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Exercise-induced asthma
Wake up in the middle of the night with shortness of breath
Shortness of breath
Cough
Have wheezing
Nighttime cough
Fatigued
Not seeing your symptoms? No worries!
A condition where the airways are highly sensitive and overreact to foreign substances or environmental changes. The underlying cause is unclear but involves genetics. Many triggers for asthma flares include smoke, pollen, dust mite droppings, cold weather, exercise, and viral infections.
Your doctor may ask these questions to check for this disease:
Treatment involves identifying and avoiding triggers. The doctor may prescribe different inhalers for different purposes (prevention and rescue). In cases of Severe and Uncontrolled Asthma, biologic therapies should also be considered, which are targeted medications that address specific immune system pathways and reduce inflammation in the airways. Severe attacks can be life-threatening and require emergency medical care. Doctors who specialize in treating patients with asthma are called allergists and pulmonologists.
Reviewed By:
Phillip Aguila, MD, MBA (Pulmonology, Critical Care)
Dr. Aguila graduated from West Virginia University School of Medicine. He has trained in Pulmonary and Critical Care Medicine at The University of North Carolina in Chapel Hill and Internal Medicine at Medical College of Pennsylvania/Hahnemann University at Allegheny General Hospital in Pittsburgh Pennsylvania. He has served as Assistant Professor since 2010.
Eisaku Kamakura, MD (Pulmonology)
Dr. Kamakura graduated from the Tokyo Medical and Dental University, School of Dentistry, and the Niigata University School of Medicine. He trained at Yokosuka Kyosai Hospital and held positions in the Respiratory Medicine departments at Yokosuka Kyosai Hospital, Tokyo Medical and Dental University, Ome City General Hospital, and Musashino Red Cross Hospital. In 2021, he became the specially appointed assistant professor at the Department of General Medicine, Niigata University School of Medicine.
Content updated on Feb 19, 2025
Following the Medical Content Editorial Policy
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Q.
Short of Breath? Why Ipratropium Works & Medically Approved Next Steps
A.
Ipratropium eases shortness of breath by blocking acetylcholine to relax airway muscles, improving airflow in COPD and asthma; it starts in about 15 minutes, often pairs with albuterol, and is generally safe but does not treat heart or infection causes. There are several factors to consider; see below to understand more. Next steps include assessing severity, using prescribed rescue inhalers, seeking urgent care for red flags like chest pain, blue lips, or rapid worsening, and arranging testing and long-term control if asthma or COPD is suspected; see complete guidance below because key details could change which steps are right for you.
References:
* Agustí A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2023 Report. Eur Respir J. 2023 Mar 9;61(3):2200877. doi: 10.1183/13993003.00877-2022. PMID: 36306917.
* Reddel HK, et al. The 2023 GINA report: updated strategies for asthma management. Eur Respir J. 2023 Jul 20;62(1):2300701. doi: 10.1183/13993003.00701-2023. PMID: 37380126.
* Vandermeulen C, et al. Muscarinic receptor antagonists in the treatment of chronic obstructive pulmonary disease. Eur Respir Rev. 2019 Jun 30;28(152):180099. doi: 10.1183/16000617.0099-2018. PMID: 31253683.
* Qaseem A, et al. Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2021 May;174(5):675-690. doi: 10.7326/M20-6591. Epub 2021 Mar 30. PMID: 33780650.
* O'Donnell DE, et al. Pharmacologic Management of Dyspnea. Respir Care. 2020 Jan;65(1):108-120. doi: 10.4187/respcare.07166. Epub 2019 Aug 13. PMID: 31409605.
Q.
Short of Breath? Why Your Lungs Are Tight and Ipratropium Bromide Next Steps
A.
Shortness of breath and chest tightness usually come from airway narrowing due to asthma or COPD, and can also occur with respiratory infections or allergies, or feel similar during anxiety; ipratropium bromide is an anticholinergic inhaler that relaxes airway muscles to open the airways, often used for COPD and asthma flare ups, sometimes with albuterol. There are several factors to consider. See below to understand urgent warning signs that need emergency care, how ipratropium bromide works and differs from albuterol, likely side effects, and practical next steps like tracking triggers, checking inhaler technique, and getting lung testing.
References:
* Loh W, et al. Dyspnea: Mechanisms, Assessment, and Management. Chest. 2015 Aug;148(2):494-506. doi: 10.1378/chest.14-1689. Epub 2015 Mar 26. PMID: 26231980.
