Learn about the causes, symptoms, and types of asthma. Discover effective treatment methods and ways to recognize asthma in children and adults.
Table of Contents
- What is bronchial asthma? Definition and basic information
- The most common causes of asthma development
- Asthma symptoms – how to recognize them in children and adults?
- Types of asthma: allergic and non-allergic asthma
- Diagnosis and treatment methods for bronchial asthma
- Asthma in children – diagnosis and therapy for the youngest
What is bronchial asthma? Definition and basic information
Bronchial asthma, also known simply as asthma, is a chronic inflammatory disease of the airways characterized by bronchial hyperreactivity, leading to their narrowing and impeding airflow. In practice, this means that people with asthma experience periodic narrowing of the bronchial walls due to chronic inflammation, which often triggers characteristic symptoms such as wheezing, shortness of breath, chest tightness, or a persistent cough. The mechanism of asthma development is based on complex interactions between genetic and environmental factors. On one hand, there is an inherited predisposition, making the risk of developing asthma higher if there is a family history of allergies or asthma. On the other hand, external factors decisively influence disease development, such as inhaled allergens (house dust mites, plant pollens, animal dander), air pollution, tobacco smoke, respiratory tract infections, or intense physical exertion. Bronchial asthma is among so-called diseases with high clinical variability – it can develop in both children and adults, and its course can range from mild and well-controlled to severe forms requiring specialized treatment.
Chronic airway inflammation is the main component of the pathophysiology of asthma. This very mechanism is responsible for bronchial hypersensitivity, which under certain stimuli leads to their sudden contraction. The variability and reversibility of symptoms are characteristic – shortness of breath or wheezing may appear suddenly, often early in the morning or at night, and usually disappear spontaneously or after using bronchodilators. It should be emphasized that asthma exacerbations can be triggered by a wide spectrum of factors, and the course of the disease is highly individual for each patient. Another important diagnostic aspect is that bronchial asthma can be oligosymptomatic, lead to chronic cough, or appear only during physical exertion. Asthma diagnosis is based on a detailed medical history, assessment of symptoms, and specialized pulmonary function tests such as spirometry, which allows assessment of the degree of airway obstruction. Modern medicine distinguishes several asthma phenotypes, with allergic (exogenous) asthma, developing as part of an allergic reaction, being the most common, and non-allergic (endogenous) asthma, where non-allergy-related factors play the main role. Although bronchial asthma is a chronic disease, with proper diagnosis, patient education, and modern treatment methods, it can be effectively controlled and a normal life can be led, while preventing exacerbations and long-term complications that affect respiratory function. It is also worth knowing that asthma is among the most common chronic diseases worldwide, affecting the population regardless of age, sex, or place of residence, and its diagnosis and treatment are key public health challenges.
The most common causes of asthma development
The development of bronchial asthma is a complex process influenced by both genetic and environmental factors, which often interact from early childhood. Family predispositions to atopic diseases such as asthma, allergic rhinitis, or atopic dermatitis play a key role. Children whose parents suffer from asthma or other allergic diseases have a significantly increased risk—estimated to exceed 40% if both parents are affected. The polymorphism of certain genes responsible for immune functioning and inflammatory responses in the airways is also significant. Hereditary factors often become apparent as early as childhood, when the first symptoms of bronchial hyperreactivity appear, especially in contact with inhaled allergens or viral infections. However, even those without a clear family history of asthma are at risk if strong environmental triggers promoting inflammation in the airways are present.
