What Is Asthma? Symptoms, Causes, and Treatment

Asthma is a chronic lung disease that narrows the airways and makes breathing difficult. Affecting approximately 350 million people worldwide and 7 million in Turkey, it is becoming more common, particularly in children. The bronchial airways become overly sensitive to triggers. Surrounding muscles contract, the lining becomes inflamed and swollen, and mucus production increases. These changes cause breathing difficulties and occasional episodes called asthma attacks . With appropriate treatment and follow-up, asthma can generally be controlled, allowing a near-normal life.

What Is Asthma?

Asthma involves chronic inflammation of the airways and narrowing, with recurring attacks. Airway muscles may suddenly contract in response to an external stimulus, narrowing the bronchi and restricting airflow. Asthma is not a contagious infection, although infections can trigger attacks. Periods of exacerbation may alternate with quieter periods.

Although often beginning in childhood, asthma can develop at any age. Atopic individuals, meaning those prone to allergies, are affected more often. Severity varies: some have mild disease, while others experience frequent attacks seriously affecting quality of life. Correct diagnosis and an individualized plan are essential for control.

What Are Asthma Symptoms?

Symptoms arise from airway narrowing and may fluctuate. The most common include:

• Shortness of breath: Breathing may be difficult, particularly breathing out.
• Wheezing: A whistling sound during exhalation, known as wheezing , is a typical symptom.
• Cough: The cough is generally dry. In particular, coughing attacks at night or toward morning are characteristic. Exertion, laughing, or crying may also trigger coughing.
• Chest tightness: Patients may feel pressure, tightness, or heaviness in the chest.
• Other symptoms: An attack may cause difficulty speaking, rapid breathing, palpitations, sweating, and, in advanced cases, bluish lips or nails. Weakness and exhaustion may follow.

Symptoms differ between patients. Some notice only mild wheezing during exercise; others have severe coughing that wakes them. Because symptoms can resemble COPD or bronchitis, accurate diagnosis matters. People with recurrent cough and breathlessness should consult a respiratory medicine specialist.

What Causes Asthma?

The exact cause is not fully known. Genetic predisposition and environmental factors are thought to interact. A family history of asthma or allergic disease increases risk. A child with asthma in both parents, for example, may have a risk as high as 60%. Childhood viral infections, frequent bronchitis, and air pollution can also contribute.

Factors increasing the risk include:

• Family history: Relatives with asthma, indicating genetic predisposition.
• Other allergic diseases: An allergic tendency, including allergic rhinitis (hay fever) or eczema.
• Sex and age: More common in boys during childhood but slightly more common in women in adulthood.
• Obesity: Excess weight may increase asthma risk.
• Tobacco smoke exposure: Active smoking or childhood secondhand smoke from parents increases risk.
• Occupational exposure: Workplaces involving dust, chemical fumes, or strong odors, such as farming, baking, hairdressing, or manufacturing, may cause asthma.
• Air pollution: Prolonged exposure to exhaust fumes and industrial pollution.

Environmental triggers of asthma attacks can suddenly cause or worsen symptoms in affected individuals. Although triggers vary, the most common include:

• Allergens: Pollen, house dust mites, mold, animal fur, and dander frequently trigger attacks. People with allergic asthma should take particular care during high-pollen seasons such as spring and autumn.
• Tobacco smoke: Active smoking and secondhand exposure trigger symptoms. People with asthma should strictly avoid tobacco smoke.
• Air pollution and chemicals: Industrial smoke, exhaust, strong paint or cleaning-product odors, perfumes, and deodorant sprays may cause exacerbations.
• Cold air: Cold, dry air makes airways more sensitive. Attacks may increase in winter, and sudden temperature changes may have similar effects.
• Exercise: Strenuous activity, particularly in cold, dry air, may trigger exercise-induced asthma . Take suitable precautions before activity, such as warming up and, when needed, using a doctor-recommended inhaler beforehand.
• Respiratory infections: Viral illnesses such as colds, influenza, or sinusitis may trigger attacks. Preventive measures, such as annual influenza vaccination, are therefore important.
• Stress and emotional factors: Intense sadness, fear, anger, and stress may worsen symptoms by changing breathing rate and rhythm. Stress management may help.

