Different Types of Asthma: Which One Do You Have?

There are several different types of asthma. Knowing which type of asthma you have can help ensure you get the right treatment.

Common types of asthma include:

• Allergic asthma
• Non-allergic asthma
• Cough-variant asthma
• Nocturnal asthma
• Exercise-induced bronchoconstriction
  
• Occupational asthma
• Obese asthma
• Medication-induced asthma
• Viral-induced asthma
• Glucocorticoid-resistant asthma

They all have similarities, but some have unique aspects that affect how they're triggered, diagnosed, and treated.

This article explores the most common types of asthma, what additional symptoms they cause, and what extra diagnostic tests and treatments they require.

What Asthma Types Have In Common

Asthma has certain features that remain the same across most types:

• Classic symptoms: Wheezing, chest tightness, shortness of breath, cough, asthma attacks
• Causes/risk factors: Genetics and environmental exposures (like smoke)
• Diagnosis: Pulmonary function tests (PFTs) and assessing response to asthma medications
• Treatment: A rescue inhaler for asthma attacks and possibly daily inhaled or oral medications to prevent symptoms

Because of this, it's easy to assume that all types of asthma are fundamentally the same. While that's true to a certain extent, the differences between the types matter. That makes an accurate diagnosis crucial.

Allergic Asthma

Allergies are involved in between 50% and 80% of asthma cases. People with seasonal allergies (hay fever) may also be diagnosed with seasonal allergic asthma.

Symptom Triggers

Common triggers of allergic asthma include:

• Pollen
• Mold
• Dust mites
• Animal dander

Additional Symptoms

Classic asthma symptoms are accompanied by allergy symptoms, such as:

• Nasal congestion
• Runny nose
• Scratchy throat
• Sneezing
• Itchy, red, and/or watery eyes

Causes and Risk Factors

Allergic asthma is believed to have a heavy genetic component plus hypersensitivity and exposure to the triggering substances.

Additional Diagnostic Tests

To confirm allergic asthma and determine your triggers, your healthcare provider may also order the following:

• Skin tests: Common allergens are put on your skin to see if you react to them.
• Blood tests: Elevated levels of immunoglobulin E (IgE) antibodies, which your body produces in response to allergens, confirm an allergic reaction.

Additional Treatments

You'll need to manage both asthma and allergies. That may include avoiding triggers, taking allergy medicine (antihistamines), or allergy shots (immunotherapy).

Non-Allergic Asthma

Between 10% and 33% of all people with asthma have non-allergic asthma. It usually develops later in life than allergic asthma.

Some research suggests non-allergic asthma is more severe than other forms. Some studies also suggest it's more common in women.

Symptom Triggers

Non-allergic asthma symptoms can have a variety of triggers, including:

• Cold weather
• Humidity
• Stress
• Exercise
• Heartburn/acid reflux
• Pollution, smoke, or other irritants in the air
• Respiratory infections (e.g., cold, flu)
• Strong odors and sprays

Additional Symptoms

Non-allergic asthma isn't associated with additional symptoms.

Causes and Risk Factors

Things that may lead to non-allergic asthma include:

• Environmental tobacco smoke
• Viral infections
• Other medical conditions

Additional Diagnostic Tests

No test can specifically diagnose non-allergic asthma. Diagnosis can involve skin and blood tests to rule out allergies.

Additional Treatments

You may not need treatments beyond what's generally prescribed for asthma.

However, some people with non-allergic asthma don't respond well to inhaled corticosteroids (ICS). These drugs are used as daily preventive medication for moderate to severe asthma.

If ICS don't work for you, you may need other preventive drugs such as:

• Leukotriene modifiers
• Long-acting beta-agonists (LABAs)
• Long-acting muscarinic antagonists (LAMAs)

Cough-Variant Asthma

A dry cough is the main symptom of cough variant asthma (CVA). It may remain your sole symptom. Or you may go on to develop other symptoms, especially if it's not adequately treated.

