What Type of Asthma Do You Have?

Symptoms, causes, and treatments

Symptoms like breathing difficulty and chest tightness surely define asthma. But there are actually several types of asthma, and they vary in terms of their triggers and additional symptoms.

  • Occupational asthma
  • Glucocorticoid-resistant asthma
  • Obese asthma

Adult-onset asthma can be further broken down into the subtypes of:

  • Allergic asthma
  • Non-allergic asthma
  • Cough-variant asthma
  • Medication-induced asthma
  • Nocturnal asthma
  • Viral-induced asthma
  • Exercise-induced asthma
  • Adult-onset asthma

The major types of asthma are:

It's possible to have more than one type of asthma, such as non-allergic and nocturnal. Most people with asthma will experience exercise-induced bronchoconstriction at some point.

In addition to type, asthma comes in multiple severities, which may change over time. Most asthma types can occur at any severity.

The official name of your diagnosis, therefore, may be something like moderate-persistent occupational asthma or intermittent allergic asthma with EIB.

Some elements of asthma are the same across most or all types and severities:

  • Classic symptoms: Wheezing, chest tightness, shortness of breath, cough, asthma attacks are common to all types of asthma.
  • Causes/risk factors: Genetics and environmental exposures (like smoke) are believed to play causal roles across the board, though some types have additional causes specific to them.
  • Diagnosis: In all cases, your doctor will review your symptoms and triggers, test your lung function, and assess your response to asthma medications.
  • Treatment: While some asthma types have unique underlying mechanisms that require specific additional treatments, almost everyone with asthma has a rescue inhaler for asthma attacks. People with moderate-to-severe cases also use daily inhaled or oral medications to prevent symptoms.

But there are differences between asthma types in all of these areas as well, and they can affect how your asthma is triggered and best managed.

Allergic Asthma

Between 50% and 80% of all asthma cases are allergic asthma, which is also called extrinsic asthma. In people with seasonal allergies (hay fever), this type may be called seasonal asthma.

With allergic asthma, your immune system responds inappropriately to allergens, which triggers both allergy symptoms and asthma symptoms (airway obstruction, wheezing).

Symptom Triggers

If you have allergic asthma, it's important for you to identify what triggers your asthma. Common triggers include:

Additional Symptoms

Your asthma symptoms will be the same as with other types but will also be accompanied by allergy symptoms:

  • 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 combined with hypersensitivity and exposure to the substances that trigger symptoms.

Additional Diagnostic Tests

To confirm your asthma is allergic, and possibly to determine triggers, your doctor may order:

  • 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

In addition to standard asthma treatments, you need to manage your allergies. That includes avoiding triggers when possible and taking allergy medicine, such as antihistamines or immunotherapy (allergy shots).

Non-Allergic Asthma

Between 10% and 33% of all people with asthma have non-allergic asthma, which is sometimes called intrinsic asthma. It usually develops later in life than allergic asthma.

Some research suggests non-allergic asthma is more severe than other forms as measured by the Global Initiative for Asthma (GINA) score. Some studies also suggest a higher prevalence among women, but this hasn't been universal.

Symptom Triggers

Non-allergic asthma symptoms can be triggered by a variety of things most people wouldn't expect to cause asthma problems, 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 any additional symptoms.

Causes and Risk Factors

This asthma type is caused by viral infections and other irritants. Things that may lead to non-allergic asthma include:

Conditions such as rhinosinusitis (non-allergic sinus problems) and gastroesophageal reflux disease (GERD) frequently occur in people with non-allergic asthma and may contribute to its development.

Additional Diagnostic Tests

While no test can specifically diagnose non-allergic asthma, you may be given skin and blood tests to rule out allergic triggers.

Additional Treatments

You shouldn't need treatments beyond what's generally prescribed for asthma.

However, people with non-allergic asthma are less likely to respond to inhaled corticosteroids (ICSs), which are used as daily preventive medication for moderate-to-severe asthma.

