7 types of asthma and how to treat each one
- Types of asthma include allergic asthma, exercise-induced asthma, cough-variant asthma, asthma-COPD overlap, nocturnal asthma, occupational asthma, and non-allergic asthma.
- Some of the jobs that carry the greatest risk for occupational asthma include animal handling, farming, and food production, since they all involve inhaling particulates that could irritate the lungs.
- If your main asthma symptom is a persistent dry cough, without typical signs of wheezing, then you may have cough-variant asthma.
- This article was reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine.
Asthma is a chronic respiratory disease that affects more than 25 million people in the US. Asthma generally causes swelling of your airways, making it harder to breathe and causing symptoms like coughing.
However, there are many different types of asthma, like allergic or occupational asthma, that can have a variety of symptoms. Finding out which type of asthma you have can help you figure out the best way to treat it.
Here is what you need to know about the different types of asthma and how each is treated.
Allergic asthma
Allergic asthma is the most common type of asthma, and affects about 60% of asthmatics in the US. If you have allergic asthma, your symptoms, like coughing or struggling to breathe, are triggered when you breathe in allergens.
Some of the most common allergens are:
- Pollen
- Dust mites
- Mold
- Pet dander
When you are exposed to these triggers, your immune system interprets them as harmful invaders and releases antibodies that cause your airway to swell up and become narrower, making it harder for you to breathe.
Your doctor can determine what allergen triggers your symptoms by doing blood or skin tests. If you have allergic asthma, you will need to avoid allergy triggers and you may need to take a prescription medication like Montelukast (Singulair), which helps decrease the inflammatory response that tightens airways.
Your doctor may also suggest allergy shots, which slowly introduce small amounts of an allergen into your body so that you gradually build up a tolerance. You may also need an albuterol rescue inhaler, which can quickly open your airway during an asthma attack.
Exercise-induced asthma
Exercise-induced asthma is a more mild form of asthma in which your symptoms only arise after exercising.
"Symptoms do not start during exercise when the airways are dilated, but rather 10-15 minutes after when adrenaline levels, which help dilate the airways, come down," says Arjan Flora, MD, a professor of pulmonology at the University of Cincinnati.
You are most likely to have asthma symptoms like chest tightness or wheezing after exercising in cold, dry air, since it can make your airways swell and constrict.
According to Flora, the best ways to prevent exercise-induced asthma are:
- Improving your cardiac fitness so you don't breathe as hard during exercise.
- Avoid working out in cold weather.
- Taking two puffs of an albuterol inhaler 5 to 20 minutes before exercising to open up your airways.
- Do exercises like yoga, tennis, or hiking, as opposed to endurance-centered workouts.
And be sure to always carry an inhaler when you know you are going to be working out.
Cough-variant asthma
If you have cough-variant asthma, your main asthma symptom is a persistent dry cough. It's typical not to have other asthma symptoms like shortness of breath or wheezing.
"Treatment for cough variant asthma is largely the same as for regular asthma, using the same medications," says Neil Schachter, MD, a professor of pulmonary medicine at the Icahn School of Medicine at Mount Sinai.
This includes daily corticosteroid inhalers like budesonide (Rhinocort) and flucytosine (Flovent) to reduce swelling in your airways and an albuterol rescue inhaler for flare-ups.
"However, the most important feature of treatment is making sure that the diagnosis is correct," Schachter says. This is because other conditions like hay fever or acid reflux can also cause a chronic cough. Discussing your symptoms with your doctor can help rule out other possible conditions.
Asthma-COPD overlap
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that prevents your airways from expanding properly, leaving some air trapped inside your lungs when you exhale. COPD symptoms usually begin in middle age and the main symptoms are shortness of breath, coughing, and excess phlegm.
If you have asthma-COPD overlap (ACO), you may exhibit all the symptoms of COPD along with typical asthma symptoms like wheezing and chest pain. ACO can cause attacks that are especially severe and can lead to hospitalization.