Symptom Triggers

Because a dry cough doesn't usually make people think they have asthma, symptom triggers are an important part of figuring out you have the condition.

Watch for bouts of coughing that:

• Wake you up
• Come on after exercise
• Worsen in cold, dry weather
• Worsen with hay fever or other things you're allergic to

Additional Symptoms

CVA doesn't have additional symptoms.

Causes and Risk Factors

Cough-variant asthma may be an early symptom of emerging asthma; children have it more often than adults. Even so, only about 30% of people with CVA develop classic asthma.

Additional Diagnostic Tests

CVA is hard to diagnose. In addition to standard asthma tests, your healthcare provider may order a sputum test to look for white blood cells that are often increased with asthma. Sputum is a type of mucus that's coughed up from the lungs.

Additional Treatments

Treatment for cough-variant asthma is generally the same as for other types of asthma.

Nocturnal Asthma

Nocturnal asthma, as a diagnosis, is usually added to a pre-existing asthma diagnosis. If you have marked nighttime symptoms, you might have nocturnal asthma, or it could be that your asthma is not well controlled.

More than 50% of adults with asthma have nocturnal asthma. About 10% of children with asthma have this form as well.

Symptom Triggers

With nocturnal asthma, you may experience nighttime symptoms several times a week or even every night.

Environmental symptom triggers can include irritants like pet dander or dust in your bedroom or sleeping with the window open.

Additional Symptoms

The symptoms of nocturnal asthma are the same as classic asthma symptoms. They just happen to be more prominent at night.

Sleep interruptions from nocturnal asthma can leave you tired during the day. You may notice you're waking up several times overnight. But many people fall back to sleep quickly and don't recall waking up.

Disrupted sleep from nocturnal asthma can increase your risk of serious complications, including heart disease, respiratory arrest, and asthma-associated death.

Causes and Risk Factors

Nocturnal asthma is believed to be caused by changes in your body that occur at night.

Your circadian rhythm, which is your internal body clock, contributes to nocturnal asthma by causing nighttime shifts in:

• Muscle control
• Airway resistance
• Inflammation
• Hormones

Additionally, obstructive sleep apnea, a sleep disorder that interrupts breathing during sleep, is common among people who have asthma. And the conditions can exacerbate one another.

Additional Diagnostic Tests

Testing your breathing during the day isn't helpful in diagnosing nocturnal asthma. Thus, your healthcare provider may have you test your breathing with an at-home monitor close to your bedtime.

Depending on your symptoms, you might also be sent for a sleep study. For that, you spend the night at a sleep lab and have your symptoms monitored. Some sleep studies can also be done at home with special equipment.

Treatment Changes

Nocturnal asthma is treated with the same medications as classic asthma. But it may require adjusted timing of your medication.

For example, rather than taking a daily control medication in the morning, you might take it in the afternoon or early evening.

Some researchers have suggested time-release tablets for treating this type of asthma. These dissolve slowly, so they're effective over a longer period of time.

Exercise-Induced Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) used to be called exercise-induced asthma (EIA).

Up to 90% of people with any type of asthma may have exercise-related symptoms. However, many people with EIB don't fulfill the diagnostic criteria for asthma.

Symptom Triggers

In EIB, your bronchial tubes (airways) narrow when you exercise. It's believed rapid breathing during exercise can dehydrate the bronchial tubes, which then constrict.

Typically, symptoms begin during exercise but may continue getting worse for 10 to 15 minutes after you stop.

They generally clear up on their own within 30 minutes. But it's safer to use your rescue inhaler than wait to see if you improve without it.

When combined with exercise, certain factors may make EIB more likely. They include:

• Cold weather or a cold environment (such as a skating rink)
• Hot air (such as during hot yoga)
• Chlorine in swimming pools
• Air pollution or other airborne irritants
• Recent respiratory infection or asthma attack
• High pollen count (especially if you also have allergic asthma)
• Odors such as perfume, paint, cleaners, and new carpet or exercise equipment

Low-intensity activities (walking, hiking) or sports with short bursts of exertion (baseball, wrestling, gymnastics) are less likely to trigger EIB.

