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Asthma is a chronic respiratory condition where airways can become inflamed or even narrowed as a result of different triggers. Breathing is one of those things most people do every day without much thought. If you have asthma, getting enough air in and out of your lungs can be difficult.

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How asthma develops

Asthma can develop at any stage of life. It’s an unpredictable condition because it can develop naturally or as a result of a severe viral infection.

For some people, cutting the grass or hiking off the beaten path can trigger an asthma attack, when your airways become inflamed and swollen. For others, their asthma gets worse at different times of the day.

You’re not alone if you’ve felt this way. Coughing, wheezing or shortness of breath can be signs that you have a specific asthma trigger or combination of triggers. You can trust that our team of allergists will help you get to the bottom of your asthma condition.

Patient using an inhaler pump during an asthma attack in her living room and experiencing shortness of breathe.
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An asthma attack can be a medical emergency. If you have difficulty breathing, chest pains or other concerning symptoms, call 911 immediately. Every second counts.

Asthma symptoms can vary depending on where your asthma occurs or can be a combination of several key symptoms, including:

  • Chest tightness
  • Coughing
  • Shortness of breath
  • Wheezing

Asthma triggers

Before putting you on a path to a healthier you, we’ll have to first confirm what triggers your asthma.


Allergens are nearly invisible substances to the naked eye and float around in the air we breathe. Your body views allergens as dangerous, and it will react accordingly, sometimes as an asthma attack.

How much of the allergen you breathe in will affect the severity of your asthma attack. It’s also important to know that experiencing shortness of breath or wheezing doesn’t automatically mean you have asthma.

What are examples of common allergens that trigger asthma attacks?

  • Dust
  • Molds and spores
  • Pet dander
  • Pollen

How quickly can an asthma attack due to allergens come on?

  1. Early phase response: Asthma attacks usually peak within 30 minutes after exposure, then get better over the next several hours if you’re no longer exposed to the allergen.
  2. Delayed response: Asthma attacks can peak 6–12 hours after exposure. For example, let’s say you’re visiting a friend who has a pet cat. Breathing in enough cat dander while you’re at their house can lead you to have an asthma attack later that day. 

There is increasing evidence that inhaling low levels of an allergen over a long period can make asthma worse in the long term. 


Irritants are things our lungs dislike. Some doctors call asthma caused by irritants “reactive airway disease” because it’s clear that asthma is present, but undiagnosed. Lung sensitivity to irritants will change over time.

While irritants differ from allergens, exposure to allergens will make your lungs more sensitive to irritants.

What are examples of common irritants that trigger asthma attacks?

  • Cold air
  • Dust
  • Fiberglass
  • Smoke
  • Volatile odors

How quickly can an asthma attack due to irritants come on?

Irritants can cause an asthma attack within 1 minute. Removing the irritant can improve your situation within 5–10 minutes.


Exercise-induced asthma is a lung condition that causes coughing, chest tightness, shortness of breath and wheezing after exercise.

How quickly can an asthma attack due to exercise come on?

If a person with exercise-induced asthma works out, lung function can go from normal to greatly reduced in 5–10 minutes. 

Food additives

While you may love a certain food, whatever additives are in that food may not love you back. Asthma attacks from food additives happen when our bodies cannot metabolize the ingredients normally.

What are examples of common food additives that trigger asthma attacks?

  • Monosodium glutamate (MSG)
  • Sulfites (commonly found in wine)
  • Yeast

How quickly can an asthma attack due to food additives come on?

Sulfites, the most common additive that causes asthma, can lead to a reaction within 5 minutes. 

Diurnal variations

Diurnal variations cover how your body responds to allergens or irritants over a 24-hour period. Several studies have revealed that asthma symptoms can worsen at night.

To get a better idea of your body’s reaction to diurnal variations, it’s common to compare peak flow readings. This measures airflow out of the lungs in the morning and evening.

How do diurnal variations affect asthma symptoms?

Diurnal variations are not yet fully understood. Allergens in bedding, such as dust mites, could play a role. Regurgitating acid into the back of the throat at night could also be a factor, especially for people who have hiatal hernias of the stomach.

Viral infections

A virus's effect on asthma is very unpredictable and can range from mild asthma to fairly severe prolonged asthma. That's because a virus can make your lungs more sensitive to other allergy triggers.  

Many people can pinpoint the start of their asthma as when they experience a severe viral infection or viral pneumonia. As of now, there isn't evidence that bacterial infections of the lungs cause asthma.

How quickly can asthma flare-ups caused by a virus come on?

A typical pattern we see is that when a person becomes ill with an upper respiratory infection, they may develop a cough followed by asthma over 4–6 days. Post-viral asthma can be very persistent and last for many weeks.

Sinus infections

While the medical community isn’t in full agreement on whether sinus infections can make asthma worse, it’s possible. This is the one instance in which antibiotics might help asthma.

Reflux disease

When stomach acid regurgitates into the esophagus, it can make asthma worse. And especially at night, you may also inhale tiny droplets of stomach acid into the trachea.



