Living with Asthma

Asthma is a chronic respiratory condition that affects millions of people worldwide. While there’s no cure, understanding your condition and working with your healthcare provider can help you manage symptoms effectively. With proper treatment and lifestyle adjustments, most people with asthma can live active, fulfilling lives without significant limitations.

What Is Asthma?

Asthma is a chronic lung disease that inflames and narrows the airways, making breathing difficult. During an asthma episode, the muscles around your airways tighten (bronchospasm), the lining of the airways becomes swollen, and excess mucus may be produced. This combination restricts airflow and causes the characteristic symptoms of asthma.

Asthma affects approximately 262 million people globally and accounts for hundreds of thousands of deaths annually, many of which are preventable with proper management. The condition can develop at any age but often starts in childhood. About 8% of adults and 7% of children have asthma, with rates varying by geography and population.

Types of asthma include:

• Allergic Asthma - Triggered by allergens like pollen, dust mites, pet dander, or mold
• Non-Allergic Asthma - Triggered by factors like stress, exercise, cold air, or respiratory infections
• Exercise-Induced Bronchoconstriction - Symptoms triggered specifically by physical activity
• Occupational Asthma - Caused by workplace irritants or allergens
• Aspirin-Exacerbated Respiratory Disease - Asthma worsened by aspirin and NSAIDs

Causes and Risk Factors

The exact cause of asthma isn’t fully understood, but it likely results from a combination of genetic and environmental factors.

Risk factors include:

• Family history of asthma or allergies
• Personal history of allergies or eczema
• Childhood respiratory infections
• Exposure to secondhand smoke, especially during childhood
• Occupational exposure to chemicals, dust, or fumes
• Air pollution
• Obesity
• Being born prematurely or with low birth weight

Common asthma triggers:

• Allergens (pollen, dust mites, mold, pet dander, cockroach droppings)
• Respiratory infections (colds, flu, sinus infections)
• Exercise and physical activity
• Cold air or changes in weather
• Air irritants (smoke, strong odors, pollution, chemical fumes)
• Strong emotions (laughing, crying, stress)
• Certain medications (aspirin, beta-blockers, NSAIDs)
• Sulfites in food and beverages
• Gastroesophageal reflux disease (GERD)

Common Symptoms

Asthma symptoms can range from mild to severe and may vary over time. Not everyone experiences all symptoms, and frequency can differ.

• Shortness of breath, especially during physical activity
• Wheezing (a whistling or squeaky sound when breathing)
• Chest tightness or pain
• Persistent coughing, particularly at night or early morning
• Difficulty sleeping due to breathing problems
• Rapid breathing
• Fatigue during exercise or activities
• Worsening symptoms during colds or respiratory infections
• Needing to use a rescue inhaler frequently

Warning signs of a severe asthma attack:

• Severe shortness of breath making it hard to walk or talk
• Lips or fingernails turning blue or gray
• Rescue inhaler providing no relief
• Rapid worsening of symptoms
• Confusion or difficulty concentrating
• Extreme difficulty breathing while walking or talking

Diagnosis

Asthma diagnosis involves several assessments to confirm the condition and rule out other respiratory problems.

Diagnostic process:

• Medical history - Discussion of symptoms, family history, and potential triggers
• Physical examination - Listening to your lungs and checking for signs of allergies or other conditions
• Spirometry - The main test for asthma; measures how much and how quickly you can exhale
• Peak flow measurement - Measures how fast you can blow air out of your lungs
• Bronchoprovocation testing - Measures airway response to specific triggers
• Allergy testing - Identifies specific allergens that may trigger your asthma
• Exhaled nitric oxide test - Measures airway inflammation
• Chest X-ray - Rules out other conditions

After diagnosis, your doctor will classify your asthma severity (intermittent, mild persistent, moderate persistent, or severe persistent) to guide treatment.

Treatment Options

Asthma treatment aims to control symptoms, prevent attacks, and maintain normal activity levels. Most treatment plans include medications and trigger avoidance.

Long-term control medications (taken daily):

• Inhaled corticosteroids - The most effective long-term treatment, reducing airway inflammation
• Long-acting beta-agonists (LABAs) - Open airways for extended periods (used with corticosteroids)
• Leukotriene modifiers - Block inflammation-causing chemicals
• Long-acting muscarinic antagonists (LAMAs) - Help keep airways open
• Biologics - Targeted therapies for severe asthma

Quick-relief medications (rescue medications):

• Short-acting beta-agonists (SABAs) - Rapidly open airways during an attack
• Ipratropium - Helps relax airways quickly
• Oral corticosteroids - For severe attacks

Other treatments:

• Bronchial thermoplasty - A procedure that reduces smooth muscle in airways
• Allergy shots (immunotherapy) - For allergic asthma
• Asthma action plan - A written plan developed with your doctor for managing symptoms

What You Can Do

Effective asthma management involves medication adherence, trigger avoidance, and monitoring your condition.

1. Take medications as prescribed - Use controller medications daily, even when you feel well. They work to prevent symptoms, not just relieve them.

2. Identify and avoid your triggers - Keep a diary to track what worsens your symptoms. Once identified, take steps to minimize exposure.

3. Use your inhaler correctly - Improper technique reduces medication effectiveness. Ask your doctor or pharmacist to demonstrate proper use and review your technique regularly.

4. Monitor your symptoms - Use a peak flow meter as recommended and pay attention to early warning signs. Track patterns in your symptoms.

5. Follow your asthma action plan - Work with your doctor to create a written plan that outlines daily management and steps to take when symptoms worsen.

6. Keep your home allergen-free - Use allergen-proof bedding, vacuum regularly with a HEPA filter, maintain low humidity, and address mold or pest issues.

7. Stay active - Exercise is important for overall health. Work with your doctor to manage exercise-induced symptoms so you can stay physically active.

8. Maintain a healthy weight - Obesity can worsen asthma symptoms and make them harder to control.

9. Get vaccinated - Annual flu shots and pneumonia vaccines reduce the risk of respiratory infections that can trigger attacks.

10. Don’t smoke and avoid secondhand smoke - Tobacco smoke is a major irritant that worsens asthma and reduces medication effectiveness.

When to See a Doctor

Regular checkups are important for asthma management. Schedule an appointment if:

• Your symptoms are getting worse or more frequent
• Your rescue inhaler isn’t providing relief
• You need to use your rescue inhaler more than twice a week
• Asthma is interfering with work, school, or daily activities
• You’re experiencing medication side effects
• Your peak flow numbers are declining
• You’ve had recent asthma attacks

Seek emergency care immediately if:

• You’re experiencing severe shortness of breath or difficulty speaking
• Your lips or fingernails are turning blue
• Your rescue inhaler isn’t working
• You’re getting worse despite following your action plan
• You feel scared or panicked about your breathing

Key Takeaways

• Asthma is a chronic condition that can be effectively managed with proper treatment and lifestyle adjustments
• Knowing and avoiding your triggers is essential for preventing asthma attacks
• Both long-term controller medications and quick-relief rescue medications play important roles in treatment
• Working with your healthcare provider to create and follow an asthma action plan helps you stay in control of your condition