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Q. Can you outgrow asthma?
A. No. Asthma is a chronic disease, which means that it doesn't go away once you have it, and you are always at risk for symptoms. Some people think children outgrow asthma because they have fewer symptoms or attacks as they get older. But asthma causes changes in the lungs' airways. Those changes don't go away, and symptoms can return at any time. Even after a long time without symptoms, asthma can be triggered again. About a third of children with asthma still have symptoms when they become adults.
Q. My 8-year-old has difficulty breathing during gym class, but I'd like for him to enjoy the benefits of developing healthy fitness habits and participating in team sports. What can I do?
A. It sounds like your son could have EIB, also called exercise-induced bronchoconstriction. Simply put, EIB is difficulty breathing during or shortly after exercising. As many as nine out of every 10 people with asthma have EIB, and one in 10 people without asthma have it, too, including many of our nation's most elite athletes.
When properly diagnosed and managed, children and adults with EIB should not have to stop exercising. Walking, hiking, golf, baseball, football, gymnastics, and shorter track and field events are considered less likely to trigger EIB than endurance sports such as running and basketball.
See a board-certified allergist, who can diagnose your son and prescribe appropriate treatment to help him stay in the game.
Q. I cough when lying down at night. Could this be asthma even though I'm just resting?
A. Absolutely. In fact, coughing, especially at night, when exercising or laughing, is a common sign of asthma. Allergies and asthma can be triggered at any time, even at rest. Dust, mold, tobacco smoke and pets in your bedroom are a few possible causes. Make an appointment with a local allergist, who can identify your asthma and allergy triggers and stop them at their source.
Q. I react strongly to perfumes or indoor air fresheners, which can set off my asthma. How can I deal with this in my work environment?
A. Reactions to perfumes or indoor air fresheners are usually not a problem when asthma is well controlled.
If they do cause a reaction, the best policy is often to go straight to the co-worker and tell them, "I have asthma, it’s well controlled and I’m taking medicine for it, but sometimes your perfume or your indoor air freshener sets off my symptoms. Would it be all right with you if you didn’t use that – or used less of it?" Most people will understand and work with you.
This is typically a better initial approach than going straight to your boss, since that may create some ill will. You can reserve going to the boss for later, should the co-worker ignore or refuse your request and your symptoms worsen.
Q. When I’m stressed at school, my asthma tends to flare up. What can I do to reduce my stress level?
A. There is good research that psychological stress plays a role with asthma. It can make asthma more difficult to control and increase the likelihood of asthma flares. And it can also increase the duration and severity of symptoms.
It’s important to identify stressors that may be playing a role with your asthma. It could be your amount of schoolwork, bullying at school or through social media, or feeling different from your peers. It could be that you’re simply stressed about controlling your asthma at school.
Or it could be a personal issue, such as conflict with a family member or friend, or the death of a loved one.
In addition to working with a board-certified allergist to make sure your asthma is well controlled, you may want to reach out to a mental health specialist or social worker to figure out stressors and how to manage them so they don’t affect your asthma – and your daily life.
Consider what is going on in your life and if stress is playing a part in it. Keep a record of stressful situations or experiences to see if there’s a pattern, and then work with your allergist to modify your Asthma Action Plan.
Q. My son recently was selected for his junior high school basketball team. During his last game, I noticed that, after playing for about 6-7 minutes, he appeared tired and more winded than usual, especially after he got back to the bench. He continued to play, but moved slowly up and down the court. Later he told me that had been experiencing breathing difficulty and coughing during practice sessions. His coach recently told him that he was not in good enough shape" and needs to run more to catch up to the other players. For many years, he has suffered with nasal allergies during the spring and fall but never before has he had difficulty breathing. I am very worried - what should I do?"
A. Your son could have exercise-induced asthma - also called exercise-induced bronchospasm - in addition to his nasal allergies. This is a very common condition in which exercise can trigger constriction of the bronchial airways resulting in symptoms of shortness of breath, chest tightness, and cough during or after intense aerobic exercise (such as running). Asthma symptoms begin within minutes after starting an exercise activity that causes a rapid increase in heart rate. Individuals (like your son) who have nasal allergies may be at higher risk for exercise-induced asthma.He should be evaluated as soon as possible by a board certified allergist. The allergist will assess your son s breathing condition and determine the best treatment. A measurement of his lung capacity, with breathing tests before and after exercise, may be done. To prevent exercise-induced asthma symptoms, the allergist may advise your son to take a relief inhaler/bronchodilator (such as albuterol) 20-30 minutes before every practice and game. In nearly every case, symptoms can be managed so that your son should be able to enjoy playing basketball and other sports. With proper treatment prior to events, many elite athletes affected by this condition have been able to compete successfully!
