CARE GUIDE Adult Asthma

Adult Asthma

The experience of asthma in adults varies widely, from “It’s not that big of a deal” to “I can’t breathe at all.” In all, more than 25 million Americans (adults and children) struggle with the effects of asthma on their breathing—and their daily lives.

Asthma is a long-term disease that makes the airways in your lungs sensitive and irritated. When you have an asthma attack, these airways narrow, swell and produce thick and sticky mucus. The narrowing—called bronchospasm—is caused by tightening of the muscles that control your airways. The combination of bronchospasm, swelling and mucus prevents air from moving freely in and out of your lungs.

Symptoms of an asthma attack include:

Wheezing, a whistling or squeaking sound during breathing (the most common symptom of asthma)

Shortness of breath

Coughing, especially at night and in the morning

Tightness in the chest

Difficulty sleeping because of asthma symptoms

Asthma symptoms are usually tied to the inhalation of specific substances that irritate the airways, known as triggers. Triggers may also include activities like exercise, an upper airway infection and certain medications. Asthma affects people of all ages. Asthma usually begins in childhood, but it also may start when you're an adult. Among adults, more women than men have it. The cause of asthma is mostly unknown, but it appears to run in families. You may inherit genes that make you susceptible to it. Triggers like allergies, infections or exposures to substances like smoke, fumes and pollution may trigger those genes to become active.

There is no cure for asthma. If you have it, you have it all the time—even when you feel fine. Triggers and treatments differ from person to person. But, with the right diagnosis and treatment, you can learn how to manage your asthma and live a full and normal life.

To help reduce your risk of asthma attacks, be sure you know:

  • The things in your life that can trigger an attack
  • Ways to avoid triggers
  • Steps to take to control and relieve asthma symptoms

Asthma Triggers

Everyone with asthma has his or her own triggers. Most people with asthma have allergies. For them, allergens— the substances that cause allergy symptoms—are common triggers. They have what's called allergic asthma. For others, common triggers might be exercise or occupational exposures like fumes, dust or gasses.

Allergy testing can help pinpoint your personal allergic asthma triggers. Common ones include:

  • Dust mites
  • Cockroaches and their droppings
  • Pet dander
  • Mold spores
  • Pollens from grasses, trees and flowers

Common non-allergic asthma triggers include:

  • Physical exercise
  • Some medications, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and beta-blockers
  • Upper respiratory infections like the cold or flu
  • Acid reflux
  • Weather extremes like cold, dry air or high humidity
  • Some foods, food additives and preservatives called sulfites
  • Strong emotions or stress
  • Cigarette smoke
  • Air pollution
  • Occupational exposures

Doctors and Specialists

If your primary care doctor is able to control and manage your asthma, you may not need to see a specialist. However, you may need a specialist if you:

  • Have life-threatening asthma attacks
  • Have been hospitalized for asthma attacks
  • Are having unusual asthma symptoms
  • Have additional health problems
  • Have poor asthma control despite months of treatment

If you have severe asthma, your doctor may refer you to one of these specialists:

  • Allergist (also called an allergist/immunologist): A doctor who specializes in caring for people with allergies, asthma and allergic asthma
  • Pulmonologist: A doctor who specializes in caring for people with respiratory diseases
  • Pulmonary rehabilitation therapist: A nurse or respiratory therapist who can provide additional support and information about healthy living with asthma.

Preparing for Your Appointment

After you make an appointment for adult asthma treatment, there are some steps you can take to make your visit a smooth one:

  • Write down all your symptoms, even ones that don’t seem related to your concerns about asthma.
  • List all the medications you are taking—prescribed and over-the-counter—along with any vitamins or dietary supplements you take. Include dosages for each.
  • Be prepared to talk about when your asthma symptoms are most bothersome—for example, during certain times of the year, at night or when you’re exposed to the things that trigger your symptoms.
  • Note any recent life changes or major stress you’ve experienced recently.
  • Consider asking a friend or family member to go with you to see the doctor. He or she can help you remember what the doctor tells you.