Triggers differ between individuals. Learn what affects your asthma through experience and avoid it where possible. Doctors generally advise adapting home and work environments accordingly.

Types of Asthma

Asthma has subtypes based on presentation or underlying cause. Identifying the type helps select treatment. The main asthma types and characteristics are:

In addition to the forms listed above, intrinsic asthma is a form that is not related to allergies. Some people may also experience a condition called stress-related (psychological) asthma , in which asthma-like complaints occur under intense stress. Whatever the type, understanding asthma triggers and taking appropriate precautions are part of treatment.

Asthma Treatment Options

At present, asthma unfortunately has no definitive treatment that provides a complete cure, but the condition can be controlled successfully with appropriate treatment. The main goals of asthma treatment are to minimize symptoms, allow patients to lead a normal life, and prevent asthma attacks. Treatment plans generally use medication and lifestyle measuresin combination.

The main approaches used to treat asthma are:

Inhaled Medications: These are the cornerstone of asthma treatment. Spray or dry-powder devices called inhalers deliver medication directly into the airways. These medications fall into two main groups:

• Rescue (reliever) inhalers: These are used when asthma symptoms begin or during an attack. They act quickly, usually within 5-10 minutes, to relax the bronchi and make breathing easier. The most common examples are short-acting bronchodilators, such as sprays containing salbutamol . People with asthma are advised to carry these fast-acting inhalers at all times. If an inhaler is needed more than a few times a week, asthma is not adequately controlled and additional treatment is necessary.
• Preventer (controller) inhalers: These medications are taken regularly every day to prevent asthma symptoms. The main controller inhalers contain corticosteroids (cortisone). Corticosteroid inhalers reduce airway inflammation and prevent asthma attacks over the long term. Regular use makes a major contribution to asthma control. Inhaled corticosteroids act locally and are given at low doses, resulting in far fewer side effects than oral cortisone. Nevertheless, the mouth should be rinsed with water after use to prevent oral thrush. Controller inhalers do not work immediately; they must be taken every day at the prescribed dose to provide their full benefit.
• Combination inhalers: In some cases, doctors may combine medications with both reliever and preventer effects in a single inhaler. These combinations are particularly preferred for patients with moderate or severe asthma that cannot be controlled with one medication.

Oral or Injected Medications: These are used when inhaled treatment does not provide adequate control or when additional treatment is needed. In particular, leukotriene inhibitors (such as montelukast tablets) may help control asthma; taken orally, they reduce airway inflammation. When necessary, medications such as theophylline may also be added to dilate the bronchi. Theophylline is used less often today and requires caution because of the risk of side effects. Patients with severe asthma or serious attacks may be given a short course of oral corticosteroid (cortisone) tablets . Because these medications have systemic effects, prolonged use may lead to unwanted effects such as weight gain, high blood pressure, and osteoporosis. They are therefore used only under medical supervision and when necessary. In recent years, biological therapies that target specific immune mechanisms have been developed for patients with very severe asthma, such as injections given at regular intervals, including anti-IgE or anti-IL5 treatments. These monoclonal antibody treatments can be highly effective in selected patients whose asthma does not respond to conventional therapies.

Lifestyle Changes: Avoiding triggers and adopting healthy habits are as important as medication in asthma management. Patients should avoid smoking and control allergens such as dust, mold, and pet dander at home and at work. Reducing carpets, soft toys, and dust-collecting objects in the home, washing bed linen at high temperatures, and cleaning regularly can reduce house dust mites and relieve allergic asthma symptoms. Regular exercise on medical advice, with medication beforehand if necessary, maintaining an ideal weight, eating healthily, and avoiding stress also help control asthma. Patients should attend follow-up visits at the intervals recommended by their doctors and undergo monitoring such as lung function testing. If your doctor has prepared a written asthma action plan , following its instructions can help you learn how to adjust medication doses temporarily when symptoms worsen.