Q. Can asthma be caused by emotions, or stress?
A. Asthma is not an emotional or psychological disease, although strong emotions such as laughter or crying, and psychological stressors can definitely trigger asthma or make symptoms worse. People with asthma have very sensitive lungs that may react to numerous triggers, causing the airways to tighten, swell and fill with mucus. These factors can then lead to symptoms of difficulty breathing - shortness of breath, a sensation of chest tightness, coughing and wheezing. Regarding stress, a previous study showed that college students with asthma had reductions in lung function the week prior to final exams!
Q. I am a pregnant mom-to-be with asthma and I have several questions. Are asthma medications safe to take during pregnancy? Is it safe to continue my allergy shots while pregnant? And should I take my asthma medications with me to the hospital, for use during labor and delivery?
A. The risks from letting asthma get out of control during pregnancy are much greater than any associated with asthma medications, so these medications are safe in pregnancy. When the airways get obstructed (even before you feel symptoms), you don't get as much oxygen as you or the baby needs to grow properly. Secondly, if you have reached your maintenance dose of allergy injections with no problems, then these are safe to continue during pregnancy. We won't begin immunotherapy or increase the dose during pregnancy but it's safe to maintain the dose. Regarding your final question, hospitals often don't want patients to use medications brought from home, but it's important for hospital staff to see what you have been using. Fortunately, very few women have worsening asthma during delivery. Follow your daily asthma action plan as normal; it s unlikely you'll need a bronchodilator medication, but if you feel like you do, speak up.
Q. Can you tell me if fog machines sometimes contribute to asthma attacks?
A. Fog machines use various components to create their effects. Water, dry ice, liquid nitrogen and liquid air have all been used to create a fog effect, and additional chemicals can be added - such as glycol in water-based fog. The first issue with these machines is assuring adequate ventilation to allow proper oxygen levels. In people with asthma and airways hyper-reactivity, the irritant effect of short term exposure to water-based fog machines - particularly when the chemical glycol is used - could trigger acute asthma symptoms including cough, wheeze, chest tightness and shortness of breath. Even in a person without asthma, short term exposure to glycol-containing fog machines can be associated with headaches, dizziness, drowsiness, and eye irritation. Prolonged exposure to this substance in a person with asthma could trigger even more severe respiratory difficulty and could cause bronchitic symptoms even in those without asthma. Long term exposure to smoke and fog can result in upper airway and voice symptoms as well, while extended (multi-year) exposure to smoke and fog has been associated with both short-term and long-term respiratory health problems. So be careful around fog machines if you have asthma - and check how they generate their "fog"! Fog machines using liquid air are the safest, as those do not reduce oxygen levels and do not contain glycol.
Q. How can asthma be controlled when one is also suffering from GERD?
A. GERD, or Gastro-Esophageal Reflux Disease, triggers or worsens respiratory symptoms in a number of people with asthma. Once the GERD is controlled, asthma often improves - leading to a reduction in medication required and allowing easier breathing. GERD is a common condition in which the acid from the stomach flows up the esophagus causing irritation and inflammation. This is often felt as a burning sensation in the upper abdomen and can lead to a bad taste in the mouth and a sense of burning in the chest if the fluid rises high enough. Since the nerves in the lower esophagus are connected to the nerves in the lungs, it is common for acid reflux to trigger asthma symptoms so it is important to control the reflux as much as possible. The most important way to control reflux is to first see a doctor to make sure that reflux is the correct diagnosis, as other conditions can mimic it. The treatment for GERD itself is the same as if one did not have asthma. In many cases a simple trial of an acid reducer such as ranitidine, which is available over the counter, might control the symptoms. Stronger medications called proton pump inhibitors also can reduce acid secretion. From a dietary standpoint, it helps to avoid eating meals for several hours before bedtime (avoiding large evening meals) and to reduce fat intake. Alcohol consumption in excess and caffeine can also predispose to acid reflux. Sleeping on several pillows with the upper body propped up to let gravity keep the fluid down may help. Weight loss for those who are overweight is recommended, as weight gain can worsen reflux. It is also important to assess whether certain asthma medications may be worsening GERD. Asthma medications that could increase reflux include theophyllines and oral steroids, and should be used only if there are no other alternatives. For most who suffer from both conditions, asthma can be controlled with the usual asthma therapies along with treatment of GERD. If these simple measures don't work, then more extensive evaluation and treatment may be needed. Sometimes, medical therapy is not adequate and GERD will require a surgical repair. Further evaluation should be done under the supervision of a qualified physician.