You may need to take additional or alternative medications to prevent asthma attacks, such as:

Cough-Variant Asthma

While a mucousy cough may accompany the usual symptoms of asthma, some people's only asthma symptom is a dry cough. This is called cough variant asthma (CVA).

The cough may remain your sole symptom or you may go on to develop other symptoms, especially if your asthma isn't properly 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

Cough-variant asthma doesn't have additional symptoms.

Causes and Risk Factors

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

Additional Diagnostic Tests

Cough-variant asthma is difficult to diagnose. In addition to standard asthma tests, your doctor may order a sputum culture to confirm this diagnosis.

Sputum is mucous from your lungs. In people with asthma, it often contains high levels of blood cells called eosinophils.

Additional Treatments

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

However, some doctors are more aggressive in the hopes of preventing other asthma symptoms from developing, especially if the cough is severe.

In this instance, standard asthma medications are used, but you may be given drugs that would normally be reserved for a more severe case.

Asthma Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Medication-Induced Asthma

Several medications have been found to induce asthma in some people and to worsen attacks in some people with pre-existing asthma. Aspirin was the first such drug identified as having this effect and, as such, this condition is often called aspirin-induced asthma (or drug-induced asthma).

The relevant drugs come from two main classes: non-steroidal anti-inflammatory drugs (NSAIDs) and beta-blockers. Asthma attacks linked to these drugs can be fatal.

Symptom Triggers

NSAIDs are typically used to treat pain from inflammation and to lower fevers. Those that have been linked to this type of asthma include:

  • Aspirin (acetylsalicylic acid)
  • Motrin/Advil (ibuprofen)
  • Aleve (naproxen)
  • Voltaren/Cataflam/Cambia (diclofenac)

Other NSAIDs may cause symptoms as well, especially in people highly sensitive to those listed above. Corticosteroids typically used to treat asthma relieve inflammation in a different way than these, however, and are not linked to drug-induced asthma.

Any beta-blocker can trigger symptoms in sensitive people, as well. Beta-blockers are typically used for heart conditions, high blood pressure, and migraines. Common ones are:

  • Corgard (nadolol)
  • Inderal (propanolol hydrochloride)
  • Normodyne (labetalol)

Reactions can occur with other drugs from other classes as well, but these two are the most common.

A class of blood-pressure lowering drugs called ACE inhibitors used to be suspected of causing drug-induced asthma because they frequently cause a dry, chronic cough and may also cause wheezing in some people. However, it's now known that such symptoms are drug side effects related to an increase in the cough reflex and accumulation of substances that give way to bronchconstriction.

Additional Symptoms

Symptoms of this asthma type are the same as for classic asthma, but they're more likely to be severe.

Causes and Risk Factors

The cause of medication-induced asthma isn't yet known but several hypotheses are being explored. Some researchers suspect the problem drugs may contribute to oxidative stress in some people or set up a complicated chain reaction that leads to asthma symptoms.

About 20% of adults with asthma who also have nasal polyps are sensitive to aspirin and other anti-inflammatory drugs. Alternative pain relievers that are typically safe include:

  • Tylenol (acetominophen)
  • COX-2 inhibitors
  • Corticosteroids

Most people with asthma react to beta-blockers that are non-selective.

Additional Diagnostic Tests

No additional tests are used to diagnose medication-induced asthma.

Additional Treatments

The primary treatment for this type of asthma is standard asthma medications and avoiding the problem drugs.

If you absolutely need to take a problem drug for another condition, you may be able to do so by undergoing a process called drug desensitization.

With this method, an allergist or immunologist administers the drug in a very small dose, then increasing doses after set amounts of time have passed until the full dose is given. According to the American Academy of Allergy Asthma & Immunology, "this procedure temporarily allows an allergic patient to take the medication by tricking the immune system into accepting it."

Nocturnal Asthma

Nocturnal asthma, as a diagnosis, is usually added on to a pre-existing asthma diagnosis. If you have marked nighttime symptoms, it can either be nocturnal asthma or that your asthma is poorly 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 mostly the same as classic asthma symptoms. They just happen to be more prominent at night.

