Uncontrolled Asthma: How It Can Develop and What Can Be Done

Learn the signs and symptoms of uncontrolled asthma. Find out how it develops and what can be done to prevent it.

What is Asthma?

Asthma is a medical condition of the respiratory system that results in the blockage and constriction of bronchial airways, leading to inflammation and swelling. This then causes mucus production and clogging of the bronchial tubes which leads to breathing difficulties, triggers coughing, and causes a whistling sound and wheezing. 

Asthma is a chronic condition that can never go away, but it is possible to get temporary treatment and prevent severe attacks. It can range from mild attacks to severe ones requiring emergency treatment. 

It is possible to come up with an action plan and discuss treatment goals with the primary care physician. This would mean sticking to medication schedules, diet, doctor visits, climate monitoring, staying away from environmental triggers, and also keeping oneself in a positive place emotionally. 

As obesity can be a trigger for asthma, it is important to keep body weight in check. It is thought that asthma attacks can have a long-term effect on sleep and contribute to sleep deprivation. This could lead to weight gain, diabetes, depression, and exacerbation of existing asthma symptoms, making it more severe and resistant to medications. 

It is a major non-communicable disease¹ (also known as a chronic disease) and affects both children and adults. The world health organisation (WHO) estimated that asthma affected 262 million people in 2019, and caused 461,000 deaths.² It primarily affects people in low-income countries where it’s often misdiagnosed and treated incorrectly. 

The main types of medications for asthma are bronchodilators and steroids. Bronchodilators, such as salbutamol,³ help in opening airways. Steroids, for example, beclometasone,⁴ assist in reducing inflammation in airways. 

Symptoms of Asthma

Symptoms include many of the following. It is not a one-size-fits-all group of symptoms and is highly variable in different patients. It can range from mild to severe, and can happen during triggers or even while exercising. Some of them are an everyday occurrence :

• Shortness of breath
• Difficulty breathing while lying down
• Heavy coughing and wheezing
• Frequently standing up or sitting to breathe
• Hunched shoulders, strained neck and stomach muscles
• Wheezing while breathing out is predominantly seen in children patients

Some symptoms that indicate an asthma attack is growing severe would include:

• Frequent and bothersome coughing, wheezing and laborious breathing
• An incessant desire to use the inhaler more often

Some symptoms that require immediate emergency care:

• Inhaler use does not reduce symptoms and it worsens with time 
• Asthma symptoms, like inability to breathe and coughing, increase in frequency and are present, even with minimal physical activity

Causes and triggers of asthma:

There are many factors that trigger asthma and they can either be environmental or genetic components that irritate the respiratory system. According to mayoclinic.org:⁵

• Air pollutants like pet dander, pollen, dust mites, smoke particles.
• Daily stress and rigorous physical activity. 
• Cold air, common respiratory infections like the common cold
• Processed foods containing sulfites, preservatives like beer, wine. 
• Gastro esophageal reflux disease. 
• Medications like ibuprofen, non-steroidal anti-inflammatory disease and aspirin. 

Risk factors

There are various factors associated with asthma and these are:

• Gender: people assigned male at birth (AMAB) are more susceptible to developing asthma. people assigned female at birth (AFAB) are more vulnerable after age 40.
• Age: Younger people and children are more susceptible to getting it, while it’s possible to get age-onset asthma after age 40.
• Genetics: It is easier to get asthma if it runs in the family. 
• Obesity: Being overweight and obese is a high-risk factor for getting asthma. 

Uncontrolled Asthma vs. Severe Asthma

Patients with uncontrolled asthma respond to treatments even with comorbidities⁶ (presence of one or more diseases or conditions in a person), and are in a different class to those suffering from severe asthma. Uncontrolled asthma is easier to cure. Severe asthma is usually diagnosed⁷ if proper inhaler techniques are not followed, medications are not taken properly, asthma misdiagnosis, obesity and other comorbid conditions.

How Does Uncontrolled Asthma Develop?

Severe asthma exacerbation and persistent asthma can occur with comorbid conditions like obesity, obstructive sleep disorder, etc. An asthma flare-up can happen with strong emotions or stress. Airway inflammation, causing severe allergic asthma, can occur due to pet dander. One can also get uncontrolled asthma due to changes in weather or in hormones e.g. puberty in people AFAB. 