Q. My son’s asthma specialist recommended I put a valved holding chamber on his bronchodilator inhaler. How do they work and why are they important?
A. A valved holding chamber is a handheld device that attaches to a metered-dose inhaler (MDI) and captures the asthma medication as it sprays out. The medication is trapped inside the holding chamber long enough for you to inhale it at your own speed.
Valved holding chambers are very important because they can increase how much medication is delivered into your lungs. The average inhaler – even when used correctly – only delivers about 60 percent of medication into the lungs. The valved holding chamber allows you to better streamline delivery of the medication so more of it can get into your lungs, making it more effective at controlling your asthma. It can also pull out larger particles of medication unable to make it into your narrow airways, keeping them from settling in your mouth or throat.
It's a good idea to keep your valved holding chamber right next to your asthma inhaler so you don’t forget to use it! Some inhalers even come with the holding chambers already attached, which may be more helpful for patients who find it difficult to remember to use it all the time.
It’s often helpful – especially for children – to use a mask that attaches to the valved holding chamber. The mask should fit over the mouth and nose and allow the user to take several breaths to inhale the medication fully.
It’s very important to clean your valved holding chamber. If you don’t, it can collect dust mites and mold – allergens that can often make your asthma worse. Valved holding chambers should be washed at least once a week if used every day. Read and follow the package instructions for proper cleaning – some can even go in the dishwasher!
Some insurance plans will cover valved holding chambers, and some won’t. The good news is the cost of valved holding chambers is not very high – around $10-15 apiece. If you do have to pay out of pocket, they are affordable and fairly long-lasting.
Q. I recently lost 10 pounds and noticed my asthma improved. What is the connection between weight and the respiratory system? What are some ways to lose weight so that it helps your asthma?
A. This is really a question of body mechanics. When you are overweight or obese, most excess weight is usually in the central area of the body, or the midsection. This can reduce your lung volume, making you not able to breathe as well.
Also, the foods you put in your body are an important factor. With obesity, there’s often a pro-inflammatory diet that includes sugary, starchy foods. This can cause your body to release inflammatory hormones, such as leptin, that increase inflammation in the lungs and can lead to asthma symptoms.
Diseases that often occur with obesity, such as gastroesophageal reflux disease (GERD), diabetes and hypertension, have also been found to worsen asthma. So losing weight can also help you reduce the risk of developing these conditions.
Losing 10 pounds can make a huge difference in a person’s asthma symptoms. And as an added benefit, weight loss allows patients to be better able to exercise – obviously the less weight you have, the easier it is to move around. Regular exercise has been shown to improve not only asthma symptoms but also asthma outcomes.
A good way to start is to eat a healthy, balanced diet that includes more fruit and vegetables and less sugary, starchy foods. Regular exercise is also important, but make sure you warm up properly, stay hydrated and keep your quick-relief inhaler with you if exercise causes asthma symptoms. Ask your doctor or allergist for a referral to a nutritionist or dietitian.
Q. Do certain foods cause asthma symptoms to flare up? Are there any foods to avoid?
A. Research studies do not directly link specific foods to asthma flares – however, there are some important dietary considerations to keep in mind if you have asthma.
1) Eat a healthy diet that includes the following:
- Vitamin D – people with asthma and allergies have been found to have low vitamin D levels. Check your vitamin D level and then maintain normal levels, through both a dietary supplement and getting extra sunshine. This may help keep asthma symptoms at bay.
- Fruits and vegetables –good sources of antioxidants like vitamins C, E and flavonoids. Fruits and vegetable have an anti-inflammatory effect that may improve asthma and prevent symptoms.
- Fish and other sources of Omega 3 – they also have an anti-inflammatory effect that may prevent asthma flares.
2) Avoid foods with sulfites. Some studies link sulfites – an additive that serves as a food preservative – to triggering asthma in those with moderate to severe symptoms. Sulfites are found in wine, dried fruit, pickles, shrimp and condiments. Sulfites also naturally occur in vegetables such as asparagus and onions and can be found in corn starch and soy.
