In this article:
- Asthma is a persistent inflammatory disease.
- Asthma is incurable, but it can be regulated with proper measures.
- It is vital to recognize allergens and avoid exposure.
- Various medical treatments are available to ease “living with asthma.”
- Seeking advice from a medical practitioner is recommended to help control the underlying inflammation and the symptoms.
Asthma is a widespread respiratory tract disease that varies in severity from an infrequent, mild wheeze to acute, fatal airway closure. It is highly prevalent among children and is associated with other atopic diseases, such as hay fever and eczema.
Various factors can trigger an immediate hypersensitive reaction in asthmatic patients. The asthma attacks and exacerbations contribute to increased hospital admissions and healthcare costs. The condition may be fatal if not dealt with urgently.
Asthma causes inflammation in the airways, resulting in a hyper response, excessive mucus production, obstruction in the airways, and, if left untreated, structural changes in the airway wall. It poses a serious threat to health and also has socioeconomic implications.
Usually, asthma is a consequence of sensitization to inhaled allergens, such as animal dander, pollens, certain fungi, cockroaches, and dust mites during childhood. (1)
Diagnosis of Asthma
The foremost step for asthma diagnosis is obtaining a medical history and family history, especially for previous allergies and asthma cases in close relatives. Further diagnostic procedures include, but not limited to, the following tests: (2)
- Physical exam: This exam involves listening to your breath and examining you for signs of asthma or atopy, including swollen nasal passages, wheezing, and allergic skin conditions such as eczema.
- Pulmonary function tests: Spirometry is used to obtain a baseline for comparison during flare-ups and to rule out other conditions. Between flare-ups, spirometry results may be normal.
If, however, at the time of the test abnormalities are noted, then the test may be repeated after giving inhaled bronchodilators.
A “normalizing” response to the bronchodilator makes the diagnosis of asthma highly likely, but the diagnosis is a clinical one, taking into account the symptoms, history, and tests.
- Bronchoprovocation tests: These tests are performed when asthma is suspected, but the diagnostics elements (symptoms, history, baseline tests, etc.) are not conclusive.
Again, the diagnosis remains a clinical one, but an abnormal response to bronchoprovocation tests suggests airway irritability and hyperresponsiveness.
You may be advised some other tests that include:
- Blood tests
- Allergy testing
- Chest X-ray (as a baseline for comparison later and to rule out other conditions that may have similar presentations)
Children under 6 years of age may be given asthma medicines based only on their medical history and symptoms, as these tests cannot be performed on them.
Further diagnosis is made on the child’s response to the drugs after a few months of use. Approximately 40% of the children that have wheezing as a symptom of respiratory tract infections are, initially, diagnosed with asthma.
Medical Treatment for Asthma
Despite being incurable, asthma can be managed with medications and preventive measures. Since all cases vary, it is highly advised to visit a doctor and get a treatment plan.
The plan will include guidance for taking medicines and will also provide a list of triggers you need to avoid. Generally, asthma treatments are aimed at:
- Controlling inflammation in the airways
- Enabling the patient to carry out daily activities without experiencing any problems or symptoms
While some asthma medicines are available in the form of a pill, a majority of them require the use of certain devices that enable the drug to enter your lungs directly. These medical devices include:
- Inhaler (puffer): Inhalers are of two types:
- Metered-dose inhalers (MDI) – deliver a short bust of medicine through a plastic mouthpiece with an aerosol canister
- Dry powder inhalers (DPI) – administer the drugs in powder form
- Nebulizer: A nebulizer dispenses the drug in the form of a fine mist through masks or mouthpieces. This device does not require the patient to learn any technique.
It involves simple breathing and is therefore generally used for young children or people with severe asthma who are not comfortable with using inhalers.
- Spacer: A spacer is recommended if an individual is unable to use an MDI properly. The medication is sprayed into a chamber and then inhaled by the patient.
Inhalers and nebulizers are essential in delivering the medication to the lower airways. Thus, it is important to learn the techniques for using them correctly.
Asthma drugs are broadly classified into the following two types:
- Long-term control medicines that prevent the occurrence of attacks. These medicines help in reducing the frequency and severity of asthma flare-ups by reducing the inflammation and opening up the airways. However, they are not useful when an attack is in progress. These medications include:
- Inhaled corticosteroids: They help in reducing inflammation and are usually the first class of drugs prescribed to patients with asthma.
