Doctors told about non-obvious signs of bronchial asthma

Coughing, shortness of breath, wheezing, and a feeling of tightness in the chest may indicate bronchial asthma, but none of these symptoms by themselves confirms the disease. To make a diagnosis, the doctor needs to assess the nature of the seizures and objectively check the functioning of the lungs. About how to recognize asthma, distinguish it from other diseases and what treatment methods are used today — in the material of Izvestia.

What happens to the respiratory tract in asthma

According to updated data from the World Health Organization, published in April 2026, about 363 million people suffered from asthma in 2023. The disease caused approximately 442,000 deaths. A significant part of the severe consequences is associated not with the lack of effective therapy, but with late diagnosis, insufficient treatment, and limited access to inhaled medications.

What symptoms may indicate asthma?

The most common manifestations of asthma include recurring episodes of difficulty breathing, wheezing, a feeling of pressure or tightness in the chest, and coughing. The latter may be dry or accompanied by sputum production. In some patients, it is the cough that remains the only noticeable symptom — this course is called the cough variant of asthma.

Asthma is more likely to occur if it worsens at night or early in the morning, occurs after running, laughing, contact with animals, dust or pollen, and also recurs after each respiratory infection. According to allergist and immunologist Juan Carlos Murillo, patients with undiagnosed asthma often describe their condition as follows: "Every cold sinks into my chest, and I cough for weeks."

Seizures can occur several times a day, or just a few times a year. However, rare symptoms do not always mean a low risk: severe exacerbation is possible even in a person who usually experiences asthma infrequently. The combination of respiratory symptoms with allergic rhinitis, atopic dermatitis, or food allergies also speaks in favor of the disease. The risk is higher if close relatives have asthma. But the disease can also be non-allergic, so the absence of allergies does not allow it to be excluded.

Why coughing alone is not enough for diagnosis

Coughing, wheezing, and shortness of breath occur in a variety of conditions. Similar symptoms may occur after infection, with chronic obstructive pulmonary disease, gastroesophageal reflux disease, chronic rhinosinusitis, heart failure, or impaired functioning of the vocal cords. A feeling of lack of air can also be associated with anxiety disorder, anemia, obesity, and insufficient physical fitness.

Therefore, the diagnosis cannot be made solely on the basis of complaints, listening to the lungs, or the fact that a person feels better after using a bronchodilator inhaler. The doctor must simultaneously confirm the presence of characteristic variable symptoms and obtain objective evidence that the patency of the respiratory tract changes over time. Usually, an initial examination is performed by a therapist or pediatrician. In case of a complex course, the patient may need to consult a pulmonologist or an allergist-immunologist.

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How asthma is confirmed

Spirometry remains the main diagnostic method. During the examination, the patient takes a deep breath, and then abruptly and completely exhales the air into a special device. The doctor evaluates how much air a person is able to exhale in the first second and how quickly the lungs empty.

Then the study can be repeated after applying a bronchodilator drug. If the indicators noticeably improve, this indicates a reversible narrowing of the airways, characteristic of asthma. Normal spirometry does not always exclude the disease. If the examination is performed during a period when there are no symptoms, lung function may look normal. In this case, the test is repeated during the deterioration or other methods are used.

If there is no access to spirometry, the doctor may suggest measuring the peak exhalation rate in the morning and evening for one to two weeks. A portable peak flowmeter is used for this purpose. Significant fluctuations in the results on different days or during the day support the diagnosis, although this method is considered less accurate than spirometry.

If the complaints persist, but the standard tests remain normal, a bronchodilator test is sometimes performed. The patient inhales a substance or performs a load capable of causing controlled bronchial constriction. Such an examination should be carried out under medical supervision.

What are the different types of asthma?

Asthma is not a single disease with a single mechanism, but a group of conditions with similar symptoms. Doctors divide them into phenotypes and endotypes, variants that differ in their appearance and biological mechanisms of inflammation.

The most common type of inflammation is considered to be the second type. It includes allergic and eosinophilic asthma. In the first case, the symptoms are associated with an immune reaction to certain allergens. In the eosinophilic variant, eosinophils accumulate in the respiratory tract — cells of the immune system that can support inflammation.

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In asthma with low activity of the second type of inflammation, the indicators of FeNO and eosinophils may remain normal. Other immune cells, including neutrophils, are sometimes involved in the process. Such a disease is more difficult to classify, and some drugs have a weaker effect on it.

In addition, asthma is isolated, which occurs or worsens due to working conditions, physical activity, or taking aspirin and other nonsteroidal anti-inflammatory drugs. The definition of a specific option is not necessary for formality: the choice of therapy depends on it, especially if it concerns a serious disease and biological drugs.

What can trigger an attack?

Common triggers include plant pollen, house dust mites, mold, wool, and animal skin particles. However, possible allergens should not be completely eliminated without proven sensitivity. Such measures can be expensive, complex, and useless if the chosen substance is unrelated to the patient's symptoms.

Viral infections are a common cause of exacerbations. An attack can also be triggered by cold air, sudden weather changes, tobacco smoke, vaping, air pollution, forest fires, strong odors and chemicals.

Physical activity can cause short-term bronchial constriction, but it is usually not necessary to give up sports with controlled asthma. Properly selected treatment should allow a person to lead an active life. If shortness of breath regularly causes you to stop walking or exercising, this is a reason to discuss therapy correction with your doctor.

Stress is not considered the only cause of the disease, but strong emotions and rapid breathing can provoke symptoms in a person with already hypersensitivity of the bronchi. However, shortness of breath should not be automatically attributed to anxiety until respiratory and cardiovascular causes are excluded.

If symptoms appear in adulthood, it is important to assess the working conditions. Occupational asthma may be indicated by an improvement in well-being during weekends or vacations. It can be caused by flour, wood dust, chemicals, paints, aerosols, latex, and other substances that a person encounters in the workplace.

Is it possible to cure asthma completely

Modern drugs make it possible to achieve a condition in which a person does not wake up at night due to coughing, exercises freely, rarely needs an emergency inhaler and does not face exacerbations. However, the persistent absence of symptoms does not mean that the disease has disappeared.

In some children, asthma symptoms weaken or stop by adolescence, but may return later. Some patients with severe asthma develop clinical remission on the background of biological drugs. This is about disease control, sometimes supported by therapy, rather than a guaranteed cure.

It is impossible to cancel inhaled corticosteroids on your own after improvement. With stable monitoring, the doctor can gradually reduce the amount of therapy and find the minimum effective dose. It is recommended to consider such a transition after maintaining good control for two to three months and continue monitoring.

When urgent help is needed

It is necessary to seek medical help immediately if it is difficult for a person to speak in whole sentences, drink or lie down due to shortness of breath, breathing worsens rapidly, and the prescribed medication does not bring relief. Drowsiness, confusion, blue lips, a sharp weakening of respiratory noises and a "mute chest" when wheezing suddenly disappears with severe obstruction are also considered dangerous signs.

Before medical care arrives, you should follow an individual plan drawn up by a doctor. There is no universal dosage regimen for all patients, and severe shortness of breath that occurs for the first time may be associated not only with asthma, but also with anaphylaxis, pneumonia, pulmonary embolism, or heart disease.

The main goal of treatment is not to tolerate the symptoms until the next attack, but to achieve sustainable control. With a properly confirmed diagnosis, a suitable inhaler, and regular monitoring, asthma in most cases should not interfere with normal physical activity, work, study, and sleep.