe to assume that it’s probably a combination of environmental factors and genetic factors. For example, if someone in your immediate family has asthma, you’re more likely to have it too, according to the Centers for Disease Control and Prevention (CDC). Beyond that, the general cause is a stronger-than-normal response from your immune system to certain triggers, which is why you get all that inflammation when people without asthma don’t, says the NHLBI.
Speaking of triggers, everyone has different ones. For some people, asthma flares up in specific situations, according to the Mayo Clinic. For example, it’s possible to have exercise-induced asthma, occupational asthma, and allergy-induced asthma. Exercise-induced asthma is pretty much what it sounds like, and may be worse when the air is dry and cold. Your workplace might trigger occupational asthma if you’re around irritants like chemical fumes, gases, or dust. Allergy-induced asthma happens around airborne substances like pollen, mold spores, cockroach waste, or particles of skin and pet dander. You can learn more about these and the other the different types of asthma here.
So, what are the symptoms you should watch out for?
Which signs of asthma you might experience differs from person to person and some are more common than others, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, tells SELF. It’s possible that you’ll have such a mild reaction to one of your personal asthma triggers that you don’t take much note of it. But if the effects get worse, they can turn into an asthma attack, which is a potentially life-threatening exacerbation of asthma symptoms. That’s why it’s so important to know the common signs of asthma, including the more subtle ones.
These are classic asthma signs you should know:
Shortness of breath: This is an obvious complication that happens when you can’t get enough oxygen due to the way your airways and their surrounding muscles are reacting to asthma triggers, Sadia Benzaquen, M.D., a pulmonologist and associate professor in the department of internal medicine at the University of Cincinnati College of Medicine, tells SELF.
: When an irritant gets into your throat or airways, it stimulates nerves that prompt your brain to make the muscles in your chest and abdomen expel air from your lungs with a cough, according to the Mayo Clinic. Since a sensitivity to irritants can cause asthma symptoms, coughing is a hallmark sign of this condition, says Dr. Benzaquen. In fact, it’s the most common sign of asthma Dr. Parikh has seen people ignore.
: When your airways narrow, you don’t have as much space through which to breathe. As a result, you can experience wheezing, which may sound similar to the whistling sound you might hear if you were to breathe through a straw, Dr. Parikh says.
Chest tightness: When you have asthma, it’s tough to get air in—but it’s also tough to get air out, Dr. Casciari says. “If you take a really deep breath and then try to take another one on top of it, your chest feels tight. That’s what it can feel like when you have asthma, because air gets trapped in there,” he says.
Some people may have these less common signs of asthma:
: Okay, so we did cover that coughing can be one of many common signs of asthma—but a persistent cough might also be the only sign of asthma you have. That’s because there’s this entire type of asthma called cough-variant asthma, according to the American College of Allergy, Asthma, and Immunology. If you have it, you can cough in response to triggers like pollen, animal dander, and mold, but you won’t experience other signs of asthma, like wheezing or breathlessness, May-Lin Wilgus, M.D., a pulmonologist and assistant clinical professor at UCLA, tells SELF.
: “Asthma will cause people to wake suddenly from sleep due to shortness of breath, cough, or wheezing,” Anastasiya Kleva, M.D., a board-certified allergist at ENT and Allergy Associates NY, tells SELF. This is likely because at night, your body can release higher levels of the stress hormone cortisol that may promote more bodily inflammation, including in your airways. That can cause your airways to narrow and make you cough, which can wake you up, Dr. Wilgus says.
: If you have too much trouble fully expelling air from your lungs, which can happen often if you have asthma, you might automatically breathe more quickly to make up for it, Dr. Casciari says.
: There’s a big difference between getting tired because you’re going extra-hard at the gym and feeling wiped because you have asthma. A few signs you might be struggling with asthma, per the Mayo Clinic: You regularly cough and wheeze when you work out, you have chest tightness, you struggle more than you feel you should to catch your breath when you stop, you’re still feeling tired hours after you work out, and you feel out of shape even though you know you’re not. These symptoms typically set in during or right after exercise and can last for upwards of 30 minutes.