Environmental factors are led by allergens, the main cause of so-called allergic asthma, especially in children and adolescents. The most common are airborne allergens—house dust mites (their secretions and body fragments), grass, tree and weed pollens, molds, animal dander, as well as certain food and occupational allergens. Prolonged exposure to these factors leads to sensitization and subsequently to chronic airway inflammation, promoting typical asthma symptoms. Respiratory viral infections, especially during infancy and early childhood, when the immune system is immature—frequent infections, e.g., with RS virus or influenza viruses—can induce chronic inflammation and sensitize the bronchial epithelium. The steadily deteriorating quality of atmospheric air is not insignificant either. Pollutants such as PM2.5 and PM10 particulates, nitrogen and sulfur oxides, and ozone increase airway irritation, trigger greater production of inflammatory mediators, and impair ciliary epithelial function. Contact with tobacco smoke—both active and passive—greatly increases the risk of asthma and worsens its course, especially in children; children of smokers more often suffer more severe forms and respond poorly to therapy. Modern lifestyles featuring low physical activity, frequent stays in closed, poorly ventilated spaces, and excessive hygiene also play a role—the hygiene hypothesis suggests that lower exposure to natural microbes in childhood promotes allergic diseases, including asthma. Less common causes include psychological stress, strong emotions, extreme weather conditions (sudden changes in temperature, humidity), certain drugs (e.g., aspirin and other NSAIDs, beta-blockers), and occupational factors for those exposed to irritating chemicals at work. Asthma may also appear as a complication of other respiratory diseases, such as chronic rhinitis or gastroesophageal reflux disease. Such a wide range of risk factors explains why asthma is among the most commonly diagnosed chronic respiratory diseases globally. Its prevention and effective control require an interdisciplinary approach both on the individual and public health levels.
Asthma symptoms – how to recognize them in children and adults?
Asthma symptoms are varied and not always easy to clearly recognize, especially since they can fluctuate over time and differ by patient age. The most common symptoms are: paroxysmal shortness of breath, wheezing (especially on exhalation), dry, persistent cough, chest tightness, and breathing difficulties. These symptoms may be continuous or occur periodically, mainly at night or in the early morning—a characteristic feature of asthma. In children, especially the youngest, the symptomatology of asthma is often nonspecific and commonly mistaken for respiratory infections or allergies. Paroxysmal cough mainly at night, chronic hoarseness, exertional shortness of breath, or bluish discoloration around the mouth may signal developing asthma, especially if symptoms recur cyclically and intensify after exposure to typical allergens, cold air, or physical activity. In older children, it’s easier to notice wheezing, especially on expiration. In adults, the symptomatology may initially be downplayed and attributed to e.g. chronic fatigue, infections, or smoking; that’s why, in this age group, it’s very important to observe chronic or recurring breathing problems, chronic cough not linked to any other obvious cause (such as a cold), frequent lower respiratory tract infections, and limited exercise tolerance.
It is worth stressing that asthma exacerbations can be triggered by various environmental factors, such as contact with allergens (plant pollens, house dust mites, animal dander), air pollution, viral infections, intense physical exertion, or sudden temperature changes. An important aspect of recognizing asthma is noticing the variability and reversibility of symptoms—typically, a patient may have symptom-free periods, followed by sudden episodes of shortness of breath and coughing. Symptoms also commonly occur at night, leading to sleep interruptions and daytime fatigue. In children, respiratory insufficiency may manifest as feeding difficulties, getting tired quickly during play, audible wheezing without a stethoscope, or flaring nostrils when trying to take a breath. Many young patients also experience recurring episodes of bronchitis that do not resolve after antibiotic therapy. In teenagers and adults, asthma symptoms may periodically be less severe but occur in stressful situations, after exercise, or upon exposure to strong odors (perfumes, cigarette smoke). Improper recognition or ignoring recurring symptoms leads to chronic airway inflammation and deepened bronchial hyperreactivity. For early detection, especially in children, it is crucial to observe any respiratory abnormalities, chronic cough of unknown cause, sudden-onset or situational shortness of breath, and wheezing, which may indicate insidious asthma development. Remember, this disease may follow an individual course in each person and present different symptoms depending on phenotype and triggers. Therefore, meticulous medical history and careful observation are fundamental for rapid diagnosis and effective treatment, minimizing the risk of serious health complications.
Types of asthma: allergic and non-allergic asthma
Bronchial asthma is a heterogeneous disease that can appear in various forms, depending on the trigger factors and pathogenic mechanisms. The two primary phenotypes are allergic (atopic) asthma and non-allergic (non-atopic) asthma. Allergic asthma is by far the most commonly diagnosed type, especially in children and young people. Its development is closely connected to hypersensitivity to specific environmental allergens such as house dust mites, animal dander, molds, plant pollens, or some foods. The main feature of allergic asthma is the presence of an IgE-dependent mechanism—activation of the immune system after exposure to an allergen, leading to a rapid inflammatory response in the airways. Symptoms of allergic asthma often occur seasonally or upon contact with a specific trigger, making it relatively easy to link exacerbations with environmental situations. In children, allergic asthma is often associated with atopic dermatitis or allergic rhinitis, forming the so-called allergic march—the progression of allergic diseases in sequential developmental stages. Elevated specific IgE levels in blood or positive skin tests are also typical. Treatment focuses on allergen avoidance, symptomatic pharmacotherapy (mainly inhaled corticosteroids), and in some cases, specific immunotherapy (desensitization). Immunotherapy yields the greatest benefits when specific symptom-triggering allergens are identified, sometimes leading to significant alleviation of the disease course.
