- How to Prevent the Long-Term Health Effects of Asthma
- The Importance of Controlling Your Asthma
- Asthma symptoms include a cough, wheezing, chest tightness and breathlessness.
- Lung Health Program
- Physical Effects of Asthma
- Interference with normal activities
- Interference with sleep
- Time missed from work or school
- Emergency department visits and hospitalizations
- Long term complications
- Facts about asthma
- The causes
- Reducing the asthma burden
- WHO strategy for prevention and control of asthma
- Asthma Complications: What You Might Run Into Now and Later
How to Prevent the Long-Term Health Effects of Asthma
Asthma can also cause trouble with breathing at night, interfering with your ability to get a good night’s sleep and to function well the next day, says Lockey. “When you can’t sleep and you’re tired during the day,” he says, “it’s hard to go to work and get your job done.”
And the problems go beyond the physical: A review published in 2013 in the journal CHEST found that people with uncontrolled asthma had difficulty focusing on their tasks and were more likely to be stressed, anxious, and depressed than those who didn’t have asthma.
People with asthma also have a higher risk of developing gastroesophageal reflux disease (GERD), which can develop when stomach acid backs up into the esophagus. That’s because an asthma flare-up causes the lower esophageal sphincter — which sits just above the stomach — to open up, allowing the stomach acid to enter the esophagus, according to the American Academy of Allergy, Asthma & Immunology (AAAAI).
For pregnant women, severe, uncontrolled asthma can cause serious complications for both the mother and the child. Women can experience high blood pressure, toxemia, premature delivery, and even (in rare circumstances) death, according to the AAAAI. And because uncontrolled asthma can decrease the amount of oxygen that’s transferred to the fetus, there is an additional risk that the pregnancy could fail.
The Importance of Controlling Your Asthma
People with asthma should see their doctor if they’re experiencing any respiratory symptoms — things like chest tightness, coughing, and shortness of breath, says Dr. Li. Your doctor can help you learn more about what’s causing the symptoms and how to avoid any triggers in the future.
You may not need to take medication every day, explains Li. Instead, you might be able to manage your condition by avoiding triggers like pollen or ragweed if you have allergic asthma. On the other hand, if your asthma is more severe, you might need to keep rescue medication (quick-relief inhalers or nebulizers) handy in case of an emergency.
“It’s important to be examined by a doctor who knows how to treat asthma,” says Li. “People leave our clinic with an asthma action plan and the medications they need, including rescue medication, controller inhalers, or steroid tablets.”
After your diagnosis, you’ll schedule regular follow-up appointments. Your doctor will tell you how often you’ll need a checkup, says Li, though it will usually be every one to six months.
Above all, it’s crucial to take asthma seriously. Although it’s a manageable condition, more than 3,000 people died from asthma in 2015, according to the CDC. And, says Lockey, that tally doesn’t have to be repeated.
“If people with asthma take their medication,” he says, “99.9 percent should lead a normal life.”
Asthma symptoms include a cough, wheezing, chest tightness and breathlessness.
Badly controlled asthma can have an adverse effect on your quality of life. The condition can result in:
- underperformance or absence from work
- inability to exercise, leading to other health problems such as high blood pressure or weight gain
- permanent problems with your lungs
- repeated visits to hospital
- psychological problems including stress, anxiety and depression
- learning problems in children
If you feel that your asthma is seriously affecting your quality of life, contact your doctor. Your personal asthma action plan may need to be reviewed to better control the condition.
In rare cases, asthma can lead to a number of serious respiratory complications, including:
- pneumonia (infection of the lungs)
- a collapse of part or all of the lung
- respiratory failure, where the levels of oxygen in the blood become dangerously low, or the levels of carbon dioxide become dangerously high
- status asthmaticus (severe asthma attacks that do not respond to treatment)
All of these complications can be life-threatening and will need medical treatment.
Lung Health Program
Physical Effects of Asthma
Having asthma can affect a person in many ways. Physical effects can range from the somewhat annoying (an occasional cough) all the way to the life-threatening (not being able to breathe). The frequency and seriousness of asthma symptoms depends on the overall severity of the asthma and how well it is controlled.
Whether your asthma causes mild or severe symptoms, it’s essential to have an asthma management plan in place. The asthma doctors at UI Health can help. We’ll take the time to understand your symptoms and gauge the severity of your asthma. Then we’ll work with you to put together a plan that will address the physical effects asthma is having on your body.