Common Questions About Adult Asthma

You can print out the following lists of questions about adult asthma to take with you when you visit your doctor.

Questions to ask your doctor:

Before the diagnosis:

  • What do you think is causing my symptoms?
  • Are there other possible causes?
  • Will I need to have tests? If so, which ones?

If you’re diagnosed with asthma:

  • Do you recommend allergy testing to help identify the cause of my asthma symptoms?
  • What treatment do you recommend for me?
  • Are there other treatment options to consider?
  • What should I expect as a result of treatment? Will my symptoms go away?
  • Do I need to take medication? If so, what type? How does it work?
  • Is there a generic version of the medication you’re prescribing?
  • How often should I take it? How long will I need to take it?
  • Do I have to take it with food?
  • How will I know if it’s working?
  • What are the risks if I don’t take my medication as directed?
  • If I forget a dose, what should I do?
  • What side effects could occur?
  • Are there side effects that I should call you about?
  • Do I need to avoid any foods, beverages, dietary supplements or anything else while on this medication?
  • Will I need to use an asthma inhaler? Can you show me how it works? Should I make any changes in my lifestyle to help prevent asthma attacks?
  • Can I still take part in my favorite activities, despite having asthma?
  • Is exercise important? If so, how much, and what kind do you recommend?
  • I have additional health problems—what’s the best way to manage them together?
  • Should I see a specialist for additional information or care?
  • Are there any brochures or other printed material that I can take home with me?
  • What websites do you recommend visiting for more information?
  • Will you provide written instructions for my treatment?
  • Will you help me create an asthma action plan?
  • How can I tell if an asthma attack is coming on? What should I do if this happens?
  • When is an asthma attack an emergency, and what should I do then?

Questions your doctor may ask you:

To help make the diagnosis for adult asthma:

  • How long have you been having breathing problems?
  • Do your breathing problems affect your everyday life? If so, how?
  • What are your symptoms? For example, do you cough? Wheeze? Does your chest feel tight?
  • How severe are your symptoms?
  • What, if anything, seems to bring on your symptoms?
  • Is there any activity that makes your symptoms worse?
  • Do your symptoms worsen during certain times of the year?
  • Do you get symptoms during the day or night, or both times?
  • Did you have asthma, hay fever, or eczema when you were a child?
  • Does anyone in your family have asthma, hay fever or eczema?
  • Are you taking aspirin, ibuprofen or a beta-blocker medication? If so, does it make your symptoms worse?
  • Do you have any pets?
  • Do you smoke or breathe secondhand smoke?
  • What is your job?
  • Could anything in your workplace be causing your symptoms?

If you’re diagnosed with asthma:

  • Do you understand your asthma action plan?
  • Do you feel sure you can follow it?
  • If not, what are your concerns?

Tests and Diagnosis

Along with your medical and family history and the results of your physical examination, certain tests will help your doctor determine if you have asthma. Your doctor may:

  • Evaluate your breathing and lung function
  • Check for any allergies
  • Check for other disorders that could cause asthma symptoms or trigger asthma attacks

Tests and Evaluations to Help Diagnose Asthma


This test is done to assess how well your lungs work, determine the extent of airway obstruction and measure lung capacity. Using a mouthpiece, you breathe into a spirometer (a device that measures airflow), which tests how much air you can breathe in and out over a set amount of time, and how fast. You may breathe in only air, a gas like nitrogen or helium or a medicine to show its effect on your lungs.

Methacholine Challenge Test

This test is done to help confirm or rule out an asthma diagnosis if spirometry results are unclear. It evaluates your ability to expel air quickly from your lungs. You fully inhale increasing doses of methacholine (an airway-narrowing agent), then expel your breath as quickly as possible. Spirometry is done before and after each dose to compare results. At the end of the test, medication is given to reverse methacholine’s effects.