* Alipour B, et al. Anticholinergic bronchodilators in the treatment of COPD: a review. Adv Ther. 2014 Feb;31(2):162-80. doi: 10.1007/s12325-014-0091-6. Epub 2014 Feb 13. PMID: 24522955.
* Singh D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD 2023 Report. Eur Respir J. 2023;61(1):2200549. doi: 10.1183/13993003.00549-2022. Print 2023 Jan. PMID: 36049918.
* Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program (NAEPP). EPR-4: Severe Asthma in Adolescents and Adults. J Allergy Clin Immunol Pract. 2021 Feb;9(2):1232-1234. doi: 10.1016/j.jaip.2020.08.016. PMID: 33568284.
* Cazzola M, et al. Ipratropium bromide. Pulm Pharmacol Ther. 2006;19(4):255-63. doi: 10.1016/j.pupt.2005.11.006. Epub 2005 Dec 1. PMID: 16386411.
Q.
Can’t Breathe? Asthma Symptoms & Medically Approved Next Steps
A.
There are several factors to consider. Asthma symptoms commonly include shortness of breath, wheezing, chest tightness, and coughing, often triggered by allergens, cold air, infections, exercise, smoke, or strong smells; see below for medically approved next steps and important details. Start by seeing a clinician for diagnosis and an asthma action plan, use rescue and controller inhalers correctly, and avoid known triggers; get emergency care right away if symptoms worsen fast, make it hard to speak, turn lips or nails bluish, or do not improve after a rescue inhaler.
References:
* Al-Ahmadi, Y., & Hameed, M. (2022). Asthma: An Update. *Current Medical Research and Opinion, 38*(9), 1541-1550.
* Gupta, R., Sharma, M., & Singh, N. (2023). Current Approaches to Diagnosing Asthma: A Narrative Review. *Pulmonary Therapy, 9*(3), 481-499.
* Rabe, K. F., & Watz, H. (2022). Acute exacerbations of asthma: current challenges and opportunities. *European Respiratory Review, 31*(164), 210166.
* Reddel, H. K., Canonica, G. W., FitzGerald, J. M., Levy, M. L., Price, D. B., & Bateman, E. D. (2022). Global Initiative for Asthma (GINA) Strategy Report, 2022: Executive Summary and Asthma in Adolescents. *Journal of Allergy and Clinical Immunology: In Practice, 10*(1), 12-25.e5.
* Gibson, P. G., Powell, H., Wilson, A. J., Abramson, M. J., Haywood, P., & Ryan, S. (2021). Self-management education and medication for adults with asthma. *Cochrane Database of Systematic Reviews, 3*(3), CD005008.
Q.
Still Struggling to Breathe? Why Budesonide is Key & Your Medically Approved Next Steps
A.
Budesonide is a key controller medicine for asthma and chronic airway inflammation that targets the root problem, lowering airway swelling, mucus, and attacks when used correctly and consistently, with benefits that build over 1 to 8 weeks rather than immediately. There are several factors to consider, including inhaler or nebulizer technique, adherence, trigger reduction, when to escalate to a combination inhaler, and red flags that need urgent care; see below for medically approved next steps and practical details that could change which path you take.
References:
* Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Buhl R, Cruz AA, Ernst P, FitzGerald JM, Fleming L, Garcia-Marcos L, Gibson PG, GINA Scientific Committee. GINA 2023: Focused updates to the Global Strategy for Asthma Management and Prevention. Eur Respir J. 2023 Jul 26;62(1):2300067. doi: 10.1183/13993003.00067-2023. PMID: 37375628.
* Agustí A, Celli BR, Criner GJ, Singh D, Wanner A, Wedzicha JA, Wise RA; GOLD Scientific Committee. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. Eur Respir J. 2023 Apr 13;61(4):2200788. doi: 10.1183/13993003.00788-2023. PMID: 37045763.
* Niven RM, Magnussen H, Reddel HK, Pavord ID. Optimising inhaled corticosteroid use in asthma: the case for budesonide/formoterol maintenance and reliever therapy. Respir Med. 2021 Sep;185:106497. doi: 10.1016/j.rmed.2021.106497. Epub 2021 Jul 15. PMID: 34384976.
