What Are Hyperactive Airways (Twitchy Airways)? 

Asthmatics have hyperactive airways. A neat way of describing this is to say that they have “twitchy airways.” So, what is this anyway? Here’s what to know.

The discovery of asthma as an inflammatory condition

For 99.99% of history, asthma was treated as an acute disease. Acute means it’s happening now. Back then, when you felt good, you didn't take medicine. You only took medicine when you felt symptoms and when symptoms were acute, or happening right now.

This was how it was when I was a kid. Back in the 1970s and 1980s you only took your medicine when you felt symptoms. Suffice to say, back then my asthma was poorly controlled.

This all changed in the late 1980s. By then, asthma researchers discovered that all asthmatics have some degree of underlying airway inflammation. And, even better, they discovered that this inflammation is greatly reduced by corticosteroids. By taking an inhaled corticosteroid inhaler every day you can significantly reduce this airway inflammation. It’s how most asthmatics obtain good asthma control.

So, the change was that asthma was no longer treated as an acute disease. The shift in the late 80s was that asthma was now treated as a chronic disease. That underlying airway inflammation must be treated every single day.

So what are hyperactive airways?

This airway inflammation makes airways hypersensitive, meaning that they are over-sensitive to asthma triggers. The inflammation worsens when exposed to your asthma triggers. When it gets worse you start to feel asthma symptoms, such as shortness of breath, chest tightness, coughing, and wheezing.

Actually, even before these symptoms are present, you may experience unusual or early asthma symptoms. These include an itchy chin, stuffy nose, sneezing, headache, and anxiety. There are many more early warning symptoms, and some are unique to the individual.

Anyway, underlying airway inflammation makes airways hypersensitive this way. Other terms used to describe this are hyperactive or twitchy. Hyperactive airways are twitchy in response to asthma triggers.

By twitchy, we mean that bronchial smooth muscle spasm. Mucus glands become irritated and secrete excessive mucus. The combination of these effects obstruct airways. This causes airflow limitation and asthma symptoms.

Do all asthmatics have allergies?

Allergies cause asthmatics to develop sensitivities to allergens. Examples include sensitivities to dust mites, pollen, mold spores, animal dander, and some foods. When you have a sensitivity to allergens, exposure to them may trigger asthma symptoms. It may cause hyperactive airways to spasm and constrict.

However, not all asthmatics have allergies. And even if you don’t have allergies, if you have asthma then you always have hyperactive airways. It’s just that the cause is something else instead of allergies. In fact, most childhood-onset asthma is allergic and most adult-onset asthma is non-allergic.

How inflammation differs in asthma subtypes

There are now many known subgroups (phenotypes) of asthma. Allergic asthma is one. Eosinophilic Asthma is another. Both of these fall under the subheading and umbrella subgroup Th2 Dominant Asthma.

These subgroups generally respond to traditional asthma medicines or a combination of traditional asthma medicines and biologics. These work to reduce this underlying airway inflammation. They make airways less twitchy, which helps them obtain good asthma control.

Control means that asthma symptoms occur rarely, and are less severe and easier to control or reverse when they do occur.

Other subgroups are caused by a different type of inflammation. It may be Th1 Dominant or non-Th2 Dominant. It may be caused by neutrophils. Perhaps it's Paucigrranulocytic Asthma, which is inflammation caused by the cells themselves. All of these special subgroups of asthma still involve underlying airway inflammation.

It’s just more stubborn and responds less well to traditional asthma medicines. And, in many cases, it is more twitchy than eosinophilic inflammation. There are at the present time no medicines for these asthmatics. So, they tend to have a diagnosis of severe asthma.

Treating airway inflammation

All asthmatics have some degree of underlying airway inflammation. This makes airways hypersensitive (twitchy) to asthma triggers. Exposure to asthma triggers causes your asthma symptoms. And taking asthma medicines every day can control this inflammation, thereby making airways less hyperactive. And this is how good asthma control is obtained.

Most asthmatics respond well to traditional asthma medicines. So, most are able to obtain good asthma control. Other asthmatics have severe asthma that is poorly controlled. Researchers are working overtime to learn more about this type of asthma. They are working to develop treatments for helping all asthmatics obtain ideal asthma control.

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