Physical Symptoms of Asthma
Asthma symptoms and severity vary substantially from person to person. Most people with asthma do not have symptoms constantly. Bothersome asthma symptoms can mean that asthma is not controlled sufficiently or that an acute asthma episode may be starting. Common asthma symptoms include:
- Tightness in in the chest
- Shortness of breath
- Awakening in the night from coughing or wheezing
If you do not have asthma, you can help yourself imagine what it feels like to have an asthma episode:
- Run in place for a minute or two, until you can feel your heart start to beat fast. Take a plastic drinking straw and put it in your mouth. Hold your nose closed and continue to breathe through the straw. OR
- Take a deep breath in and hold it a moment. Now let out about a tenth of the air in your lungs. Breathe back in. Breathe out that same small amount of air. Breathe back in. Repeat until you can’t stand it anymore.
Asthma Symptoms in Children
Children are not always able to express in words that their asthma symptoms are worsening. They may have noticeable coughing and wheezing, but these are not always the first indications of breathing distress. Different children show asthma trouble in different ways.
Some possible indications of the beginning of an asthma episode include:
- Unusual tiredness or restlessness
- Trouble sitting still
- Looking worried or scared
- Pale, sweaty skin
- Fast breathing
- Slouching Over
Levels of Asthma Severity
Just as we do not yet know exactly what causes asthma, we do not know why the disease is mild in some people and very severe in others. National guidelines classify asthma severity into four levels:
Mild Intermittent Asthma
- Wheeze or cough 2 or fewer times per week
- Symptoms at night 2 or fewer times Per month
Mild Persistent Asthma
- Wheeze or cough 3–6 times per week
- Symptoms at night 3–4 times per month
- Increased symptoms with activity
Moderate Persistent Asthma
- Daily symptoms
- Daily inhaled beta2-agonist (bronchodilator) medication use
- Symptoms at night 5 or more times per month
- Decreased exercise capacity
- Continual symptoms limiting activity
- Frequent exacerbations
- Frequent symptoms at night
Asthma Management Can Help
A single individual’s asthma does not necessarily remain in the same category permanently. A person with seasonal asthma triggers may find that at a certain time of year — for instance, when ragweed pollen is in the air — he or she is in a higher severity group than during the rest of the year.
Asthma that starts during childhood also may become less severe as a person grows and his or her airways become wider. For any person with asthma, effective ongoing asthma control can help them move into a less severe category.
The asthma experts at UI Health can help you bring your asthma under control. To request an appointment, please fill out the online form or call 312.996.3300.
Asthma is a chronic disease, which means that asthma is likely to affect you for the rest of your life. Even when you are not experiencing asthma symptoms, your airways can still be inflamed.1
For many people, asthma requires taking medication daily and taking steps to avoid triggers. At times, this can be overwhelming. However, if your asthma is under control, you should be able to:2
- Enjoy normal activities, including exercise.
- Attend school or work.
- Get a good night’s sleep.
- Have fewer or no symptoms.
- Use your rescue medication less often.
Poorly controlled asthma can interfere with school, work, and other activities. Asthma attacks often require medical care, either in a doctor’s office or at the hospital. Severe asthma attacks can be life-threatening and lead to other complications. Thankfully, asthma-related deaths are rare.
Interference with normal activities
For people with well controlled asthma, symptoms do not interfere with normal activity.2 “Normal activities” include any kind and amount of activity that are typical for that age group.3 For children, this includes playing actively and participating in organized sports. For adults, this may include exercise, housework, and caring for others. A national survey in 2008 showed that asthma limited the activities for:3
- 5.5% of children.
- 6% of employed adults.
- 27% of not employed adults.
Interference with sleep
People with well controlled asthma wake up less than once or twice per month due to asthma.2 Unfortunately, as many as 75% of people with asthma report having nighttime asthma symptoms.4 If you are waking up frequently due to asthma, your quality of life is likely to suffer. Children with nighttime asthma are absent more often and do not do as well in school. Their parents also miss more work.5
Time missed from work or school
People with uncontrolled and severe asthma miss time from school and work. Symptoms may limit their participation in daily activities. Results from the 2008 national survey showed that among people who had had an asthma attack in the past year:3
- 60% of children had at least one asthma-related school absence; in total, this added up to 10.5 million missed days of school.
- 34% of employed adults missed at least one day of work due to asthma, which added up to 14.2 million days of missed work.