- Cromolyn: This drug aims at mitigating the action of mast cells, which are involved in allergic reactions.
- Inhaled long-acting beta-2 agonists (LABAs): LABAs help to prevent the airways from narrowing down and are used as an adjunct to inhaled corticosteroids.
- Leukotriene modifiers: These oral drugs block the action of inflammation-causing molecules and thus help prevent the contraction of airways.
- Biologics: These drugs attack specific molecules involved in the body’s hypersensitive response to allergens. They are prescribed to people with severe asthma who are unresponsive to other treatments or need high doses of corticosteroids.
Biologics are administered through subcutaneous or intravenous injections and include omalizumab, benralizumab, reslizumab, and mepolizumab. Omalizumab targets IgE antibodies, which play a primary role in allergic responses.
- Immunotherapy: This therapy may be beneficial for some people. This treatment prevents allergic responses that can trigger an asthma attack. The drugs and methods vary for children (5-16 years) and adults (above 18 years).
- Rescue or quick-relief medicines that help to subside ongoing attacks within a few minutes. They relax the contracted muscles around the airways (bronchi), therefore opening (dilating) them. Thus, these medicines are known as bronchodilators.
These drugs act like first aid in case of an asthma attack and can be taken right before any heavy exercise to prevent a flare-up. These short-acting medications include:
- Inhaled beta-agonists (such as albuterol)
- Intravenous or oral corticosteroids
Consult your general practitioner for the quick-relief drugs you need as well as how and when to use them. You must provide a detailed medical history to your healthcare provider as asthma medicines may have side effects.
Keep up with your regular follow-up appointments, and mention to your doctor if your ongoing treatment is beneficial or if you are having any side effects or untoward reactions. These checkups enable the doctor to help control your asthma with a minimum amount of drugs.
Management of Asthma at Home
Taking measures toward changing your lifestyle and modifying your diet can help in the management of asthma and preventing attacks.
1. Preventive Self-Care Measures
While asthma is incurable, attacks can be prevented with the help of the following measures:
- Avoid triggers: Identify your asthma triggers, and avoid exposure to pollutants, irritants, allergens, and respiratory infections.
Allergens, such as hair, pet dander, feathers, scales from the skin, and dried urine or saliva, may aggravate the condition. Always check the weather conditions for allergens before stepping outside.
- Use a humidifier: Air purifiers and humidifiers can improve indoor air quality. Using essential oil diffusers might be beneficial if the fragrance does not act as a trigger for you.
The oils are known to help reduce chronic inflammation and also airway inflammation. However, no direct studies establish a link between the two.
- Disinfect your house: Clean the house and change your bedding and clothing regularly. Keep a close check on mold growth as it can cause an allergy flare-up.
- Avoid smoking: Cigarette smoke contains about 4000 harmful chemicals and is one of the primary triggers for asthma. About 75% of people with asthma start wheezing in a smoky room. Therefore, refrain from smoking to prevent attacks in others as well. (3)
- Take your medicines properly: Follow your treatment plan properly, and continue the medications even if you don’t feel the need. Learn the proper technique for using inhalers and use a spacer if needed.
- Get a flu vaccination: Your asthma may worsen if you contract respiratory infections, such as the flu or the common cold, and can even lead to severe diseases, such as pneumonia. Therefore, get vaccinated before the flu season starts to prevent infection.
- Practice breathing techniques: As an adjunct to your asthma medications, breathing exercises, such as yoga and the Buteyko method, may be beneficial. (4)
These exercises provide relief from the symptoms by relaxing your body, but they are effective only after regular practice. More studies are needed to confirm their role and efficiency in managing asthma symptoms. (4)
- Manage your body weight: Studies have found an association between increased body mass index and asthma, although the exact mechanism is not yet established. (5)
Additionally, a study reported that weight loss in obese patients with asthma improved their symptoms. (6)
- Get an action plan: Consult your doctor for a proper Asthma Action Plan. This plan includes the medicines you need to take and how to take them. It also informs you of the measures to be done to control asthma flare-ups and when flu-like symptoms first appear.
- Maintain a journal: Keeping track of your asthma symptoms can help your medical practitioner to analyze your condition and determine when it is worsening. Note down your symptoms daily using a diary or smartphone.
- Identify signs of a flare-up: Symptoms like coughing and wheezing can be indicative of an upcoming flare-up and may occur up to 24 hours prior. It is important to recognize these signs, especially after having a few.
