Types of asthma and what they mean

Anytime you have trouble breathing, it can be scary. Wheezing, struggling to catch your breath, coughing – asthma can make breathing difficult and uncomfortable. In America, one in 13 people has asthma, making it one of the most common health conditions in the country.

Many people know what asthma is generally, but few know that there are actually different types of asthma. We’ll cover the differences between them and what makes them unique, plus the levels of asthma and the ways to manage it so it doesn’t rule your life.

What is asthma?

With each inhale, you draw air into your lungs through a network of branching tubes called airways. When someone has asthma, their airways are always slightly irritated, also known as chronic inflammation. This makes the airways extra sensitive when exposed to one or more stimuli, such as particles in the air, a change in breathing or a shift in the weather. Airways “overreact,” resulting in an asthma attack, during which:

  • The muscles surrounding the airway tighten
  • The lining of the airway swells
  • The airways create too much mucus

These all constrict airflow in and out of the lungs, making it difficult to breathe.

If you’ve had asthma for some time, you may already be familiar with your “triggers,” or the stimuli that cause your asthma symptoms to temporarily worsen. You may have more than one trigger, and triggers can change over time and with the seasons. It can be helpful to know what triggers your asthma so you can minimize your chance of an asthma flare-up.

Common asthma triggers include:

  • Smoking, vaping and secondhand smoke
  • Outdoor air pollution and poor indoor air quality
  • Allergies to dust mites, pollen and pets
  • Illnesses like the common cold, influenza, RSV and sinus infections
  • Acid reflux – commonly known as heartburn – including gastrointestinal reflux disease (GERD)
  • Cleaning and disinfecting products
  • Strong odors and fragrances
  • Mold (whether you’re allergic to it or not)
  • Cockroaches, mice and other household pests
  • Exercise
  • Weather and climate
  • Strong emotions

For more information on asthma triggers, visit the HealthPartners asthma treatment page.

Is asthma genetic?

Medical experts aren’t sure yet what exactly causes asthma, but there’s evidence to suggest that several factors contribute to its occurrence. One of those is genetics. Having a parent with asthma makes you 3-6 times more likely to develop the condition in your lifetime.

Other factors that increase your likelihood of getting asthma include having one or more severe respiratory infections in childhood, having allergies and experiencing socioeconomic challenges. Studies have shown that low-income neighborhoods are subjected to higher concentrations of air pollution because of their proximity to busy roads and manufacturing operations. This air pollution makes it more likely that children born and raised in these areas will develop asthma.

What does asthma feel like?

Depending on the severity of your asthma and the type you have, you may not often feel symptoms. Or you may feel them all the time. Asthma symptoms are different from an attack in that they are mild, but they may lead to an attack if left unaddressed.

Common asthma symptoms are:

  • Stubborn, dry cough
  • Chest tightness or pain
  • Shortness of breath
  • Frequently waking in the night because of coughing
  • Wheezing or whistling sounds when breathing

Signs of an asthma flare-up

An asthma flare-up – also called an asthma attack – is a temporary worsening of asthma symptoms. An asthma flare-up can come on suddenly, or gradually over the course of several days, but an early sign is frequent coughing. In the case of a severe asthma flare-up, someone will be unable to do anything besides cough.

An asthma attack can feel like a band tightening around your chest. Your breathing is fast and shallow, and you just can’t get enough air in or out of your lungs. You might hear a pronounced wheezing or whistling sound coming from your chest as air struggles to squeeze through narrowed airways.

Call 911 or go to the emergency room right away if someone experiencing an asthma attack also has:

  • Symptoms that don’t improve with the use of inhaled medication
  • Breathlessness (panting) even when resting
  • Insufficient breath to speak more than a few words at a time
  • Blue-tinted lips or fingers
  • Visible ribs as they try to draw in air (known as lung retractions)

Types of asthma

The term “asthma” comes from the Greek word for “short of breath.” As recently as the early 20th century, anyone experiencing shortness of breath was considered asthmatic. With continued medical research, our understanding of asthma and other lung diseases has grown and diversified.

We can now differentiate asthma from other conditions that affect the lungs and our breathing, like allergies, COPD, bronchiolitis and cystic fibrosis. We also now know that asthma has varying types based on symptom triggers, symptom frequency and when those symptoms first appeared. Your primary care doctor can use this information to diagnose your lung condition or asthma type.

You can have more than one type of asthma, and the categories listed below can also appear together.

Pediatric or childhood asthma

Asthma frequently develops during childhood, and it’s the most common chronic disease among children. The symptoms of pediatric asthma are very similar to those of adult asthma, but children can have a hard time describing how they feel. This can make childhood asthma a tricky thing to spot. If your child has asthma, they may:

  • Complain of chest discomfort while engaging in physical play
  • Have frequent nighttime coughing fits that keep them awake
  • Feel tired often and become disinterested in their favorite activities

Most cases of childhood asthma can be diagnosed by your child’s primary care doctor. Pediatric asthma is more common in children who also have allergies. Children may outgrow asthma as they enter puberty, but asthma can return in adulthood.

