Why Is My Asthma Getting Worse?

Overview

A multitude of conditions are being exacerbated due to environmental damage, including asthma which is characterised by inflammation in the airways of the lungs. 

About Asthma

Asthma accounts for a high prevalence of 5.4 million people in the UK and is considered to be a habitual lung condition whereby the airways (bronchi) in the lungs that transport air are damaged.¹ This damage restricts oxygen uptake and, as a result, provokes shortness of breath and wheezing. The condition is considered to be epigenetic, as it can arise from both inherited and environmental factors. Both adults and children can be affected by this chronic condition. 

Signs of worsening asthma

It is important to understand the potential signs of asthma. Symptoms should be constantly monitored and measured at home using a peak flow monitor or a spirometer. The signs of asthma exacerbation are as follows:²

• An increase in shortness of breath
• Tightening of the chest
• A decrease in stamina, even while performing light physical activity
• Coughing or wheezing which alters the sleep patterns
• Breathing discomfort for which you need to use an inhaler more than twice a week
• Interference with a daily routine

Why have my asthma symptoms got worse?

The worsening of your asthma could be due to an increase in triggering factors, notably allergies, cold air and cigarette smoking. When asthma worsens, it is called an asthma flare-up, and this can occur even if you regularly manage your symptoms. One study concluded that stress exacerbates asthma and needs to be managed through journaling, meditation, or yoga.³ It is hard to manage stress in our daily lives, but there are multiple resources, such as ‘Headspace’, a meditation app, that can help with reducing stress levels for short periods during the day. 

Environmental factors that include an increase in pollution levels and humidity can also be considered as factors which negatively affect your asthma. In the UK, the number of higher air pollution days tripled from 9 days per year in 2017 to 25 days per year in 2018 and is still rising sharply. ⁴  As pollution levels reach unprecedented heights, it is advisable to observe whether or not this triggers your asthma.

What should I do if my asthma is getting worse?

If your asthma is worsening, the foremost step is to contact your GP or call 111 in order to prevent the occurrence of an asthma attack. According to the San Francisco Health Plan, asthma sufferers should continuously record their symptoms using a diary chart and create an Asthma Action Plan.⁵ With your GP’s assistance, an action plan would consist of a green zone whereby you are reminded to take medication daily, a yellow zone whereby you become aware of when to use your rescue medication, and finally, a red zone at which point you are recommended to visit the A&E.⁵

Treatment options

Asthma symptoms can be managed through the following array of treatments:

Inhalers 

A preventer inhaler contains a low dose of steroids and helps to lower the inflammation within the lungs. This type of inhaler should be used when symptoms occur between two to three times a week, keeping you awake at night due to symptoms or when you’ve had an asthma attack within the last two years.⁶

Reliever inhalers work to relieve typical asthma symptoms of coughing and breathlessness. It is recommended that this inhaler is only used when symptoms arise or when you are suffering from an asthma attack.⁶  Using this type of inhaler multiple times a week is a warning sign that your asthma is worsening, and your treatment plan should be reviewed by an authorized medical specialist. In a study conducted in 2019, 90% of participants revealed their preference for using both a reliever inhaler and a preventer inhaler as part of their weekly treatment plan.⁷ 

Long-acting Bronchodilators

Bronchodilators are drugs administered through an inhaler in order to maximize the amount of the drug reaching the airways in a rapid response.⁸  This type of medication is used to relieve symptoms in the short term. A GP may typically prescribe a combination inhaler that contains both the long-acting bronchodilator as well as the preventer medication. 

Montelukast 

Montelukast is a prevention tablet that does not contain steroids and, therefore, needs to be taken alongside a regular preventer inhaler. Typically, this medication is prescribed if you continue to develop symptoms despite using an inhaler regularly. Three types of this tablet exist: tablets to be swallowed with water, chewable tablets and granules to be placed in food.⁹

Steroid tablets

Oral steroids are most commonly prescribed to relieve symptoms short-term or after an asthma attack. This type of steroid is commonly taken alongside inhalers. If you frequently use this type of medication, you should be consulting with a respiratory specialist.  A steroid care card will be handed to you in order to let healthcare professionals know your course of treatment and how to manage further complications.

How can I prevent the worsening of asthma?

There are a few steps that can be taken to prevent the aggravation of asthma. The National Heart, Lung, and Blood Institute suggests keeping pets out of the house if that is a trigger of your asthma, removing dust, and mould, avoiding strenuous physical activity, avoiding tobacco smoking, and staying indoors if the air quality outside is poor.¹⁰ Certain lifestyle changes can also be implemented in your day-to-day life, notably managing stress, eating a balanced diet, maintaining a healthy weight, and, regularly engaging in physical activity. By knowing the triggers of your asthma, you can discuss with your healthcare provider what steps you should take to reduce exposure to your asthma triggers. 

When to seek medical care

If you notice that your symptoms are worsening, then you should seek out medical care in order to formulate a new treatment plan that will work for you. Another occasion when you should seek medical care is if you feel the need to use your reliever inhaler multiple times a week. Medical care should be sought out even if you find that your mental health is being affected due to the strain of asthma. It is important to be in frequent contact with your healthcare provider and to track both your symptoms and triggers as well as your medication intake.

Summary

Asthma is a chronic lung condition that causes the airways of the lungs to be inflamed and thus restricts the amount of airflow within the lungs. The worsening of this condition can be caused by climate change or an increase in exposure to your triggers. Treatment options for this condition include the use of inhalers to both prevent and relieve symptoms. Supplemental treatment options include bronchodilators which are administered through inhalers, preventer tablets (montelukast) and steroid tablets. In terms of reducing the worsening of this condition, it is vital to identify your triggers and come up with an Action Plan. Medical care should be sought out if there is a worsening of your symptoms or an increased need for medication during the course of a week.