Asthma is a chronic condition that affects the airways in the lungs. When asthma becomes active, the airways can become inflamed, swollen and narrower, making it more difficult for air to move in and out of the lungs. Symptoms can occur at any age and may come and go over time.
Recognising the early warning signs is important because asthma symptoms can sometimes become significantly worse and develop into an asthma attack, which may require urgent medical attention.
Important: Having one or more of these symptoms does not automatically mean that you have asthma. Other respiratory conditions can cause similar symptoms. A healthcare professional may need to perform breathing or lung-function tests to confirm the diagnosis.
1. WHEEZING OR A WHISTLING SOUND WHEN BREATHING
One of the most recognisable symptoms of asthma is wheezing.
It may sound like:
- A high-pitched whistle when breathing out
- A squeaking sound from the chest
- Noisy breathing
- A whistling sound that becomes more noticeable at night or during exercise
Wheezing happens because the airways become narrowed, making it harder for air to flow normally.
However, not everyone with asthma experiences obvious wheezing, and the absence of wheezing does not necessarily rule out asthma.
2. REPEATED COUGHING
A persistent or recurring cough can be another sign of asthma.
Asthma-related coughing may:
- Become worse at night
- Occur in the early morning
- Appear during exercise
- Become worse after exposure to cold air
- Occur after exposure to smoke, dust or allergens
- Continue even after other cold symptoms have disappeared
For some people, coughing may be the most noticeable asthma symptom.
A recurring cough, particularly when it follows a predictable pattern, should be discussed with a healthcare professional.
3. SHORTNESS OF BREATH
Another important warning sign is shortness of breath, where a person feels that they cannot get enough air.
Someone experiencing asthma-related breathlessness may describe it as:
- Feeling unable to take a deep breath
- Feeling that the chest is not getting enough air
- Becoming breathless during ordinary activities
- Needing to stop frequently while walking or exercising
- Feeling unusually breathless at night
The severity can vary considerably from one episode to another.
4. CHEST TIGHTNESS OR PRESSURE
Asthma can cause an uncomfortable sensation of tightness in the chest.
A person may describe the feeling as:
- Pressure around the chest
- A band-like sensation around the chest
- Feeling as though something is squeezing the chest
- Difficulty expanding the chest fully
Chest tightness may occur together with coughing, wheezing or shortness of breath.
5. SYMPTOMS THAT BECOME WORSE AT NIGHT
Asthma symptoms can follow a particular pattern and may become worse during the night or early morning.
Possible nighttime symptoms include:
- Repeated coughing
- Wheezing
- Shortness of breath
- Chest tightness
- Waking up because of breathing difficulties
Regularly waking up because of coughing or other breathing symptoms can be a sign that asthma is not well controlled or may need further assessment.
6. BREATHING PROBLEMS DURING OR AFTER EXERCISE
Some people notice asthma symptoms particularly when they are physically active.
Symptoms may appear during or after:
- Running
- Brisk walking
- Cycling
- Sports
- Climbing stairs
- Other strenuous activities
The person may develop coughing, wheezing, chest tightness or unusual shortness of breath.
Exercise can be one of several factors that trigger or worsen asthma symptoms.
7. SYMPTOMS TRIGGERED BY COLD AIR
Cold air can trigger asthma symptoms in some people.
A person may notice:
- Coughing after going outdoors in cold weather
- Wheezing
- Chest tightness
- Shortness of breath
- Breathing discomfort during exercise in cold conditions
Not everyone with asthma has the same triggers, so identifying patterns can be useful when discussing symptoms with a healthcare professional.
8. BREATHING PROBLEMS AFTER EXPOSURE TO ALLERGENS
Asthma symptoms may become worse after exposure to substances that trigger an allergic or airway response.
Possible triggers include:
- Dust mites
- Pollen
- Mould
- Animal dander
- Smoke
- Air pollution
- Certain workplace substances
For someone who repeatedly develops coughing, wheezing or breathing difficulty after exposure to a particular substance, this pattern should not be ignored.
9. COUGHING OR WHEEZING AFTER A COLD OR VIRAL INFECTION
Respiratory infections can trigger or worsen asthma symptoms.
A person may notice that after a cold or viral infection:
- The cough lasts longer than expected
- Wheezing develops
- Breathing becomes more difficult
- Chest tightness appears
- Symptoms become worse at night
According to NHLBI, asthma symptoms may start or worsen with viral infections such as a cold.