Also, you should know when to visit the emergency room, especially during a severe flare-up. Make sure your child’s teachers, coaches, and relatives have knowledge about managing attacks.
- Submit for regular checkups: Visit your doctor at regular intervals for checkups, which also allow your doctor to update your treatment plan accordingly.
2. Lifestyle Changes
Simple lifestyle changes may help manage the symptoms and prevent asthma attacks.
Stressful conditions can worsen the symptoms of asthma and may even induce an attack.
A review paper published in 2013 revealed that community, family, or individual-level stress influences asthma and its morbidity. Psychologic stress through pre-and postnatal maternal/caregiver stress, post-traumatic stress disorder (PTSD), violence, and family deprivation also affects asthma morbidity. (7)
There is a need for further innovative studies to establish the relationship between stress at various levels and asthma and to find the pathway behind it. The results will provide a better understanding of asthma morbidity and may give clues to its prevention. (8)
Stress can be managed by mind-body exercises, meditation, sharing your feelings, or indulging in hobbies. Emotional well-being is essential for your general health and keeping asthma under control.
It is advised to use stress-management techniques daily to manage asthma as excess stress may trigger flare-ups.
Follow an exercise regimen
The severity of the disease may lower with the help of daily physical activities. Aerobic exercises can help strengthen the heart and lung muscles, and practicing yoga boosts lung function.
It is recommended to perform light exercises, such as slow dancing and brisk walking, which do not put pressure on your lungs.
Note that exercise can also trigger asthma. Taking suitable medicines before exercising and doing warming-up and limbering-down exercises (15 minutes each) may help.
Daily exercise is recommended by the American Thoracic Society (ATS) and the American College of Sports Medicine (ACSM) for patients with asthma.
The ACSM promotes aerobic exercise such as walking or activities involving large muscle groups two to three times a week. Exercises such as basketball, cycling, and running, on the other hand, can induce asthma. (9)
A review study published in 2019 gave scientific evidence on the safety of daily exercise in patients with asthma. Results showed that exercise promoted aerobic fitness, alleviates symptoms, and helps improve the quality of life. However, lung function and airway hyperresponsiveness did not show significant improvement. (10)
Regular exercise may be beneficial, but it is recommended to seek your doctor’s advice on the activities you can perform to avoid exercise-induced asthma.
Record your peak flow rates
A peak flow meter is a piece of medical equipment used to measure the speed of inhaled or exhaled air and thus helps in monitoring asthma. The peak flow number lowers when the airways narrow, such as during an attack.
The device can detect these contraction hours or days before the symptoms and thus enables you to take preventive measures and medications.
Everyone has their own best peak flow number, which may be determined during a two to three week period when you don’t experience asthma symptoms.
It is the highest peak flow number measured during this span and can differ from the average number of someone of your build.
3. Dietary Recommendations
Scientific studies do not associate asthma flare-ups with any food, but changes in your diet may help manage symptoms.
It is vital to consume a well-balanced diet with vegetables and fruits that are rich in flavonoids and antioxidants, such as vitamins C, D, and E. These compounds also act as anti-inflammatory agents and aid relief.
Caffeine is a mild bronchodilator and also helps in alleviating respiratory muscle fatigue. It has various other pharmacological effects and is chemically similar to theophylline, a drug used for asthma treatment.
Furthermore, caffeine might slightly improve airways function for around 4 hours in patients with asthma. Hence, it is important to refrain from caffeine for at least 4 hours before a lung function test, as it may give false results. (12)
Despite being beneficial for the respiratory system, caffeine intake should be moderated. Avoid large amounts of caffeine as it does not have any long-term effects, and the available scientific evidence regarding its use is insufficient. (13)(14)
Certain foods may act as triggers for some individuals and should be avoided. These foods include:
- Processed foods: Chemicals in packaged and processed foods containing artificial additives and preservatives, may trigger attacks.
- Saturated fat: Excessive amounts of saturated fats can hinder the effect of some asthma medications.
- Sulfites: Dried fruits containing sulfites might worsen asthma symptoms and cause adverse reactions.
Pickles, bottled melon or lime juice, alcohol, maraschino cherries, and shrimp should also be avoided for the same reason. Consumption of fresh fruits such as bananas and apples is encouraged.
- Gas-inducing foods: Foods such as carbonated drinks, garlic, onion, fried foods, and beans may cause bloating and gas, which may cause difficulty in breathing. This can lead to chest tightness and can induce an asthma attack.
