Asthma
What Is Asthma?
Asthma is a common condition involving spasms within the lung’s airways. During these spasms, airways narrow, causing patients to wheeze, cough, and experience shortness of breath. In patients with asthma, these spasms are often triggered by allergens (pollen, dander, dust mites, cedar, etc.), exercise, cold air, or viral infections of the upper respiratory or lower respiratory tract.
As many as 75% of asthma cases are diagnosed in patients younger than 7, but keep in mind that not all wheezing is asthma. If you’re an adult experiencing wheezing for the first time, it’s unlikely to be asthma.
What Does Asthma Feel Like?
Common symptoms of asthma include the following:
- Wheezing: A high-pitched whistling sound, usually on exhalation
- Cough: Dry cough, often worse at night
- Shortness of breath: Chest tightening, breathlessness, difficulty breathing, or trying but failing to take in full breaths
Asthma patients typically have two or three of the symptoms above, but some patients may not experience all of them. Patients with mild asthma are typically asymptomatic between exacerbations. Patients with more advanced asthma might experience symptoms or require an inhaler daily or multiple times per week.
What Is an Asthma Exacerbation?
An asthma exacerbation is a sudden worsening of the symptoms described above, often caused by triggers. When the trigger is removed, asthma exacerbations become less and less frequent. During an exacerbation, patients should see a doctor immediately and receive treatment to prevent the risk of airway compromise and expedite recovery in less severe cases.
Patients not experiencing exacerbation are typically asymptomatic, and can remain so for long periods of time. This is often because the patient is not around common triggers, such as particular trees or pollen. Pollen is seasonal, so some patients experience exacerbations only during certain times of the year. However, patients can go into exacerbation when they encounter these triggers again.
Nausea can have various causes. Looking at the most common causes can help you identify the cause of your nausea and/or vomiting, and whether you should be seen by a doctor.
Dr. Kingsley’s Tip
The sooner you can treat an asthma exacerbation, the more effective treatment will be. Also, if asthma patients can avoid triggers, they will reduce their exacerbations and hospitalizations. However, it’s not always possible to avoid triggers.
What Are Common Asthma Triggers?
There are four main categories of triggers that can push asthmatic patients into exacerbations.
Allergens
Common allergens include dust mites, mold, animal dander/fur, cockroaches, and various pollen types. Medications including aspirin, Aleve, Advil, ibuprofen, and motrin can precipitate asthma exacerbations. Symptoms may appear 30-120 minutes after taking one of these medications.
Exercise
Exercise is not a risk factor for developing asthma, but it can be a trigger for asthma patients. In fact, some studies have suggested that regular exercise might lower the risk of developing asthma in children. Up to 90% of patients may have some degree of sensitivity to strenuous exercise. The degree to which exercise triggers exacerbation depends on the severity of the patient’s asthma. Someone with mild asthma may never experience an exacerbation during vigorous exercise. However, those who use an inhaler daily are more likely to trigger exacerbation after a minimal amount of vigorous exercise.
Cold Air
Cold, dry air coupled with exercise is a typical culprit for weather-induced asthma exacerbation. However, extreme temperature and humidity can also precipitate asthma exacerbation. In some patients, weather patterns like thunderstorms can induce exacerbation, as high amounts of pollen and mold spores enter the atmosphere. Those who experience weather-induced exacerbations can reduce or eliminate risks by wearing scarves or masks to help warm and increase the humidity of the air they breathe.
Viral Infection
Viral infection is a predominant cause of asthma exacerbation. The most common infections to induce asthma exacerbations include rhinovirus (one of the main common cold viruses), influenza, sinus infections, and pneumonia. It’s important to note that COVID-19 does not appear to trigger asthma infections despite early concerns.
How Is Asthma Treated?
Treating your asthma depends on what you are experiencing. Below, we go over treatments for asthma exacerbation as well as chronic asthma.
Asthma Exacerbation Treatment
If you are currently in exacerbation, the first step is to treat it before dealing with anything else. Once your breathing has returned to normal, it’s safe to proceed to the section below. Asthma exacerbation treatment includes 5 days of prednisone (oral steroid) along with rescue inhalers (albuterol or Ventolin). Make sure to talk to your doctor if you are diabetic, as oral steroids can increase your sugar levels. Those with poorly controlled high blood pressure should also take caution, as short courses of steroids can cause blood pressure to rise significantly.
Chronic Asthma Treatment
There are two main areas of focus for chronic asthma treatment: controlling symptoms and reducing future risks of exacerbation.
Controlling of Asthma Symptoms
Controlling asthma symptoms typically involves achieving the following goals:
- Freedom from symptoms throughout the day
- Few nighttime awakenings (two or fewer per month is considered optimized)
- Minimal need for a rescue inhaler (using the inhaler fewer than two times per week)
- Maintenance of daily activities including work, sports, exercise, school activities, etc.
If you suffer from asthma and haven’t achieved the above goals, your doctor should be able to help you get there. If they can’t, ask for a referral to a pulmonologist (lung doctor).
If your symptoms are not controlled, your treatment regimen will include the following:
A short-acting inhaler (albuterol). This is often referred to as a rescue inhaler because it is used only when asthma symptoms flare up, as opposed to an inhaler used daily.
If symptoms aren’t controlled with just a rescue inhaler, we recommended:
Inhaled low-dose steroid: Pulmicort (180 to 360 mcg) inhaler. This is a scheduled medication that should be taken daily despite the presence of symptoms.
If symptoms remain uncontrolled, it’s time to ask your doctor for a referral to a pulmonologist (lung doctor).
Reducing Future Risks of Exacerbations or Hospitalizations
Properly reducing your risk of exacerbations takes more than simply controlling asthma symptoms. You must also:
Identify triggers and reduce or eliminate exposure whenever possible.
Take your inhalers properly. If you use a metered-dose inhaler with a propellant (i.e., you press a button on top of the inhaler), time your inhalation correctly. A rule of thumb: if you can taste the inhaler, your timing is off. For those who use nebulizers, the common error is in stopping treatment too soon.
Improve adherence. Some patients get confused when starting a daily inhaler. They may use it only when they have symptoms since they’re used to rescue inhalers. But failing to use scheduled inhalers regularly all but eliminates their effectiveness in preventing exacerbations.
Quit smoking or vaping. This is known to lower the threshold of triggering an asthma exacerbation.
Failing to eliminate these risk factors can lead to future exacerbations and hospitalizations. The more exacerbations and hospitalizations asthmatic patients have, the more likely they are to stunt their lung development (in children) or lose their lung function (in adults).
If you have never been diagnosed with asthma and are exhibiting exacerbation of the symptoms mentioned in the first part of this article — or if you have been diagnosed but do not have an optimized treatment regimen — it’s time to see a doctor to help control your life and your breathing.