Non-allergic asthma, more frequently diagnosed in adults and the elderly, features a different development mechanism and is generally more challenging in its course. This type does not involve typical allergens or high levels of IgE, and attack triggers can be very diverse. The most common include viral and bacterial respiratory infections, air pollution, tobacco smoke, cold air, stress, and intense physical exertion. For some patients, symptoms may be aggravated by medications—typically NSAIDs or some beta-blockers. Non-allergic asthma typically starts later (usually after age 30), with lower symptom variability, and responses to medications are less predictable—standard corticosteroid treatment is often less effective. Furthermore, patients with non-allergic asthma are at higher risk for chronic inflammation and remodeling in the bronchi, leading to persistent narrowing of the airways and a severe disease course. Clinically, other asthma phenotypes are also observed, such as late-onset asthma, eosinophilic asthma, or obesity-related asthma, highlighting the complexity of this disease and the need for individualized treatment. Differential diagnosis between asthma types is based on detailed history, lab tests, and pulmonary function assessment. Identification of the phenotype allows use of modern targeted therapies, such as biologics, especially in patients with severe, hard-to-control asthma. Current treatment guidelines stress the importance of regular symptom monitoring and adjusting treatment according to asthma phenotype, individual risk factors, and response to previous therapies—offering a better chance of preventing exacerbations and improving quality of life, regardless of the specific type.
Diagnosis and treatment methods for bronchial asthma
Diagnosing bronchial asthma is based on a comprehensive clinical assessment, including a detailed patient history and pulmonary function testing. The key to diagnosis is identifying characteristic symptoms—wheezing, paroxysmal shortness of breath, cough, chest tightness—as well as their variability and reversibility. The doctor analyzes trigger circumstances: are the symptoms paroxysmal, do they intensify on contact with potential allergens, after physical exertion, or at night? Asthma is diagnosed based on the presence of symptoms and confirmation of bronchial hyperreactivity and obstruction, which is demonstrated through spirometry. Spirometry allows evaluation of parameters such as forced expiratory volume in 1 second (FEV1) and the FEV1/FVC ratio, as well as their reversibility after bronchial dilator administration. Reduced FEV1 values and significant improvement after inhalation confirm asthma diagnosis. Bronchial challenge tests with methacholine or histamine are also often used to demonstrate airway hypersensitivity. Peak expiratory flow (PEF) measurements, regularly performed by the patient, help monitor disease course and treatment effectiveness individually. Differential diagnosis excludes other respiratory diseases, such as COPD, chronic rhinitis, cystic fibrosis, or heart failure, to prevent treatment errors. In children, additional tests—skin allergy testing and levels of total and specific IgE—help reveal the allergic basis of the disease. The exhaled nitric oxide (FeNO) indicator is used for assessing the degree of eosinophilic inflammation, providing valuable information for determining asthma phenotype. Diagnostic results enable precise identification of asthma type and severity necessary for selecting appropriate treatment methods and monitoring therapy progress.
