Worsening asthma: Asthma symptoms getting worse | Asthma + Lung UK
6 Signs Your Asthma Is Worsening
Over time, asthma often progresses. Knowing the signs of worsening asthma is the first step to getting your condition under control.
By Elizabeth Shimer BowersMedically Reviewed by Lindsey Marcellin, MD, MPH
Reviewed:
Medically Reviewed
If you have asthma, you know an attack can come on suddenly, literally taking your breath away. But asthma, a chronic lung disease that inflames and narrows the airways, can also gradually exacerbate over time — even if you’re avoiding triggers, following your treatment plan, and doing everything you’re supposed to do.
“A number of factors can worsen asthma, including prolonged exposure to dust, pollen, mold, pollution, and other irritants in the air,” says Sharon R. Rosenberg, MD, co-director of the asthma and COPD program at Northwestern University’s Feinberg School of Medicine in Chicago.
But for some people, asthma gradually worsens without any exposure to triggers.
Symptoms get worse as inflammation builds over time, explains Guha Krishnaswamy, MD, director of allergy and clinical immunology at Wake Forest Baptist. “The mucus membranes become more swollen, smooth muscle becomes a little twitchier, and the airways produce thick mucus,” he says. These changes lead to worsening asthma symptoms.
Anyone who has asthma needs to be on the lookout for signs that the condition is getting worse. The reason is simple: Uncontrolled asthma can be a severe, life-threatening disease.
Signs of Worsening Asthma
Here are six signs your asthma may be getting worse:
1. Increased difficulty breathing.
“You may notice more shortness of breath during normal activities,” Dr. Krishnaswamy says. For example, if you used to be able to carry a grocery bag from your car to your kitchen with ease and now you are huffing and puffing, that could be a sign of worsening asthma.
2. A drop in peak flow meter readings.
“For people with asthma, a peak flow meter is like a blood pressure cuff for people with high blood pressure — it gives you an objective measurement of your condition,” Krishnaswamy says. Chronically lower peak flow meter readings can indicate that your asthma is getting worse.
3. Exercise limitations.
If you’re lacking the motivation you used to have for working out, or you’re experiencing decreased stamina or trouble breathing during exercise, your asthma may be getting worse.
4. Using a quick-relief inhaler more often.
“I saw this happen with my own mother,” Krishnaswamy says. “She was breathless and needing to use her rescue inhaler more and more frequently.” If you need to use quick-relief medicine more than twice a week, your asthma isn’t under control, according to the National Heart, Lung, and Blood Institute.
5. Waking up at night with coughing or wheezing.
“Attacks at nighttime that wake you up at 2 in the morning with coughing and wheezing and reaching for your rescue inhaler are a sign your asthma is poorly controlled or getting worse,” Krishnaswamy says.
6. Having to disrupt your normal routine because of asthma.
During times of high stress, you might experience a flare that causes you to miss school or work. “Maybe you’re having a stressful morning — your child is sick — and your asthma worsens, then it quickly reverses once the stress has passed,” Krishnaswamy says. But if your asthma symptoms are keeping you home from work or school on a regular basis, the condition is likely getting worse.
What to Do If Your Asthma Is Getting Worse
If you experience any of these symptoms of worsening asthma, call your doctor so he or she can make changes to your asthma management plan. “Your physician will make sure you are on an appropriate asthma management regimen and give you the right rescue medications to use when your symptoms get worse,” Dr. Rosenberg says. He or she may also change your medication types, dosages, or frequencies, as needed.
In addition, everyone with asthma should have an action plan for controlling flares and exacerbations, she says.
The Centers for Disease Control and Prevention offers sample asthma action plans online.
Remember, if you have chronic asthma, it’s important to stick to your treatment regimen, no matter how good you feel. “Too often, people will ease up on their controller medications and use their rescue inhaler instead,” Krishnaswamy says. “But if you have persistent asthma, you need persistent therapy.”
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8 Signs Your Asthma Is Getting Worse
If you’re experiencing asthma symptoms regularly or your symptoms are getting worse despite treatment, you may need a more effective treatment method.
Severe asthma is often harder to control than mild to moderate asthma. It may require higher dosages and more frequent use of asthma medications. If you’re not managing it properly, severe asthma can be dangerous and even life threatening in some cases.
It’s important that you’re able to recognize when your condition isn’t properly managed. Doing so can help you take steps to find a more effective method of treatment.