However, the sleep interruptions associated with nocturnal asthma can leave you tired during the day. You may be aware of waking up several times overnight, but many people aren't; they fall back to sleep quickly enough to not remember it.

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 internal body clock, or circadian rhythms, contributes to nocturnal asthma by causing nighttime shifts in:

  • Muscle control
  • Airway resistance
  • Inflammation
  • Hormones

Additionally, the sleep disorder obstructive sleep apnea, which interrupts your breathing during sleep, is common in people with asthma and the conditions can exacerbate one another.

Additional Diagnostic Tests

Testing your breathing during the day isn't that helpful when diagnosing nocturnal asthma, so your doctor may instruct you to test your breathing at home closer to nighttime.

Depending on your specific symptoms, your doctor might also send you for a sleep study.

Treatment Changes

Nocturnal asthma is treated with the same medications as classic asthma, but it may require changes to the timing of your medication. For example, rather than taking a daily control medication in the morning, your doctor may instruct you to use it in the afternoon or early evening.

Some researchers also have suggested time-release tablets for treating this type of asthma.

Viral-Induced Asthma

Viral-induced asthma is caused by a respiratory tract infection, such as the common cold, flu, or COVID-19. An estimated 50% of acute asthma attacks have a viral trigger.

A viral respiratory tract infection can cause asthma:

  • In people who've never had asthma symptoms before
  • In adults who "outgrew" childhood asthma
  • By being an exacerbating factor to other types of asthma

Symptom Triggers

The respiratory tract infection itself is the symptom trigger in this asthma type.

Additional Symptoms

Viral-induced asthma can cause asthma attacks even if your symptoms typically are well-controlled. So while it doesn't cause additional symptoms, it does exacerbate those you already experience.

Causes and Risk Factors

Doctors don't yet know why certain respiratory tract infections trigger asthma in some people and not in others.

The primary viruses responsible for new-onset or worsening asthma are:

Rhinovirus alone is the cause of between 60% and 70% of cases, with flu and RSV causing the majority of the rest.

Other viruses linked to a small percentage of viral-induced asthma cases include:

Additional Diagnostic Tests

Your doctor may suspect viral-induced asthma if you have your first asthma symptoms during a respiratory illness or if symptoms suddenly appear after a period of excellent control.

You may be given standard asthma diagnostic tests, even if you're already diagnosed with asthma, because viral-induced cases tend to result in significantly worse results.

If you haven't previously had asthma, your doctor will likely send you to a pulmonologist for more extensive testing to confirm an asthma diagnosis.

You may also get a viral test to confirm the presence of a certain virus, such as RSV or the flu.

Additional Treatments

For viral-induced asthma, it's important to treat the viral infection as well as possible. The asthma itself doesn't need treatment beyond what's standard for asthma, although if your symptoms are worsened, you may need to add or increase medications.

Doing what you can to avoid respiratory infections can help prevent this type of asthma.

If you have asthma, had it as a child, or have a strong family history of asthma, talk to your doctor about a flu vaccine, avoid people with respiratory infections, and practice social distancing, handwashing, and other virus-avoidance strategies.

Exercise-Induced Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) used to be called exercise-induced asthma (EIA). EIB is considered a more accurate term because while up to 90% of people with all types of asthma may be triggered by exercise, many people with EIB don't fulfill the diagnostic criteria for asthma.

Symptom Triggers

In EIB, your bronchial tubes (airways) narrow and you develop asthma-like symptoms when you exercise. It's believed that the loss of heat and/or water from the airways due to the rapid breathing of exercise is the actual culprit. The bronchial tubes become dehydrated, which leads to constriction.

Typically, symptoms begin during exercise but may continue getting worse for 10 to 15 minutes after you stop before clearing up on their own (typically within 30 minutes). It's safest to use your rescue inhaler, though, rather than waiting and seeing if you improve without it.

