Getting to know which kind is causing your symptoms can help you get the best possible treatment.
Although there are numerous types of asthma, they all characterized by 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 persons 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.
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.
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.”
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.”
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.
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.
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.
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.