Additional Symptoms

EIB can have a few symptoms not common in asthma, including:

• Decreased endurance
• Upset stomach
• Sore throat

Causes and Risk Factors

If you have asthma, minor irritation or dehydration from exercise may cause EIB. In this case, the cause of EIB is underlying asthma.

For people who don't have asthma, repeated exposure to cold, dry air, or airborne irritants while exercising may damage bronchial tubes and cause EIB.

This may explain why EIB is especially common in cold-related sports (ice hockey and skiing) and among competitive swimmers (due to chlorine fumes).

People with environmental allergies or who have close relatives with environmental allergies have a higher risk of developing EIB.

Additional Diagnostic Tests

Whether or not you've been diagnosed with asthma, your healthcare provider may test your breathing before and after exercise to determine whether you have EIB.

They'll check your forced expiratory volume (FEV1), which is a measure of how much air you can force out of your lungs.

Then you'll exercise while being supervised, and your FEV1 will be measured again. A decrease of 15% or more generally leads to a diagnosis of EIB.

Treatment

If you're also diagnosed with asthma, preventing bronchoconstriction will be part of your overall treatment plan.

You may be able to prevent symptoms of EIB by:

• Warming up for 10 to 15 minutes before exercising
• Covering your face with a mask or scarf while exercising
• Avoiding exercise in areas where you're exposed to pollutants or allergens

Your healthcare provider may recommend the following:

• A rescue inhaler or a long-acting inhaler before exercise to prevent attacks
• A rescue inhaler when an attack occurs

Occupational Asthma

Some jobs expose you to substances that can lead to occupational asthma (OA). This may account for about 15% of asthma cases in the U.S.

If you have other forms of asthma, these same workplace exposures can make your symptoms worse.

Symptom Triggers

More than 250 substances are believed to cause and trigger OA symptoms. Typically, symptoms are only triggered by the substance(s) you're in regular contact with.

Common triggers include:

• Animals
• Certain types of mold
• Cleaning products
• Chemicals including hydrochloric acid, sulfur dioxide, and ammonia
• Dust from wood, flour, or grains
• Insects
• Latex
• Paints

Many other potential triggers exist, as well.

Additional Symptoms

Many people with IgE-mediated (allergic) asthma develop occupational rhinitis (nasal allergy) symptoms prior to the onset of OA symptoms.

Symptoms from work-related exposures can happen right away or take years to develop.

Causes and Risk Factors

Regular exposure to fumes, gasses, dust, or other irritants causes OA. The exposure either directly damages your airways or causes sensitization to the offending substance.

With sensitization, your body gradually develops an abnormal immune reaction to a substance. You're at risk for OA if you work in the following places:

• Bakery
• Detergent manufacturing facility
• Drug manufacturing facility
• Farm
• Grain elevator
• Laboratory (especially those that involve animals)
• Metal-processing facilities
• Mills
• Plastics manufacturing facility
• Woodworking facility

This list is far from complete. Many other workplaces may expose you to potentially problematic substances.

If you outgrew childhood asthma or have a family history of asthma, you're more likely to develop the occupational type.

Additional Diagnostic Tests

If your provider determines you have asthma and rules out seasonal allergies as a trigger, they can start investigating work-related causes. It can help if you provide Material Safety Data Sheets for chemicals you're exposed to at work.

The next steps can include:

• Testing for the allergen with a skin test or blood test
• Breathing tests over the course of the workday
• Bronchoprovocation, or purposefully irritating the airways with the suspected trigger, to see if your lung function drops at least 20%

Occupational asthma is sometimes misdiagnosed as bronchitis. If you're diagnosed with bronchitis, but treatment isn't effective, and symptoms tend to be worse at work than in other places, bring this up with your healthcare provider.