Here are eight signs that your severe asthma is getting worse and what to do next.
If you’ve been having to use your quick-relief inhaler more often than usual, or you’ve started to feel like it doesn’t help as much when you do use it, your severe asthma may be getting worse.
It can be hard sometimes to keep track of exactly how many times you use your inhaler during a given week. If you suspect your usage is increasing, you may want to start keeping track in a journal or in a note-taking app on your phone.
Keeping a log of your inhaler usage can also help to identify what may be triggering your severe asthma symptoms.
For example, if you mainly use your inhaler after being outdoors, an environmental trigger like pollen may be causing your asthma to flare up.
Another sign that your severe asthma may be getting worse is if you’re coughing or wheezing more often than usual.
Talk with your doctor about adjusting your treatment plan if you constantly feel like you’re about to cough. Also speak with them if you find yourself wheezing with a whistle-like sound more than once a day.
If you’re ever jolted awake in the middle of the night by a fit of coughing or wheezing, you may need to modify your asthma management plan.
Properly managed asthma shouldn’t wake you up from sleep more than 1 or 2 nights a month. If you’re losing sleep due to your symptoms more than this, it may be time to discuss treatment modifications with your doctor.
Your peak flow readings measure how well your lungs are functioning at their best. This is usually tested at home with a handheld device called a peak flow meter.
If you’re a peak flow meter user, and your peak flow levels drop below 80 percent of your personal best, it may be a sign that your severe asthma is poorly managed.
Another sign that your asthma is getting worse is if your peak flow reading varies greatly from day to day. If you notice low or inconsistent numbers, contact your doctor as soon as possible.
Another sign that your asthma is getting worse is if you start to feel out of breath even when you’re not doing anything strenuous.
It’s normal to feel winded after exercising or climbing more stairs than you’re used to. But stationary activities like standing, sitting, or lying down shouldn’t cause you to lose your breath.
Minor chest tightness is common for people with asthma. But frequent and intense chest tightness can mean your severe asthma is getting worse.
Chest tightness is often the result of the muscles surrounding your airways contracting in reaction to asthma triggers. It may feel as though there’s something squeezing or sitting on top of your chest.
If you experience unusually intense chest tightness, particularly while sitting still, speak with your doctor.
If you find it difficult to speak a full sentence without pausing to take a breath, you should make an appointment with your doctor. Trouble speaking is usually the result of an inability to take enough air into your lungs to allow you to let it out at the slow, deliberate rate required for speech.
You may notice that you’re unable to keep up with any type of physical activity if your severe asthma symptoms are getting worse.
Talk with your doctor if you find yourself coughing or using your inhaler more often at the gym or during activities like jogging or playing sports.
If your chest tightens more often during everyday physical activities like climbing the stairs or walking around the block, you may need to change your medications to get your symptoms under control.
Am I having an asthma attack?
The signs of worsening asthma can be uncomfortable but should still be easy enough to manage until you’re able to see a doctor.
If you experience a more sudden and severe onset of symptoms that deviate from your normal symptoms, you may be having an asthma attack or exacerbation. This can include extreme difficulty breathing, wheezing, chest tightness, cough, and shortness of breath, among other symptoms.
If you or someone around you experiences symptoms of an asthma emergency, call 911 or your local emergency number, or go to the nearest emergency department.
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If you think that your severe asthma is getting worse, the first thing you should do is make an appointment to see your doctor. Before your appointment, write down a list of the symptoms you’ve been experiencing and bring it with you to review together.
Your doctor will likely listen to your chest and check your peak flow levels to see how they compare with your previous readings. They may also ask you about your routine for taking your asthma medication. Plus, they may check to make sure you’re using the proper technique with your inhaler.
If you’ve been using your inhaler properly and still experience severe symptoms, your doctor may change your treatment plan. They may increase the dose of your inhaler or prescribe an add-on treatment like a leukotriene receptor antagonist (LTRA) tablet or biologic therapy.
In some cases, your doctor may also prescribe a short “rescue” course of oral steroid tablets. These can reduce the amount of inflammation in your airways.
If your doctor does change the dosage of your current medication or prescribe an add-on treatment, consider scheduling a follow-up appointment in 4 to 8 weeks to ensure that your new treatment plan is working.
It’s important to be able to spot the warning signs that your severe asthma is getting worse. This is a vital part of managing your symptoms and may help to prevent a potentially life-threatening asthma attack.
