What happens during an asthma attack?

The immune system—or, more specifically, an abnormal response of the immune system—is at the heart of the respiratory symptoms associated with asthma.

When exposed to certain triggers, the immune system overreacts and releases chemicals into the bloodstream that can lead to abnormal lung function.

The three hallmarks of an asthma attack tend to be:

  • A tightening of the muscles around the airways, called bronchoconstriction, through which less air can enter the lungs
  • Too much mucus, blocking the airways
  • Inflammation of the airways due to an abnormal immune response

These physiological effects can cause wheezing, coughing, chest tightness, and shortness of breath during an asthma attack.

Causes of bronchoconstriction

The normal size of the airway is regulated by the autonomic nervous system. This is the branch of the nervous system responsible for reflexes.

Stimulation of nerve endings (through dust, cold air, or other asthma triggers) can prompt the release of a chemical called acetylcholine.

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In asthmatics, acetylcholine acts on cells in the smooth muscle of the lungs, causing bronchospasm and excess mucus production.

cause of inflammation

Inflammation is caused by a slightly different process. In people with a functioning immune system, any appearance of foreign particles is processed by antigen-presenting cells (APCs).

APCs are cells that the body uses to “check” the particle and determine if it’s safe. In asthmatics, APCs mistakenly identify particles as threats and immediately switch to defense cells called TH2.

The role of TH2 is to signal the immune system to protect itself, which is associated with inflammation. In the absence of disease, the consequences of lung inflammation can be profound, leading to:

  • Mucosal cell enlargement and mucus overproduction
  • Airway wall thickening and airflow limitation
  • Airway tissue overreacts, further triggering spasms

If left untreated, persistent attacks can lead to airway remodeling and progressive scarring of lung tissue that can leave permanent, irreversible damage.

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prevent asthma attacks

While the best treatment for asthma is to avoid triggering it, this is not always possible or reasonable. Therefore, medications are often used to control symptoms or avoid flare-ups.

Among the currently available options:

  • Rescue drugs quickly relieve bronchospasm and respiratory restriction by relaxing the smooth muscles of the airways.
  • Inhaled and oral steroids prevent symptoms by suppressing the immune response and reducing inflammation.
  • Long-acting bronchodilators are used in combination with other medications to provide better asthma control.
  • Anticholinergics are drugs that provide relief by blocking acetylcholine receptors.

Identifying the triggers for attacks and the drugs that can best stop them are steps toward achieving durable control of asthma symptoms. Lifestyle interventions may also help.

Maintaining a healthy weight is important because obesity is associated with increased asthma severity and poor asthma control.

In addition, regular exercise appears to be protective, especially against exercise-induced asthma. Yoga is a great option because it has been shown to improve quality of life and reduce asthma symptoms.

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Finally, eating more fruits and vegetables may help. Foods rich in fiber and antioxidants are associated with better asthma control, including airway reactions and inflammation. These associations do not prove causation. However, this plant-based diet may help with weight management, thereby improving the control of asthma symptoms.