When combined with exercise, certain factors may make EIB especially likely, including:

  • Cold weather or a cold environment (such as in a skating rink) because cold air is drier than warm air
  • 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/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 come with a few symptoms not shared by asthma, including:

  • Decreased endurance
  • Upset stomach
  • Sore throat

Causes and Risk Factors

In people with asthma, who already have inflamed bronchial tubes and a hyper-responsive airway, minor irritation or dehydration from exercise may cause EIB. In this case, the cause of EIB is the underlying asthma.

In non-asthmatics, repeated exposure to cold, dry air or airborne irritants while exercising may cause damage to the bronchial tubes that leads to EIB. This may explain why EIB is especially common in cold-related sports such as 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're diagnosed with asthma, to diagnose EIB, your doctor may test your breathing before and after exercise.

Typically, they'll test your forced expiratory volume (FEV1) to see how much air you can force out of your lungs, then have you exercise on a treadmill or stationary bike while being supervised, then test you again. A decrease of 10% or more generally leads to a diagnosis of EIB.

Treatment

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

If you're not also diagnosed with asthma, you may be able to prevent symptoms 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 doctor may recommend a rescue inhaler or a long-acting inhaler before exercising to prevent attacks as well as using a rescue inhaler when an attack occurs.

Adult-Onset Asthma

Adult-onset asthma (AOA) is basically just asthma that develops during adulthood, but it does have some features that distinguish it from types of asthma that more commonly develop in children. It also has multiple subtypes.

Adult-onset asthma doesn't require any special diagnostic tests, but some subtypes do. These subtypes also have some differences in terms of how they are treated (see below). Avoiding triggers may be more beneficial than standard asthma medications.

Symptom Triggers

Symptom triggers for adult-onset asthma that's not identified as a specific subtype tend to be the same as those of other asthma types. While allergies are overall less likely to be involved, cat dander is the biggest trigger.

Additional Symptoms

On top of typical asthma symptoms, people with AOA often take an especially long time to recover from chest infections, such as colds.

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

Causes and Risk Factors

Possible causes of adult-onset asthma include:

  • Female sex hormones
  • Allergies
  • Chronic sinus problems
  • Respiratory infections
  • Workplace or environmental exposure to pollutants and irritants
  • Certain medications, especially aspirin
  • Obesity

Adult-onset asthma is more common in women.

Occupational Asthma

Some jobs expose you to substances that can lead to occupational asthma, a subtype of AOA. This may account for about 15% of asthma cases in the U.S.

If you have other forms of asthma, workplace exposures that can cause asthma may cause your symptoms to get worse.

Symptom Triggers

More than 250 substances are believed to both cause and trigger symptoms of occupational asthma. 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
  • Dusts from wood, flour, or grains
  • Insects
  • Latex
  • Paints

Additional Symptoms

Occupational asthma doesn't cause additional symptoms.

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

Causes and Risk Factors

Occupational asthma is caused by regular exposure to fumes, gasses, dust, or other irritants. The exposure either directly damages your airways or causes sensitization to the offending substance. (That is, your body gradually develops an abnormal immune reaction to something.)

You're at risk for occupational asthma if you work in/at a:

  • 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

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

Additional Diagnostic Tests

No additional tests can diagnose occupational asthma.

Once your doctor determines you do have asthma and rules out seasonal allergies as a trigger, they can start investigating work-related causes. Providing Material Safety Data Sheets for chemicals you're exposed to at work can help them figure out what's causing your symptoms.

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 other places, bring this up with your doctor.

Getting a proper diagnosis and the correct treatment is important. If occupational asthma continues unchecked, it can cause permanent lung damage.

Additional Treatments

Standard asthma treatments are typically used for occupational asthma.

In addition, you'll want to take steps to avoid the problem substance(s) if possible. This may require the help of your employer in the form of Reasonable Accommodation, which is a legal requirement under the Americans With Disabilities Act (ADA).

