Asthma — Triggers, Diagnosis and Treatment

A cough that keeps you awake at night, a tight chest after climbing stairs, a whistling sound when you breathe out — these are some of the most common reasons patients walk into my clinic. Very often, the answer is asthma.

What is asthma?

Asthma is a chronic inflammatory condition of the airways. The lining of the bronchial tubes becomes swollen and over-sensitive, the surrounding muscles tighten, and extra mucus is produced. The result is narrowed airways and difficulty moving air in and out of the lungs.

The key feature is that this narrowing is variable and reversible. You may feel completely well for weeks and then have a flare-up after a trigger. Asthma can start in childhood or appear for the first time in adulthood.

Common triggers

Triggers differ from person to person. In allergic asthma, the immune system overreacts to harmless substances. The most common triggers I see include:

• Dust mites, pollen, mold, and pet dander
• Cigarette smoke, dust, fumes, and air pollution
• Viral respiratory infections such as colds and flu
• Cold air and exercise
• Strong smells, perfumes, and cleaning products
• Certain medicines, including aspirin and other NSAIDs, and beta blockers
• Stress, strong emotions, and uncontrolled acid reflux

Symptoms to look for

Typical symptoms include a high-pitched wheeze (especially when breathing out), a persistent dry cough, chest tightness, and shortness of breath. Symptoms are often worse at night or in the early morning, and may flare with exercise or exposure to a trigger.

How is asthma diagnosed?

Diagnosis starts with a careful history and examination: when the symptoms occur, what sets them off, and whether there is a family history of asthma, eczema, or allergies. Objective testing then confirms it.

Spirometry

Spirometry is the main test. You blow out as hard and as fast as possible into a device that measures how much air you exhale (FVC) and how much you exhale in the first second (FEV1). A low FEV1/FVC ratio suggests airflow obstruction. If the FEV1 improves significantly after a bronchodilator — usually by 12% and 200 mL or more — that reversibility strongly supports asthma.

Peak flow monitoring

A peak flow meter is a small handheld device that measures how fast you can blow air out. Readings taken morning and evening over a couple of weeks show whether your airflow varies from day to day, which is typical of asthma. It is also useful at home to track control once you are diagnosed.

Treatment: inhalers

Asthma cannot be cured, but it can be controlled very well. Most treatment is delivered by an inhaler, which sends the medicine directly to the airways. Using a spacer makes this easier and more effective, especially for children.

• Reliever inhalers are fast-acting bronchodilators such as salbutamol. They relax the airway muscles within minutes and relieve wheeze and breathlessness.
• Controller inhalers contain inhaled corticosteroids, which reduce airway inflammation and are taken regularly, even when you feel well.
• Combination inhalers pair a steroid with a long-acting bronchodilator for moderate or persistent asthma.

Current guidelines, including GINA, advise against relying on a reliever alone, because untreated inflammation raises the risk of severe attacks. If you need your reliever more than twice a week, your asthma is not well controlled and your treatment should be reviewed. Allergic asthma may also benefit from allergen avoidance and, in selected cases, additional therapies.