Allergen Immunotherapy (Allergy Shots): Particularly in people with allergic asthma , the body's sensitivity to the responsible allergen can be reduced with immunotherapy . This approach involves administering specific doses of allergen extract as injections under the skin or drops under the tongue over several years. The aim is for the immune system to develop tolerance to that substance. In suitable patients, immunotherapy may relieve allergic asthma symptoms and reduce the need for medication.

Bronchial Thermoplasty: This is a surgical procedure used rarely in very severe asthma that cannot be controlled with other treatments. Bronchial thermoplasty aims to destroy some of the smooth muscle in the airway walls using heat energy applied to the inner surface of the bronchi. The goal is to reduce the ability of the bronchi to contract and narrow. Performed by bronchoscopy under general anesthesia, this procedure is not suitable for everyone and is considered only in selected cases.

Supportive and Alternative Approaches: Medical treatments are essential in asthma care, but some supportive practices are also used alongside them. Breathing exercises such as diaphragmatic breathing exercises and yoga-like techniques may strengthen respiratory muscles when practiced regularly and provide indirect benefits by reducing stress. Herbal treatments , however, have no proven effectiveness as asthma medications. Although various herbs, such as ginger, thyme, and black cumin, are suggested in folk medicine, they cannot control asthma on their own. Always consult a doctor before taking any supplement or herbal product. Salt rooms and speleotherapy (cave therapy) are tried by some people, but their effectiveness has not been clearly established scientifically. People with asthma must never replace their prescribed medications with alternative approachesand should use them, at most, as supportive measures on a doctor's advice.

How Can an Asthma Attack Be Relieved?

An asthma attack is a sudden worsening of asthma symptoms that causes severe shortness of breath. A person having an asthma attack, or those around them, can help provide relief by taking prompt and appropriate action. The steps to take during an asthma attack are briefly outlined below:

1. Stay calm: First, try not to panic. Panic makes breathing even more difficult. Focus on breathing slowly and in a controlled way.
2. Use your fast-acting inhaler: If you are carrying your rescue inhaler (such as salbutamol), use it immediately at the dose recommended by your doctor, usually 1-2 puffs. If possible, use a spacer to help the medication work more effectively. If you have a nebulizer, put the fast-acting bronchodilator medication into it and start treatment.
3. Sit upright and relax: Sitting upright or standing increases airflow into the lungs. Loosen clothing around the neck and remove any tie. Rest your hands on a table to allow your chest muscles to help with breathing.
4. Take slow, deep breaths: Once your airways begin to open, try taking a deep breath through your nose and breathing out slowly through your mouth. Controlling your breathing helps more oxygen enter your body and helps you relax.
5. Call for medical help if necessary: If there is no improvement within 15-20 minutes despite using your inhaler, call 112 emergency services . Emergency medical attention may be needed if you are too breathless to speak or develop serious symptoms such as blue lips or confusion. If possible, continue using your medication at intervals while waiting for the medical team, as previously instructed by your doctor.

If you are with someone having an asthma attack, reassure them and help them feel that they are not alone while following the steps above. A medical review after an attack is advisable because another attack can sometimes occur within hours, or additional treatment may be needed. Your doctor may prescribe medications such as cortisone tablets for a period after the attack.

Preventing asthma attacks is easier and less risky than trying to treat them. Attend regular checkups, and if you notice worsening symptoms, review your treatment plan with your doctor. Every person with asthma should also have an emergency action plan . This plan explains which medications to increase, by how much, at different stages of an attack, and when to go to hospital. Developing your own action plan with your doctor and following it calmly during an attack can also help make attacks less severe.

Asthma and Cancer Risk

The relationship between chronic asthma and cancer has attracted scientific interest in recent years. Because asthma creates an ongoing state of inflammation in the body, it is thought that this chronic inflammation may lead to certain cellular changes over the long term. Various studies have examined the risk of developing cancer in people with asthma. A meta-analysis published in 2017 showed that people with asthma were 44% more likely to develop lung cancer than those without asthma. In 2023, a large study published in Cancer Medicine reported that people with asthma, particularly those who did not use their inhaled steroid medications regularly, might have a somewhat increased overall cancer risk.

