Taking in that first, deep breath of the warm air each spring or catching your breath after running to make a train are things most of us take for granted. But for more than 25 million Americans who have asthma, breathing can be a constant struggle.

Asthma is a chronic inflammatory disease of the airways that affects children and adults.

“It’s like having a rash on your skin, with redness and swelling, but instead of it being on your skin, it’s inside your airways, which are lined with cells similar to the ones that make up your skin,” says Geoffrey Lowell Chupp, MD, director of Yale Medicine’s Asthma & Airways Program.

When the cells become inflamed, extra mucus is produced and the smooth muscle cells around the airway get irritated and go into spasm. The airways are particularly sensitive to common irritants, allergens and viruses.

The main symptoms of this condition are wheezing, shortness of breath and either a chronic cough or a cough that flares up when the patient is exposed to triggers such as exercise, cigarette smoke, pet dander, trees and grass, or a virus such as influenza.

Most patients with mild asthma respond well to inhaled bronchodilator medications, which are used during an asthma attack to relax the smooth muscles and make breathing easier.

“These are topical anti-inflammatory medications —it’s like rubbing cortisone on your skin,” says Chupp.

Metered dose inhalers use an aerosol spray, and dry powder inhalers deliver the medicine in a powder form. Both types of inhalers send the medication directly into the lungs.

Patients who have symptoms for more than two days a week usually require a daily regimen of an inhaled corticosteroid medication.

“There are many different medications on the market right now, with different potencies and different devices to deliver them, but within the same class of drug they have very similar effects – they reduce the inflammatory response and the twitchiness of the airways,” says Dr. Chupp.

With some new long-acting bronchodilators, one puff of medicine can last up to 24 hours, says Dr. Chupp.

In addition to taking inhaled steroids, patients have to stay on top of the allergies that set off their symptoms. Doctors may prescribe antihistamines and other allergy medicines, such as leukotriene antagonists, which can help control allergies and asthmatic inflammation.

For patients with severe, persistent asthma that requires a lot of rescue medication, doctors at Yale Medicine can perform bronchial thermoplasty, an innovative procedure that can greatly reduce asthmatic attacks.

“The patient’s airways are heated up gently with a probe, which injures the smooth muscle layer that is around the airway wall and reduces the bronchospasm,” says Dr. Chupp.

The minimally invasive outpatient procedure takes about one hour, and because the scope is inserted down the patient’s mouth or nose, no incisions are made and only moderate sedation is required.

“The future of asthma treatment is in biologic therapies, which are genetically engineered antibodies that are usually given by subcutaneous injection or I.V.,” says Dr. Chupp. “We use these for patients with moderate to severe asthma who are not responding adequately to other asthma medications. They can significantly reduce inflammation and flare-ups.”

A great amount of research is going on at the Center for Asthma and Airways Disease, where up to 20 clinical trials are active at a time. Yale Medicine is also on the cutting edge of new individualized asthma therapy and precision medicine for individuals with asthma.

“We see a future where we will be identifying a patient’s particular genetic risk factors and the molecular signals that are driving their particular disease,” says Dr. Chupp. “We will develop a combination of treatments that is individualized for a given person that will include both inhaled therapies and biologics that will maximally manage their asthma without guesswork.”