To get an idea of what it’s like to live with asthma symptoms, try this the next time you meet your friends for happy hour: Instead of tossing the skinny cocktail straw that comes with your drink, try breathing through it. That’s right. Shake it dry, bring it to your mouth, and use it to inhale and exhale for two full minutes—the duration, give or take a few seconds, of what’s considered a mild asthma attack.

Scary, right? That’s what it feels like for the 20 million adults in the U.S. with asthma during an “asthma exacerbation”—otherwise known as an asthma attack, according to the Asthma and Allergy Foundation of America.

During an asthma attack, “you can’t get enough air into your lungs, and it gradually becomes more and more uncomfortable,” explains Panagis Galiatsatos, M.D., a lung doctor and assistant professor in the division of pulmonary and critical care medicine at Johns Hopkins School of Medicine.

But there’s plenty you can do to keep asthma symptoms in check. Keep reading to find out more about this surprisingly common yet complex disease.

What is an asthma attack?

First, a quick primer on asthma itself. “Asthma is a disease of the airways,” Dr. Galiatsatos explains. For most of us, air flows freely in and out of the lungs. “When we take a breath in, our lungs expand and the diameter of those airways are at their largest,” he says. “When we exhale, the diameter of those airways close. That shrinkage of the diameter isn’t an issue—unless you have asthma.”

With asthma, your airways are always inflamed, meaning they become swollen and produce mucus. When an irritant—such as pollen, dust, dry air, pet dander, or smoke—triggers your asthma symptoms, your airways become even more swollen and the muscles surrounding them tighten. As a result, air has difficulty moving in and out of the lungs, causing asthma symptoms like coughing, wheezing, shortness of breath, and chest tightness. That, in short, is an asthma attack.

What does asthma feel like?

People describe the feeling of asthma in different ways. Depending on how well-controlled it is—or isn’t—asthma can feel like a dull ache in your chest or like you’re drowning in air. Your breathing becomes labored. Your chest tightens. And then there’s the straw metaphor, which Dr. Galiatsatos says his patients often use to describe how they are feeling.

What are asthma symptoms?

The first early warning sign of asthma is arguably the one most commonly associated with the disease: wheezing, or that squeaky sound in your chest when you have trouble breathing.

You might first only hear wheezing when you’re breathing out, but as the asthma attack worsens, you might also hear wheezing when breathing in. It’s also important to note that during a severe asthma attack, you might not hear any wheezing, which means not enough air is moving through the airways.

“People with asthma can have one of any number of symptoms,” says Neeta Ogden, M.D., an asthma specialist and immunologist in New York City. “The most common tend to be chest tightness, shortness of breath, or feeling like you can’t get in a good breath of air.

Here’s a little bit more about what to expect from the signs and symptoms of asthma:

1. Shortness of breath

Shortness of breath 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.

2. Cough

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 sensitivity to irritants can cause asthma symptoms, coughing is a hallmark sign of this condition, Dr. Benzaquen says, and it’s one people often ignore.

3. Wheezing

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.

4. Chest tightness

When you have asthma, it’s tough to get air in—but it’s also tough to get air out, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, tells SELF. “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:

5. A cough that won’t go away

Okay, so we did mention 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 a type of asthma called cough-variant asthma. 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.

6. Difficulty sleeping

“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.

7. Rapid breathing

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.

8. Struggling with exercise

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:

• You regularly cough and wheeze when you work out, you have chest tightness.

• You struggle to catch your breath more than you feel you should when you stop.

• You’re still feeling tired hours after you work out.

• 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.

9. Awful colds

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 wiped out 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.

10. Constant fatigue

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 are obviously many 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.

How do you know if your asthma is mild, moderate, or severe?

Asthma severity is typically classified as intermittent, mild, moderate, and severe. While there are several factors that play into the classification, here are some general guidelines:

• Intermittent asthma typically means your symptoms occur less than twice a week.

• If you have mild asthma, these symptoms might happen twice a week or more, but not daily.

• With moderate asthma, you can experience symptoms every day, but you won’t regularly have multiple flares.

• Severe asthma is uncontrolled, meaning symptoms kick in virtually every day, several times a day despite regular medication.

While mild and moderate asthma usually improves with treatment, that’s not typically the case with severe asthma.

Do asthma symptoms feel different at night?

Somewhere between 30 and 70% of people with asthma report symptoms of what’s known as “nocturnal asthma” at least once a month¹. Daytime asthma symptoms are no walk in the park, but nighttime asthma symptoms can be especially disruptive.

For one, asthma symptoms can wake you out of a dead sleep. “Imagine if someone put a pillow over your face,” Dr. Galiatsatos says. “If they did it during the day, it would still be uncomfortable, but at night you have the added insult of being awakened out of sleep.”

But who are these people with asthma who experience nighttime symptoms?

“There are some patients who experience worse breathlessness at night for a variety of reasons,” Dr. Galiatsatos explains. “Some of it is that the physiological change in body temperature could be enough to set off someone’s asthma. When I’m told asthma is awakening a patient at night I have to think about what’s going on in that bedroom.”

Some questions to ask yourself are: Do you sleep with your pet? Get in bed without showering off the day’s pollutants? Slumber with the windows open? If you answered yes to any of these things, one simple solution is to address those behaviors. Simply having your pet sleep in another room, showering before bed, or closing the windows to keep irritants out of the room may be enough to reduce the discomfort.

What are the types of asthma?