Asthma medications like systemic corticosteroids and inhaled corticosteroids⁸ can interact with other medications and cause asthma exacerbation. Certain foods can also cause persistent asthma by causing hives, vomiting and diarrhoea. Sometimes asthma could be of another class like eosinophilic asthma,⁹ and asthma medication may be ineffective. Therefore, different types of conditions mean a proper diagnosis is key for treating the disease. Some asthma flare-ups are misdiagnosed for some other conditions like allergic rhinitis.

Possible Long-Term Effects of Uncontrolled Asthma

Airway remodelling, airway inflammation, and severely damaged lung function in an asthma patient will further cause lung damage and airway scarring of tissues in controlled asthma, uncontrolled asthma, severe asthma and chronic asthma conditions. In children, it can cause developmental delays and slowing down of puberty. ¹⁰

The narrowing of airways and scarring of tissue further exacerbates asthma and causes lung infections like pneumonia. It can result in difficulty attending school or work and can require time off. This can also cause sleep deprivation and increase the risk of developing anxiety and depression. ¹¹

Since a multiple set of comorbidities develop with this condition, it’s important to monitor and take control of uncontrolled asthma before it can control you. For example, simple conditions like the common cold must be kept in check so that it does not cause a flare up.

What Happens When Asthma Isn't Controlled

According to health line.org, when asthma is not controlled with asthma medicines, inhaled corticosteroids and/or pharmacological treatments, it can cause sleep deprivation and sleep disturbances. Incessant coughing and inability to breathe can prevent a person from sleeping or having a quality sleep. This can cause further problems like anxiety and depression. ¹²

It also results in other issues, such as the risk of developing diabetes, high blood pressure, and obesity. In children, it can cause growth delays, puberty being later than normal, and create a higher risk of developing learning disabilities. This can result in taking time off from school and maybe even frequent hospital visits. In adults, it causes permanent narrowing of bronchial tubes and increased emergency treatment. Depending on the personal circumstances and country of living, this can bring about financial distress associated with frequent hospital visits and medications. It is not only a chronic disease condition but can also be an expensive one. 

Taking Control of Asthma

Steps to follow while taking care of asthma are:

1. Being aware of triggers and keeping them at bay
   One must always know from their action plan the type of triggers that were associated with previous attacks. Being aware of them also means avoiding them, like keeping oneself informed on pollen attacks and staying away from pet dander and dust mites. 
   
2. Taking medications and sticking to it
   It can be very easy not to be consistent, but it might save the extra trip to the doctor if medication plans are strictly followed. It is not sufficient to use medications only on days of symptoms, but regularly even when asthma symptoms are not there. 
   
3. Knowing how to use the inhaler like an expert
   The inhaler releases quick acting asthma medications like Advair.¹³ Improper use can result in asthma being left untreated and exacerbate symptoms. Omalizumab¹⁴ reduces airway inflammation, but inhalers are the best and cheapest way to get treated for asthma. Perform usage of inhalers in front of the physician and they can advise you on the proper technique. 
   
4. Exercising to improve the immune system and also to strengthen respiratory breathing apparatus
   Breathing exercises to clear congestion like pranayama, stress-relieving exercises like tai-chi, yoga have a positive effect on preventing strong emotions that are triggers for severe asthma. 
   
5. Quitting smoking
   One must also try and reduce secondhand smoke as it is a very common allergen and an environmental trigger for severe asthma and uncontrolled asthma. Smoking can also reduce the effectiveness of medications and interfere with the severity and frequency of attacks making them more intense. 
   
6. Having an asthma action plan
   This would mean sticking with medication plans, doctors’ plans for monitoring environmental triggers like air pollutants, and also with keeping stress at a low level. 
   
7. Maintain good hygiene
   This would mean frequent hand washing, eating healthy immune boosting foods, keeping the surroundings clean, and regularly exercising. One must be regular with flu shots, pneumonia shots, and get enough sleep. Rest and a good diet can be effective in killing viruses. It is also important to keep conditions like cold and flu and other conditions that can exacerbate asthma in check.

Conclusion

Asthma is defined as a chronic condition in which the airways get inflamed and swollen, causing coughing and wheezing and the inability to breathe. This can be caused by environmental pollutants and other triggers. Asthma attacks can be managed with pharmacological interventions, frequent clinician visits, and hospital visits when required. It is also treatable (but not curable) with medications like corticosteroids and quick-relief medications.