Peak Flow Meter Monitoring

This test is done to assess your asthma severity and monitor your treatment’s effectiveness. While standing, you take a deep breath and breathe into the meter as hard and fast as you can.

Challenge Test for Exercise and Cold Air

This test is done to determine the effect of exercise and cold air on your airflow. Your airflow is measured by spirometry before and after you exercise on a stationary bike or treadmill or take several breaths of cold air. For most people with asthma, airflow is reduced during or after they exercise or inhale cold air.

Sputum Testing

This test looks for a type of white blood cell that appears in the sputum of people with asthma. You will be asked to cough to produce the sputum sample.

Blood or Skin Tests for Allergy

You may be sent to an allergist for specific allergy testing if your doctor thinks you have allergic asthma.

Testing to for Other Disorders

Other health conditions can cause symptoms that mimic asthma, or they may trigger asthma symptoms. Testing may include imaging studies of your lungs and sinuses, and tests, such as endoscopy or X-ray, to look for conditions such as sleep apnea or gastroesophageal reflux disease.

Medications and Treatment

The main goal of asthma treatment is long-term symptom control. This means reducing your asthma attacks and the need for emergency care. With well-controlled asthma, you may have no limits on physical activity, minimal need for quick-relief medication and few or no side effects from asthma medication. The treatment plan for adult asthma is based on the severity of your symptoms:

  • Mild intermittent: You have mild symptoms up to two days per week and up to two nights per month.
  • Mild persistent: You have symptoms more than twice weekly but only one symptom, if any, in a single day.
  • Moderate persistent: You have symptoms once daily and more than one night per week.
  • Severe persistent: You have symptoms all during the day on most days and often at night.

Medications Used to Treat Adult Asthma

Asthma treatment involves two types of medication. Long-term (or controller) medications are those that you use every day to reduce asthma attacks. Quick-relief (or rescue) medications are ones that you use at the first sign of an asthma attack to quickly open airways.

Controller medications: These reduce airway swelling. They can reduce asthma attacks but are not used to treat an attack. Types of controller medications include:

  • Inhaled corticosteroids (fluticasone, beclomethasone, ciclesonide): These are the most common medications for long-term asthma control. They reduce airway inflammation, swelling and tightening.
  • Leukotriene modifiers (montelukast,zafirlukast, zileuton): These medications block the effects of immune-system chemicals (leukotrienes) that cause asthma symptoms.
  • Long-acting beta agonists (salmeterol, formoterol): These inhaled medications reduce airway swelling and open narrowed airways. These medications are not used alone but rather in combination with inhaled corticosteroids.
  • Mast cell stabilizer (cromolyn): This medication is usually given by breathing in a mist with the aid of a nebulizer. The medication prevents release of cells that cause inflammation.
  • Bronchodilator (theophylline): This oral medication opens up breathing tubes. It may be taken with other asthma medications to improve treatment results.

Types of rescue medications include:

  • Short-acting beta agonists (albuterol, aevalbuterol, pirbuterol): These inhaler medications quickly relieve asthma symptoms and open airways. They are usually the first choice for fast relief.
  • Bronchodilator (ipratropium): This is an inhaler that quickly relieves asthma symptoms by relaxing and opening airways.
  • Oral and injectable corticosteroids (prednisone, methylprednisolone): These medications are used for severe asthma attacks. They reduce airway inflammation. Because of side effects, these medications are used only for a short time.

If you have allergic asthma, other treatments may include:

  • Antihistamines and decongestants: These medications are available by prescription or over-the-counter to relieve allergy symptoms. Antihistamines block allergic responses to immune system triggers. Decongestants shrink swollen tissues and blood vessels in the nose. Some combination products contain both an antihistamine and a decongestant.
  • Immunotherapy: This treatment involves a series of injections that start with a very small amount of an allergen. The injected amount is increased over time until you develop a greater tolerance for the allergen. This leads to less severe allergic reactions.
  • Immune system modulator (Omalizumab): This medication is given by injection every few weeks for people with severe allergies and asthma. It blocks the allergic response.

