8 Types of Asthma–and What to Know About Each
Even though there are different types of asthma, they all involve the same basic process: The muscles around your airways tighten, making it difficult to breathe and bringing on additional symptoms of wheezing, coughing, chest tightness, or rapid breathing.
The different types are based on what triggers the symptoms, when they occur, or if there’s a predominant symptom. Some people have more than one type of asthma, and knowing the differences can help dictate treatment.
“It’s key to know what is driving the asthma or exacerbating it to achieve best asthma control,” says Andrew Rorie, MD, assistant professor of allergy and immunology at the University of Nebraska Medical Center in Omaha.
Here, we break down the different types of asthma you should know about.
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Allergic asthma is the most common type of asthma, afflicting as many as 80% of people with the condition, says Alan Mensch, MD, a pulmonologist and senior vice president of medical affairs at Plainview and Syosset Hospitals in Long Island, New York. In people with allergic asthma, coming into contact with an allergen sets off an immune reaction that causes your airways to swell. That, in turn, can precipitate an asthma attack. Through skin tests and other lab work, your doctor can help pinpoint exactly what you’re allergic to that’s causing your symptoms. That’s important, says Dr. Rorie, “because we want patients to have the ability to avoid allergic triggers.”
Non-allergic asthma is similar to allergic asthma in that something irritates the airways, but the symptoms don’t come from an immune system response. Instead, your airways are simply hypersensitive to different triggers. Common asthma-inducing irritants include respiratory infections like a cold or the flu, exercise, tobacco smoke, stress, cold or dry air, and even strong odors. Stay away from irritants when you can, and always make sure you have your rescue medications with you.
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Also called exercise-induced bronchoconstriction (EIB), this is shortness of breath or wheezing triggered by exercise, especially if it’s done in cold, dry air. The symptoms usually start a few minutes after you begin exerting yourself and may go on for an extra 10 or 15 minutes after you finish. Coughing is the most common symptom of exercise-induced asthma.
Ideally, your doctor should be able to treat you so you can continue to do any exercise you want, says Dr. Rorie. But to be extra careful, sports that involve shorter bursts of energy (like volleyball and baseball) are less likely to exacerbate asthma than those that require lengthier endurance (like running marathons) or that take place in cold weather. Also, says Dr. Rorie, “doing a slow warm-up is helpful.”
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As many as 5% of people with asthma have aspirin-induced asthma, which occurs when taking aspirin triggers an asthma attack. Other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil) or naproxen (Aleve) can also set off asthma symptoms. If you have this type of asthma, research suggests that the offending NSAIDs make your body produce excess amounts of a type of chemical that causes the squeezing around your airways. People with nasal polyps are more likely to have aspirin-induced asthma. “It can be very, very severe or even life-threatening,” says Dr. Rorie. Stay away from NSAIDs if you have this asthma type; acetaminophen (Tylenol) should be safe.
While asthma is more common in childhood, it can also develop during adulthood, called adult-onset asthma. “It can happen at almost any age,” says Dr. Mensch. Children can supposedly “outgrow” asthma, then get it back as adults, usually in middle age. “Some people say, ‘I never had asthma as a child’ but when you go back in their history, they remember, ‘Oh yeah, I did have some wheezing,’” Dr. Mensch says.
Adult-onset asthma is less likely to be allergy-driven. It can be a result of hormonal fluctuations, illnesses, and infections–and it can be more difficult to treat than childhood asthma. Adult-onset asthma is sometimes confused with other conditions like heart disease, chronic obstructive pulmonary disease (COPD), and bronchitis; it’s important to know if you have any of these conditions so as to prevent serious consequences.
Wheezing and shortness of breath are considered classic asthma symptoms. And while many people with asthma also experience coughing, it’s the main symptom in cough-variant asthma. Because many people, including doctors, often don’t think of coughing as the first sign someone has asthma, this type can easily be misdiagnosed, says Dr. Rorie. Cough-variant asthma is triggered by many of the same things as other types of asthma–viruses, allergens, exercise, and more–but can be more difficult to treat than other asthma types. You’re going to want to make sure you get the right diagnosis and the right treatment.
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People in certain occupations are more prone to developing asthma as adults. Others may already have asthma–or had it as children–and find their symptoms are exacerbated by their work environment. Certain occupations seem especially prone to asthma, including baking, farming, and working in metal, wood, and plastics industries. You may be able to recognize this type of asthma if symptoms get worse on days you work compared to weekends and vacations (although sometimes symptoms also turn up when you’re off the clock). With the proper diagnosis and help from your doctor (and employer), you might be able to make changes in your work environment to manage your triggers.