Do your best to avoid your asthma triggers, and don’t be afraid to contact your doctor if you think your current treatment isn’t working as well as it should be.
Bronchial asthma: how to avoid exacerbation
Bronchial asthma (BA) is one of the most common diseases affecting millions of people. It is manifested by wheezing, shortness of breath, a feeling of congestion in the chest, cough. These symptoms – asthma attacks – require immediate attention. As such help, many patients use short-acting bronchodilators in the form of inhalations, which, indeed, quickly eliminate attacks and alleviate symptoms, but do not cure the disease itself and even mask the worsening of its course.
Patients generally find that the 1 emergency inhaler helps control their asthma, so they often do not see the need for additional treatment. However, the opposite happens: the number of symptoms and attacks increases, which means that bronchial asthma is not controlled 2 and an exacerbation can develop – a condition when emergency inhalers and other conventional therapy no longer help to alleviate the patient’s condition.
The severity of symptoms and the frequency of attacks is rapidly increasing, and the patient is forced to urgently consult a doctor, call an ambulance, and sometimes go to the hospital. Severe exacerbations can result in the death of the patient, even with enhanced therapy.
Thus, the use of an emergency inhaler more than twice a week is an alarm signal and a reason to evaluate your dependence on it in order to consult a doctor in a timely manner to select the appropriate modern therapy that will reduce the risk of severe exacerbations and death from bronchial asthma.
Why is emergency inhaler not enough anymore?
Previously, it was believed that the mechanism of development of bronchial asthma is based on bronchospasm, therefore, for 50 years, emergency short-acting inhalers were the basis of therapy. They quickly alleviate the symptoms, however, without having an anti-inflammatory effect, they do not affect the main cause of the development and progression of AD – chronic inflammation.
Now experts have concluded that monotherapy with short-acting emergency inhalers is dangerous 1 for patients with bronchial asthma: the use of more than three short-acting emergency inhalers per year increases the risk of asthma exacerbations 3 , more than twelve is associated with an increased risk of death from this disease 3 .
Asthma care: a new approach
Since 2007, the Global Initiative on Asthma (GINA) has been actively seeking new ways to treat asthma in order to reduce the risk of asthma-related exacerbations and death.
Currently, the medical community has radically revised the principles of bronchial asthma treatment: modern therapy should not only eliminate symptoms, but also reduce the risk of exacerbations in the future . Now, for the basic therapy of patients with any severity of bronchial asthma, international and Russian clinical guidelines recommend prescribing anti-inflammatory drugs, primarily inhaled glucocorticosteroids (IGCS), using them as monotherapy or in combination with fast-acting bronchodilators of long or short action.
For the relief of symptoms, it is primarily recommended to use fast-acting bronchodilators in combination with ICS (anti-inflammatory bronchodilators).
The current treatment of choice for asthma of any severity is an on-demand anti-inflammatory bronchodilator, with or without supportive care (depending on physician prescription). Exact adherence to all doctor’s recommendations reduces the risk of asthma exacerbations 4.
Check if you are dependent on emergency inhaler
Sources :
1. Global Initiative for Asthma. GINA 2020. [Electronic resource], 08/21/2020. URL: https://ginasthma.org.
2. Schatz M et al. J Allergy Clinic Immunol. 2006;117:995-1000.
3. Stanford RH et al. Ann Allergy Asthma Immunol. 2012;109:403-407.
4. Beasley R et al. N Engl J Med. 2019 May 23;380(21):2020-2030
5. Partridge MR et al. BMC Pulm Med. 2006;6:13.
6. Chuchalin A.
G. et al. International Journal of COPD, 2014:9963–974
7. Federal clinical guidelines for the diagnosis and treatment of bronchial asthma. 2019. Russian Respiratory Society. [Electronic resource], 08/21/2020. URL: http://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/
8. Arkhipov V.V. et al. Pulmonology. 2011;(6):87-93.
Exacerbation of bronchial asthma
Asthma exacerbations are episodes of progressive deterioration characterized by cough, wheezing, feeling of heaviness in the chest, difficult breathing, weakness, tachycardia.
The causes of exacerbations are usually the ineffectiveness of the basic treatment or the impact of adverse factors. For any form of asthma other than very mild intermittent, inhaled glucocorticoids should be taken continuously daily until remission is achieved.
The dose of anti-inflammatory drugs should be selected by a doctor depending on the severity of asthma, the goal of treatment is to achieve a stable remission with minimal asthma symptoms and a qualitatively full life of the patient.