Adult-onset asthma

Asthma can develop at any age, so some people who never had it as children may have it as adults. The most common cause of adult-onset asthma is allergies; when people encounter an allergen for the first time as an adult, it can trigger their asthma. In other cases of adult-onset asthma, a viral infection leaves a cough that just won’t go away. The hormonal changes that women experience during and after pregnancy and menopause can also lead to adult-onset asthma. You’re also more likely to develop asthma as an adult if you’re a frequent smoker or obese.

Children who outgrow asthma may have their asthma return in adulthood.

Allergic asthma

While allergies and asthma don’t always go together (you can have one without the other), it’s more common that they do. People with allergic asthma, also called allergy-induced asthma, have asthma that is triggered by their allergies.

With allergic asthma, an asthma attack is often accompanied by other signs of an allergic reaction, like red, itchy eyes, sneezing and nasal congestion. Allergic asthma can also be triggered by exposure to skin and food allergies.

People with allergy-induced asthma do best with treatments that address both their asthma and allergies. This is why most allergists also treat asthma.

Non-allergic asthma

If you have non-allergic asthma, your symptoms are triggered by things other than allergies – weather, exercise, illness, heartburn, food, certain medicines and stress can all exacerbate your asthma symptoms. This variability makes it difficult to pin down exactly what causes your asthma to flare. It may be helpful to keep a record of when you experience symptoms to start to narrow down your triggers.

Non-allergic asthma is less common than allergic asthma, and it mostly affects adult women.

Exercise-induced asthma

Most people with asthma can have their symptoms triggered by exercise, but exercise-induced asthma can also affect people who don’t have any other type of asthma. This means they only experience asthma symptoms during or after physical activity, and not at any other time. Exercise-induced asthma, also called exercise-induced bronchoconstriction, is commonly triggered by exercising outdoors in cold, dry air. Symptoms typically appear within three minutes of beginning physical activity and should resolve within an hour after stopping.

Asthma can make exercise a bit more complicated, but physical activity is still an important part of most asthma treatment plans and overall health. Exercise can actually improve asthma symptoms by strengthening your lungs, but talk with your doctor about the right kind of exercise for you.

Occupational asthma

Occupational asthma is the result of inhaling irritants at your workplace. These irritants often include chemical gases, fumes and vapors, metal particles, fabrication dust, and other raw materials and byproducts released into the air during various manufacturing processes.

At the onset of occupational asthma, your symptoms can improve when you’re away from the workplace, like over the weekend and while on vacation. However, your asthma can become chronic with prolonged exposure, and you may start to experience frequent symptoms outside the workplace.

Cough variant asthma

Cough variant asthma has just one symptom: a chronic dry cough. A cough is considered chronic for adults after more than eight weeks of no improvement and for children after more than four weeks. People with cough variant asthma often don’t realize they have asthma and will try several cough remedies without finding long-term relief.

Eosinophilic asthma

Eosinophilic asthma, sometimes referred to as e-asthma or eos asthma, is named for the cause of airway inflammation. An “eosinophil” is a type of white blood cell responsible for fighting off infection. In a condition called eosinophilia, the body is overactive in its attack, producing too many of these white blood cells or concentrating them in only one area. Eosinophilic asthma results from too many of these white blood cells gathering in the airways of the lungs.

This type of asthma is most common among people who develop asthma in adulthood.

Nocturnal (nighttime) asthma

Nocturnal asthma isn’t quite its own distinct type of asthma, but more of a common asthma symptom pattern. Asthma symptoms typically get worse at night, either just before bed or as you sleep, waking you up frequently. Most types of asthma are accompanied by nocturnal asthma, and experiencing symptoms at night (or right away in the morning) can be a sign that your asthma is poorly controlled. Nocturnal asthma causes disrupted sleep, which in turn leads to a variety of other issues both during the day and at night.

To prevent nighttime asthma, keep your bedroom cool and use a humidifier to make sure the air doesn’t get too dry. Sleep on your back or left side with your head slightly elevated to keep airways open. You’ll also want to launder your sheets and blankets regularly to keep them free of allergens.

Classifications of asthma based on symptom severity

In addition to asthma types, there are different classifications of asthma based on symptom severity. Your asthma symptoms can fluctuate over time – that’s why it’s important to be familiar with what differentiates one level from the next so you can tell if your asthma is getting better or worse. These asthma classifications also help your health care provider develop a treatment plan that’s right for you.

You may find it helpful to keep a log of the timing and frequency of your asthma symptoms and asthma flare-ups to share with your care provider.