- 29.1% of adults who were not currently employed missed days of work around the house, totaling 22 million.
People with asthma may also miss school or work because of doctor’s visits. In 2008, there were 13.9 million asthma-related office visits.3 Not all of these visits were urgent. This figure includes regular follow-ups that are recommended for people with asthma.
Emergency department visits and hospitalizations
Asthma attacks can lead to emergency department visits and hospitalizations. Each year, asthma leads to 1.75 million emergency department visits and 456,000 hospitalizations.3 That is equal to 8.4 emergency visits and two hospitalizations per 100 people with asthma.6
Many emergency department visits are avoidable. When asthma is well controlled with medications, the risk of an asthma attack is lower.2 Your health care provider should work with you to make a written Asthma Action Plan that describes what to do in the event of an asthma flare-up. Your plan should who and when to call based on your peak expiratory flow measurements and the type of symptoms you are having.2 In some cases, it may be possible to be seen for an urgent visit with your primary care provider, rather than the emergency department.
Long term complications
Frequent asthma attacks and ongoing inflammation can lead to structural changes in the airways, called airway remodeling.2 The muscles surrounding the airways become thicker. The layers of cells that line the airway become overgrown. When this happens, medications are not able to fully open the airways. Currently available medications do not prevent these changes from occurring. It is not known whether these changes are permanent.
Long-term use of the steroid medications used to treat severe asthma attacks can have serious side effects. These side effects include high blood pressure, Cushings disease, osteoporosis, cataracts, as well as many other less serious side effects.2
Compared with other serious lung diseases, asthma deaths are rare and declining.7 Per 10,000 people with asthma, there are 1.4 deaths each year.6 In 2008, there were 3,447 asthma-related deaths in the US. Still, even a single death from asthma is too much.3
An estimated 17 million people living in the United States have self-reported asthma. Asthma is a chronic (or long-lasting) disease marked by these symptoms:
- chest tightness
- shortness of breath
- excessive coughing while exercising or following exercise
- nighttime coughing/difficulty breathing
Asthma is the most common chronic illness among children, and if left untreated can result in loss of sleep, exercise limitations, absenteeism, emergency room visits, worsening lung function, and, in a few cases, death.
Some people can categorize the type of asthma they have by their “triggers.” For example:
- Allergic asthma: Asthma symptoms appear when certain allergens are present, like pet dander, mold or pollen.
- Seasonal asthma: Like allergic asthma, seasonal asthma is triggered by allergic reactions, but these allergens are tree, grass and/or weed pollens traveling in the air during their peak seasons.
- Non-allergic asthma: These asthma symptoms occur whenever air irritants are present, such as tobacco smoke, wood smoke, room deodorizers, fresh paint, or perfume.
- Exercise-induced asthma: Asthma symptoms show up during exercise or physical activity.
- Nocturnal asthma: These asthma symptoms can occur in a patient with any type of asthma, though those symptoms increase or worsen at night.
If asthma is left untreated, it can worsen, and unfortunately it’s not something that will just go away. With a proper diagnosis and a custom treatment plan, asthma can be controlled and its effect on your quality of life kept in check.
Asthma is a major noncommunicable disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. Symptoms may occur several times in a day or week in affected individuals, and for some people become worse during physical activity or at night. During an asthma attack, the lining of the bronchial tubes swell, causing the airways to narrow and reducing the flow of air into and out of the lungs. Recurrent asthma symptoms frequently cause sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism. Asthma has a relatively low fatality rate compared to other chronic diseases.
Facts about asthma
- WHO estimates that 235 million people currently suffer from asthma. Asthma is the most common noncommunicable disease among children. Most deaths occur in older adults.
- Asthma is a public health problem not just for high-income countries; it occurs in all countries regardless of the level of development. Most asthma-related deaths occur in low- and lower-middle income countries.
- Asthma is under-diagnosed and under-treated. It creates substantial burden to individuals and families and often restricts individuals’ activities for a lifetime.
The fundamental causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as:
- indoor allergens (for example, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander)
- outdoor allergens (such as pollens and moulds)
- tobacco smoke
- chemical irritants in the workplace
- air pollution.
Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma: aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine).
Urbanization has been associated with an increase in asthma. But the exact nature of this relationship is unclear.
Reducing the asthma burden
Although asthma cannot be cured, appropriate management can control the disease and enable people to enjoy a good quality of life. Short-term medications are used to relieve symptoms. Medications such as inhaled corticosteroids are needed to control the progression of severe asthma and reduce asthma exacerbation and deaths.