There are several tests we turn to for determining if you're living with asthma and, if so, the triggers that worsen your condition. These tests involve evaluating your lungs to better understand how you breathe and what may be restricting your airflow. Additionally, your doctor may order a skin test to pinpoint your specific asthma trigger.

Methacholine challenge test (MIC)

The methacholine challenge test (MIC) involves taking a deep breath of methacholine aerosol mist to gauge a person's natural response to the mist. We couple an MIC with another test called spirometry that measures lung function before and after the challenge.

We can determine if asthma is present if you experience the following during the test:

  • Airway spasms and narrowing
  • Reduction in lung function by at least 20%

Rest assured, your care team will have a close eye on your reactions and overall health the entire time. Following the test, you'll receive a bronchodilator to reverse any reactions to the methacholine.

Pulmonary function tests

A pulmonary function test analyzes how well the lungs are performing. The tests measure lung volume, capacity, rates of flow and gas exchange.

Skin testing

Skin testing delivers very small traces of an allergen with either a prick or injection to see if your body has an allergic reaction. Our goal is to pinpoint the allergy triggers that can affect your asthma.



Your doctor will consider your symptoms, asthma history and testing results to create a long-term wellness plan. Your care plan can include one or a combination of the following treatment methods to help manage symptoms and deliver much-needed oxygen to the lungs:  

  • A BiPAP machine
  • Bland aerosol therapy
  • Distancing yourself from known allergy triggers
  • Incentive spirometer
  • Inhalers, medications and nebulizers
  • Oxygen therapy

The truth is asthma triggers can overlap and are naturally complex, so it may be difficult to pinpoint the cause of your asthma at any given time. We'll look to you to keep us informed about how the medications and treatment therapies are working. We can adjust your treatment or recommend additional testing like peak flow monitoring by staying in the loop on your progress.

Peak flow monitoring measures the air flowing out of the lungs. This is often very helpful in determining the effectiveness of your medications. We can monitor it over several weeks or months to get a complete understanding of your asthma.

BiPAP Machine

A BiPAP (Bi-level Positive Airway Pressure) machine offers lungs the breath of fresh air they need when they're not strong enough to get it naturally. The small machine connects to a face mask with a tube. When you breathe in, the machine blows pressurized air through the face mask and into your lungs, helping them get the right amount of oxygen.

BiPAP machines have different pressure settings that can match your natural respiratory cycle. This machine may feel clunky at first, but most people adjust to it over time.

BiPAP machines are helpful treatment options for people living with allergies and asthma, as well as a range of other pulmonary conditions.

Bland aerosol therapy

Bland aerosol therapy delivers a light medicinal mist into the lungs to relax your airway muscles. When these muscles relax, your body does a better job of breathing naturally and fighting infections. Aerosol therapy is used to treat conditions that affect your airways, like allergies, asthma and a variety of pulmonary disorders.

Incentive spirometer

An incentive spirometer is a handheld device that helps people take slow, deep breaths. It's commonly used after surgery or during recovery from pneumonia and other lung disorders like asthma.

Think of an incentive spirometer as a strength-training coach for your lungs — it helps you perform breathing exercises that strengthen your lungs the more you use it. Incentive spirometers are even proven to lower the risk of developing future lung complications.

Inhalers, medications + nebulizers

Medication is a safe way to manage your reactions and symptoms. Your doctor will align your medications to your asthma condition and known allergy triggers. Medications come in different shapes and sizes, like oral pills, inhalers, injections or nebulizers.

The key difference between nebulizers and inhalers is how the medicine is delivered: Nebulizers are larger, electronically powered devices whereas inhalers are handheld, non-electric devices.

Nebulizers are lunchbox-sized devices that convert liquid medicine into a mist when inhaled through a face mask or mouthpiece. They take about 10–20 minutes to deliver the medicine.

An inhaler is small enough to easily fit in your pocket, and uses pressure to pump medicine into the lungs that starts acting immediately. Inhalers are typically used to treat asthma and pulmonary conditions like COPD. There are 2 main types of asthma inhalers:

  • Metered dose inhaler (MDI): An MDI is a pressurized canister that delivers a puff of medicine into the lungs through a mouthpiece. A chemical propellant is used to push the medication out of the inhaler.
  • Dry powder inhaler: This handheld device delivers only medication to the lungs when inhaled. That means, unlike MDIs, dry powder inhalers don't use chemical propellants or any other ingredients as part of the inhaler. 
Oxygen therapy

Breathing is a natural activity we do without much thought, but when you're living with a condition that restricts your airflow, it can become a big challenge. Oxygen therapy helps your body get the right amount of oxygen. There are 2 ways we supply oxygen therapy:

  • In a metal cylinder that delivers oxygen to the lungs through a face mask
  • Through a small tube inserted into the windpipe

People living with allergies, asthma or other pulmonary conditions can find relief with oxygen therapy. 

Anasuya Gunturi MD, PhD talks with patient at Lowell General Hospital's Women's Wellness Center clinic appointment.
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