If asthma treatment is chosen incorrectly, the doses of basic anti-inflammatory drugs are insufficient, or the patient inaccurately follows the doctor’s recommendations, independently reducing the doses of drugs or using the inhaler incorrectly, then stable remission will not be achieved, there is a threat of frequent exacerbations.
The following factors can provoke a worsening of asthma:
- exposure to an allergen,
- infection: viral or bacterial;
- taking certain medications:
- inhalation of chemicals that irritate the respiratory tract;
- physical activity;
- meteorological factors,
- nervous stress.
Deterioration usually worsens over hours or days. Patients should know how to recognize an incipient exacerbation in order to consult a doctor in time and begin treatment. Symptoms of early exacerbation are: deterioration in sleep, irritability, decreased tolerance to physical exertion, the appearance of a cough, a feeling of heaviness in the chest.
An important symptom of an incipient exacerbation is the appearance or increase in nocturnal asthma attacks, which indicates an increase in inflammatory changes in the bronchi. An important sign of deterioration is also an increase in the dose of inhaled bronchodilators. In some patients whose exacerbation is caused by the addition of an infection, signs of exacerbation may be an increase in the amount of sputum and a change in its color to yellow.
If the patient has a peak flowmeter and he regularly measures his indicator of bronchial patency – the peak exit rate, then it is possible to record a decrease in PEF below his individual norm, indicating the onset of an exacerbation of the disease. Here you can remind patients about the “zone system” and adequate correction of treatment.
“Yellow zone” means that an exacerbation may occur and you need to see a doctor to correct the treatment. The “red zone” indicates a more serious condition, this is an alarm signal. Frequent hitting the “yellow zone”, or getting into the “red zone” indicates the ineffectiveness of treatment in the “green zone”.
After the exacerbation is eliminated, it is necessary
review the plan for basic drug treatment, as well as environmental control measures. Treatment of an exacerbation should be started as early as possible, under the supervision of a physician, and with regular examination of bronchial patency.
It is necessary to start treatment with an increase in the dose of the basic drug with preliminary inhalation of sympathetics. With insufficient effectiveness of such treatment, the doctor decides on the appointment of theophylline drugs.
If there is no improvement, the doctor prescribes tableted glucocorticoids or refers the patient to a hospital. If the patient has a severe course of asthma, and he constantly takes tableted glucocorticoids, then during the period of exacerbation their dose should be increased.
Causes of attacks in patients with asthma are not completely clear, these are activation of the inflammatory process at night, accumulation of sputum in the distal bronchi, increased tone of the vagus nerve at night, and contact with an allergen.
The most common allergen – house dust – contains the remains of insects, bacteria, fungi, food remains, human and animal dander, as well as an important component – the house mite, which is the main allergen. Carpets, upholstered furniture, woolen things, pillow feathers contain a large number of mites. Studies have shown that adults and children with mild asthma improve after contact with house dust children is stopped.
The following rules should be followed to reduce the allergic reaction of an asthma patient:
- pack mattresses and pillows in allergen-impervious materials.
- bedding should be washed weekly at 55°C;
- During the day, the bed should be covered with a bedspread so that dust does not accumulate on the bed.
- do not sleep on upholstered furniture;
- carpets must be removed from walls and floors;
- reduce the humidity in the room to less than 50%;
- the bedroom should have a minimum of furniture and no bookshelves
- Curtains should be of lightweight material and washed frequently;
- Clothes must be put away in the closet with the closet doors closed tightly.
- it is necessary to carry out frequent wet cleaning in the bedroom, incl. and under the bed
- dust should be washed with a damp soft cloth that collects but does not disperse dust in the air;
- do not store children’s toys in the bedroom;
- Pets are not allowed in the bedroom.
For the prevention of nocturnal attacks, it is recommended to inhale an inhaled glucocoticoid at bedtime, if necessary in combination with a sympathomimetic.
Patients who have a large amount of sputum are recommended to inhale a bronchodilator before going to bed, then after 15-20 minutes, an expectorant solution should be inhaled using an ultrasonic home inhaler. It can be physiological saline, alkaline mineral water, 2% soda solution, etc. After that, take a drainage position and cough.
A patient with asthma who suffers from nocturnal attacks of suffocation should have a thermos filled with hot water or an infusion of expectorant herbs on the bedside table.