Breathing is just one of those things you take for granted until it feels like every inhale or exhale is a struggle. Unfortunately, people with severe asthma have to deal with breathing issues way more often than anyone should, and it can be completely terrifying.
Asthma is a respiratory condition that affects the airways that extend from your nose and mouth to your lungs, according to the National Heart, Lung, and Blood Institute (NHLBI). When you’re exposed to triggers like animal fur, pollen, mold, exercise, and respiratory infections, these airways can narrow, restricting your airflow. This can then make the muscles surrounding your airways constrict, making it even harder to breathe, and cause your airways to produce more mucus than normal, further compounding the problem. All together, this can lead to asthma symptoms like shortness of breath, coughing, wheezing (a whistling sound when you breathe), and chest tightness or pain, according to the NHLBI.
Like most health conditions, asthma severity runs along a spectrum, Emily Pennington, M.D., a pulmonologist at the Cleveland Clinic, tells SELF. Some people have cases where they experience minor symptoms here and there (maybe even so mildly that they don’t realize they have asthma). Others can have asthma that is basically an ever-present problem and might result in scary asthma attacks, which is when symptoms ramp up in severity and can even become life-threatening.The most important part of preventing severe asthma attacks is knowing you have the condition in the first place. Here are the top signs you have severe asthma, plus which kinds of treatment may help.
1. Difficulty breathing jolts you out of sleep at night
If your asthma symptoms don’t only affect you most days, but also rear their head more than one night a week, you may have what experts call “severe persistent” asthma. This is the most serious classification of this condition, according to the Mayo Clinic.
Doctors don’t know exactly why asthma can flare up at night, but they think it may be due to hormonal changes your body goes through while you sleep, Dr. Pennington says. During the wee hours of the night, your body can release higher levels of the stress hormone cortisol which may cause more inflammation, including in your airways, she explains. Voila, nighttime asthma flares.
2. You’re short of breath even when you’re not exerting a lot of energy
Obviously you’re going to be winded when you do something strenuous, like run a 5K. However, you should pay close attention if you’re getting out of breath when you do everyday stuff like walk around your house. While people who have less intense cases of asthma may experience this here and there when they have asthma attacks, people with severe asthma may have airways that are pretty much constantly inflamed, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, Calif., tells SELF. This can restrict your airflow to the point where you have trouble breathing even when you’re not pushing yourself physically.
3. Sometimes it’s hard to speak in complete sentences, seemingly out of the blue
Asthma doesn’t just keep you from getting air in; it can also cause issues getting air out. “People [with severe asthma] can’t get enough air in to be able to expel air at a slow enough rate to speak a sentence before they need to take another breath,” Dr. Casciari says. This is especially likely to happen during an asthma attack, when airways narrow even more than usual, Sadia Benzaquen, M.D., a pulmonologist and associate professor in the department of internal medicine at the University of Cincinnati College of Medicine, tells SELF. Unfortunately, people with severe asthma are more likely to have these flare-ups that can make speaking way too difficult.
4. You feel breathless even when you sit or lie down
If you’re huffing and puffing, your instinct may be to sit or lie down to try to breathe more easily. “Theoretically, sitting or lying [down] reduces your energy expenditure and therefore reduces the need for oxygen,” Dr. Casciari says. For many people, this makes it easier for your lungs to get enough air to breathe comfortably. But severe asthma doesn’t really work that way, so sitting or lying down won’t suddenly make it way easier to breathe if you’re still exposed to a trigger or haven’t started treating your symptoms, Dr. Pennington says.
5. Your chest constantly feels like it’s stuck in a vise
Chest tightness is often part and parcel of having asthma, but people with a severe form of the condition can feel like their chest is constantly under pressure. This is due to how the muscles surrounding your airways react to irritants, allergens, and other things that can activate your asthma. When you’re exposed to these triggers, muscles clamp down and narrow your airways, making your chest feel tight, Dr. Pennington says. If your airways and their surrounding muscles are constantly overreacting to asthma triggers, it might feel like your chest rarely (if ever) gets a break.