Getting a proper diagnosis and treatment is important. If OA continues unchecked, it can cause permanent lung damage.

Additional Treatments

Standard asthma treatments are typically used for OA. In addition, you'll want to take steps to avoid the problem substance(s) if possible.

This may require Reasonable Accommodation from your employer, which is required under the Americans With Disabilities Act (ADA). Some people have to change jobs to avoid their triggers.

Other Types of Asthma

Asthma comes in several less-common types, as well.

Obese Asthma

Obese asthma is a recently identified asthma type. It appears to be different from other types of asthma, even in people with obesity. Genetic studies suggest airway constriction comes from a different mechanism.

Obese asthma is a stand-alone diagnosis. Research suggests it has a different genetic and molecular basis plus many other unique characteristics. Not everyone who's obese and has asthma has obese asthma.

Medication-Induced Asthma

Medication-induced asthma is triggered by aspirin and a few other medications. It's believed to have a genetic susceptibility.

This can be a stand-alone diagnosis, or it may be added to a previous asthma diagnosis. It typically makes pre-existing asthma worse. It can be severe and even fatal.

Viral-Induced Asthma

In viral-induced asthma, a respiratory tract infection (e.g., the common cold, flu, or COVID-19) can trigger or worsen asthma. An estimated 50% of acute asthma attacks have a viral trigger.

This type can also be a stand-alone or add-on diagnosis.

Glucocorticoid-Resistant Asthma

Glucocorticoid-resistant asthma is a subtype of asthma. It's defined by symptoms that don't respond to the steroid treatments frequently used for asthma. It's especially likely to be severe.

Glucocorticoid-resistant asthma is always an add-on to an earlier asthma diagnosis.

Classifying Different Types of Asthma

It's not uncommon for asthma to be called by several different names.

It may be referred to by its:

• Type (as discussed above)
• Frequency: intermittent or persistent
• Severity: mild, moderate, or severe
• When it started: childhood-onset vs. adult-onset asthma

Asthma is also classified by the type of airway inflammation involved and includes:

• Eosinophilic asthma is inflammatory asthma that is typically related to an allergic reaction.
• Neutrophilic asthma is inflammatory asthma associated with severe and persistent symptoms.
• Mixed eosinophilic and neutrophilic asthma is also possible.
• Paucigranulocytic asthma is non-inflammatory asthma.
  

Some of these classifications may also be combined—for example, mild intermittent adult-onset allergic asthma or glucocorticoid-resistant occupational asthma. It's also possible to have more than one type of asthma. For example, you could have non-allergic and nocturnal asthma.

If you're unsure what's behind the name being used to describe your case, be sure to ask your healthcare provider.

These are more than just names. They indicate something about your condition that is important to its management, among other things. For example, compared to childhood-onset asthma, adult-onset asthma typically:

• Is less likely to have periods of remission
• Involves constant breathing problems
• Leads to more rapid declines in lung function
• Is more difficult to treat
• Is less likely to be associated with allergies

Summary

Asthma comes in many forms and can develop at any age. Allergic asthma is triggered by allergies. Non-allergic asthma is triggered by irritants in the air.

Cough-variant asthma is distinguished by a dry cough. Nocturnal asthma is worse at night. Exercise-induced bronchoconstriction isn't true asthma but is common in people with asthma. Occupational asthma is triggered by workplace exposure to irritants.

Less common types are triggered by certain medications or viruses. One type involves resistance to standard asthma treatments. Some types have to be diagnosed and treated differently from classic asthma.

Zeroing in on an accurate asthma diagnosis can take some time. Your precise diagnosis can have a big impact on the treatments you're given, so the diagnostic process is important.

Pay close attention to your symptoms, their frequency, triggers, and factors that may have influenced the onset to help your healthcare provider reach the correct diagnosis and treatment plan for you.