* Ramakrishnan S, Nicolau DV, Langford B, Mahdi M, Jeffers H, Liew K, Bremner P, Capstick T, Situnayake D, Burns R, Petryk J, Freegard J, Cook J, Bright S, Salawu A, Chaudhuri N, Drayson MT, Greenhalf W, Helmy M, Higham A, Jackson T, Jeavons E, Jones MG, Kelly C, Kyffin S, Laha S, Lawson M, Loke C, McGinnity P, Mellor K, Mesana M, Monaghan T, Mulvaney T, Naisbitt J, Patel J, Patel L, Perera S, Ponnusamy A, Proudfoot S, Richter A, Rolfe S, Rylance J, Singh B, Stewart R, Taylor J, Thin TN, Veenith T, Wilson AM, Wordsworth S, Yasmin F, Yates T, Javid B, Raj I. Inhaled budesonide for treatment of Covid-19 in the outpatient setting (STOIC): a multicentre, open-label, randomised controlled trial. Lancet Respir Med. 2021 Jul;9(7):749-758. doi: 10.1016/S2213-2600(21)00160-0. Epub 2021 Apr 15. PMID: 33857416.
* Barnes PJ. Inhaled corticosteroids in asthma: Past, present and future. Pulm Pharmacol Ther. 2021 Dec;66:101991. doi: 10.1016/j.pupt.2021.101991. Epub 2021 Nov 27. PMID: 34840003.
Q.
Eucalyptus Benefits: Natural Relief for Breathing & Joint Pain
A.
Eucalyptus can support easier breathing and relieve joint and muscle soreness by loosening mucus, calming inflammation, and creating a soothing cooling or warming sensation; common uses include steam inhalation, chest rubs, diffusers, and diluted topical creams. There are several factors to consider, since it is a supportive aid and not a cure; use it safely, never swallow the oil, be extra cautious for children, pregnancy, asthma, or seizures, and seek medical care for ongoing shortness of breath or worsening pain. For detailed guidance on safe methods, who should avoid it, and when to see a doctor, see below.
References:
* Jun H-S, Kim W-K, Chang Y-P, Kim B-S, Lee S-Y. Efficacy of topical eucalyptus oil on joint pain and inflammation in individuals with musculoskeletal conditions: a systematic review. Journal of Clinical Pharmacology. 2023 Apr;63(4):379-389.
* Juergens UR. Anti-inflammatory properties of essential oils and their constituents, with special attention to respiratory diseases. Inhalation Toxicology. 2020 Feb;32(2):57-67.
* Worth H, Dethlefsen U. The new generation of phytopharmaceuticals in the treatment of airway diseases. Clinical Drug Investigation. 2014 Dec;34(12):837-43.
* Kehrl W, Sonnemann U, Dethlefsen U. Therapy for acute bronchitis with a secretolytic bronchodilator containing cineole: a placebo-controlled, double-blind study. Arzneimittelforschung. 2004;54(1):A3-9.
* Juergens UR, Dethlefsen U, Steinkamp G, Gillissen A, Repges R, Vetter H. Anti-inflammatory activity of 1.8-cineol (eucalyptol) in bronchial asthma: a double-blind, placebo-controlled trial. Respiratory Medicine. 2003 Jun;97(6):675-9.
Q.
Should I rinse my mouth after using an inhaled steroid?
A.
Yes, rinsing your mouth after using an inhaled steroid is recommended to help reduce the risk of side effects like oral thrush. See below to understand more.
References:
Johnstone LK, Bereznicki BJ, Jacobson G, & Thompson AJ. (2021). Implementation of mouth rinsing after use of inhaled .... International journal of clinical pharmacy, 33029709.
https://pubmed.ncbi.nlm.nih.gov/33029709/
Yokoyama H, Yamamura Y, Ozeki T, Iga T, & Yamada Y. (2006). Influence of mouth washing procedures on the removal .... Biological & pharmaceutical bulletin, 16946510.
https://pubmed.ncbi.nlm.nih.gov/16946510/
Yokoyama H, Nakajima Y, Yamamura Y, Iga T, & Yamada Y. (2005). [Investigation of mouth washing by patients after inhaling .... Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan, 15863978.
Q.
What's the difference between rescue and maintenance inhalers?
A.
Rescue inhalers are used for quick relief during asthma attacks, while maintenance inhalers are used daily to prevent symptoms. See below to understand more.