6. You’re agitated, confused, or sleepy and aren’t sure why
When you exhale, you’re getting rid of carbon dioxide, which is a waste byproduct you create by breathing. If you have a bad case of severe asthma, it can limit your carbon dioxide output to such an extent that too much remains in your system, making you suddenly feel confused, agitated, or tired, Richard H. Huynh, M.D., a pulmonologist with Torrance Memorial Medical Center, tells SELF.
This is known as respiratory failure, and it’s extremely serious. While the above symptoms all signal that you need to see your doctor for evaluation, this one is means you need to seek emergency treatment immediately.
7. Your skin has a bluish tint
A bluish tint to your skin can be a sign of cyanosis, which happens when there is a lack of oxygen in your blood, according to the U.S. National Library of Medicine. Much like agitation, confusion, and sleepiness, this is a serious symptom that shouldn’t be ignored, Dr. Benzaquen says.
Red blood cells in your body provide oxygen to your tissues, and in doing so, they give your skin a pink or red undertone that can either be really obvious or hard to pick up on, depending on your skin color. If a condition like asthma makes it tough to get as much oxygen as you need, your blood can take on a blue hue, which can impact the color of your skin. In people with lighter skin, this can show up all over the body, and in people with darker skin, it may be more obvious in the lips, gums, nails, and around the eyes, according to the U.S. National Library of Medicine. Dr. Casciari notes that this change can happen suddenly, like if you have an intense asthma attack, or over time if you’re not getting treatment for chronic severe asthma.
Either way, if you notice this issue, you need to call 911 immediately, Dr. Benzaquen says. That’s especially true if you’re dealing with other asthma symptoms, like shortness of breath.
Whether or not you’ve already been diagnosed, if you’re having life-threatening or even seriously uncomfortable asthma symptoms, your doctor will first address those.
They can do this by administering treatment like a short-acting beta antagonist you can inhale to relax your airways, giving you an oral corticosteroid to calm airway inflammation, or even helping you breathe with an oxygen machine, according to the Mayo Clinic.
Once that’s under control, if you’ve already been diagnosed with asthma, your doctor may decide to adjust your medications so you’re less likely to deal with such severe symptoms, Dr. Pennington says. If you haven’t yet been diagnosed, they’ll want to do that before delving into your treatment plan.
Diagnosing your asthma will involve various tests to see how your lungs function.
These lung tests include spirometry, which checks how much air you can blow out after taking a deep breath along with how fast you can blow that air out, according to the Mayo Clinic.
Your doctor may also order what’s known as a peak flow test, which measures how hard you can breathe out with a handheld device. If you don’t perform well on those tests, it’s usually a sign that you’re struggling with severe asthma, Dr. Benzaquen says.
They can also perform other exams, like allergy tests to see whether you may have certain triggers that kick off your symptoms, and imaging tests to rule out things like respiratory infections as the cause of your issues, says the Mayo Clinic.
No matter your situation, it’s critical that you and your doctor work on a plan to help you control your asthma.
Treatment often involves a double-pronged approach using long-term preventive medications and quick-relief treatments, according to the Mayo Clinic. Long-term preventive medications, which include drugs like oral corticosteroids to reduce airway inflammation, are designed to make asthma attacks less likely. Then you can use quick-relief treatments, like a short-acting beta agonist to relax your airways, if your symptoms flare up anyway.
People with severe asthma don’t necessarily take different medications from those with less extreme forms of the condition, but they may take more. “Severe asthma patients tend to need higher doses of medication or multiple inhalers to keep their asthma under control,” Dr. Pennington says.
Your doctor will likely also hammer out an actual asthma action plan with you (and you should ask them for help with this if they don’t). This is a written summary of the medications you’ll need to take and how to avoid your triggers. If you have severe asthma, it’s also pretty likely that your doctor will want you to track your symptoms or regularly use a peak flow meter to see how well your treatment is helping, according to the NHLBI.
Bottom line: Don’t just ignore symptoms you suspect are due to severe asthma. Getting help now could make a huge positive impact on your health immediately and in the long-term, too.
This article originally appeared on self.com
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