Living with Asthma

Asthma affects one in 11 children and one in 12 adults in the United States, according to the Centers for Disease Control (CDC). Asthma rates are on the rise, but experts aren’t sure why, and some question how much of the increased prevalence is due to more frequent diagnosis of asthma rather than a greater number of people who have the disease.

Even when asthma begins in childhood, it does not necessarily follow a person throughout life. It is estimated that a third of the children who have asthma outgrow it, a third of the time their asthma improves and a third of the time it persists, says John N. Kalliel, MD, an allergist and immunologist at Manchester Allergy Incorporated and at Elliot Hospital and Catholic Medical Center in Manchester. “And we hope that proper treatment allows for improvement, so that you will improve as time goes on if you treat it properly,” he says. Since there is no cure for asthma, effectively managing the disease must be the goal for asthma sufferers.

Asthma is a chronic lung disease in which inflammation constricts airways, limiting airflow and leading to hallmark symptoms that include coughing, wheezing, shortness of breath and a sensation of tightness or pressure on the chest. It can be life-threatening; about nine Americans die from asthma each day, according to the CDC.

Causes of asthma are not well-understood, but there does appear to be a genetic component that places some people at a higher risk of developing the disease. “There are lots of theories out there” about factors that might contribute to asthma or raise people’s risk of developing asthma, from the quality of the air we breathe to too little or too much bacterial exposure, says Amit Kumar, MD, an allergist and immunologist at Southern New Hampshire Asthma and Allergy, and Southern New Hampshire Medical Center in Nashua. A common assumption is that an underlying allergy is usually to blame for asthma, but while it’s true that about half of people with asthma have allergies, many do not.

Manifestations of asthma can vary in terms of severity and frequency. Some individuals find that their asthma only gets worse when they’re sick with a cold, for example. It can differ so much across patients that “it’s probably not the same disease,” Kalleil says. “There are probably various forms and types of asthma.”

But in some instances the effects of asthma extend beyond the physical. “Asthma can have psychosocial issues as well as physiological issues,” Kalleil says. It can affect athletic performance, and it can even affect relationships. If your significant other has a cat, for example, and refuses to part ways with the pet even though exposure to the cat exacerbates your asthma, understandably, friction will likely result.

Asthma can also create fear. Sufferers might find that they are afraid to partake in certain activities for fear of inducing an asthma attack or episode when inflammation and symptoms worsen and make it difficult to breathe. Since improperly managed asthma can harm health as well as quality of life, the key is to control your asthma, Kalleil says. “If you control your asthma, it reduces anxiety and worry, so that’s what we strive for. Control is the magic word.”

To that end, asthmatics should identify their triggers and take steps to avoid them whenever possible. Triggers that exacerbate asthma come in many forms but commonly include viral infection, smoke, cold air, exercise, stress and allergens such as pollen, animal dander and dust mites. Perfumes or chemical scents, such as chlorine-based cleaning products or air fresheners can also bring out asthma symptoms in some people. Less typical triggers include acid reflux, anti-inflammatory medication and sodium metabisulfite, a preservative used in food and red wine.

Many asthma patients are advised to have a reliable method for measuring their asthma, such as use of a peak-flow meter, a portable device that measures breathing ability. In addition, doctors commonly recommend that asthma patients create and follow an “asthma action plan” or a customized approach for managing asthma that includes steps patients should take if asthma worsens or acts up. “When asthma is well-managed, people usually do fairly well with their disease,” Kumar says. “One of our goals is always to find the least amount of medicine that keeps [asthma] well-controlled, trying to find that fine balance.”

Fortunately, “excellent” asthma medications are available today, with new ones coming out regularly, Kalleil says. “We have great medicines out there now to control asthma. Almost everyone should have control of their asthma,” he says. “It’s not an impossible goal.”

Get back in on the action

People with asthma needn’t feel sidelined from exercise. Although some find that exercise worsens their asthma, patients can take steps that enable them to participate in sports and pursue their fitness goals. “[Asthma] should not in any way be life-limiting,” says Amit Kumar, MD, an allergist and immunologist at Southern New Hampshire Asthma and Allergy, and Southern New Hampshire Medical Center in Nashua. “We have Olympic athletes and people who participate in all levels of sports who have asthma,” he says.

Indeed, people who hope to use asthma as an excuse to hang up their sneakers and spend more time on the couch might find that they’re out of luck, just as parents who request a doctor’s note that gives their asthmatic child a pass on gym class might find that their doctor turns them down. “Our goal is that [people] be healthy and active and participate in all levels of activity to the best of their ability,” Kumar says. If a person does feel limited by asthma, it might signal that the doctor needs to reassess the individual’s medication and treatment plan, Kumar says.

Many asthma patients are advised to adjust their workout habits rather than forego exercise altogether. Avoiding exercise in cold, dry air, for example, and using an inhaler before working out helps many people with asthma maintain good health and fitness through exercise.

For more information on exercise and asthma, visit the American Academy of Allergy, Asthma & Immunology.