References:
Krings JG, & Beasley R. (2024). The Role of ICS-Containing Rescue Therapy Versus SABA .... The journal of allergy and clinical immunology. In practice, 38237858.
https://pubmed.ncbi.nlm.nih.gov/38237858/
Lipworth B, Kuo CR, Stewart K, & Chan R. (2024). Budesonide/Formoterol or Budesonide/Albuterol as Anti- .... The journal of allergy and clinical immunology. In practice, 38346474.
https://pubmed.ncbi.nlm.nih.gov/38346474/
Papi A, Caramori G, Adcock IM, & Barnes PJ. (2009). Rescue treatment in asthma. More than as-needed .... Chest, 19497897.
Q.
Can inhaled steroids for asthma cause the same side effects as oral ones?
A.
Inhaled steroids for asthma can cause side effects, but they are generally less severe than those from oral steroids. See below to understand more.
References:
Pandya D, Puttanna A, & Balagopal V. (2014). Systemic effects of inhaled corticosteroids: an overview. The open respiratory medicine journal, 25674175.
https://pubmed.ncbi.nlm.nih.gov/25674175/
Hanania NA, Chapman KR, Sturtridge WC, Szalai JP, & Kesten S. (1995). Dose-related decrease in bone density among asthmatic .... The Journal of allergy and clinical immunology, 7499672.
https://pubmed.ncbi.nlm.nih.gov/7499672/
Kuna P. (1998). [Longterm effects of steroid therapy]. Wiadomosci lekarskie (Warsaw, Poland : 1960), 9610231.
Q.
Do inhalers cause dependence?
A.
Inhalers, like salbutamol, can lead to misuse and dependency in some people, especially young users. It's important to use inhalers as directed by a doctor. See below to understand more.
References:
Edwards JG, & Holgate ST. (1979). Dependency upon salbutamol inhalers. The British journal of psychiatry : the journal of mental science, 486238.
https://pubmed.ncbi.nlm.nih.gov/486238/
Pratt HF. (1982). Abuse of salbutamol inhalers in young people. Clinical allergy, 7074823.
https://pubmed.ncbi.nlm.nih.gov/7074823/
Binnie K, McGuire C, & Carel H. (2021). Breathless patients' use of medical objects in a palliative .... Journal of material culture, 35273452.
Q.
Why do I have to taper steroids slowly?
A.
Steroids need to be tapered slowly to avoid withdrawal symptoms and to allow your body to adjust and start making its own steroids again. See below to understand more.
References:
Priya G, Laway BA, Ayyagari M, Gupta M, Bhat GHK, & Dutta D. (2024). The Glucocorticoid Taper: A Primer for the Clinicians. Indian journal of endocrinology and metabolism, 39371659.
https://pubmed.ncbi.nlm.nih.gov/39371659/
Suehs CM, Menzies-Gow A, Price D, Bleecker ER, Canonica GW, Gurnell M, et al. (2021). Expert Consensus on the Tapering of Oral Corticosteroids .... American journal of respiratory and critical care medicine, 33112646.
https://pubmed.ncbi.nlm.nih.gov/33112646/
Komminoth M, Donath MY, Hepprich M, Schuetz P, Blum CA, Mueller B, et al. (2023). TOASST" (Taper Or Abrupt Steroid STop) multicenter trial. PloS one, 37018188.
Q.
Can you die from asthma?
A.
Yes, asthma attacks can be fatal. Recognizing the signs of an asthma attack and initiating treatment quickly is critical.
References:
Fergeson JE, Patel SS, Lockey RF. Acute asthma, prognosis, and treatment. J Allergy Clin Immunol. 2017 Feb;139(2):438-447. doi: 10.1016/j.jaci.2016.06.054. Epub 2016 Aug 20. PMID: 27554811.
https://www.cdc.gov/asthma/asthma-prevalence-us-2023-508.pdf
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Nakagome K, Nagata M (2011). Pathogenesis of airway inflammation in bronchial asthma. Auris, nasus, larynx.
https://pubmed.ncbi.nlm.nih.gov/21334836/Buc M, Dzurilla M, Vrlik M, Bucova M (2009). Immunopathogenesis of bronchial asthma. Archivum immunologiae et therapiae experimentalis.
https://pubmed.ncbi.nlm.nih.gov/19688187/D'Amato G, Liccardi G, D'Amato M, Holgate S (2005). Environmental risk factors and allergic bronchial asthma. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.
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