It’s easy to think of asthma as one disease, but it’s actually an umbrella term for many different types, including:

Allergic asthma

The most common type of asthma, allergy-induced asthma is triggered by exposure to allergens like dust mites, pet dander, pollen, or mold, according to the American Academy of Allergy, Asthma & Immunology. “Allergies and asthma tend to run together so you’ll find people with allergies who also have asthma,” says Sonali Bose, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) and Pediatrics at the Icahn School of Medicine at Mount Sinai. “For those people with allergic asthma, their allergies are oftentimes the trigger for their disease.”

Exercise-induced asthma

It’s pretty normal to become winded during a workout, but if you cough, wheeze, and struggle to breathe within minutes of doing aerobic exercise like running you may have exercise-induced bronchoconstriction, which is more commonly known as exercise-induced asthma.

Non-allergic asthma

Triggered by irritants like smoke and medical conditions such as sinusitis, this type of asthma often comes on later in life than allergic asthma. Up to one in three people with asthma have non-allergic asthma².

Occupational asthma

Up to 15% of asthma cases in the U.S. are believed to be job-related, thanks to the substances—fumes, dust, gases—inhaled in the name of making a living, such as factory and agriculture workers, bakers, and painters, according to the American Academy of Allergy, Asthma & Immunology. One clue you have occupational asthma: Your asthma symptoms kick in on the days you work and improve on your days off.

Childhood asthma

Even though pediatric asthma is the most common serious chronic disease in infants and children, according to the American Lung Association, it can be hard to diagnose.

While there are certain things to watch out for, such as eczema in infancy followed by allergy to indoor and outdoor allergens and asthma, Dr. Ogden says, but “because children experience viruses, colds, and upper respiratory tract infections more frequently, we often see asthma symptoms around these illnesses more commonly in children.”

That can make it confusing when it comes to diagnosis.

Adult-onset asthma

Asthma that is unmasked during adulthood is a little sneakier than childhood asthma, Dr. Galiatstatos says. “The challenge with children is they don’t have too much reserve to compensate when their lungs get active with an asthma attack, so their asthma attacks tend to be quick,” he says. “With adults, their lungs have grown to a certain extent so it’s never ‘Oh, I can’t breathe!’ It’s more of a gradual thing over a day or two of kicking in.”

Asthma causes and triggers

Researchers haven’t yet found a clear-cut answer for what causes asthma, and it may vary from person to person. What we do know is that it’s often due to the immune system overreacting to a substance in the lungs, and right on cue, the asthma symptoms start.

Triggers can include allergens, such as:

• Pollen (tree pollen, grass pollen, weed pollen, and ragweed pollen)

• Dust mites

• Pet dander

• Mold

And irritants, such as:

• Secondhand smoke

• Chemical fumes

• Strong odors, like perfume

Other possible triggers include extreme weather conditions, exercise, and respiratory illnesses. Even seemingly inconsequential actions like a display of emotion that affect normal breathing—shouting and laughing—can trigger asthma symptoms.

How is asthma diagnosed?

“Asthma is diagnosed by a spectrum of variables, not just one thing,” Dr. Ogden says. “Your doctor will look at your clinical history and symptoms, pulmonary function testing, and response to medication.”

One thing you will need for diagnosis is a big inhale and exhale, or several. Among the breathing tests that are used to measure how well your lungs work are:

• A spirometry test diagnoses asthma severity and measures how well treatment is working. You take a deep breath and blow into a sensor to measure the amount of air your lungs can hold and the speed of the air you inhale or exhale.

• A fractional exhaled nitric oxide (FeNO) test measures how much inflammation you have in your lungs.

• Peak expiratory flow (PEF) tests measure how fast you can blow out air using maximum effort. This test can be done during spirometry or by breathing into a separate device, like a tube.

Managing and treating asthma symptoms

Asthma symptoms can usually be managed with the help of medications, most of which are breathed in through the mouth with the help of an inhaler. Sometimes systemic corticosteroids, which decrease inflammation, are needed for severe asthma attacks, and other medications can be used depending on the type and severity of your asthma.

Here are a few terms to know:

• Maintenance inhalers administer controller meds that are taken daily to keep asthma symptoms in check.

• Rescue inhalers deliver quick-relief medications to quickly open the airways and relieve asthma symptoms during a flare-up.

• Combination inhalers are used by people with severe asthma for long-term control of symptoms, and include both types of medication.

Create an asthma action plan

No matter the severity or frequency of flare-ups, everybody with asthma should work with their doctor to create an asthma action plan. This is a written set of instructions on how to manage your asthma, and usually includes:

1. A list of all medicines you take, including dosages of everything in your medicine cabinet, not just your asthma meds.

2. Signs specific to you that indicate your symptoms are getting worse. No two people with asthma experience the condition the exact same way so it’s important to detail your own particular red-flag asthma symptoms.

3. What to do in an emergency. Say, for instance, you’re showing telltale signs of a severe asthma attack—confusion, blue lips, difficulty speaking—your plan might specify where your rescue inhaler is located, or at what point emergency services need to be called.

When to see a doctor about asthma symptoms

Asthma is a chronic disease of the airways, but symptoms can be managed and treated through a combination of lifestyle and medication. Here are three easy ways to check if your asthma is under control, according to the American Lung Association:

• Do you experience asthma symptoms or reach for your rescue inhaler more than twice per week?

• Do you wake up at night with asthma symptoms more than twice per month?

• Do you find that you have to refill your rescue inhaler more than two times in a year?

If you answered yes to one or more of these questions, your asthma may not be well-controlled, and you should reach out to a health professional. Start with your primary care doctor, who can help determine if you should also see a doctor who specializes in asthma and allergies, or the lungs.

You should consider seeing a lung specialist if you’re having two or more asthma attacks throughout the year, Dr. Galiatsatos adds, as that means your asthma is uncontrolled.

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