10. SYMPTOMS THAT COME AND GO
Asthma symptoms do not necessarily remain constant.
One important pattern is that symptoms may:
- Appear for a period of time and then improve
- Become worse on certain days
- Return after exposure to a trigger
- Be worse at night or early morning
- Improve between episodes
This variable pattern is one reason asthma can sometimes be difficult to recognise.
11. UNUSUAL DIFFICULTY PERFORMING NORMAL ACTIVITIES
Asthma may begin to interfere with everyday activities.
For example, someone who previously could exercise, walk or climb stairs normally may begin to:
- Become breathless more quickly
- Stop frequently to catch their breath
- Avoid physical activity
- Have difficulty keeping up with others
- Experience coughing or wheezing during normal activities
When breathing symptoms begin affecting normal daily activities, medical assessment is advisable.
SIGNS THAT ASTHMA MAY BE GETTING WORSE
For someone who already has asthma, certain changes can indicate worsening control.
Watch for:
- Symptoms occurring more frequently than usual
- Symptoms becoming stronger or lasting longer
- Increasing use of reliever medication
- Waking up at night because of asthma
- Difficulty exercising or performing normal activities
- Increasing coughing, wheezing or chest tightness
- Breathing becoming progressively more difficult
These changes should be discussed with a healthcare professional, particularly if they continue or are getting worse.
WARNING SIGNS OF A POSSIBLE ASTHMA ATTACK
An asthma attack occurs when asthma symptoms become significantly worse and breathing becomes difficult.
Potential warning signs include:
- Severe shortness of breath
- Severe wheezing
- Significant chest tightness
- Persistent or worsening coughing
- Difficulty performing normal activities
- Reliever medication not providing adequate improvement
- Breathing becoming increasingly difficult
A severe asthma attack can be life-threatening and requires urgent medical attention.
WHEN TO SEEK EMERGENCY MEDICAL HELP
Seek emergency medical care immediately if a person with suspected or known asthma has severe difficulty breathing, symptoms are rapidly worsening, or prescribed reliever treatment is not providing adequate improvement.
Particularly concerning situations include:
- Severe breathing difficulty
- Inability to carry out normal activities because of breathing problems
- Symptoms becoming rapidly worse
- Reliever medication not helping
- Severe symptoms continuing despite following the person's asthma action plan
An asthma action plan prepared with a healthcare professional can provide specific instructions about what to do when symptoms enter a worsening or emergency zone.
COMMON ASTHMA TRIGGERS
Asthma triggers differ from person to person. Common triggers can include:
Allergens
- Dust mites
- Pollen
- Mould
- Animal dander
Environmental irritants
- Cigarette smoke
- Secondhand smoke
- Air pollution
- Strong fumes or certain workplace substances
Physical and environmental factors
- Exercise
- Cold air
Infections
- Viral respiratory infections such as colds
Identifying personal triggers can help people and their healthcare providers develop an appropriate asthma management plan.
HOW IS ASTHMA DIAGNOSED?
Asthma cannot always be diagnosed based on symptoms alone because several other conditions can cause coughing, wheezing and breathing difficulties.
A healthcare professional may:
- Ask about symptoms and when they occur.
- Ask about possible triggers.
- Examine the chest and breathing.
- Perform lung-function testing such as spirometry.
- Use peak expiratory flow measurements in appropriate situations.
- Consider other tests, such as allergy testing, when relevant.
Because asthma symptoms can vary over time, testing may sometimes be needed even when a person feels relatively well.
FINAL THOUGHTS
Asthma should not be ignored, especially when breathing symptoms repeatedly occur. The classic symptoms include wheezing, recurring cough, shortness of breath and chest tightness. Symptoms may be worse at night or early in the morning and can be triggered by exercise, cold air, allergies, smoke, air pollution or respiratory infections.
Early recognition and proper medical assessment can help determine whether symptoms are caused by asthma or another condition. For people who have already been diagnosed with asthma, following an individual Asthma Action Plan and taking medication exactly as prescribed are important parts of controlling the condition.
Disclaimer: This article is intended for general health education and does not replace professional medical advice or diagnosis. If breathing difficulty is severe, rapidly worsening, or not responding to prescribed treatment, seek emergency medical care immediately.
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