Sulfites are found in ingredients with these names: sulfur dioxide, sodium sulfite, sodium metabisulfite, potassium bisulfite and potassium metabisulfite. However not everyone with asthma will experience symptoms. If you feel you’re sensitive to foods with sulfites, keep a food diary and avoid those foods that contain sulfites to see if there is improvement.
3) If you have food allergies, avoid the foods containing your allergen. Accidental exposure to foods to which you have a true IgE-mediated food allergy can trigger an allergic reaction which can have mild to severe symptoms, including asthma symptoms such as coughing, wheezing and shortness of breath.
4) Maintain a healthy weight in general. Obesity and weight gain can worsen asthma symptoms because they put more of a demand on your lungs.
Q. At present we are having work done in our house. The dust is causing my partner to have breathing troubles, but he insists he is fine and will not seek advice or support from our general practitioner. He wheezes badly, but says that Vicks and lozenges will help him. It has been going on for months and I am concerned for his health. What is your advice to him?
If your partner does not have a history of asthma and/or environmental allergies, reactive airway disease could be responsible for the symptoms he is experiencing. Common symptoms of asthma include breathlessness, wheezing, cough, and chest tightness.
If your partner has not experienced similar symptoms in the past, and the timing of his symptoms relates with the work being done on his home, a first step would be to minimize his exposures within the home. This can be accomplished by either not being in the home while work is being done or wearing a respirator or N95 face mask while in the building.
It is also possible that your partner has asthma and his symptoms coincidentally appeared at the time of the renovation, without a direct cause and effect relationship. His allergist may want to conduct a pulmonary function test. If your partner has asthma, his treatment will be based on the severity and frequency of his symptoms.
Treatment for severe, irregular episodes typically involves use of a short-acting inhaled beta agonist. If symptoms persist and/or worsen, his allergist will likely recommend ongoing tailoring of his medications.
Your partner should discuss his symptoms and potential strategies for diagnosing and managing his symptoms with his allergist.
Q. I have been having several breathing problems for about five years now. I get shortness of breath during running. When I am relaxing and experience a sudden change in the environmental temperature, I start coughing, wheezing, and getting chest congestion. Sometimes I get a recurring faint pain in the lower right side of my ribcage. My biggest concern is that at night, around 3-4 am, I usually wake up struggling to breathe. I do not have anybody in my family with asthmatic issues, and I never used to have these problems when I was young. I have visited many doctors and taken many medications, and I have been successfully managing the breathing difficulties with salbutamol inhaler. However, I’m looking for a permanent solution to this, so that I can stop depending on the inhaler.
A. Based on the information you have provided, your symptoms seem to be compatible with asthma that is not completely controlled. Asthma can present at any age.
While salbutamol is of benefit as a “rescue inhaler,” it should not be used on a daily or very frequent basis. Patients with frequent asthma symptoms generally need a “controller inhaler,” which includes an inhaled steroid. Asthma is a very controllable disease, but so far there is no “cure” for asthma.
Allergies can create airway inflammation in allergic patients and make patients more sensitive to other triggers such as cold air and running. However, not everyone with asthma has allergies.
Your allergist can assist to determine if you are allergic to inhalant allergens such as pollen or dust mites.
If a patient has inhaled allergen sensitivities, treatment with allergen immunotherapy (allergy shots) may help to relieve asthma symptoms. Allergen immunotherapy is the closest thing that we have to a cure for asthma.
Q. Can nasal polyps cause asthma? Does removing them help?
A. No, nasal polyps are commonly seen in conjunction with asthma, but they do not cause it. However, they can lead to sinusitis, which can exacerbate asthma. Polyps are often related to allergies, and patients diagnosed with them should consult with an allergist.
Q. One of my neighbors is always outside each fall, blowing leaves off his large backyard patio, which is upwind from our yard where my seven-year-old son plays. My son has recently been diagnosed as having asthma, and I think he may have allergies as well. I do try to bring him inside when this neighbor uses his leaf blower. Is there any evidence that leaf blowers can cause worsening allergy and asthma symptoms?
A. When people are mowing lawns, they stir up a fair amount of mold spores. One would imagine this applies to leaf blowers as well. Also, leaf blowers probably put into the air little fragments of leaves, and other dust which could be irritating, and could aggravate asthma with exposure. Additionally, there are the exhaust fumes from gas-powered blowers. All in all, it's probably a good idea to avoid being in the path of the leaf spray. Such momentary exposures would not likely lead to increased allergies by themselves.