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Types of Asthma and How They Differ

Lungs

Asthma is a long-term lung disease causing inflammation that narrows the airways in your lungs. There is no cure for asthma, but treatment can control the condition. There are several different types of asthma, and many people have more than one type. Your doctor will determine what type of asthma you have in order to plan the treatment that's best for you.

According to the American College of Allergy, Asthma & Immunology, there are six basic types of asthma.

  • Adult-onset asthma
  • Allergic asthma
  • Non-allergic asthma
  • Occupational asthma
  • Asthma with chronic obstructive lung disease (COPD)
  • Exercise-induced bronchoconstriction (EIB)

Sometimes the different types of asthma overlap. For example, adult-onset asthma can also be allergic asthma. Occupational asthma can be allergic or non-allergic. Most people with other types of asthma also have EIB.

Adult-onset asthma

Asthma often starts in childhood and continues throughout life. However, adult-onset asthma is a type that starts in adult years. It's not always clear why some people develop asthma as adults. It's possible that they just weren't exposed to their main triggers during childhood. For example, if you never had a dog or cat as a child, you may start having asthma symptoms when you get a pet as an adult. In some cases, a viral upper respiratory infection may trigger adult asthma.

Symptoms of adult-onset asthma include:

  • A new and persistent cough, especially at night or during exercise
  • Shortness of breath
  • Tightness in the chest
  • Wheezing

Treating adult-onset asthma usually involves avoiding asthma triggers and taking quick-relief medications to relieve asthma attacks as well as using a daily, long-term medication to control symptoms.

Allergic asthma

Not everyone who has asthma has allergies, but if you do, allergies can trigger asthma and make it worse. Common allergies that trigger asthma are pollens, pet dander, mold and dust mites.

Symptoms of allergic asthma are similar to those for adult-onset asthma. You may also have allergy symptoms, including a runny nose, itchy eyes and sneezing. Your doctor can diagnose allergic asthma based on your allergy symptoms and by doing allergy tests.

Treatment of allergic asthma is similar to the treatment for adult-onset asthma, but immunotherapy may also be a good option for you. Immunotherapy usually involves getting allergy shots. These inject tiny amounts of the substance you are allergic to (allergen) under your skin. Over time, your body gradually stops reacting to the allergens. You may still have asthma, but this treatment will help control it. You may also take tablets under the tongue as part of immunotherapy.

Non-allergic asthma

This type of asthma is not triggered by allergies. With non-allergic asthma, symptoms often are triggered by:

  • Cold or flu virus
  • Smoke, fumes or other irritants in the air
  • Exercise
  • Extreme or sudden changes in weather conditions
  • Stress
  • Drugs or food additives

Symptoms and treatment of non-allergic asthma are the same as adult-onset asthma. Avoiding your asthma triggers is another important part of your treatment.

Occupational asthma

Occupational asthma is asthma triggered by an exposure to an allergen at work. About 15 percent of people with asthma have occupational asthma. You may have both allergic and occupational asthma if you are allergic to something at work. Common work triggers include paint, cleaning products, dust, mold and animals. More than 250 substances have been identified as possible occupational triggers, and you may have a higher risk of occupational asthma if your job involves:

  • Baking
  • Manufacturing
  • Farming, especially working with grains
  • Working with animals
  • Woodworking

Symptoms of occupational asthma are the same as the symptoms of other types of asthma. Your doctor may diagnose this type if your symptoms start after beginning a new job, get worse at work or get better when you are away from work. Treatment is the same as for other types of asthma, but you may have to make some changes at your workplace or even find another type of job.

Asthma with COPD

COPD is a group of diseases that obstruct airflow in the lungs. They include emphysema and chronic bronchitis. Most people with asthma do not develop COPD, but some people have both asthma and COPD and this is referred to as asthma-COPD overlap syndrome (ACOS). The overlapping nature of the symptoms of these conditions can make each condition harder to treat. Sometimes the first sign of ASOC is asthma that becomes harder to treat.

Symptoms of ACOS include:

  • Difficulty breathing when doing routine activities
  • Wheezing and frequent cough
  • Excess phlegm and tightness in the chest
  • Fatigue

Smoking is the biggest risk factor for COPD. Other risk factors are severe asthma, a family history of COPD and being 50 to 70 years old. If your doctor suspects you have ACOS, you may have a chest X-ray or chest imaging study to look for evidence of changes in your lungs typically caused by COPD. You may also need pulmonary function tests so your doctor can tell how well your lungs are working and decide how to treat you.

Although asthma is usually reversible, COPD is a progressive disease. Treatment for ACOS may include other medications, oxygen and exercises and breathing techniques to improve lung function (pulmonary rehabilitation).

Exercise-induced bronchoconstriction

Most people with asthma have this type, but people who don't have asthma also can develop EIB, which occurs when the lungs lose heat and moisture during exercise. EIB used to be known as exercise-induced asthma. Symptoms start within a few minutes of starting to exercise and may continue for up to 15 minutes after stopping. If you have asthma, EIB can make it worse and trigger an asthma attack. Symptoms include:

  • Typical asthma symptoms
  • Loss of endurance
  • Upset stomach
  • Sore throat

EIB may be more common if you are exercising in cold or dry weather. Chlorine can be a trigger if you exercise in a pool. To diagnose EIB, your doctor may do tests on your lungs after you exercise on a treadmill. EIB treatment can include:

  • Using a short-acting rescue inhaler before exercising
  • Warming up gradually for about 15 minutes before exercising
  • Breathing through your nose or wearing a face mask while exercising
  • Not exercising on cold or dry days

Other types of asthma

You may also hear other asthma types mentioned, such as nocturnal asthma or cough-variant asthma. Nocturnal asthma is asthma that gets worse at night. It may wake you from sleep. This type is very common. Your doctor may adjust your medications to give you more asthma control at night. Cough-variant asthma has persistent coughing as the main symptom, rather than wheezing. This type is treated the same way as other types.

Sometimes you will also hear about 'levels' of asthma. These levels classify the condition by its severity. The levels include intermittent, mild, moderate or severe.

  • Intermittent asthma causes symptoms less than twice a week
  • Mild persistent asthma causes symptoms two or more days a week
  • Moderate persistent asthma causes symptoms at least every day and wakes you up one or more nights a week
  • Severe persistent asthma causes symptoms every day and wakes you up every night.

Work with your doctor to find out which type of asthma you have, so you can develop the asthma treatment plan that's best for your particular condition. Remember that it's likely you have more than one type.

Article references

  1. American College of Allergy, Asthma & Immunology, Types of Asthma, https://acaai.org/asthma/types-asthma
  2. National Jewish Health, Asthma Types, https://www.nationaljewish.org/conditions/asthma/overview/types
  3. Asthma and Allergy Foundation of America, Asthma Diagnosis, https://www.aafa.org/asthma-diagnosis/
  4. American College of Allergy, Asthma & Immunology, Asthma Cough, https://acaai.org/asthma/asthma-symptoms/asthma-cough