What is Asthma? How to Recognise the Symptoms and Early Warning Signs

Asthma is a complex yet common condition, affecting as many as 1 in 9 Australians, and 1 in 4 children develop asthma sometime in their childhood. Whilst there’s no cure for the illness, there are ways you can learn to control your triggers. Here’s how to spot the early warning signs, and some helpful tips on how to manage your asthma symptoms effectively.

What is asthma?

Asthma is a common medical condition that affects the airways (the breathing tubes that carry air into our lungs). 1 in 9 Australians suffer with asthma, and 1 in 4 children develop asthma sometime in their childhood. However, any adult can get asthma, even if you didn’t have it as a child.

For people with asthma, their airways are sensitive to certain triggers — such as pollen, dust, smoke, irritants like chemicals and cleaning products, physical activity, and infection from bacteria or viruses — which then cause their airways to become inflamed. Inflamed airways make it difficult to breathe, which is why asthma suffers often experience symptoms like wheezing, coughing or breathlessness.

When exposed to the trigger, the airways in the lungs become much narrower, which means less air can get through, making it harder to breathe in and out.

At times, asthma can flare up, meaning the symptoms start up or get worse, compared to usual. This is also known as an ‘asthma attack’. Some asthma sufferers describe asthma attacks as feeling as though you are breathing through a thin straw. A flare-up can come on slowly over hours, days, or even weeks, or quickly over minutes.

The term can be a little confusing, because it means different things to different people – for some people an attack can be a bout of severe wheezing after exercising, and for others, it can be as severe as being admitted to hospital.

Either way, symptoms of an asthma attack won’t go away on their own; they need treatment. If it’s not treated properly, an asthma flare-up can become serious, even for someone whose asthma is usually mild or well controlled.

A severe flare-up requires urgent treatment by a doctor or hospital emergency department.

If you or someone else show signs of a severe asthma attack, call triple zero (000) immediately and ask for an ambulance.

What are the symptoms of asthma?

Asthma symptoms can differ from person to person — it’s a complex condition that impacts everyone differently, and there are also varying different types (see below).

Some people experience asthma symptoms as a child, others develop the condition in later life. Some people have symptoms often, others for short periods of time. It’s a tricky condition to understand, but the key is understanding your individual symptoms so that you can effectively manage the illness.

Whilst symptoms vary from person to person, the most common symptoms to look out for are:

• Persistent cough
• Wheezing – making a high pitch whistling sound whilst breathing (caused by narrowing of airways)
• Difficult breathing – feeling breathless, even while resting, or being unable to finish full sentences before needing to take another breath
• Tightness in the chest / chest pain

If these symptoms worsen, they can develop into an asthma attack. If the symptoms above become worse, and/or you notice more any of the more serious symptoms below, call an ambulance immediately:

• Difficulty speaking in complete sentences
• Pale skin
• Anxiety, distress or a sense of panic
• Exhaustion, difficulty walking, or even limp due to shortness of breath
• Deep sucking motions at the throat or chest while trying to breathe
• Cyanosis (blue lips, toes, or fingers)

Why do some people get asthma?

One in every nine Australians have asthma – around 2.7 million of us. But because the illness is so complex — with different types of asthma and varying individual symptoms — experts don’t know exactly why some people suffer with asthma, while others do not.

They do know, however, that asthma tends to run in families, and a child’s risk of developing asthma is significantly increased by mothers who smoke while pregnant, or smoke around their young children.

Other risk factors for developing the condition include premature birth or low birth weight, or over exposure to air pollution or mould.

Adults, however, can also develop asthma over time from indoor air pollution at work or home (for example, by breathing fumes that irritate the lungs, or breathing in dusts that they’re allergic to).

Athletes can also develop asthma after very intensive training over several years, while breathing in polluted, cold or dry air.

Asthma can be allergic or non-allergic — meaning some people’s symptoms develop as a result of an allergic reaction (like pollen or dust), while others are triggered by exercise, infections, cold air, gastroesophageal reflux disease or stress.

Allergic asthma is the most common type of asthma, and is more common in families with asthma and allergies.

What triggers asthma?

Common triggers of asthma include:

• allergens such as pollen, dust, food items and mould (allergic asthma)
• smoke from cigarettes, bushfires and traffic pollution other irritants such as cleaning products, perfumes, aerosol products and certain workplace chemicals
• physical activity (referred to as exercise-induced asthma)
• infection from viruses (such as cold or flu)

What are the different types of asthma?

There are several different types of asthma. Whilst for the majority of asthma sufferers they will display many of the common symptoms listed above, there are other types of asthma that present their own unique set of triggers and symptoms, and require specific diagnosis and treatment.

The most common types of asthma are:

• Allergic asthma – caused by allergens such as pollen, dust, food items, and mould. Alongside classic asthma symptoms, additional symptoms can include nasal congestion, runny nose, scratchy throat, sneezing, itchy, red, and/watery eyes.
• Non-allergic asthma – caused by irritants such as viruses, air particles from smoke, cleaning products, perfumes, and aerosol products. Symptoms are generally the same as classic asthma symptoms.
• Occupational asthma – caused by workplace triggers such as chemicals, animal proteins, fumes, etc. People with allergic asthma often develop occupational rhinitis (nasal allergy) symptoms prior to the onset of OA symptoms.
• Exercise-induced asthma – usually caused by physical activities. Alongside classic asthma symptoms, additional symptoms can include decreased endurance, upset stomach, and sore throat.
• Nocturnal asthma – symptoms that worsen at night, possible cause includes dust mites, heartburn or sleep cycle. No additional symptoms, other than they are more prominent at night, and sleep is generally interrupted.

Each type of asthma is brought on by a specific set of triggers, but the severity of each person’s asthmatic response will differ from person to person.
These responses are usually identified as:

• Mild intermittent. This is quite common for most asthma sufferers, and doesn’t usually interfere with daily activities. Symptoms are mild, lasting fewer than two days per week or two nights per month.
• Mild persistent. When symptoms occur more than twice a week — but not daily — and up to four nights per month.
• Moderate persistent. The symptoms occur daily and at least one night every week, but not nightly. They may limit some daily activities.
• Severe persistent. Symptoms occur several times every day and most nights. Daily activities are extremely limited. This is not a diagnosis of ‘Severe Asthma’ this is a different classification of asthma and very difficult to treat.

It’s also possible to have more than one type of asthma. You could have, for example, both non-allergic and nocturnal asthma at the same time.

Symptoms can also come on at different times in life. Some in childhood, some in adulthood. Or, in the case of allergic asthma, they tend to worsen with the seasons i.e. pollen counts in spring/summer or mould and cold temperatures during winter.

It’s also worth noting that respiratory infections (e.g., cold, flu) are rife during winter, and they tend to hit asthma sufferers the worst. In fact, the common cold is behind around 4 out of 5 bad asthma attacks.

Anyone who suffers with asthma should take preventative measures to lower their risk of infection. Take a look at the National Asthma Council’s Asthma Winter Checklist for further information.

Diagnosing asthma

There’s no one single test for asthma, your doctor will assess your medical history, your family history (if any of your relatives suffer with asthma or allergies) and issue breathing tests using a spirometer machine, to determine how well your lungs are working.

The spirometer measures the amount of air pushed through the tube, as well as lung capacity and other measurements. Most children over 5 can do this test, but younger children, or children who find breathing tests difficult may be prescribed asthma medication first (referred to as a ‘treatment trial’).

Your doctor will then monitor the effect of this medicine to make a diagnosis. Asthma is likely to be diagnosed if the symptoms improve quickly with reliever medication.

Your doctor may also issue allergy tests. Asthma is strongly linked to allergies — allergic asthma is the most common type of asthma — so your asthma is more likely to be diagnosed if your symptoms are triggered by known allergies, or occur at the same time each year (seasonal).