Managing Asthma

To help ensure you make the right treatment decisions when asthma symptoms or attacks occur, you will need to work with your doctor to create an asthma action plan. You will need to learn your asthma triggers. You may also learn how to use a peak flow meter to monitor your breathing. You should keep a diary of all your asthma symptoms. This information will help your doctor adjust your treatment over time.

General Guidelines for Long-Term Asthma Control

  • Take your long-term controller medication every day.
  • Know your asthma triggers, and avoid them whenever possible.
  • Keep your quick-relief/rescue medication(s) within easy reach so you can treat symptoms fast.
  • Learn to recognize the onset of asthma symptoms or an attack, and be sure you know what to do if this occurs and when to call the doctor or get emergency medical help.
  • Use your peak flow meter as instructed to keep track of whether your daily controller medication is keeping your asthma under control.
  • Get your flu and pneumonia vaccinations.
  • Keep all your follow-up appointments.

The bottom line: You need continuous daily treatment with long-term controller medication, even when you are not having symptoms or an asthma attack.

Action Plan

Work with your doctor to create a written asthma action plan. Your action plan should include clear, up-to-date information on:

  • Your asthma triggers, and specific ways to prevent exposure to them
  • Steps to take if you have asthma symptoms or an asthma attack, including when to (1) call the doctor and (2) seek emergency care
  • The names and dosages of all your medications, the schedule and method(s) for taking them and guidelines for when and how to increase the dosage or add medication as needed
  • Guidelines for exercising and/or participating in sports
  • A schedule for using your peak flow meter to measure how well you can breathe
  • Your personal best peak flow meter reading (to compare with daily readings)
  • Guidelines for when to call your doctor about a peak flow reading

Your asthma action plan should also include emergency phone numbers and facility locations. Always keep a copy on you and have a copy in a prominent location in your home or office and another with a family member or friend who can help you in an emergency.

Use your action plan every day to keep track of your symptoms and triggers. Update it each time you see the doctor, or at least every six months.

When to Call Your Doctor

Call your doctor right away if:

  • Your symptoms are occurring more often or are more severe.
  • Your medications are not relieving an asthma attack.
  • You are using a quick-relief/rescue inhaler more than two days per week.
  • Your peak flow meter reading is less than half of your personal best.

Call 911 or go to the hospital if:

  • You are so breathless you have difficulty walking or talking.
  • Your lips or fingernails turn blue.

Asthma Treatment Guide

While millions of people have asthma, your asthma is unique to you. That means you need to work closely with your doctor to devise a treatment plan that’s especially for you, says Dr. Norman H. Edelman, senior scientific adviser to the American Lung Association. “Your treatment plan will depend on the severity of your asthma symptoms and may need to be adjusted over time,” he says.

The first treatment is always a good defense, Edelman says. As much as you can, you want to avoid those things that can set off your asthma attacks. Of course, everyone’s triggers are different. For many people, it's animal dander, dust, mold, pollen, cigarette smoke or extreme cold that can bring on an attack. Being sick with a cold or flu or having other health conditions also can affect the severity of your asthma symptoms and what medications you can take safely.

The Path to Asthma Control

You may need medicines known as bronchodilators to help you control your asthma. For most people, that means two kinds of bronchodilators:

  • One for quick relief during an attack
  • One for long-term control

Quick-relief bronchodilators open your bronchi, the passages into your lungs, so air can move in and out more easily. They also help you cough, so you can move mucus from your lungs.

If you have asthma, you should always have your quick-relief medicine on or near you in case you need it unexpectedly.

Long-term bronchodilators help you prevent and control symptoms over time. “Most people with significant asthma need controller medicines to reduce the amount of inflammation going on in the lining of their airways,” Edelman says. These are medicines you must take every day, even if you have no symptoms.

