Asthma Symptoms & Triggers

Asthma is usually diagnosed early in a person’s life. Symptoms include coughing, wheezing, chest tightness and shortness of breath. Patients often have allergies that can trigger symptoms. They may also have a family history of asthma and allergies.

COPD tends to occur in people after the age of 40. It involves lung diseases that develop over time, primarily emphysema and chronic bronchitis. Symptoms are like asthma but also involve increased mucus or phlegm and more respiratory tract infections. COPD is often the result of long-term, heavy cigarette smoking. The disease tends to get worse over time.

A person can have both asthma and COPD at the same time. This is called Asthma-COPD Overlap (ACO). Treatment is similar – short-acting and long-acting bronchodilator inhalers and inhaled corticosteroids. But COPD may also involve long-acting muscarinic antagonists (LAMAs), also called anticholinergics.

Many people with asthma experience symptoms at night. This is called nocturnal asthma, or sometimes just nighttime asthma. Studies show lungs work best during the day, with peak lung function at about 4 p.m. Twelve hours later – around 4 a.m. – lung function is at its lowest. For most people, the fluctuation is less than 10 percent. However, people with asthma can have up to a 50 percent difference between daytime and nighttime lung function.

Other factors that can impact sleep in people with asthma include:

• Medication usage. The effects of a short-acting bronchodilator used at bedtime can wear off after 4-6 hours. This can result in waking up coughing, wheezing or short of breath because another dose is needed.
• Allergen exposure. Exposure to allergens during the day can set off a chain reaction in the immune system that produces allergic reactions and asthma symptoms hours later. Allergens such as dust mites or pet dander in the bedroom can also cause symptoms.
• Postnasal drip and congestion from allergies. This can cause multiple nighttime “micro-arousals.” These awakenings are so brief that the sleeper may not even remember them, but they affect alertness the following day.
• Gastroesophageal reflux disease (GERD). Also called acid reflux or just reflux, GERD is a backwash of stomach acid into the esophagus. Reflux is more common when a person is lying down, so people with asthma may wake up with a sudden, intense cough. This can worsen asthma symptoms at night. Studies reveal that as many as 75% of adults with asthma also have reflux.
• Sleep apnea. People with asthma are at increased risk for sleep apnea. This is a sleep disorder that causes repeat pauses in breathing throughout the night. It can set off or worsen asthma.

If you experience disrupted sleep at night two or more times per night, it may mean your asthma is getting worse. Talk with your doctor or an asthma specialist about your symptoms and whether you need to adjust your medications or Asthma Action Plan.

The best way to prevent coughing and wheezing at night is to have good asthma control. Identify your triggers and work with your doctor to take steps to limit exposure or remove them. Don’t take any medications or drink caffeine that stimulate you and keep you awake. Create a healthy sleeping environment in your bedroom.

Some people experience asthma symptoms during or after exercise or physical activity. This is exercise-induced asthma (EIA), also called exercise-induced bronchospasm (EIB). It occurs when airways narrow during vigorous exercise or physical activity. This leads to coughing, wheezing and shortness of breath. EIA can occur in people diagnosed with asthma and those who are not diagnosed with asthma.

It’s believed that dry air is a primary culprit because it can dry out the airways. Exposure to pollen and/or air pollution when exercising outdoors can also trigger symptoms. Doctors recommend people with EIA pre-treat their airways with a quick-relief albuterol inhaler prior to exercise. They should also warm up beforehand and stay hydrated before, during and after physical activity.

Some people may experience symptoms of asthma, but without an asthma diagnosis. If you experience asthma-like symptoms or asthma episodes, it’s important to consult a healthcare professional for a proper evaluation and testing. Perhaps you don’t have asthma, but if your symptoms persist, you may have a different lung disease, such as bronchiectasis, COPD or primary immunodeficiency disease.

Consider your environment. Are allergens such as pollen, mold, dust mites or animal dander triggering your cough? Are there chemicals or strong odors in your environment? Is there secondhand smoke? Identify possible allergens and irritants and do your best to avoid them. Reduce exposure to these triggers by keeping your living space clean and well-ventilated with fresh air. Monitor your symptoms by tracking their patterns – when and how often they occur and how severe. Keep a symptom diary. Do symptoms arise when you go outside? Are you at risk for respiratory infections. This information can be useful when discussing your symptoms with a health professional.

While asthma is commonly associated with wheezing, coughing and shortness of breath, other unusual symptoms can occur. These may include:

• Rapid breathing: Some people with asthma may experience rapid breathing during an asthma attack, rather than the more typical wheezing or gasping for air.
• Fatigue: Asthma can sometimes lead to exhaustion, particularly during or after an asthma attack. The effort of breathing, especially if it becomes difficult, can be physically and mentally draining.
• Difficulty speaking: In severe cases, asthma can affect the ability to speak normally or speak in full phrases due to the limited airflow and increased effort required for breathing. Strong emotions such as laughter can also trigger symptoms or make asthma worse.
• Anxiety or panic: An asthma attack can trigger feelings of anxiety, panic or fear in some people.
• Chronic cough: While coughing is a common asthma symptom, some people may experience a persistent, dry cough as a symptom of asthma. This cough may not produce any phlegm or mucus.

It is estimated that 5-10% of people with asthma have severe asthma. The number may be higher because studies show many people with asthma report their symptoms are uncontrolled.

From a medical standpoint, severe asthma is the diagnosis when…

• asthma symptoms are not well-controlled by high-dose inhaled corticosteroids (also called anti-inflammatory controller medications);

• the patient experiences two or more asthma attacks in a 12-month span requiring oral corticosteroids (pills that treat severe acute asthma symptoms).

Here’s what to watch for to indicate your asthma is severe:

• an increased use of quick-relief albuterol inhalers (two times a week or more);

• symptoms persist even though you’re taking medication;

• frequent coughing, especially at night;

• difficulty sleeping or sleep disturbances due to asthma symptoms.

A wide range of treatments are available. Talk with your doctor or a specialist in respiratory care.

Silent asthma describes a severe form of asthma that can occur even though there are no apparent symptoms. A person experiencing a silent asthma attack may not cough or wheeze. Instead they may suddenly struggle to breathe normally. They may have difficulty speaking or experience chest tightness. They may feel very dizzy, tired or distressed, and even pass out.

Silent asthma is a serious and life-threatening condition because flare-up are not easily recognizable. Talk with your doctor if you’re concerned you have this condition.