Do You Know What Type of Asthma You Have?

Up to 90 percent of people with asthma will experience airflow obstruction and breathing symptoms while exercising. 

When airflow is obstructed as a result of exercise, it’s known as exercise-induced bronchoconstriction (EIB), which is a subcategory of asthma. EIB was previously known as exercise-induced asthma; however, exercise-induced asthma incorrectly implies that exercise is the underlying cause of asthma, when it is actually its trigger, not the cause.  It’s worth noting that some cases of allergy-induced asthma also fall under the subcategory of EIB because allergens and exercise can trigger symptoms.

Exercising in cold, dry air is more likely to cause EIB than exercising in warm, humid air.

Pollution, pollen, cigarette smoke, and other airborne irritants — as well as the common cold or a recent asthma attack — can also raise your risk of experiencing EIB.

Symptoms from EIB can occur within a few minutes after you start exercising. They can also:

• Worsen 5 to 10 minutes after you stop exercising and disappear within 20 to 30 minutes
• Return as a “second wave” or “late phase” 4 to 12 hours after exercise
• Persist for up to 24 hours

Those suffering from EIB should not avoid exercise to avoid an asthmatic flare-up. In fact, according to Thomas Chacko, MD, an allergist based in Atlanta, it can worsen your case of asthma to avoid exercise.

“Fat cells, particularly in those who are classified as obese, sit on the lungs and prevent them from growing,” says Dr. Chacko. In addition, “obesity fat cells make the topical medications for asthma less effective, so you have to use more."

If you have EIB, it’s important to be familiar with your asthma treatment plan so that you know how to handle symptoms and potential attacks if and when you experience them during exercise. It’s also important to know your limits, so you don’t overexert yourself during exercise in a way that will trigger a flare up of symptoms.

And it’s important to know that research does suggest that over time, exercise has been found to reduce asthma symptoms. 

Coughing is your body’s way of ridding itself of foreign irritants, particles, microbes, mucus, bacteria, and other allergens. It is not an illness, but a symptom of an illness. By forcing air out of the lungs, the body attempts to eliminate particles it identifies as harmful.

Though a means to help your body get better, a persistent cough can be extremely irritating. The way to eliminate a cough is by identifying the cause.

Unfortunately, those suffering from cough-variant asthma (CVA) experience a dry, nonproductive cough — and symptoms tend to present only with cough. Cough-variant is often misdiagnosed as chronic cough because it has some nontraditional asthmatic symptoms.

Symptoms and complications of cough-variant asthma may include:

• Persistent cough
• Difficulty breathing or shortness of breath
• Chest tightness
• Wheezing
• Asthma attacks
• Sleep disruption
• Exhaustion
• Lightheadedness
• Vomiting

Unless adequately treated, 30 to 40 percent of adults with CVA may progress to classic asthma or develop more serious complications. 

Those suffering from cough-variant asthma may also be at risk for:

• Permanent narrowing of the bronchial tubes
• Pneumonia
• Collapsed lung
• Lung failure
• Fractured rib
• Asthma attacks that don’t respond to treatment

Proper management with inhaled corticosteroids are the mainstay of treatments and help ensure cough-variant asthma doesn’t progress to a more severe type of asthma.

If your asthma started when you changed jobs, improves when you’re away from your work environment, or is triggered by chemicals that make it difficult to breathe, then you may be suffering from occupational asthma.

Occupational factors are associated with up to 15 percent of disabling asthma cases in the United States. An estimated 11 million workers in a wide range of industries are exposed to at least one of the numerous agents known to be associated with occupational asthma. 

More than 250 manufacturing substances have been known to exacerbate occupational asthma, such as:

• Paints
• Cleaning products
• Dust from wood, grain, and flour
• Latex gloves
• Molds
• Fungi

Once you're exposed, the length of time before you experience symptoms may vary. Exposure to a high concentration of irritants can cause asthma within 24 hours. In other cases, it can take months to develop.

According to the National Institutes of Health, the following workers have a high risk for developing occupational asthma: 

• Bakers
• Detergent manufacturers
• Drug manufacturers
• Farmers
• Grain elevator workers
• Farmers
• Laboratory workers
• Metal workers
• Millers
• Plastics workers
• Woodworkers

With Nocturnal Asthma (Nighttime Asthma) Symptoms Are Worse at Night

You may notice that your asthma symptoms worsen at night.

Classified as nocturnal asthma, this type involves the same symptoms as other types of asthma, but they are exacerbated during the evening hours: 

• Coughing
• Wheezing
• Shortness of breath or difficulty breathing
• Inflammation of airway

In a series of surveys of asthmatic patients from different countries, nocturnal asthmatic symptoms were reported in 47 to 75 percent of cases. No matter which type of asthma you have, you may experience difficulties breathing at night. 

It's unclear whether or not there is a circadian rhythm factor or an additional aspect of sleep that makes asthmatic symptoms worse. Some triggers that may make asthmatic symptoms worse in the evening include:

• Having a cold, flu, or virus
• Dust or other allergens
• Smoking
• Acid reflux
• Anti-inflammatory drugs or pain relievers or beta-blockers

Nocturnal asthma has been shown to negatively affect mental performance in children. A study published in the Archives of Diseases in Children found that children whose sleep was disturbed by nocturnal asthma also exhibited signs of psychological problems and impaired functioning in school. 

Fortunately, researchers found that mental function improved when asthma symptoms were treated.

Treatments for nocturnal asthma are much the same as those for other forms of asthma — inhalers and other medications. Research has found that, in patients with hard-to-control nocturnal asthma, continuous positive airway pressure (CPAP) machines can help.  These are worn as a mask, and they work by forcing open airways using mild pressure. They are more commonly used to treat sleep apnea.

Any form of asthma that is not triggered by allergies is termed “nonallergic asthma.” While the symptoms of nonallergic asthma are more or less identical to those of allergic asthma, the triggers are different.

Some common triggers in people with nonallergic asthma include: 

• Infections
• Exercise (see EIB section above)
• Stress
• Changing weather conditions

The treatments for nonallergic asthma are often the same as those for allergic asthma, although the formulations of some inhaled or oral medications may differ.

If someone experiences asthma symptoms more than twice a week, their asthma is termed “persistent.” And among those with persistent asthma, doctors further categorize the condition as mild, intermediate, or severe.

“The symptoms of severe asthma are similar to those of mild asthma, they’re just more frequent and more severe, and require more medications to keep them under control,” says Emily Pennington, MD, a pulmonologist and asthma specialist at the Cleveland Clinic in Ohio.    

Often, if someone’s symptoms require a combination of asthma medications — such as high-dose inhaled corticosteroids as well as longer-acting drugs — that person’s asthma is termed “severe.” The same term applies to people who don’t respond well to treatment. 

“We don’t entirely understand why some people don’t respond as well to medication,” Dr. Pennington says. Genetic and underlying “molecular” factors are likely explanations, she says, but the exact causes of severe asthma are complex and likely vary from one person to the next.

There’s also an informal term, “uncontrolled asthma,” that refers to people whose asthma symptoms are not well managed. This can happen for a number of reasons: 

• Other conditions, such as heart disease, that make asthma hard to manage
• Lifestyle choices, such as the decision to smoke cigarettes, that exacerbate asthma symptoms 
• Not following a doctor’s advice or guidelines when taking medications

These people may need a combination of medications, including oral steroids, to manage their symptoms.

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