You may have short-term and long-term medicines that you inhale as a spray or mist, that you take as a pill or syrup or that you get as an injection. You might use an inhaler or puffer or a nebulizer machine that provides a medicated mist to take your medications. You also may be given oral steroids to treat a more severe asthma attack.

New medicines for severe asthma, designed to block cells that trigger the inflammation that results in an asthma attack, are coming, Edelman says. Some medications that block IgE, an antibody in your immune system that initiates allergic reactions, are on the market, and others are being developed, he says. A medicine was approved in 2016 by the U.S. Food and Drug Administration as an add-on for long-term asthma control in people age 18 and older with severe asthma who have increased levels of a white blood cell type associated with asthma.

Your Bottom Line

You always want to use the smallest amount of medicine necessary to maintain control and yet prevent asthma from damaging the airways deep in your lungs long term, Edelman says. “If you have long stretches of excellent control, your doctor may say, ‘Let’s see how you do without it.’” But, you should never stop your treatment without your doctor’s approval.

Just as your symptoms can vary over time, so can the effectiveness of your medicines. You'll see your doctor more often in the beginning, until you have your asthma under good control and you've found the asthma management plan that works best for you, but regular checkups will always be key. So will symptom tracking—and that's something only you can do.

10 Things to Know About Asthma

When you have asthma, the airways that carry air to and from your lungs are always swollen and inflamed. When you’re having an asthma attack, they become even more swollen and you can find yourself gasping for air. This is the situation for about one of every 12 people in the United States. If you're one of them, here's what you should know.

1. There's no cure for asthma. However, you can control it with proper care and medications.

2. What triggers an asthma attack is unique to you. Triggers vary from person to person. Many people are set off by contact with animal dander and breathing in pollen from trees, grasses and flowers. Cigarette smoke, direct or secondhand, is also a common trigger. It’s important that you learn your triggers and how to avoid them.

3. Most people need two types of medications. Short-term asthma medicines open your airways if you’re having an attack, and long-term medicines keep your airways from becoming permanently damaged by inflammation. You'll likely need them both.

4. Always keep your short-term medicines with you. These are called "rescue" medicines for a reason. Wherever you are, you need ready access to them in case of an attack. Also make sure you know the signs of when you’re in danger, and need to seek medical treatment right away. Have someone call 911 if you're having trouble walking or talking because you can’t breathe, or if your fingers and lips are turning blue.

5. Four symptoms could be a sign you’re having an asthma attack. Know these: chest tightness, coughing, labored breathing, and wheezing or making a whistling sound with each breath you take.

6. There are other early warning signs of an attack: Your neck itches. You have deep bags under your eyes. You’re exhausted. You snap at friends and family for no good reason. You feel nervous or edgy and can’t explain why. The "why" for all of these could be an asthma attack in the making.

7. Some people get asthma symptoms from exercise. This is called exercise-induced asthma, and symptoms usually start a few minutes after you start exercising and can last for approximately 30 minutes or so if you don’t take action. This seems to especially affect people who are sensitive to cold, dry air, or pollen, and are exercising outdoors. Your doctor may recommend that you use your inhaler before beginning to exercise. This also might be a sign that your asthma is poorly controlled, so be sure to tell your doctor.

8. Asthma can change over time. This makes it important to maintain regular contact with your doctor. If your asthma isn’t under control, you may need to take more medication. Don't do this on your own: Taking too much medication can actually make your asthma worse. On the other hand, if you've done well for months, you might be able to decrease the amount you take. Always talk with your doctor before making any changes.

9. Become an expert inhaler user. You need to learn when to use your inhaler and how to use it correctly. If you need help, ask your doctor to show you what to do.

10. Know the signs that your medicines aren’t working as well as they should. Do you have to use your rescue inhaler more than twice a week? Do you wake up at night coughing and wheezing more than twice a month? Schedule a checkup with your doctor to talk about these symptoms. It might be time for a medication change or a dosage adjustment.