Although the reason for this increase in cancer risk among people with asthma is not fully understood, the underlying mechanism is thought to be chronic inflammation . Theoretically, tissues exposed to ongoing inflammatory stimulation may become more likely to develop abnormal cells over time. There are also suggestions that inhaled corticosteroids used to treat asthma may reduce this risk by suppressing airway inflammation. Research is ongoing, and this is not a cause for concern for the vast majority of people with asthma. Nevertheless, if you have asthma, attending regular medical follow-ups and maintaining your treatment are important for your overall health.

[People with Asthma Found to Have a Higher Cancer Risk] is an article in which Prof. Dr. Mustafa Özdoğandiscusses current findings on the relationship between asthma and cancer in detail. For more information, you can read the related article: People with Asthma Found to Have a Higher Cancer Risk.

Frequently Asked Questions

• Can asthma be completely cured? Asthma is a chronic condition, and there is currently no treatment that eliminates it completely. However, some people with childhood asthma may find that symptoms disappear or become milder after adolescence. Adults can also live for years without an attack with appropriate treatment. Asthma can therefore be controlled, but it is important to be cautious about saying it has been completely cured. Symptoms may return if treatment is stopped.

• Is asthma contagious? No, asthma is not contagious. Asthma is not a microbial infection and cannot pass from person to person. However, people with asthma may be more susceptible to respiratory infections such as influenza and the common cold, and these infections can worsen asthma symptoms. They are therefore advised to protect themselves from infections, for example by avoiding close contact with sick people, washing their hands frequently, and having an annual influenza vaccination.

• Are asthma medications (cortisone) harmful or addictive? The corticosteroid inhalers most commonly used to treat asthma are generally safe and suitable for long-term use when taken at the prescribed dose with the correct technique. Inhaled corticosteroids act directly in the airways and have far fewer side effects than oral cortisone. These medications are not addictive; the body does not crave them, and they can be reduced or stopped under medical supervision when appropriate. Some patients avoid their medication because they fear the word cortisone. However, the lung damage caused by untreated asthma and attacks requiring frequent emergency visits are far more dangerous than the medications' potential side effects. Using corticosteroid sprays at the correct dose minimizes these risks. Patients taking high doses of cortisone should nevertheless remain under regular medical supervision.

• Is asthma genetic? Will my child inherit it? Genetic susceptibility plays an important role in the development of asthma. People with a family history of asthma or allergic conditions are more likely to develop asthma. For example, a child's risk increases if either parent has asthma and is much higher if both parents have it. However, genetic susceptibility does not mean that asthma will definitely be passed on ; it only increases the likelihood. Some people also develop asthma despite having no family history. The answer to whether your child will inherit asthma therefore concerns risk rather than certainty. Parents can reduce risks by not smoking, keeping the home clean, and helping protect their child from respiratory infections.

• Can people with asthma play sports? Yes, people with asthma can and indeed should exercise with appropriate precautions. Regular exercise increases lung capacity, strengthens respiratory muscles, and benefits overall health. The important points are to keep asthma under control and use medication before exercise when necessary. Warming up before exercise , avoiding exercise in cold weather, and, if needed, using a reliever inhaler 10-15 minutes beforehand as recommended by a doctor will reduce the risk of an attack. Swimming and walking are among the activities suitable for people with asthma. As long as your asthma is controlled, there is no objection to exercising outdoors in a clean environment. Many people with asthma even compete at the Olympic level. Continue taking your regular treatment and follow your doctor's advice.

Conclusion

Asthma is a condition that can be managed with accurate information and a disciplined approach. With early diagnosis and appropriate treatment, people with asthma can lead active, healthy lives like anyone else. The key is to understand the condition, avoid triggers, and work closely with your doctor. Remember that asthma can be controlled; with the right plan, you can take control of your asthma. Wishing you good health...