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Nighttime (nocturnal) asthma
As the name implies, nocturnal or nighttime asthma is asthma that gets worse at night. It may be influenced by hormones that wax and wane as part of the sleep-wake cycle, but it may also be caused by acid reflux, says Dr. Mensch. When you lie down, it’s easier for acid in your stomach to ease up into your esophagus, making you cough. Nocturnal asthma may also be “an indicator that people have generally poorly controlled asthma at baseline,” says Dr. Rorie. Regardless, it needs to be treated.
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If your body suddenly goes a little bonkers when you take NSAIDs, get in to see your doctor ASAP. They can diagnose you with AERD based on your symptoms, or even by having you take aspirin and evaluating your body’s response in a safe environment. Treatment is aimed at reducing your asthma symptoms, controlling the nasal polyps, and potentially increasing your aspirin tolerance—but your doctor can come up with the right plan for you.
3. Exercise-induced asthma
It’s possible to have “regular” asthma and, as a result, struggle to breathe when you work out. It’s also possible to only struggle with asthma symptoms when you exercise. This is a condition known as exercise-induced bronchoconstriction but more commonly called exercise-induced asthma, according to the Mayo Clinic.
Exercise-induced bronchoconstriction is different from needing to catch your breath when you’re working out really hard, which is just a normal part of busting your butt at the gym. People with exercise-induced bronchoconstriction generally experience symptoms like coughing and wheezing, shortness of breath, chest tightness or pain, or excessive fatigue when they exercise, the Mayo Clinic says. They can also feel seriously out of shape even when they’re not, and symptoms can continue after they stop working out, making exercise feel like a real punishment.
While any kind of workout can exacerbate exercise-induced bronchoconstriction, being active in dry, cold air can especially irritate a person’s airways and cause symptoms, Emily Pennington, M.D., a pulmonologist at the Cleveland Clinic, tells SELF. So can exercising when exposed to potential irritants like air pollution, pollen, and chlorine in swimming pools, or when you have any kind of respiratory infection, like a cold.
If you suspect exercise-induced bronchoconstriction is behind your colossally difficult workouts, see your doctor. They may recommend an inhaler you can use before working out to open or relax your airways, a long-term medication to calm airway inflammation, or another form of treatment that will make it easier to work up a sweat. Here’s more information on how to keep exercise-induced bronchoconstriction from ruining your workouts.
4. Occupational asthma
Some people work in environments that can prompt asthma symptoms. If you’re one of them, you might already have asthma and deal with increased symptoms due to your job, or you may develop them over time with repeated exposure to irritants at work, Dr. Pennington says.
Anyone can develop occupational asthma, but the U.S. National Library of Medicine says these people are at the greatest risk:
- Detergent manufacturers
- Drug manufacturers
- Grain elevator workers
- Laboratory workers (especially those working with laboratory animals)
- Metal workers
- Plastics workers
The best treatment is to avoid your triggers, Jamie Kiehm, M.D., and allergist and immunologist at ENT and Allergy Associates, tells SELF, but obviously that can be tough when we’re talking about your job. Since you probably just can’t up and quit, it may help to wear a face mask when you work and take medications to help your airways function well, Dr. Pennington says, which you can ask your doctor about. And, if it’s at all possible, consider trying to get transferred to a different site at your work where you’re not as exposed to your trigger, or think about other ways to prevent asthma flares on the job.
5. Emotion-related asthma
OK, so this isn’t technically a type of asthma like the others—it’s more about how strong emotions can trigger asthma. Still, it’s surprising enough that we’d be remiss to leave it out.
Researchers Define 3 Types of Severe Asthma
For the first time, a group of European researchers has succeeded in defining three distinct types of severe asthma by analyzing sputum samples from a group of patients, according to research presented at ERS 2015.
Researchers have taken the first step towards understanding how the different categories of patients vary in terms of what is causing their severe asthma, and that in the long term this would enable the development of drugs tailored to each category, as well as help identify existing drugs that could be used to help a particular group of patients.
“We knew that each new treatment does not work in all people with the disease, which is why we decided to undertake sputum ‘handprinting’ in 72 people across the severity of asthma, including smokers,” said Diane Lefaudeux, a research engineer at the European Institute of Systems Biology and Medicine, Lyon, France.
