Asthma Risk Factors

Introduction

Asthma is characterised as the swelling of the airways, usually caused by allergens or other irritants, that ultimately leads to narrowing and difficulty breathing. Symptoms of this type of asthmatic inflammation include wheezing, coughing, chest tightness, and breathlessness. There are two main categories of asthmatic reactions, atopic and non-atopic asthmatics. 

Atopic asthma is caused by allergies that result in cellular inflammation. These allergies vary widely from patient to patient but often include dust, pollen, mould, pet hair, or other aeroallergens. The second type of asthmatic condition is non-atopic asthma and includes any type of asthmatic reaction not caused by allergies. Although this form of asthma is a bit more mysterious, it is most commonly experienced in adulthood, and more frequently by women than men

Treatment options for either form of asthma differ significantly according to context, severity, and triggers. That being said, the following factors could increase your risk of developing or exacerbating asthma symptoms, and understanding their part to play is a great first step in proactively managing the condition. 

Nutrition

Nutrition is a key part of general wellbeing and can be utilised to reduce the inflammatory response responsible for asthma symptoms. First, eating to reduce weight in the case of obesity may help to improve specifically non-atopic (non-allergenic) asthmatic symptoms. Although the mechanism is unclear, studies have shown that being overweight is linked to chronic asthma symptoms. It is proposed that obesity increases a general state of low-level inflammation within the body, and therefore can trigger the symptoms of asthma associated with airway constriction, including wheezing, coughing, and difficulty breathing. Reducing caloric intake and exercising more frequently is a great first step towards losing weight and improving asthmatic complications. Here is a resource for getting started. 

Secondly, eating fruits and vegetables full of antioxidants will likely reduce inflammation. Although these foods will not impact acute inflammation caused by allergic asthma triggers, like peanuts, shellfish, or other ingestible allergens, they may reduce general inflammation associated with chronic asthma conditions or infection. 

Third, consuming vitamin D has been shown to improve asthma-associated issues. Vitamin D has been linked to a decreased incidence of asthma attacks and exacerbated symptoms. Furthermore, the supplement is also known to boost lung function and help the body fight off viral infections that might otherwise trigger breathing problems. Finally, reducing sulphite intake may also help improve asthma symptoms. Often found in wine, beer, shrimp, and dried fruits, sulphites cause wheezing and other asthma-like experiences in some people. Understanding your triggers and taking precautions is the best way to avoid asthma-inducing products. 

Infection

One of the most important causes and triggers of both atopic and non-atopic asthma is a viral infection. Respiratory infections can cause inflammation that triggerss asthma-like symptoms, and even lead to chronic bronchitis. Chronic bronchitis occurs when the bronchi of the lung are persistently inflamed, and the condition may lead to a prolonged cough or difficulty breathing. Many adults who have never experienced asthma in childhood develop the condition after suffering a long term infection. Furthermore, respiratory infections can cause permanent lung damage and in turn chronic asthma. The best way to avoid infection is to wash your hands regularly, get all recommended vaccines, and follow a diet rich in vitamins - outlined above. 

Physical Activity

For many asthma patients, especially non-atopic diagnoses, vigorous exercise can induce asthma symptoms. This response occurs because breathing often becomes more rapid during physical activity, forcing cold air in and out of the lungs quickly, therefore irritating airways. 

The best way to avoid triggering symptoms through exercise is to know your limits. Build your body up towards more vigorous activities, or try yoga, pilates, or other less intense forms of body movement

It is better to discuss options with your GP; as it may be possible that a reliever inhaler, used during the acute onset of asthmatic symptoms, could improve exercise-induced asthma. 

Although physical activity can exacerbate asthmatic conditions in some patients, the opposite also holds true. A lack of physical activity leading to obesity can also cause chronic asthma

As discussed earlier, being overweight can encourage the cellular inflammatory response that causes airway irritation and breathing difficulties. Although intensely vigorous exercise may further trigger asthma symptoms, getting the body moving  in order to reduce body weight could vastly improve the condition. 

Trying some of the tips listed above, including practisingpracticing breathwork-oriented activities and building up slowly, can help improve obesity-related asthma. 

Smoking

Smoking can cause asthma in both smokers and inhalers of secondhand smoke. For smokers, the chemicals in cigarettes irritate airways and produce symptoms much like those experienced during an asthma attack. Furthermore, smoking can lead to medication insensitivity, meaning that the treatments used to control asthmatic symptoms are often ineffective among smokers. 

Children who live in a home with a parent who smokes are far more likely to develop asthma than their peers. Surprisingly, these same children can go on to develop non-atopic asthma as adults, even if they were disease-free in childhood. Finally, death as a result of asthmatic complications is far higher in smokers than in the general group of asthma patients, likely due to medication insensitivity or reduced lung function. 

Apart from asthma, smoking can also lead to other respiratory diseases such as chronic obstructive pulmonary disease (COPD), lung cancer, and others. Of course, smoking is addictive and not an easy thing to stop. Here is a resource for getting started and staying motivated. 

Alcohol

Various alcohols contain histamines and sulphites, both of which can serve as asthmatic triggers for some patients. Reactions to alcohol can vary widely, where some may find other asthma triggers that are exacerbated by alcohol consumption, others may actually have reactions to drinking alone. That being said, the drinks that are most likely to induce asthmatic symptoms are wine, beer, and ciders. These types of alcohol contain more histamines and sulphites than spirits as a consequence of the natural brewing process. The best way to reduce alcohol consumption-related reactions is to avoid drinking altogether, or stick to the products you know would not cause issues. Purchasing low-sulphite wine is also an option, and keeping a reliever inhaler nearby in the case of an unexpected acute attack is important. 

