Is your asthma medicine working hard enough?
If you’re one of the nearly 20 million adults in the U.S. with asthma, you know that keeping symptoms from interfering with daily life is not an easy task. In fact, 60% of adults with asthma are said to have uncontrolled asthma, according to the Centers for Disease Control and Prevention.
Uncontrolled asthma means you’re experiencing more frequent symptoms than you should. You’re probably missing out on work or favorite activities as a result. Plus, your breathing trouble may be causing you to overuse your medications. It might even be contributing to long-term airway and lung damage. With spring allergy season upon us — and pollen being a common asthma trigger — now’s the perfect time to get your symptoms under control once and for all. Here’s what to consider:
Recognizing uncontrolled asthma
One of the main reasons so many people have uncontrolled asthma? There are so many triggers that can set off an attack and they can change over time, explains Rajiv Dhand, MD, a pulmonologist and the chair of internal medicine at the University of Tennessee Graduate School of Medicine in Knoxville.
“For instance, it’s not unusual for someone to move to a new location and then experience a worsening in symptoms because there are different triggers in that environment,” he notes. “Or they develop a condition like acid reflux and don’t realize that it’s an asthma trigger.”
Common asthma triggers include:
- Allergens, such as pollen, dust mites, mold or pet dander
- Infections, such as the flu, a cold or a sinus infection
- Outdoor air pollution
- Cold weather
- Tobacco smoke or other irritants
- Acid reflux
- Anxiety or other strong emotions that lead to fast breathing
- Food additives
Medication compliance is another issue. “People with asthma don’t always use their medications like they should,” says Dr. Dhand. “This is especially true if they’re feeling well. They may not think they need their medication if they’re not experiencing symptoms.”
That’s a mistake because there are 2 components to asthma. “The first is the inflammation that’s occurring in the airway. This is the real disease,” notes Dr. Dhand. “The other is the contractions or spasms of the muscle that surrounds the airway. These occur as a result of the inflammation, and they cause the symptoms.”
Consistent daily use of long-acting inhaled corticosteroids is necessary to minimize the inflammation even when you’re not experiencing asthmatic episodes, he notes. Short-acting rescue inhalers relax the muscle spasms around the airway, but they won’t help the inflammation that caused the symptoms in the first place.
Red flags that your asthma may not be under control include:
- Needing to use your rescue inhaler more than twice a week
- Coughing and wheezing more during the day
- Symptoms that are waking you up at night
- You can’t maintain your usual exercise routine
- Your peak-flow meter readings are regularly below 80%
- You often feel short of breath
- Your chest constantly feels tight
- You need to take a breath while speaking
- Missing school or work due to symptoms
Take back control and breathe easier
If you are experiencing any of the above symptoms, it’s time to get to your allergist or pulmonologist so you can work together to tweak your asthma action plan. Your pharmacist can help, too. “There is no magic treatment formula that works for everyone,” Dr. Dhand says. “Some patients with mild or moderate asthma may need a lot of medication, while some patients with severe asthma can be well controlled on less medication.”
Your asthma tool kit likely already includes a long-acting inhaled corticosteroid as well as a short-acting rescue inhaler. But remember: Doses and brands of those medications can be adjusted for better results, says Dr. Dhand. It’s a good idea to bring your inhalers to your appointment so that your doctor can see if you are using them correctly.
Keeping an asthma diary to share with your doctor can also help you identify triggers and track how well your medications work. You’ll want to note:
- Where you were
- What you were doing
- Time of day when you experienced symptoms
- What medications you used and how much they helped
- Your peak-flow readings, if you’re using a peak-flow meter. These hand-held devices measure how quickly you can push air out from your lungs.
Your doctor may also prescribe an oral steroid such as prednisone for a short time to get you closer to asthma control. Allergy testing can reveal triggers such as pollen, mold, dust mites or pet dander. “These patients can then get shots to suppress the allergic response,” he adds.
If you have severe asthma or are still unable to get your asthma under control with inhaler therapy or other treatment options, there is a new class of medications known as biologics. Biologics are genetically engineered proteins that target substances in your immune system that cause inflammation and are given as injections every few weeks depending on the formulation, explains Dr. Dhand. There are currently 5 biologic drugs approved by the Food and Drug Administration to treat asthma, with more in the works.