What Are the Types of Asthma?

There are also numerous types of asthma, including adult-onset asthma, exercise-induced asthma, occupational asthma, and COPD.

Asthma is a chronic respiratory disease that causes inflammation and narrowing of the airways, making it difficult to breathe. Asthma affects about 26 million adults and children in the U.S. and accounts for 13.8 million missed school days a year for children, and more than 14 million lost workdays for adults.

There are two main categories of asthma:

• Allergic, which is triggered by exposure to an allergen, such as pollen or pet dander
• Non-allergic, which is triggered by factors such as stress, illness, extreme weather, irritants in the air, and some medications

There are also numerous types of asthma, including:

• Adult-onset asthma in which symptoms don’t start until patients are adults
• Exercise-induced bronchoconstriction (EIB, also sometimes called exercise-induced asthma)
• Occupational asthma usually occurs in people who work around chemical fumes, dust, or other irritants in the air
• Chronic obstructive pulmonary disease (COPD) is a collection of lung diseases breathing problems and obstruct airflow and includes refractory (severe) asthma

Symptoms of asthma include:

• Coughing, especially at night or early morning, during exercise, or when laughing
• Difficulty breathing
• Shortness of breath
• Chest tightness
• Wheezing 

Asthma symptoms often:

• Come and go over time 
• Start or worsen with viral infections, such as a cold
• Can be triggered by allergies, exercise, cold air, or hyperventilation from laughing or crying
• Worsen at night or in the morning

Asthma attacks describe episodes when symptoms worsen significantly and require a change in usual treatment. Asthma attacks may have a gradual or sudden onset and can be life-threatening. 

People with asthma may also experience stress, anxiety, and depression, because asthma can result in work and school absences and an inability to participate in their usual activities.

The cause of asthma is unknown, but it usually results from a strong immune system response to a substance in the lungs.

Common triggers for asthma symptoms include: 

• Exposure to an allergen (such as pollen, ragweed, dust mites, mold, or animal dander)
• Irritants in the air (such as smoke, strong odors, chemical fumes) 
• Extreme weather conditions
• Exercise
• Illness, especially respiratory illness or the flu 
• Stress
• Physical display of strong emotion that affects normal breathing patterns, such as laughing, crying, or shouting
• Panic 
• Certain medications
• Some foods

Asthma is diagnosed with a patient’s history and a physical exam, which includes the doctor listening to a patient’s breathing, and checking for allergic skin conditions. 

Tests used to help diagnose asthma or rule out other causes include: 

• Pulmonary function tests
  • Spirometry    
  • Bronchoprovocation tests    
  • Peak expiratory flow (PEF)    
  • Fractional exhaled nitric oxide (FeNO) tests    
  • Provocation (Trigger) Tests
    • Irritant challenge
    • Exercise challenge
    • Methacholine challenge
• Allergy skin or blood tests, in patients who have a history of allergies

Diagnosing asthma in children younger than 6 can be difficult, since they usually cannot perform a pulmonary function test such as spirometry. In this case, a doctor may try asthma medicines for a few months to see how the child responds.

Asthma is usually treated with two kinds of medications: quick-relief and long-term control. Allergy shots (immunotherapy) can also be helpful.

Quick-relief medications are bronchodilators that expand the airways, and are taken at the first sign of asthma symptoms for immediate relief:

• Short-acting inhaled beta2-agonists (inhalers)
• Anticholinergics

Long-term asthma control medications are taken daily to prevent symptoms and asthma attacks and include:

• Inhaled corticosteroids 
  • Fluticasone
  • Budesonide
  • Mometasone
  • Beclomethasone
  • Ciclesonide
• Antileukotrienes or leukotriene modifiers 
  • Montelukast sodium
  • Zafirlukast
  • Zileuton
• Long-acting inhaled beta2-agonists (usually combined with an inhaled corticosteroid)
  • Salmeterol
  • Formoterol
  • Vilanterol

In severe cases, traditional asthma treatments may be insufficient, and other therapies may be used, such as:

• Biologics
  • Reslizumab
  • Mepolizumab
  • Omalizumab
  • Benralizumab
  • Dupilumab
• Oral corticosteroids
  • Prednisone
  • Dexamethasone
  • Methylprednisolone
• Immunotherapy, useful when asthma is triggered by an allergy
  • Allergy shots (subcutaneous immunotherapy [SCIT])
  • Sublingual (under the tongue) tablets or drops (sublingual immunotherapy [SLIT])
    • Only house dust mites and certain grass and ragweed pollens are treatable with tablets
    • Not used for severe or uncontrolled asthma

Complications of poorly-managed asthma include: 

• Fatigue
• Problems sleeping
• Absences from work or school
• Poor performance at work or school
• Exercise intolerance that can lead other health problems such as obesity or high blood pressure 
• Repeated hospital visits
• Psychological problems such as stress, depression, and anxiety 
• Learning difficulties in children
• Respiratory complications 
  • Pneumonia (infection of the lungs)
  • Partial or total collapse of the lung
  • Respiratory failure
  • Status asthmaticus (severe asthma attacks that do not respond to treatment)
• Death