The chronic respiratory disease is obvious in some but other patients suffer a long time while doctors struggle to figure out their problem.
Alfredo Solis describes himself as a "jack of all trades, master of none." Not much could slow him down, until he started feeling faint while working around the house.
"I'm wheezing, I'm coughing, at night you can hear gurgling in my chest," he explains.
But no explanation was found. After a battery of tests, everything came back negative.
He then turned to a more experimental test. Traditional spirometers test the amount of air coming out of your lungs and how fast it comes out to diagnose asthma. But a new, more precise technique spots asthma by measuring the nitric oxide exhaled in the breath.
The chemical is naturally produced in our bodies but an increase in N.O. levels can mean the patient suffers from lung inflammation and swollen airways, according to Cleveland Clinic's co-director of the Asthma Center respiratory Institute, Sumita Khatri
"It becomes sort of direct evidence that your airways inflamed," Khatri says.
The N.O. test helps her diagnose tough asthma cases the spirometer can't detect.
"I use it in patients with severe asthma where I feel like, well, is it severe because they're not taking their medication," she says.
With the N.O. asthma breath test, levels of nitric oxide are measured by just a few strong exhales. The device gives results in 90 seconds.
After taking the test, Solis was told his N.O. levels were at 129 parts per billion, which is more than twice as high as they should be. He was finally diagnosed with asthma. His symptoms cleared up with a simple inhaler prescription.
"I feel like a million bucks. I'm running around, I'm playing baseball, I'm doing my yard work," he says.
Doctor Khatri says the N.O. test is also a great tool to personalize medicine. After asthma is diagnosed a patient can take the test again to check their N.O. levels. Then doctors can adjust their medication as needed.
However, Khatri tells us some asthma patients have normal N.O. levels so the test doesn't work in all cases but it offers another diagnosis test for those with unresolved pulmonary issues.