Difference Between Acute and Chronic Asthma Exacerbation

Asthma is a chronic inflammatory airway illness characterised by airway hyper responsiveness and airflow restriction, both of which can improve with time or medical intervention.

There are two types of asthma attacks: acute attacks and chronic attacks. Chronic asthma exacerbations are a long-term condition, whereas its acute counterparts occur suddenly.

What is Acute Asthma Exacerbation?

When asthma symptoms like wheezing, chest tightness, cough, and shortness of breath suddenly and steadily intensify, this is called an acute asthma exacerbation. Causes might include −

Acute exacerbations can be triggered by a variety of things. Some of the more common triggers are −

  • Colds, dry and cold air

  • Upper respiratory infections

  • Allergens such as mold, dust mites, and pollen

  • Smoke of tobacco

  • Exercise

  • Cats and Dogs

  • Gastroesophageal Reflux Disease

What is Chronic Asthma Exacerbation?

Chronic Asthma Exacerbation happens when the asthma symptoms are intense and there is chronic inflammation and narrowing of the airways in the lungs. In chronic asthma, an asthma attack, is called a flareup or exacerbation.

Triggers include −

  • Respiratory viral infection, mainly rhinovirus

  • Sensitizing agents

  • Allergens like pollen, cockroach droppings, weeds, animals, mold, grass, and dust mite

  • Air pollution, chemical fumes, household cleaners, strong alcoholic perfumes or other substances in the air

  • Stress and anxiety

  • Some medications like aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs) such as naproxen and ibuprofen. Some beta-blockers – which treat glaucoma, high blood pressure, heart disease, and migraine

  • Illness like severe sinusitis (inflammation of sinuses), flu, heartburn and acid reflux

Differences: Acute and Chronic Asthma Exacerbation

The following table highlights the major differences between Acute and Chronic Asthma Exacerbation −


Acute Asthma Exacerbation

Chronic Asthma Exacerbation


Sudden in onset

Long – developing syndrome

Key features

  • IgE production

  • Mucus Hypersecretion

  • Airway Hyperactivity

  • Eosinophilic inflammation in the pun g

  • Smooth muscle hypertrophy

  • Fibrosis and remodelling

  • Epithelial cell changes

  • Goblet cell metaplasia


  • Agitation

  • Increase in heart rate

  • Reduced lung function

  • Hyperventilation

  • Difficulty in difficulty speaking or breathing

  • Tightened neck and chest muscles, called retractions

  • Chest tightness or pressure

  • Constant coughing

  • Feelings of anxiety or panic

  • Feel confused, lost, agitated and unable to focus

  • Very rapid breathing

  • Severe wheezing when breathing both in and out

  • Difficulty and discomfort in talking

  • Pale, sweaty face

  • Bluish tint to your lips

  • Hunched shoulders, and strained muscles in the neck and stomach


  • An overly sensitive immune system that makes the bronchial tubes become inflamed and swollen when you’re exposed to certain triggers. Asthma triggers vary from person to person.

  • Common acute asthma attack triggers include: Mold, pollen, pets, and dust mites.

  • Lung infections, such as a cold or the flu

  • Strong emotions and stress

  • Smoke inhalation

  • Preservatives added to some types of foods and beverages

  • Certain medications, including aspirin, beta-blockers, naproxen, and ibuprofen

  • Menstrual cycle in some women

  • Gastroesophageal reflux disease (GERD)

Subset – Life threatening

Dyspnea interferes with or limits usual activity

Too dyspneic to speak, perspiration

Clinical Course

  • Usually needs frequent visits to emergency department and even hospitalization

  • Oral systemic corticosteroids; some symptoms last for greater than 3 days after the start of treatment

  • Partial relief and comfort from frequently inhaled Short-acting beta-agonists (SABAs) like albuterol and levalbuterol

  • Adjunctive therapies are beneficial

  • Very less or no relief and comfort from frequently inhaled Short-acting beta-agonists (SABAs) like albuterol and levalbuterol

  • Intravenous corticosteroids – Fluticasone (Flovent HFA), Budesonide (Pulmicort Flexhaler), Mometasone (Asmanex Twisthaler), Beclomethasone (Qvar RediHaler), Ciclesonide (Alvesco)

  • Adjunctive therapies are sometimes helpful


Acute and chronic asthma exacerbation are two different types of asthma attacks that require different approaches to treatment and management. Understanding the difference between acute and chronic asthma exacerbation can help individuals with asthma effectively manage their symptoms and improve their quality of life.

Updated on: 03-Apr-2023


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