Asthma

What it is

Asthma is reversible airway narrowing from inflammation and muscle constriction, producing wheeze, cough, chest tightness and breathlessness. Modern inhaled treatment controls it well in the great majority of people.

What frequently sits alongside it is a dysfunctional breathing pattern - fast, shallow, upper-chest breathing, often with hyperventilation. It produces breathlessness, chest tightness and light-headedness that feel like asthma, do not respond to a reliever inhaler, and lead to escalating medication for symptoms that are not asthma at all. Breathing retraining addresses that layer specifically.

What it feels like

• Wheeze, cough, chest tightness and breathlessness, often worse at night or early morning
• Triggered by exercise, cold air, allergens or infection
• Relieved by a reliever inhaler when it is genuinely asthma
• Breathlessness with frequent sighing, air hunger and light-headedness where a breathing pattern problem coexists
• Avoiding exercise because of the symptoms, which is common and counterproductive

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Airway inflammation and hyperresponsiveness

Inflamed airways narrow in response to triggers that would not affect a normal airway. Inhaled steroids treat the inflammation, which is why they work as preventers rather than relievers.

Dysfunctional breathing patterns

Fast, shallow, upper-chest breathing coexists with asthma in a substantial proportion of people. It produces symptoms that mimic asthma, does not respond to inhalers, and responds well to breathing retraining.

Exercise-induced bronchoconstriction

Airway narrowing triggered by the drying and cooling of the airway during exercise. In someone with asthma it usually indicates that the underlying control is not adequate rather than that exercise should be avoided.

Allergens and triggers

House dust mite, pollen, animals, cold air, smoke and viral infections all provoke symptoms in susceptible airways. Identifying and reducing personal triggers is part of management.

Poor inhaler technique

A very large proportion of people use their inhalers ineffectively, so the medication never reaches the airways. It is one of the most common and most correctable reasons asthma appears uncontrolled.

Not taking the preventer

Preventer inhalers work only when taken regularly, and adherence is poor because they produce no immediate sensation. Over-reliance on the reliever is a marker of poor control and of risk.

Obesity

Associated with worse asthma control and with breathlessness that is partly mechanical rather than airway-related. Weight loss improves control.

Anxiety

Both a consequence of breathlessness and a driver of the fast shallow breathing that amplifies it. The two are closely intertwined and both benefit from breathing retraining.

Deconditioning

Avoiding exercise because of symptoms produces poor fitness, which means more ventilation is needed for the same task, which produces more symptoms.

Vocal cord dysfunction

Inspiratory difficulty from the larynx rather than the airways, commonly mistaken for asthma. Difficulty breathing in rather than out, and no response to inhalers, are the clues.

Who tends to get it

• Anyone with a personal or family history of asthma, eczema or hay fever
• People with poor inhaler technique or low preventer adherence, which is a large proportion
• Anyone who has stopped exercising because of symptoms
• People with obesity, in whom control is typically worse
• Athletes, in whom exercise-induced symptoms and vocal cord dysfunction are both common

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineBreathing & Ribcage

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Rescue inhaler not working, difficulty speaking in sentences - emergency

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Well-controlled asthma should not limit exercise, and regular exercise improves both fitness and asthma symptoms. Breathing retraining produces meaningful improvement over four to eight weeks in the substantial group whose symptoms are partly a breathing pattern problem. Exercise-induced symptoms in someone taking their preventer regularly usually mean the control needs reviewing rather than the exercise stopping. Worsening symptoms, increasing reliever use or a severe attack needs urgent medical attention.

Prevalence basis: Respiratory epidemiology

Others the same routine covers

These share the Breathing & Ribcage routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.