Intermittent asthma

Those with intermittent asthma experience symptoms two or less times a week. Asthma attacks are infrequent and last just a few hours or a few days. Nighttime symptoms are present less than two times a month.

Mild persistent asthma

Those with mild persistent asthma experience symptoms more than two times in a week but not more than once a day. Their activity level is affected by asthma attacks, and they have nighttime symptoms more than twice a month.

Moderate persistent asthma

Those with moderate persistent asthma experience symptoms every day and have to use rescue medication daily. Asthma attacks occur twice a week or more and impact activity levels. They experience nighttime symptoms more than once a week.

Severe persistent asthma

Those with severe persistent asthma experience near-constant symptoms and find little relief from inhaled medications. They can’t partake in many forms of physical activity, and symptoms wake them up almost every night. Asthma attacks are frequent.

When is asthma well controlled or poorly controlled?

Once classified, your asthma can also be categorized as poorly controlled or well controlled, based on how often you feel symptoms and the frequency of your asthma attacks.

Your asthma is well controlled if:

  • Asthma symptoms don’t wake you or keep you awake at night.
  • Your daily activities, including exercise, are not interrupted by asthma symptoms.
  • You use quick-relief inhaled medication two times or less in a week.

Your asthma is poorly controlled if:

  • Your asthma frequently wakes you from sleep and keeps you up at night.
  • Coughing and difficulty breathing affect your ability to participate in daily activities, including exercise, work and school.
  • You use quick-relief inhaled medication more than two times a week.

What makes asthma “difficult to control”?

We can’t always control our environment, and we certainly can’t control the weather. It’s important to know that an asthma attack is hardly ever your fault, but it’s an indication that there may be other things you can do to better manage your condition.

So, if there’s no avoiding secondhand smoke, cats and dogs, thunderstorms and high humidity, air pollution, or stressful situations, you can make sure to always have your inhaler with you and take your controller medication regularly. Difficult asthma is different from severe asthma in that you should find relief and symptom improvement by following an asthma care plan.

Life is unpredictable, and people with asthma should be able to experience it all. That’s why it’s important to have treatment strategies when you find yourself in uncertain circumstances.

Treating asthma

There’s no cure for asthma currently, but you can usually successfully control it. Asthma is a lifelong condition, meaning it’s unlikely to ever go away, but the ways we have to manage it continue to improve.

Asthma medications take many forms, and most treatment plans involve using them in combination. The most common types are quick-relief medication (also called rescue medication) and long-term medications (also called controller medication). Rescue medicines provide immediate symptom relief, whereas controller medicines are taken for long-term symptom reduction, even when symptoms are not present.

These medicines are taken using an inhaler or nebulizer, but there are also pills or injectables available for those with more severe asthma. To learn more about asthma medication, visit the HealthPartners asthma treatment page.

Use devices

The following devices are available for asthma control:

  • Nebulizer: A nebulizer is a device that converts liquid asthma medicine into vapor that you can inhale through a mask or mouthpiece.
  • Inhaler: An inhaler is a small, portable device that sends medication into your lungs through a vapor puff that you inhale. You can choose to use your inhaler with a spacer, which goes between you and the inhaler mouthpiece. It makes it a little easier for people to breathe in the medicine.

Work with your doctor to ensure you’re using them correctly.

Incorporate lifestyle changes

Making certain changes to your lifestyle is one of the best ways to manage your asthma:

  • Create an asthma action plan: An asthma action plan is a written record of your unique asthma symptoms and asthma attack signals, as well as the steps you can take to calm symptoms or recover from an asthma attack. It’s usually created in partnership with your primary care doctor.
  • Reduce your exposure to triggers: It’s impossible to avoid your asthma triggers entirely, but you can take conscious steps to try and lessen the likelihood that you’ll encounter them. For example, if your asthma is reactive to allergens, you should designate an allergen-free space in your home, ideally your bedroom. It’s also important to avoid smoking or vaping of any kind.
  • Exercise: Consistent exercise can improve asthma symptoms by increasing lung capacity and strength. Talk to your primary care doctor about what steps to take before, during and after exercise to prevent flare-ups. This may include pulmonary rehabilitation.
  • Diet: An anti-inflammatory diet focused on lean meat, vegetables, fruit and whole grains can also help ease asthma symptoms.
  • Monitor your lung function and asthma symptoms: People with asthma may find it helpful to keep a log of asthma flare-ups, including possible triggers, if it happened during the day or night, and if it required rescue medication. You can use a journal, but there are also several mobile apps available.

Next steps for managing your asthma

Your asthma is unique like you, but this individuality can lead to frustration as you try to manage the condition. It may feel like no one understands or identifies with how you experience asthma.

Your primary care doctor can offer support, guidance and a personalized treatment plan as you navigate your care, or give you a diagnosis if you’re not sure whether you have asthma. Depending on the type and severity of your asthma, your primary care doctor may refer you to an asthma specialist for more advanced care.