People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms and exacerbations. Inadequate access to medicines and health services is one of the important reasons for the poor control of asthma in many settings.
Medication is not the only way to control asthma. It is also important to avoid asthma triggers – stimuli that irritate and inflame the airways. With medical support, each asthma patient must learn what triggers he or she should avoid.
Although asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.
WHO strategy for prevention and control of asthma
WHO recognizes that asthma is of major public health importance. The Organization plays a role in coordinating international efforts against the disease. The aim of its strategy is to support Member States in their efforts to reduce the disability and premature death related to asthma.
WHO’s programme objectives are:
- surveillance to map the magnitude of asthma, analyse its determinants and monitor trends, with emphasis on poor and disadvantaged populations;
- primary prevention to reduce the level of exposure to common risk factors, particularly tobacco smoke, frequent lower respiratory infections during childhood, and air pollution (indoor, outdoor, and occupational exposure); and
- improving access to cost-effective interventions including medicines, upgrading standards and accessibility of care at different levels of the health care system.
Global Alliance against Chronic Respiratory Diseases
The Global Alliance against Chronic Respiratory Diseases (GARD) contributes to WHO’s work to prevent and control chronic respiratory diseases. It is a voluntary alliance of national and international organizations and agencies from many countries. It focuses on the needs of low- and middle-income countries and vulnerable populations, and fosters initiatives that are tailored to local needs.
Asthma Complications: What You Might Run Into Now and Later
Airway Remodeling If you have asthma, your airways become inflamed, which causes them to swell and produce extra mucus. Unless you’re able to control this inflammation with medication, it can ultimately lead to a permanent narrowing or other structural changes in the lungs’ bronchial tubes, Dr. Rosenstreich says.
This “airway remodeling” is irreversible and can affect how well you breathe. Some people may ultimately need to use an assistive device, like an oxygen machine, to breathe. (9)
It’s believed that everyone who has asthma experiences airway modeling to some degree, however, severe airway remodeling is rare. “When inflammation in the lungs isn’t properly controlled by therapy with corticosteroids or bronchodilators, scar tissue can form and the airways are no longer able to open up, even after using an inhaler,” Rosenstreich says. “It can begin shortly after the onset of asthma, which is why we encourage people to stick to their prescribed therapy.”
Anxiety and Depression As with some other chronic diseases, asthma may increase your risk for anxiety and depression. Some research has found that people with asthma are nearly twice as likely to develop depression as those without asthma. (10)
Some research suggests the psychological stress and negative emotions (like fear, panic, and irritability) associated with asthma are what put individuals with asthma at higher risk for these mood disorders. (11) Sleep disturbances and inflammatory factors associated with asthma may also contribute. (11)
“A condition like asthma can have a significant psychological toll,” Rosenstreich says. If you’re feeling depressed or anxious, talk to your doctor to ensure you get the treatment you need. “Asthma can be a challenge, but it’s treatable,” he adds.
Weight Gain Asthma can make it difficult to exercise, either because exercise triggers symptoms or symptoms leave you feeling fatigued and without the energy to be physically active. Some asthma medication can increase appetite. For all these reasons, many people with asthma — roughly 2 out of 3 — have said their condition has caused them to gain weight, according to surveys by the nonprofit Asthma UK. (12)
But at the same time, there’s good evidence that losing weight can help alleviate asthma symptoms. (13)
A lot of nutrition research suggests a diet rich in whole foods — especially fruits and vegetables — and low in processed and refined grains can help people lose weight.
RELATED: 9 Hard Truths About Weight Loss That Can Help You Slim Down
Higher Risk of Developing GERD Gastroesophageal reflux disease (GERD) is a condition in which stomach acid travels up into the esophagus — the tube connecting the stomach and mouth — and causes burning (heartburn), a mucous-clearing cough, or other symptoms. (14)
Up to 75 percent of people with asthma experience GERD. (15) And there’s some evidence that GERD may worsen asthma symptoms and further reduce the effectiveness of treatment. Also, asthma can make GERD symptoms worse. (15)
“There’s some evidence that the bronchodilators used to treat asthma may promote acid creation in the stomach and regurgitation in the esophagus,” Rosenstreich explains. If you notice heartburn or other GERD symptoms, be sure to talk to your doctor.