: Obviously having a terrible cold or getting sick all the time doesn’t automatically mean you have asthma. But people with asthma often have viral infections that seem to last longer and be worse than what others experience, because that infection causes even more inflammation in their airways, Dr. Casciari says. If you find that you tend to get obliterated when you have a cold while your friends seem to coast through with some meds and extra tissues, it’s worth flagging for your doctor.
: Asthma limits your body’s ability to efficiently collect oxygen. When you can’t get enough oxygen in your body, it can make you feel tired, Dr. Kleva says. There is obviously a slew of reasons why you might be feeling tired on the regular, but if you’re grappling with fatigue that seems abnormal, it’s always worth talking to your doctor, whether or not you think it’s asthma.
If you suspect you might have asthma, definitely head to the doctor.
Your doctor will probably give you a physical exam first to examine the general state of your health. After that, they’ll likely put you through some lung function tests, like a spirometry, which checks how much air you can exhale after taking a deep breath along with how fast you can expel air, according to the Mayo Clinic. Or they may do a peak flow test, which measures how hard you can breathe out. If you can’t exhale enough air or breathe out quickly, it may be a sign your lungs aren’t working well, which could point to asthma, Dr. Benzaquen says.
There are other exams they can use, too, like exposing you to methacholine, a known (and mild) asthma trigger, to see if your airways narrow, or allergy testing, since allergies and asthma are so often connected.
If you are diagnosed with asthma, it’ll be with one of four categories, according to the Mayo Clinic. Mild intermittent asthma means you have minimal asthma symptoms for up to two days a week and up to two nights a month, while mild persistent asthma means you’re experiencing symptoms more frequently than twice a week, but not more than once on any given day. Moderate persistent asthma ups the ante; you’ll be dealing with symptoms once a day and more than one night a week. Finally, severe persistent asthma involves constant symptoms most days and frequently at night, too.
And here’s what you can expect with treatment, which is generally either long-term and preventive or short-term for quick relief.
One of the most important ways to treat asthma is to avoid being exposed to your triggers, Dr. Wilgus says. Of course, that can feel impossible if your trigger is something that’s seemingly everywhere, like dust or pollen. Though you can definitely take steps to reduce your exposure to those, avoiding them entirely is tough. Luckily, there are medications that can help when you’ve done everything you can trigger-wise.
Asthma medications can generally be split into two categories: long-term preventive medications and fast-acting drugs that can help when you’re having an asthma attack or on your way to one. Long-term preventive medications like allergy medications and inhaled anti-inflammatory corticosteroids are designed to help control your asthma so you’re less likely to have an asthma attack in the first place, the Mayo Clinic says. Quick relief medications (also called rescue medications) like short-acting beta agonists that you use via an inhaler can help relax your airways when they’re acting up enough that your asthma is noticeably worse.
Once you and your doctor have figured out the best way to treat your asthma, the two of you should jot it all down in an asthma action plan. That’s essentially a written document that spells out your treatment, including which medications to take when your asthma is well-controlled, which to turn to when you’re having some asthma issues, and which to try when you’re having an asthma attack. It also includes information like your doctor’s contact information and notifies you of which asthma symptoms are signs that you should seek immediate medical treatment. Make no mistake: If you have asthma, creating an action plan is crucial. “It’s important to have a plan with your physician for what to do when your asthma symptoms flare,” Dr. Wilgus says.
Another important thing to keep in mind right now: If you have moderate to severe asthma, you may be at higher risk for getting very sick from COVID-19, per the CDC, so make sure to be especially diligent with prevention measures. You might also want to talk to your doctor about how you should adjust your asthma action plan amid the pandemic, given that things like stress and disinfectants can trigger asthma attacks. The CDC has some recommendations for how to avoid triggering an asthma attack while disinfecting to prevent COVID-19 here.
Whatever you do, don’t resign yourself to living with asthma symptoms like trouble breathing and coughing all the time. “Asthma is a very controllable illness as long as the signs and symptoms are not ignored,” Dr. Parikh says.