Asthma Demystified: From Causes to Those Most at Risk

Asthma is a chronic condition that affects your breathing. It happens when your airways, the tubes that carry air in and out of your lungs, become swollen and narrow. This makes it harder to breathe and may lead to coughing, wheezing, shortness of breath, and chest tightness. There’s currently no cure for asthma, but treatment […]
December 8, 2023
Dr. Ves Gitchev
Dr. Ves Gitchev MD is the Director of Global Healthcare Partnerships at Science 37. A pioneer and innovator with nearly 2 decades of experience in the research industry, Dr. Gitchev's focus is on delivering the highest quality results to drive scientific advancement.

Asthma is a chronic condition that affects your breathing. It happens when your airways, the tubes that carry air in and out of your lungs, become swollen and narrow. This makes it harder to breathe and may lead to coughing, wheezing, shortness of breath, and chest tightness.

There’s currently no cure for asthma, but treatment can control the symptoms. This means you can live a normal, active life despite having breathing issues. Asthma affects more than 27 million people in America, including 4.5 million children. It accounts for millions of emergency room visits and tens of billions in healthcare costs annually.

What Does Asthma Feel Like?

To understand lung difficulties, it is necessary to understand the normal breathing process. In a typical breathing cycle, air enters your body through your nose or mouth and travels down your throat. It proceeds into your airways and eventually reaches your lungs. Within your lungs, numerous small air passages help transport oxygen from the inhaled air into your bloodstream.

However, when asthma sets in, the usual flow of air is disrupted. The lining of your airways becomes inflamed, and the muscles around them tighten. Mucus then fills the airways, further reducing the space available for air to pass through.

These combined conditions - muscle tightening, mucus production, and inflammation – can trigger asthma "attack," characterized by the hallmark symptoms of asthma, including shortness of breath, coughing, and wheezing.

What Are the Symptoms of Asthma?

Asthma symptoms vary from one person to the other. Some people have symptoms all the time, others only at specific times, like during exercise, and so on. Symptoms include:

    •    Shortness of breath

    •    Coughing, especially at night or early morning

    •    Wheezing

    •    Chest pain or tightness

People may also experience:

    •    Rapid breathing

    •    Trouble sleeping

    •    Panic or anxiousness

    •    Difficulty talking

    •    Fatigue

Asthmatic symptoms range from mild to severe and can happen daily or once in a while. The symptoms tend to worsen during an asthma attack and may come gradually or suddenly. Seek treatment if you experience the following symptoms of an asthma emergency:

    •    Confusion

    •    Dizziness

    •    Severe breathing difficulty

    •    Pale/blue fingernails or lips

    •    Gasping for air

    •    Difficulty talking or walking

Asthma Causes, Triggers, and Risk Factors

While the exact cause of these breathing difficulties is not fully understood, researchers have identified various elements that play a role in its development.

Genetics and Family History

Genetic predisposition is a significant factor in the development of asthma. If you have a family history of asthma, particularly if a parent or sibling has the condition, you are 3 - 6 times more likely to develop asthma than someone who doesn’t have a parent with asthma.

Viral Respiratory Infections

Viral respiratory infections, particularly in early childhood, can increase the risk of developing asthma. People with a history of respiratory syncytial virus (RSV) or rhinovirus are at a higher risk of developing the condition.

Environmental Factors and Triggers

Environmental factors and exposure to various triggers can contribute to the development and exacerbation of asthma. Common triggers include:

    •    Allergens

    •    Air pollution

    •    Tobacco smoke

    •    Respiratory irritants

    •    Pests

    •    Intense emotions

    •    Environmental irritants

    •    Extreme weather conditions

    •    Certain medications, including NSAIDs

Occupational Exposures

Certain work environments, where individuals are exposed to irritants or allergens, can increase the likelihood of occupational asthma.

Obesity

People who are obese or overweight are at a greater risk of asthma. While scientists are still trying to establish the connection, some evidence shows that extra weight can lead to low-grade inflammation and changes in lung function.

Who is at Risk for Asthma?

Asthma affects people of all ages, but the most vulnerable populations include those who:

    •    Smoke or are exposed to secondhand smoke

    •    Are overweight

    •    Have another allergic condition like hay fever or atopic dermatitis

    •    Have a blood relative with asthma

    •    Are exposed to pollution or chemicals used in manufacturing, hairdressing, or farming

Types of Asthma

There are many different types of asthma with different causes and triggers. Some common ones are:

    •    Allergic asthma (extrinsic asthma) is triggered by exposure to allergens such as pollen, dust mites, mold, pet dander, or cockroach droppings. This is the most common type of asthma.

    •    Non-allergic asthma (intrinsic asthma) is caused by factors like respiratory infections, cold air, exercise, smoke, strong odors, or stress.

    •    Occupational asthma happens due to exposure to irritants or allergens in the workplace. It can be triggered by substances like industrial chemicals, dust, fumes, or gases.

    •    Exercise-induced bronchoconstriction (EIB) often occurs during or after strenuous exercise and can affect both athletes and non-athletes.

    •    Childhood asthma develops in childhood and persists into adulthood and is often referred to as childhood-onset asthma. It may be allergic or non-allergic and can improve or worsen over time.

    •    Adult-onset asthma develops in adulthood, often in people who did not have asthma as children. It can have various triggers and causes, including respiratory infections, hormonal changes, or environmental exposures.

    •    Aspirin-exacerbated respiratory disease (AERD) is triggered by the ingestion of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). It is often associated with nasal polyps and chronic sinusitis.

    •    Cough-variant asthma is characterized by chronic cough without the typical wheezing or shortness of breath seen in other asthma types.

    •    Seasonal asthma happens when one experiences symptoms primarily during specific seasons when allergens like pollen are at their highest levels.

    •    Brittle asthma is a severe form of asthma characterized by unpredictable and sudden severe exacerbations. It can be challenging to manage and often requires intensive medical care.

How to Manage Your Asthma

Although you can’t prevent asthma, your doctor can offer a plan to help you live with the condition and prevent asthma attacks. This may include:

    •    Strategies to avoid triggers: Identify and minimize exposure to asthma triggers. For example, if you have allergic asthma, take proactive steps to reduce exposure to dust mites, pollen, pet dander, etc. And if you have occupational asthma, you should use protective equipment to minimize exposure to workplace irritants.

    •    Quick-Relief Medicines: These medicines are used as needed when you experience sudden asthma symptoms like wheezing or shortness of breath. They relax the muscles around the airways, opening them up and making it easier to breathe.

    •    Maintenance medications: These are used daily to manage and prevent asthma symptoms. They work to reduce airway inflammation and keep the airways open.

    •    Lead a Healthy Lifestyle: Maintain a healthy weight through a balanced diet and regular exercise, as obesity is linked to increased asthma risk.

We have made significant progress in understanding and managing this chronic condition. But there is still much to learn. More research is needed to uncover the underlying causes, improve treatment options, and enhance the quality of life for those living with asthma.

As part of these efforts, Science 37 is currently enrolling individuals for asthma clinical trials. Volunteers with asthma are needed to help test an investigational budesonide/albuterol combo inhaler which offers relief for asthma symptoms while also treating underlying inflammation.

Your participation in research like this is an opportunity to benefit from the latest advancements in symptom management and a chance to be part of a larger mission to advance our understanding of the condition. And the best part is you get to do it from the comfort of your own home.

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