Understanding asthma and determining treatment for you

Odds are, you know someone with asthma — about 1 in 12 Americans has it.

The chronic disease can inflame the lung’s airways, making them narrower, and it leads to classic symptoms of shortness of breath, coughing, wheezing and tightness in the chest.

Although the incidence of asthma has increased over the past two decades, there are numerous treatments available to help keep it under control, or even put it into remission.

Here are answers to some common questions about asthma:

What’s the connection between asthma and allergies?

Asthma is really a disease of inflammation in the airway tubes at the lungs. For some people, that inflammation could be from allergies. The world isn’t a clean space. We breathe it in, and your immune system sees that in your airways and puts inflammation there.

If you are sensitized to a pollen or a pet for instance, you breathe in that antigen and your immune system will put inflammation in your airway, triggering the symptoms of asthma. Not all asthma is allergic asthma, but for those with allergies and asthma, we know that controlling allergy is a really important part of controlling your asthma symptoms.

What are the differences among inhalers, nebulizers and oral medications?

It really stems back to what type of medication is in these delivery tools.

The mainstay of treatment for asthma is going to be inhalers. Inhalers come in a couple of different delivery systems and contain different medications. An inhaler might be a maintenance steroid medication that you’re using every day for asthma, or it might be a reliever medicine, such as albuterol or formoterol, that you’re using when symptoms show up.

Nebulizers are a more passive delivery system, easier for children to use, and generally only deliver the reliever medicines.

There are some oral medications that we might use for asthma in certain circumstances — particularly montelukast, branded as Singulair — for patients who also use an inhaler. There are other oral medications that we used to use for asthma, but they’re not as effective as inhalers.

How do you determine which medication is right for which patient?

It really depends upon the degree and frequency of symptoms that a person is experiencing. Some people have symptoms of asthma only a couple of times a month and do well with just an anti-inflammatory reliever inhaler. Others with more-frequent symptoms are going to require daily maintenance inhalers in addition to reliever inhalers.

The best inhaler for you is going to be the one that you can get and take on a regular basis. You should follow up with your doctor to determine which medication is best for you, and how frequently you need to take it.

Are there any new asthma medications or treatments on the horizon?

We’ve had a lot of advances in asthma treatments in recent years, particularly with new injectable therapies for asthma. There’s more in the pipeline, including one that might be able to be dosed only every six months! There are also promising studies looking at new classes of inhaler medications that look to be helpful for patients who have asthma that’s uncontrolled despite taking several different inhaled medications.

Still, the mainstay of asthma therapy remains an inhaled steroid, and we add more medications on top of this as required to maintain good control of symptoms and improve lung function.

What tends to trigger flare-ups in asthma?

Far and away, the most common trigger of an asthma flare-up or exacerbation is a viral respiratory infection. Things like the common cold, influenza, RSV or COVID-19 probably account for about 90% of asthma flare-ups.

Exposures to allergens such as dust mites, mold or pollen can also trigger a flare-up. Poor air quality is another trigger, and one that was a frequent issue when we were downwind of some large wild fires.

Can asthma be fatal?

Even the mildest of asthma can potentially be fatal. And we know that up to 30% of deaths due to asthma come from patients who only have occasional asthma symptoms.

Knowing the signs and how to monitor your lung function at home can help you seek appropriate care for your asthma and know when you need to go straight to the emergency department.

Are there environmental changes that can help reduce asthma triggers?

Patients commonly ask me about what they can do to help improve their environment for asthma.There’s a lot of money that you can spend looking to change your environment, but not a lot of data to tell us what is most helpful or who’s going to benefit the most from some of these more complex or expensive environmental changes. But there are some things that we do know that work: if you have allergies, if you’re known to be allergic to a pet or to dust mites, taking steps to rid your indoor environment of those triggers is important.

Attention to indoor air quality can largely come from making sure you’re avoiding secondhand smoke and doing things to ensure properly ventilated areas around cooking.

I generally don’t recommend spending a lot of money on expensive air purifiers, but it might be worth making sure you change your HVAC filters on a regular basis.

What roles do diet and exercise play in managing asthma?

I recommend any patient with asthma to maintain a diet rich in fruits and vegetables for the general health benefits, and to maintain regular exercise with aerobic and strength exercises a couple of times a week.

We know that weight is one of the most common comorbidities to come along with asthma. Among patients with obesity, weight loss and exercise can significantly improve the degree of symptoms that we see from asthma. One of the best ways to reduce symptoms of exercise-induced asthma is to improve your fitness.

Is asthma a lifelong illness, or could you actually outgrow it?

Asthma can affect people across the spectrum of life. We see it in kids, and we see it all the way through elderly individuals, but it’s also a variable disease. For some people who had asthma symptoms in childhood, they may have no symptoms or mild, intermittent and infrequent symptoms in adulthood.

For some people, you may have symptoms of asthma only in one era of your life and be much better controlled in another. Know that if you’ve been diagnosed with it in the past, even if you’re in a space of good control, symptoms may return in the future.