Glucocorticoid-Resistant Asthma

While glucocorticoids are one of the most potent anti-inflammatory drugs available and are normally very effective asthma treatments, they don't work well in between 5% and 10% of people with asthma. When that happens, the patient is said to have glucocorticoid-resistant or steroid-resistant asthma, another subtype of AOA.

Managing this form of asthma is very expensive and represents a significant healthcare problem. This small group of patients accounts for between 50% and 80% of all asthma-related healthcare costs.

Symptom Triggers/Additional Symptoms

This type of asthma isn't associated with any additional symptoms or symptom triggers, but it is especially likely to be severe.

Causes and Risk Factors

Researchers have several theories about why some people don't respond to steroids, but they've made some important discoveries in recent years.

One major finding appears to be that different immune-system cells are involved. In most people with asthma, cells called eosinophils are part of the inflammatory response that causes airway constriction. Steroids do a good job of treating this type of inflammation.

However, most steroid-resistant people tend to have lower levels of eosinophils and higher levels of cells called neutrophils. Neutrophils are typically associated with bacterial infection, and the possible role of bacteria in steroid-resistant asthma is currently under investigation.

Several other possible mechanisms are being explored, as well. 

Additional Diagnostic Tests

This type of asthma is diagnosed based on the lack of response to treatment rather than any specific tests.

Alternative Treatments

People with steroid-resistant asthma may require:

  • High doses of steroids
  • Secondary immunosuppressant drugs
  • Disease-modifying biologic drugs

These drugs can be costly and come with some serious side effects that can have a significant negative impact on quality of life.

Obese Asthma

A newer asthma classification and subtype of adult-onset asthma, obese asthma has several distinct features that set it apart from other types of asthma, and from even in other types of asthma in people who are obese.

Obesity has long been considered a risk factor for asthma, including severe cases that are difficult to treat. This new classification is expected to help doctors better address some problems.

Characteristics of obese asthma include:

  • Adult-onset
  • Non-allergic
  • Female dominant
  • Common co-existing conditions
  • Steroid resistance
  • Neutrophil dominance
  • Asthma goes away with weight loss

Someone who developed asthma before becoming obese or whose asthma doesn't fit the criteria for obese asthma may simply have asthma and obesity as co-morbid conditions rather than obese asthma.

Symptom Triggers

Inflammation is a major symptom trigger in obese asthma, just as it is in other asthma types. However, in obese asthma, the inflammation appears to be caused and maintained by a different mechanism.

Additional Symptoms

No additional symptoms are associated with obese asthma, except that symptoms are more likely to be severe.

Co-existing conditions that are common with this type of asthma include:

GERD and sleep apnea are both known to exacerbate asthma, and both are exacerbated by obesity.

Causes and Risk Factors

As in glucocorticoid-induced asthma, obese asthma tends to feature more neutrophils than eosinophils, which is believed to be why it's less likely to respond to steroid treatments.

While exact causes aren't yet understood, several risk factors are associated with obese asthma, including:

Additional Diagnostic Tests

Additional diagnostic tests aren't necessary to diagnose obese asthma. However, your doctor may calculate your body-mass index (BMI), which can indicate high levels of body fat and is indirectly used to classify people as overweight or obese.

The formula for calculating BMI is your weight divided by your height in inches squared, then multiplied by 703, or weight / [height (in)]2 x 703.

A BMI of 25 to 29.9 indicates overweight; a BMI of 30 or more indicates obesity.

Additional Treatments

Because obese asthma goes away with weight loss, recommended treatments include diet and exercise. If those fail, bariatric surgery might be an option, but it's important to consider the risks versus the benefits.

Because of the altered gut microbiome, prebiotics and probiotics may help as well.

Additionally, treatments for glucocorticoid-resistant asthma may be used for obese asthma.

A Word From Verywell

Zeroing in on an accurate asthma diagnosis can be difficult and take some time. Know that your precise diagnosis can have a big impact on what treatments you're given, so it's an important process.

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

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading