The Call-On-Doc Guide to Asthma

Asthma symptoms are caused by changes occurring inside the lungs. Current medical understanding identifies three core processes:

Airway Inflammation

Asthma involves chronic inflammation of the airways triggered by allergens, irritants, or infections. This inflammation narrows the airways and makes breathing more difficult.

Airway Hyperresponsiveness

The airways become overly sensitive. When exposed to triggers, immune mediators such as histamine and leukotrienes cause airway muscle contraction, swelling, increased mucus, and heightened nerve sensitivity.

Mucus Overproduction

Inflammation stimulates excess mucus production, further narrowing the airways and worsening airflow obstruction.

Because of these changes, people with asthma often react more strongly to everyday environmental exposures.

Symptoms vary by severity and frequency and may include:

• Shortness of breath

• Wheezing or whistling sounds when breathing

• Persistent or recurrent coughing

• Chest tightness

• Fatigue with activity

Many individuals experience symptoms intermittently, while others have persistent symptoms requiring daily management.

An asthma attack occurs when airway inflammation, muscle tightening, and mucus production worsen suddenly. According to pediatric and adult pulmonary guidelines, symptoms may escalate gradually or occur abruptly and can include:

• Severe shortness of breath

• Chest pain or tightness

• Coughing fits

• Anxiety or panic due to air hunger

• Extreme fatigue

• Bluish discoloration of lips or fingertips (cyanosis in severe cases)

Asthma attacks can be life-threatening and require prompt treatment.

Asthma prevalence varies by age and sex. Asthma is more common in boys during childhood, but after puberty, women are more likely than men to experience asthma. Hormonal influences—particularly estrogen and progesterone—are believed to affect airway inflammation and responsiveness. Many women report worsening symptoms during menstrual cycles, while some experience improvement during pregnancy.

The exact cause of asthma is not fully understood. According to the American Lung Association, risk factors include:

• Family history of asthma or allergies

• Allergic sensitization

• Smoking or vaping

• Obesity

• Occupational or environmental exposures

Adult-onset asthma often presents with more persistent symptoms and may be harder to control.

Common Asthma Triggers

The National Heart, Lung, and Blood Institute identifies common triggers such as:

• Pollen, dust mites, mold, and pet dander

• Smoke and air pollution

• Strong odors or chemicals

• Respiratory infections

• Exercise

• Weather changes

• Stress

• Certain medications

Avoiding triggers is a critical part of asthma management.

Nighttime asthma may be related to circadian hormone changes, increased airway inflammation, post-nasal drip, acid reflux, and environmental exposures such as dust mites in bedding. Poor nighttime control often signals the need for treatment adjustment.

Asthma is diagnosed using:

• Medical history and symptom review

• Physical examination

• Spirometry to measure lung function

• Additional testing such as allergy evaluation or imaging when needed

Diagnosis and ongoing monitoring are essential for proper treatment selection.

Asthma can be classified by type (allergic, non-allergic, exercise-induced, occupational, pediatric, asthma-COPD overlap) and by severity:

• Mild intermittent

• Mild persistent

• Moderate persistent

• Severe persistent

Severity determines treatment intensity.