Asthma
Asthma is a condition that can cause variable breathing symptoms, often related to airway inflammation and airway narrowing.[1]
Common symptoms
- Wheezing
- Cough, especially at night or with exercise
- Chest tightness
- Shortness of breath
Common triggers
Triggers may include respiratory infections, allergies, exercise, smoke, irritants, weather changes, reflux, or occupational exposures.[1]
Care themes
- Identifying triggers
- Correct inhaler technique
- Symptom monitoring
- An asthma action plan when appropriate
Seek urgent care for severe shortness of breath, blue lips, confusion, severe chest tightness, or symptoms not improving with prescribed rescue treatment.
Evaluation
How is asthma evaluated?
Asthma diagnosis involves a combination of clinical history, physical exam, and lung function testing.[1]
Spirometry (lung function testing)
- Spirometry measures how much air you can exhale and how quickly. It is the primary test for evaluating airflow obstruction.[2]
- You breathe forcefully into a mouthpiece. The test measures FEV1 (air exhaled in one second) and FVC (total air exhaled).
- In asthma, the FEV1/FVC ratio may be reduced, indicating airway narrowing.
- A bronchodilator reversibility test is often performed: spirometry is repeated after inhaling a rescue inhaler. Significant improvement suggests asthma.[1]
- The test is painless, takes about 15–30 minutes, and requires only your best effort breathing.
Other tests
- Peak expiratory flow (PEF): A simple handheld meter to monitor airflow variability at home.
- Fractional exhaled nitric oxide (FeNO): Measures airway inflammation. Elevated FeNO may suggest eosinophilic inflammation responsive to inhaled corticosteroids.[1]
- Bronchoprovocation testing: Inhaling a substance (e.g., methacholine) to test airway sensitivity when spirometry is normal but asthma is suspected.
- Allergy testing: Skin prick or blood tests to identify specific allergic triggers.
- Chest X-ray: Not diagnostic for asthma, but may exclude other conditions.
Treatment
How is asthma treated?
Asthma treatment follows a stepwise approach, adjusting medications up or down based on symptom control.[1]
Controller medications
- Inhaled corticosteroids (ICS): The cornerstone of asthma treatment. All patients with asthma should receive ICS-containing treatment.[1]
- ICS/formoterol combination: Used as both maintenance and reliever therapy (MART), now recommended by GINA as a preferred approach.[1]
- Long-acting beta-agonists (LABA): Added to ICS when symptoms are not controlled on ICS alone. Always used with ICS, never alone.
- Leukotriene receptor antagonists (LTRA): Oral medications (e.g., montelukast) added in certain situations.
- Biologic therapies: Injectable medications for severe uncontrolled asthma (e.g., omalizumab, mepolizumab, dupilumab, tezepelumab).[1]
Reliever and supportive
- Short-acting beta-agonists (SABA): Rescue inhalers (e.g., albuterol) for quick relief. GINA now recommends against SABA-only treatment without ICS.[1]
- Oral corticosteroids: Short courses for acute exacerbations. Long-term use should be minimized due to side effects.
- Trigger avoidance: Reducing exposure to known triggers (allergens, smoke, irritants).
- Asthma action plan: A written plan to adjust medications based on symptoms or peak flow readings.
- Inhaler technique review: Poor technique is one of the most common reasons for uncontrolled asthma.
Related topics
- Inhaler Technique — correct MDI, DPI, and spacer use
- COPD — can overlap with asthma
- Shortness of breath
- Sleep–Lung Connection — nocturnal asthma and sleep quality
- Pulmonary Fibrosis
References
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Updated November 2025. Available from: ginasthma.org
- Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. Am J Respir Crit Care Med. 2019;200(8):e70-e88. doi:10.1164/rccm.201908-1590ST