Obstructive Sleep Apnea (OSA) OSA is a condition in which the throat’s airways temporarily close during sleep. It can cause snoring and breathing difficulties during sleep, nighttime arousals, daytime fatigue, and potentially serious complications — including heart disease. Asthma is associated with an increased risk for OSA because asthma’s common features, such as nasal obstruction and nasal and airway structures that can limit breathing promote sleep apnea symptoms. (16)
Also, OSA can make asthma’s symptoms worse because of the narrowing of the airways, gastroesophageal reflux, and inflammation associated with OSA. (16)
If you have asthma, it’s important to tell your doctor if you’re snoring, waking up frequently during the night, or showing other symptoms of OSA.
Most patients with asthma have mild disease. By definition, this means they’ve had symptoms for ≥1 year that require occasional use of acute rescue treatment with short-term beta-agonists (SABA) without the regular use of bronchodilators; also, it is not associated with airflow limitation. 1 The stability of mild asthma over time and the risk factors that may exacerbate it have not been well-studied, however. A recent study examined the long-term trajectory of mild asthma in persons aged 14-45 years and attempted to identify demographic, clinical, and treatment-related factors present during the earliest stages of disease that could be associated with progression.1
This prospective cohort study was based on provincial health administrative databases from British Columbia from January 1997 through December 2012 that captured health information on all 4.2 million residents of the Province. Asthma diagnosis was based on International Classification of Diseases codes; severity was graded according to healthcare resource utilization of inhaled corticosteroids (ICS). For each 12-month period, asthma in each individual was classified as mild/dormant, moderate, or severe based on their utilization of asthma-related healthcare resources using a previously validated algorithm.1
During each patient-year, patients were classified as having mild asthma if they filled ICS prescriptions equivalent to a mean daily dose of up to 500 μg/day of a beclomethasone equivalent, or below 250 μg/day if they were also taking another controller; SABA had to be ≤3 doses/week, and patients could have no exacerbations.
Exposure variables that were investigated as possibly related to the transition of mild asthma to more severe asthma included
- Excessive use of rescue medication relative to controlled medication
- Use of ICS versus ICS/LABA
- Age, sex, socioeconomic status
- Assessment of comorbidity (Charlson comorbidity index, CCI)
- Presence of allergic rhinitis
A total of 70,829 patients had mild asthma; average follow-up was 5.4 years. Baseline mean age was 30.5 years and 62% were women.1 Most patients had a CCI score of 0 at baseline, 13% had allergic rhinitis, and approximately 42% lived in low socioeconomic neighborhoods.1 Asthma tends to be more common and more severe in poorer areas.
According to co-investigator Don D. Sin, MD, MPH, Professor of Medicine and at the University of British Columbia and Head of Medicine at Providence Health Care, the most important finding of the study was that “one in ten patients with mild asthma experienced disease progression to more severe stages of asthma over the ensuing 10 years, while nine out of ten remained in the mild stages of disease. The risk factors for progression into more severe stages included older age and having one or more co-morbid conditions.” Inappropriate use of rescue medication was observed in 12% of patients, while 52% of patients did not use any ICS treatment in the index year.1 Of those using ICS treatment, 35% used ICS monotherapy, 12% used an ICS and a LABA in combination, and 1% used both types.1
Patients initially treated with ICS/LABA combination therapy had a slightly better prognosis than those treated with ICS monotherapy.1 There could be several reasons for this, including a consequent improvement in pulmonary function or better adherence with the combination regimen.1 The presence of allergic rhinitis did not alter the long-term trajectory of mild asthma, which was surprising, since allergic rhinitis is known to have a significant effect in adult-onset asthma.2 Only 12% of patients in this study had a CCI score >1, suggesting that comorbidity may not have a substantial impact on asthma progression.1 Dr. Sin confirms that these findings are consistent with others in the literature. Limitations of the study include the fact that lung function and symptoms were unavailable in the administrative data, that medication usage might not indicate severity of disease, or that dispensed doses of drugs might not indicate actual patterns of use. Patients could, for example, have stockpiled medications and thus been misclassified as more severe. The prevalence of allergic rhinitis could also have been underestimated if patients used over-the-counter medications. Finally, risk factors such as obesity and smoking status were not captured in the administrative data. Nevertheless, findings indicate that mild asthma in adults takes a generally benign course, and that inappropriate use of rescue medications, older age, comorbidity, and combination versus monotherapy could have an effect on the long-term course of mild asthma.
Published: August 29, 2018