- Allergens: Some people might be allergic to certain foods such as peanuts. Children with asthma, in particular, can have severe allergic reactions to food allergens.
It is important to identify your allergens and avoid their consumption. Contact may induce coughing, wheezing, and difficulty in breathing immediately.
Note: Food intolerance differs from an allergy and does not trigger asthmatic symptoms.
Food allergens and required restrictions vary among people. A diet including sources for all vitamins and minerals is essential, as one single source cannot provide all nutrients necessary for good health. Take recommendations from your doctor or nutritionist before changing your diet.
When to See a Doctor
It is recommended to visit a pulmonologist or respiratory therapist if you recognize asthma symptoms. You may schedule a visit with a pediatrician if your child is having asthma-like symptoms.
The symptoms of asthma are similar to the symptoms of other lung diseases, such as a chest infection, and, therefore should be checked by a doctor for a timely diagnosis.
The doctor can recommend emergency care if:
- Rescue medicine does not alleviate the symptoms.
- The lips or nails turn gray or blue.
- The heartbeat is elevated.
- The nostrils flare on breathing.
- There is difficulty in walking or talking.
- The neck, chest, or ribs pulling with each breath, called retractions
If you experience an asthma attack, call 911 or your local emergency number immediately.
What your doctor may ask you:
- What symptoms are you experiencing?
- Have you identified any triggers?
- Are you exposed to any irritants or allergens in the workplace or at home?
- Is there any daily activity that may be triggering flare-ups?
What you may ask your doctor:
- Do I need to get an allergy test to detect the cause of my asthma?
- What measures should I take at home to relieve my/my child’s asthma?
- Can I travel during treatment with medicines?
- Can I exercise with asthma?
- Will I/my child be able to control this condition?
- Will asthma medicines have side effects? How should I manage them?
Expert Answers (Q&A)
Answered by Dr. Maeve O’ Connor, MD (Allergist/Immunologist)
If no quick-relief or rescue inhaler is available (having a rescue inhaler on hand is VERY IMPORTANT), the best way to manage an asthma attack is to CALL 911.
While waiting for the ambulance, staying calm is one of the most important things you can do, which can help your respiratory muscles become less constricted.
Sit in an upright position to stop breathing constriction. Take slow, deep, and long breaths to prevent hyperventilation. Use the “relaxing breath” technique –breathe in through the nose for a count of 4, hold the breath for 1 second, and then slowly exhale for a count of 4.
Staying calm may prevent further tightening of your chest muscles and make your breathing easier. The most important thing to remember is not to delay seeking emergency care when needed.
Asthma is a chronic condition and unfortunately cannot be cured. It can be managed effectively by avoiding known triggers and taking controlling medications as prescribed. If asthma is limiting your daily activities or waking you up at night, it is important to talk to your doctor about your asthma action plan.
Coughing at night is a hallmark sign of poorly controlled asthma. If you are waking up more than two nights per month with coughing, wheezing, or shortness of breath, you should talk to your doctor to better understand your type of asthma and be given proper treatment to manage the symptoms.
Poor sleep impacts your entire life, resulting in lost productivity and mood disturbance. For these reasons, it is very important to minimize coughing at night.
Hot caffeinated drinks such as coffee can help to open up the airways slightly, providing symptomatic relief for an hour or two; however, this is not a long-term solution to asthma symptoms.
Each individual patient has unique triggers for his/her asthma. Some patients may have food allergies that can worsen asthma or cause symptoms that can be confused with asthma.
If you are experiencing a severe allergic reaction and an asthma flare-up, it is important to err on the side of caution and treat with epinephrine for anaphylaxis first. Time is of the utmost importance, and epinephrine should be administered quickly.
Nasal saline rinses may help to clear mucus in the upper airway, which often impacts the lower airways. It is also important to stay well hydrated by drinking at least 2 liters of water per day unless you have kidney or heart issues.
About Dr. Maeve O’Connor, MD: Dr. O’Connor provides a more progressive approach for the treatment of patients with allergy, asthma, and immunological disorders. She is board certified by both the American Board of Internal Medicine and the American Board of Allergy and Immunology.
She is one of the only three specialists to have completed the University of Arizona Fellowship of Integrative Medicine, and she has been selected by her peers to be included in the Best Doctors of America database from 2011 to currently.