Asthma is also more likely to be diagnosed if you have eczema or hayfever, and if your symptoms:

• keep coming back, or happen at the same time each year
• are worse at night or in the early morning
• are clearly triggered by exercise, allergies or infections, or have a seasonal pattern
• improve quickly with reliever medication

What are the treatments for asthma?

Whilst there is no cure for asthma, there are a number of treatment options to help manage and control your symptoms. These effective treatments work to keep your lungs healthy, prevent asthma symptoms from interfering with everyday life, and to help prevent flare-ups of asthma attacks. Treatments typically include:

Medication

The three main types of asthma medication — relievers, preventers and controllers.

Every child, adolescent or adult with asthma should carry a reliever inhaler (e.g. puffer) with them all times, so they can use straight away if they experience asthma symptoms. They work within minutes and the effects can last up to four hours.

Along with a reliever inhaler, most adults and adolescents, and some children, also need to take daily asthma preventer medicine to reduce their risk of flare-ups (asthma attacks). Most preventers contain inhaled corticosteroids – a type of medicine that soothes inflammation inside the lungs.

Asthma controller medicine helps to control asthma by correcting the underlying changes in the airways, such as swelling and excess mucus. These are usually prescribed when a preventer medication isn’t enough. They work in a similar way to asthma reliever medications, but they last longer, and are often combined with a preventer medicine into a single inhaler.

Learning and avoiding your asthma triggers

Asthma symptoms are brought on by certain triggers, and whilst they vary from person to person, learning which ones trigger your asthma can help to control and manage your symptoms. Once you identify your triggers, you can try to avoid them to help keep your symptoms to minimum.

If you are unsure what your asthma triggers are, you can take a look at the National Asthma Council’s list of potential triggers to help identify which ones are most relevant to you.

Write an Asthma Action Plan

It’s also beneficial to devise a personalised Asthma Action Plan (a written set of medical advised instructions) based on your individual asthma symptoms. Your doctor will be able to help you with this.

They will first, sit down with you to talk about your asthma patterns, triggers, and how you currently manage your symptoms. They will then devise a written set of instructions that includes a list of your current asthma medications and doses, guidance on what to do should your asthma flare up, or if you have an asthma emergency, and your doctor’s contact details.

A written Asthma Action Plan helps you recognise when your asthma is getting worse and what to do about it. Keep this plan somewhere easy to find, and you should also make close friends or family aware of your plan, so they know what to do in an emergency.

Adults should have their Asthma Action Plan reviewed every year.

Here are some examples of Asthma Action Plans to refer to:

Asthma.org.au Asthma Action Plan

Nationalasthma.org.au Asthma Action Plan

Can you prevent asthma?

Whist you can’t entirely prevent asthma, there are some effective ways to reduce your risk of an asthma attack, and to help manage and minimise your symptoms.
Here are some practical tips from healthdirect.gov.au to help you breathe easily and live your live to the full.

• Get vaccinated: Covid, flu and other respiratory viruses are common triggers for asthma, so getting vaccinated regularly will help to protect you against any illness or infection that can make your asthma symptoms worse.
  
  
• Manage your allergies: asthma and allergies are closely linked, so try to avoid anything that triggers your allergies as these can make your asthma symptoms worse. As an added precaution, take allergy medication, like antihistamines for hayfever, to reduce your symptoms.
  
  
• Quit smoking: quit smoking if you smoke, and avoid any second-hand smoke (passive smoking).
  
  
• Eat healthily: being overweight or obese makes asthma harder to manage, so stick to a healthy, nutritional diet to maintain a healthy weight.
  
  
• Take care of yourself: living with asthma can be distressing, particularly when symptoms are severe. Asthma is commonly associated with increased risk of anxiety and depression. If you are feeling sad, anxious or withdrawn, reach out to a friend or make an appointment with your GP who will be able to help.
  
  
• See your doctor regularly: asthma needs to be regularly assessed and managed, and your medication needs may change over time. Ensure your asthma action plan is up to date by checking in with your doctor regularly.

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