The most common cause of COPD is exposure to cigarette smoke, though some people may develop the condition after long-term exposure to irritating gases or fumes like car exhaust. By the time your symptoms appear, "the lungs are frequently damaged beyond repair," says Schachter. This means that while you can get your symptoms under control, you generally can't stop the disease from progressing.
Though ACO can be more serious than asthma, "in many ways the treatment is the same," Schachter says. This can include taking a long-acting airway opener like Singulair, a corticosteroid inhaler like Pulmicort, and an albuterol rescue inhaler for attacks. You may also need to add on additional medication to prevent mucus build-up.
Occupational asthma
Occupational asthma occurs when you develop asthma symptoms after being exposed to irritating substances like chemical fumes, animal waste, or smoke in your workplace. There have been over 250 different agents identified that can trigger occupational asthma.
Occupational asthma develops when you regularly inhale substances that can irritate your lungs, which leads to swelling of your airways and difficulty breathing. This irritation can be caused by an allergen, like animal dander or plant substances, or a universally irritating substance, like chlorine gas, chemicals in detergents, or metals like platinum.
According to Flora, some of the most high-risk jobs for exposure to allergens are:
- Animal handlers
- Farmers
- Food production workers/seafood processors
The most high-risk jobs that may expose you to general lung irritants are:
- Metal workers/welders
- Carpenters
- Hairdressers
- Insulation installers
- Commercial painters
The best way to prevent and treat occupational asthma is for companies to provide protective gear and train workers to safely handle irritants. Under the Occupational Safety and Health Administration (OSHA) guidelines, your employer is legally required to offer you these protections. You can also meet with your doctor to come up with an individual safety plan and get standard asthma medications.
Nocturnal asthma
Nocturnal asthma occurs when your asthma symptoms get significantly worse at night. Nocturnal asthma is common and can happen along with any type of asthma, including allergic or non-allergic.
The symptoms of nocturnal asthma are the same as regular, daytime asthma, but you may also experience symptoms like daytime sleepiness and frequent waking in the night. This is because frequent bouts of nocturnal asthma can interfere with your natural sleep schedule and lower the quality of your sleep.
Experts aren't sure why asthma symptoms can become worse at night, but one factor may be your hormones. In particular, levels of a hormone called histamine can spike while you are asleep , which can lead to swelling of your airways and awaken you from sleep.
"Additional complicating factors include dust mites and pet dander which can be in bed sheets, pillows, and mattresses," says Flora. So if you have allergic asthma, you may need to wash your bedding more often and keep pets out of the bedroom to fight off nighttime symptoms.
Non-allergic asthma
Non-allergic asthma occurs when your asthma symptoms are triggered by factors unrelated to allergens like pollen and dust. Non-allergic asthma generally starts later in life – most people over 40 who develop asthma for the first time will have non-allergic triggers.
Experts are not certain why non-allergic asthma develops, but having repeated infections in your airway like bronchitis can increase your risk of non-allergic asthma, Flora says.
There are many possible triggers for non-allergic asthma, including:
- Respiratory infections like the flu
- Irritants in the air including perfumes, cleaning supplies, and smoke
- Weather conditions, particularly cold air
- Stress and anxiety
The symptoms of non-allergic asthma are essentially the same as allergic asthma, including chest tightness, coughing, and difficulty breathing. After having an allergist rule out the possibility of an allergy, your doctor may work with you to identify your triggers. The treatment is also similar to allergic asthma, using long-term preventative medications and fast-relief inhalers.
The bottom line
If you find yourself having asthma symptoms, it's important to meet with a doctor as soon as possible to help get your symptoms under control.
Monitoring your own symptoms can also help out with diagnosis, Flora says. "Keeping a diary of onset of symptomatic episodes with potential triggers/exposures, time of day, location (ie work, outdoors), and the presence of other medical conditions can help you and your doctor discover what type of asthma you have and how you may prevent symptoms from occurring."