The research was carried out by U-BIOPRED (Unbiased BIOmarkers in PREDiction of respiratory disease outcomes), a public/private partnership, using information and samples from European adults and children in order to learn more about the different types of asthma.
For their research on severe asthma, the scientists analyzed patient sputum samples using gene expression measurements (transcriptomics), abundance of proteins (focused and non-focused proteomics), and measurements of abundance of certain lipids (focused lipidomics).
“Each ‘omic’ type brings a different and complementary piece of information concerning the biology of asthma and severe asthma, leading to the combination of fingerprints which make up the handprint of disease,” said Lefaudeux.
Difficult-to-treat asthma affects about 5% of the 30 million European asthma sufferers, and of those probably about half a million suffer from severe asthma, said the researchers. “We presume that severe asthma develops in patients who already have asthma and therefore the question is: what drives the evolution? We now believe that there may be a number of causes, since we have found that severe asthma consists of a number of different phenotypes,” said Lefaudeux.
The researchers intend to follow up their work by linking their findings to the large amount of clinical data and additional ‘omics’ data types that has been collected by the clinical centres of U-BIOPRED. Further and deeper analyses and interpretation of these data will help to understand the underlying biology of the newly identified groups of severe asthma patients.
Asthma affects people all over the world and of all ages – in Canada, it is the third-most common chronic disease. It affects more than 3.8 million people. Tragically, 317 Canadians are diagnosed with asthma every day, and every week, 4 Canadians die from an asthma attack. But, with proper asthma management, people can live healthy and active lives.
What is Asthma?
Asthma is a chronic or long-term disease of the airways, the tubes that carry air into our lungs. It causes inflammation and narrowing of the bronchial tubes that leads to airflow limitation.
The airways of our lungs are surrounded by muscles and contain mucus glands. These muscles are normally relaxed but if you have asthma, they are often sensitive and inflamed.
When people with asthma encounter triggers, these muscles react by tightening even more, the lining of the airways swell and the airways can fill up with mucus. This makes breathing very difficult and leads to asthma symptoms or an asthma attack.
Asthma is caused by two types of triggers (a trigger is anything that irritates your airways):
- Allergic, caused by inflammatory triggers such as dust mites, pollens, moulds, pet dander, viral infections
- Non-allergic, triggered by smoke, exercise, cold air, certain air pollutants, intense emotions
Asthma can be different for everyone. Asthma symptoms can also vary over time, with few or no symptoms when asthma is well-controlled. The most common symptoms include:
Regular coughing often occurs at night or early in the morning, although it can happen at any time of day. Coughing is a major feature of asthma, especially in children. Sometimes, persistent coughing can be the only sign of asthma.
Wheezing is a breathing with difficulty and with a whistling sound coming from your airways.
Shortness of breath gives you the feeling that you cannot breathe well enough. You may even find it difficult to eat, sleep or speak.
Chest tightness is an unpleasant feeling of heaviness or pressure in the chest. It can make breathing more difficult.
Increased mucous production is characterized by high levels of a thick fluid accumulated in your airways.
These symptoms can occur slowly over hours or days, or they can come on as sudden, recurring attacks after which the symptoms can persist for some time before disappearing. If left untreated, asthma can cause permanent structural changes in your airways called – “airway remodelling,” – which is why it is important to get asthma under control and keep treating it over the long term.
What Causes Asthma?
Nobody can say for sure what causes asthma. However, researchers have determined that the following risk factors can lead to asthma development:
- Family history/genetics
Children of mothers with asthma are 3 times more likely to suffer from asthma, and 2.5 times more likely if the father has asthma. More than 30 genes have been linked to asthma so far, and gene-gene interactions, gene-environment interactions and epigenetic modifications also play a part. Genetic differences also play a role in differences in response to treatment.
People are more likely to have asthma if they have certain types of allergies, such ones which can affect the eyes and nose. However, not everyone who has allergies will get asthma and not everyone who has asthma is affected by allergies. Respiratory allergies as well as some types of asthma are related to an antibody called immunoglobulin E (IgE), which the immune system produces in response to allergens. To protect the body, the IgE causes allergic reactions that can affect the eyes, nose, throat, lungs and skin.
- Premature birth
Children born before 37 weeks are at increased risk of developing asthma later.
- Lung infections
Babies or little children may be at risk of developing asthma later if they had certain lung infections at a very early age.