Hydration

Hydration is important for general wellbeing and keeping your body functioning normally. Furthermore, histamines are produced by the body more often when dehydrated, causing inflammation and potentially asthmatic symptoms.

 Histamines in the blood can increase sensitivity to allergens, therefore staying hydrated is especially important for atopic asthma patients. Try downloading a hydration tracker app, or keeping multiple water bottles in spaces you use frequently: by the bed, on your desk, etc. 

Sleep

Sleep is a key component of the body’s ability to function, and regular sleep cycles can be seriously disturbed by asthma symptoms. Nocturnal asthma is a form of asthma whereby symptoms are most persistent during the night. Sufferers of nocturnal asthma may lose sleep due to breathing difficulties that limit the overall quality of life. This type of asthma problem is especially serious among non-allergic or non-atopic asthmatics who find that anxiety triggers their symptoms. Lack of sleep can exacerbate stress, creating a feedback loop where the symptoms causing sleep loss become even more severe. Reducing stress-inducing activities can help improve asthmatic issues and increase sleep quality. Try physically scheduling time for yourself into your day, or practising breathing exercises typical of yoga or tai-chi. Here is another great resource for those who experience anxiety-induced asthma. 

Weight/BMI

As previously discussed, obesity is a serious risk factor for developing asthma, although the reason is unclear as to why. It is hypothesised that obesity causes low-grade inflammation throughout the body, which can become exacerbated by other non-atopic triggers such as exercise, stress, and infection. 

Losing weight may improve feelings of breathlessness, and encourage you to do the things you enjoy. Furthermore, you have the potential to reduce other health problems associated with obesity including cardiovascular disease, diabetes risk, and others. Here is another great resource for beginning the process of losing weight, and staying motivated.

Gender

Gender-related asthma risk depends on the type and cause of symptoms. In the case of allergic asthma, onset usually occurs in childhood and is most common among boys. Contrastingly, non-allergic asthma typically begins in adulthood and is more frequent among women. Because asthma is a complex chronic condition, explaining gender differences is rather difficult. Furthermore, the gender-related risk is not something you can change. However, female smokers are 70% more likely to develop asthma than non-smokers. The point being, understanding how gender can impact your likelihood of partaking in other risk factors may help prevent the development of asthma. 

Conclusion

In conclusion, there are various risk factors that can increase your risk of developing asthma. First, proper nutrition can reduce inflammation that leads to symptoms as well as helps you avoid ingestible triggers. Second, an infection can inhibit lung function, as well as exacerbate the inflammatory response that causes breathing difficulties for many asthmatics. Third, physical activity may trigger asthma symptoms and knowing your personal limits is important. Fourth, smoking can increase your risk of developing all sorts of lung disease complications, as well as impact the children of smokers through second-hand smoke. Fifth, alcohol serves as a trigger for many and its consumption should be avoided or monitored. Sixth, hydration is important for reducing inflammation and improving general health. Seventh, obesity is a key risk factor for low-grade inflammation and may cause chronic asthma. Eighth, gender influence on asthma differs across age and onset, but understanding other factors that can compound gender-related risk may reduce its impact. 

All of these factors are perfectly manageable so long as you know how to deal with them. Speaking with your GP about what treatment options work best for you and sticking to a plan is the best way to keep your asthma under control. 

References

  1. https://www.nhs.uk/conditions/asthma/
  2. https://www.sciencedirect.com/topics/medicine-and-dentistry/atopic-asthma
  3. https://www.medicalnewstoday.com/articles/325536
  4. https://www.medicalnewstoday.com/articles/325536#intrinsic-vs-extrinsic
  5. https://www.mayoclinic.org/diseases-conditions/asthma/expert-answers/asthma-diet/faq-20058105
  6. https://www.lung.org/blog/the-link-between-asthma-weight
  7. https://www.nhs.uk/live-well/healthy-weight/start-the-nhs-weight-loss-plan/
  8. https://uk.cochrane.org/news/high-quality-evidence-suggests-vitamin-d-can-reduce-asthma-attacks
  9. https://my.clevelandclinic.org/health/articles/11323-sulfite-sensitivity
  10. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/asthma-symptoms-causes-risk-factors/asthma-risk-factors
  11. https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-bronchitis
  12. https://www.gohealthuc.com/library/respiratory-infection-symptoms
  13. https://floridachest.com/pulmonary-blog/extrinsic-vs-intrinsic-asthma-the-main-differences
  14. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/asthma-and-exercise
  15. https://erj.ersjournals.com/content/41/3/716
  16. https://www.nhs.uk/live-well/quit-smoking/10-self-help-tips-to-stop-smoking/
  17. https://www.asthma.org.uk/advice/triggers/alcohol/
  18. https://asthma.net/living/ask-the-experts-is-there-a-connection-between-dehydration
  19. https://www.webmd.com/asthma/guide/nocturnal-asthma-nighttime-asthma
  20. https://www.asthma.org.uk/advice/manage-your-asthma/emotional-support/anxiety/
  21. https://www.asthma.org.uk/advice/living-with-asthma/weight-loss/
  22. https://pubmed.ncbi.nlm.nih.gov/18156099/

Kristen Bowles

Masters of Science - MSc Epidemiology Student, London School of Hygiene and Tropical Medicine, England
Kristen graduated as Summa Cum Laude and is now pursuing Masters of Epidemiology in LSHTM.
Experienced in cultural anthropology from the University of St. Andrews, and hopes to continue working in Europe with a special focus on medical mistrust and how these social factors influence health data, equity, and disease spread.

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