Even if you live thousands of miles away from a wildfire this summer, there’s a good chance wildfire smoke will impact, or has already impacted, your air quality.
Air quality plays a role in everyone’s lung health, but it’s especially important for people with asthma to pay attention.
We spoke with Nora Barrett, M.D., associate professor of medicine at Harvard Medical School, about how women can recognize the signs of uncontrolled asthma and regain control of their condition.
What are signs that asthma is well controlled?
When you have two or fewer symptoms in a week, that’s considered well controlled. If you’re getting three or more symptoms in a week, that’s a sign your medication isn’t working well. It might be time to change your inhaler or increase your dose.
What symptoms indicate that asthma is uncontrolled?
Symptoms are chest tightness, coughing, wheezing, shortness of breath and trouble breathing. Another sign your asthma is uncontrolled is when you wake up with asthma symptoms around 3 or 4 a.m. That’s the time when the natural steroids your body makes are at their lowest. It’s a sign that you’re just on the edge of control, and it’s a predictor of worse problems to come, like a flare-up.
Are there warning signs that a flare-up or asthma episode may be about to happen?
We’ve found that only 1 in 5 asthma patients notice their symptoms before they get really bad. Even if you aren’t noticing specific symptoms, there are situations where you can be on alert. If you know your asthma is triggered by a specific allergen or a respiratory virus, start to tune in to your body. Some people are triggered by chemical irritants, like hair spray or chlorine from the pool. We see a lot of runners in February getting flare-ups due to the cold, dry air. When you know your triggers are present, start to be aware of symptoms and how often they’re happening. Air quality is a big deal this summer. When the AQI, or air quality index, is greater than 50, people with asthma are at risk.
How is asthma typically treated?
These days, asthma is managed differently from how we did it in the decades prior. Many patients can achieve asthma control with two medications used together. The first is an inhaled steroid, which you take daily while symptoms are present. The second is a beta agonist, which is usually called a rescue inhaler and contains long-acting albuterol. If an asthma flare-up can’t be controlled with these, you’ll want to see a specialist, like an allergist or a pulmonologist.
If oral corticosteroids (inhalers) provide relief, is there a downside to using them?
Yes. Oral steroids are only a short-term treatment and should only be used during a flare-up. The list of possible side effects is enormous. Steroids can cause hypertension, diabetes, osteoporosis and more. They can even reduce the body’s natural steroid production.
Is there a difference between uncontrolled and severe asthma?
Yes. Uncontrolled asthma is when you’re using inhalers and still having symptoms. That’s when you’re referred to a specialist. We determine how severe your asthma is by its impact on your lungs. We measure lung function with spirometry, which is a test that measures the amount of air you can blow out in one second. The higher the number, the better the lung function.
What treatment options are available for moderate to severe asthma that is uncontrolled?
We now have biologics available. One type of biologic, which is reserved for more severe asthma, goes after allergy antibodies and takes effect after six months. Other biologics block proteins called IL-13 and IL-4. These biologics have shown improvement in day-to-day lung function and can reduce flare-ups by up to 81%, for severe symptoms. Another group of medications, called IL-5 inhibitors, stops IL-5 production. IL-5 is a protein that causes the growth of allergy blood cells that are responsible for the chronic inflammation we see in the lungs of patients with asthma. Drugs that slow down the IL-5 receptor are very effective in patients who have high levels of these cells. Overall, they can reduce flare-ups by 50% but don’t impact day-to-day lung function.
If your asthma is poorly controlled by inhalers, your specialist may be able to recommend a biologic.
Biologics are medicines that are made up of living cells or organisms and used to safely treat many chronic conditions.
Why does asthma become uncontrolled even when taking medication?
Asthma is inflammation caused by the immune system and can become uncontrolled by a variety of factors, usually involving exposure to an allergen or something that triggers a big immune response. Asthma medications manage symptoms and reduce inflammation, but they don't stop the underlying immune response that creates asthma.
Are there long-term effects of uncontrolled asthma?
If asthma is poorly controlled, you can lose lung function over time. Lung function impacts everything from playing sports to just walking across the room or being able to take a deep breath. Limited lung function also causes strain on your other organs.
If your asthma is uncontrolled, you’ll want to see a specialist.
This educational resource was created with support from GSK, Sanofi and Regeneron.
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