The treatment of bronchial asthma is a long-term, multi-stage process, depending on the disease phenotype, symptom severity, and patient age. Its main goal is to control the disease, minimize exacerbations, improve quality of life, and prevent long-term complications. The therapeutic foundation is inhaled drugs, primarily glucocorticosteroids (ICS), which are the most effective tool for reducing chronic airway inflammation. They are used daily as baseline therapy, even during symptom-free periods, as they decrease bronchial hyperreactivity and the frequency of exacerbations. When symptoms persist despite the use of ICS, long-acting beta2-agonists (LABA) are added to therapy, which dilate the bronchi and improve breathing comfort. Treatment intensification may also include antileukotrienes, theophylline, and in severe asthma—biologic drugs such as monoclonal antibodies (e.g., omalizumab) targeting IgE or other inflammatory mediators. Pharmacological treatment is supplemented by non-pharmacological strategies—patient education, an individualized therapeutic action plan, and elimination of exacerbating factors, including allergen avoidance, quitting smoking, and minimizing exposure to air pollutants. In allergen-induced asthma, specific immunotherapy (desensitization) may significantly reduce hypersensitivity to particular allergens. Treating asthma in children requires special attention due to different disease mechanisms and difficulties in using some medications. In this group, therapy aims for the fastest possible control of symptoms with minimal side effects. Regular treatment evaluation, correct inhalation technique oversight, and adjustment of pharmacotherapy to the patient’s current condition are key. In patients with severe, hard-to-control asthma, specialist consultations and hospital-based actions—including complex therapies and lung function monitoring—are undertaken. Patient and family education remain integral to treatment, including recognizing signs of exacerbations, proper use of rescue medications, and following an emergency plan. Interdisciplinary cooperation and regular contact with the medical team allow effective asthma control and significantly limit the impact of the disease on patients’ quality of life.
Asthma in children – diagnosis and therapy for the youngest
Diagnosing asthma in children, especially preschoolers, presents a major challenge for pediatricians and allergists due to symptom diversity, their changing dynamics, and difficulties in accurately assessing lung function in the youngest patients. Asthma symptoms in children often mimic non-specific viral respiratory infections—mainly dry or productive cough attacks, especially at night or early morning, wheezing, recurrent shortness of breath, physical fatigue, or even feeding difficulties in infants. Children may also have recurrent infections or prolonged shortness of breath attacks that interfere with daily functioning and lead to withdrawal from activities. Family predisposition to allergic diseases, co-occurrence of atopic symptoms such as eczema or allergic rhinitis, and a history of environmental allergen exposure significantly increase the probability of asthma development. The key diagnostic element is a thorough clinical interview with parents or guardians, analysis of symptom frequency, duration, and triggers, and observation of responses to standard anti-inflammatory treatment. For children over 5 years old, spirometry is possible and facilitates diagnosis, but in younger patients, diagnosis is mainly based on clinical symptom assessment and tracking changes during treatment. Additional diagnostic tools include allergy testing, total and specific IgE measurements, and exhaled nitric oxide (FeNO) levels to confirm the allergic nature of chronic airway inflammation. A common phenomenon is the so-called wheezing syndrome in young children, of whom only some develop full-blown asthma—hence, verifying reversibility and symptom persistence with anti-inflammatory treatment is crucial. Good differential diagnosis distinguishes asthma from other chronic respiratory diseases such as cystic fibrosis, foreign bodies, or recurrent croup.
Treating asthma in children requires an individualized approach focused on controlling symptoms, minimizing therapy side effects, and ensuring proper physical and psychological development. The most important therapy elements are long-term use of inhaled glucocorticosteroids as first-choice anti-inflammatory drugs and rapid administration of short-acting beta2-agonists for sudden symptom escalation. Drug dosages must be tailored to asthma severity, age, and body weight, and therapy effectiveness is regularly assessed based on clinical observation and, where possible, functional tests. Parent and child education is key—this includes correct inhaler use, recognizing triggers (allergens, tobacco smoke, air pollution, infections), and keeping a symptom diary to ensure rapid response to exacerbations. Implementing an action plan for shortness of breath attacks reduces hospitalization risk and enhances child safety. Asthma therapy demands close cooperation of a multidisciplinary team—pediatrician, allergist, pulmonologist, dietitian, and physiotherapist—plus regular follow-up visits to adjust therapy as the child grows and develops. In some children, especially those with severe asthma or atypical courses, modern biological treatments targeting specific inflammatory mediators are used. Thanks to advances in diagnosis and treatment, greater therapy access, and education, it is possible to achieve good asthma control even in the youngest children and provide them a comfortable, active childhood free from serious disease limitations.
Summary
Bronchial asthma is a chronic respiratory disease with diverse causes and symptoms that can occur at any age. Early recognition of symptoms such as shortness of breath, wheezing, or chest tightness enables prompt, effective diagnosis and treatment in both children and adults. Differentiating types of asthma, especially allergic and non-allergic forms, is key to selecting the right anti-inflammatory, inhaled, or bronchodilator therapy. Proper therapy and patient education allow for symptom control and improve the quality of life of people with asthma.