- Occupational exposures
There are more than 200 substances including gases, dust particles and chemical fumes and vapours that can cause asthma in the workplace. This type of asthma known as occupational asthma is a common cause of adult onset asthma.
Some women can develop adult onset asthma during or after menopause.
Smoking, exhaust fumes and airborne particulate matter can be linked to causing asthma.
Extra weight around the chest might squeeze the lungs and make it more difficult to inhale. Fat tissue produces inflammatory substances that might influence the lungs and affect asthma.
Diagnosis and Lung Tests
Symptoms observed upon physical exam, medical, and family history may support a diagnosis of asthma. Other lung conditions have similar symptoms, which your healthcare practitioner may have to rule out. It is important to explain all of your concerns and to ask any questions you may have. Something you think is not important may be useful in pinpointing the problem.
Only a healthcare provider can diagnose asthma. Conditions such as pneumonia, cystic fibrosis, heart disease, and chronic obstructive pulmonary disease (COPD) have to be ruled out before your doctor can be certain that you have asthma.
To confirm the diagnosis, your healthcare provider may ask you to do breathing tests. They check how well your lungs perform and how asthma affects your breathing. These lung function tests include spirometry breathing tests and peak flow breathing tests.
What is spirometry?
Spirometry is a type of pulmonary function test (PFT) used to diagnose lung conditions like asthma and COPD. A spirometer measures the amount of air you can breathe out in one second and the total volume of air you can exhale in one forced breath.
How is a spirometry test performed?
- You will sit upright
- You will be given a clip to place on your nose
- You will be given a plastic mouthpiece connected to a spirometer
- You will place the mouthpiece in your mouth and create a tight seal with your lips
- You will take a deep breath in and then blow out as hard and fast as you can until you can’t blow out any more
- You will do the test several times, until the best result is recorded
- You will take some puffs of a bronchodilator medication
- After 15 minutes, you will do the test again, to see if the medication helps your breathing. If your results are much better after taking the medication, you may have asthma.
Your healthcare provider will explain your results.
*Infants and small children under 5 to 6 years old usually cannot do the spirometry test.
How to prepare for spirometry tests?
Your healthcare provider will give you detailed instructions prior to the test. Generally, you will be asked to refrain from using certain inhalers for a period of time prior to the test. If you are a smoker, you will be asked to refrain from smoking for a period of time prior to the test. For support to quit smoking, visit You can quit smoking. We can help.
What is a peak flow meter?
A Peak Flow Meter estimates the Peak Expiratory Flow Rate, which is a measure of the fastest speed at which you can exhale the air from your lungs, after inhaling a big breath. The measurement relates to how well the air is moving through your airways, so if asthma is present with airway inflammation or bronchoconstriction, the peak flow levels will be lower. Three peak flows are measured in succession and the best reading is recorded.
Using the Asthma Monitor for these measurements allows you to monitor your asthma on a day to day basis and will help determine the effectiveness of prescribed anti-inflammatory (controller) medications.
If you are diagnosed with asthma, a healthcare practitioner will
Create a customized treatment plan known as an Asthma Action Plan that fits your particular needs, lifestyle and triggers, as well as the frequency and intensity of your symptoms.
If necessary, refer you to other healthcare professionals – individuals who can help you with specific aspects of asthma treatment and management.
Prescribe you asthma medicines to minimize your symptoms.
Recommend that you visit regularly so that your symptoms can be monitored and your treatment adjusted if necessary.
Preparing for Your Appointment
You can get the most out of your time with your healthcare provider by planning carefully before you go.
Things you can do to prepare for your appointments include bringing:
- A list of your most recent symptoms, including notes about whether they’ve changed since your last visit
- A record of your recent peak flow meter readings or symptom diary records
- Your Asthma Action Plan so that you and your doctor can develop a plan. If you already have one, then bring it in case it needs to be modified
- Your inhaler(s) to review your technique
- A list of any questions you have, e.g. What makes my asthma worse? Is it okay to keep playing a sport? What should I do if I have an asthma attack?
Can Asthma Be Cured?
Despite advances in understanding the disease, and the availability of more efficacious medications, asthma is still a major cause of morbidity. This is often a result of under-diagnosis, under-treatment, lack of public understanding and knowledge about the disease, and inadequate asthma supervision.
There is still much research that needs to be done to fully understand how to prevent, treat and cure asthma. Even though most people with asthma do not die as a result of the disease, they may spend part of their daily lives coping with the symptoms. But, with proper management, people can live healthy and active lives.