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Asthma

Get the facts on controlling asthma, so you can breathe easier

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For the millions of people in the United States who have asthma—chronic inflammation of the airways that can lead to wheezing, chest tightness, and coughing, there's plenty of good news. Thanks to safe and effective medicines, asthma can usually be controlled; however, many people don't understand how to control their asthma.

Here, experts clear up common misconceptions.

You Only Need Medicine When You Have an Attack.

That depends. There are four categories of asthma: intermittent, mild persistent, moderate persistent and severe persistent. People who have mild, moderate or severe persistent asthma need a daily long-term controller medicine, usually an inhaled corticosteroid, to control inflammation and minimize asthma attacks. "Inflammation is the root cause of everything we see in asthma," says Rand Sutherland, M.D., MPH, chief of the Division of Pulmonary and Critical Care at National Jewish Health in Denver, a leading respiratory health hospital. And since even intermittent asthma can worsen, everyone who has asthma needs to have a short-acting inhaled beta-agonist—known as a quick relief medicine—on hand.

Once your asthma is under control, your doctor may change your medicine or decrease your dosage—even take you off it. "Asthma is not about going on medication and staying on it," says Norman Edelman, M.D., Chief Medical Officer for the American Lung Association. "There is always an adjustment." But even if symptoms ease, you need to have a quick-relief medicine nearby.

People Can Outgrow Asthma.

True. While childhood asthma can persist for life, it can also quiet down in adulthood. "A person can do well for years and then the disease becomes active again in mid- to later life," says Dr. Sutherland. Asthma can also be diagnosed for the first time in an adult, though it may turn out that her asthma was never detected when she was a kid.

Asthma Is Easy to Control.

This depends on how vigilant you are about sticking to your treatment plan. The goal is "to minimize as much as possible the daily impact of the disease on a person's life," says Dr. Sutherland. Ideally, you should have symptoms no more than two days per week and one to nights per month.

This doesn't happen automatically. "Developing really good asthma control requires some effort," says Dr. Edelman. A 2007 study in The Journal of Allergy and Clinical Immunology reported that 55 percent of patients had uncontrolled asthma. A phone survey of 200 patients with asthma found that more than one-third took less than 75 percent of their prescribed puffs of controller medicine, primarily corticosteroids, during the previous week. As a result, 46 percent had to take two or more puffs of rescue medicine. According to the study, published in the Annals of Allergy, Asthma and Immunology in 2007, most people didn't like the idea of a fixed-treatment schedule.

Asthma and Allergies Go Hand in Hand.

Inflamed airways are more sensitive to allergens. According to findings from the 2007-2008 National Health and Nutrition Examination Survey, published in The Journal of Allergy and Clinical Immunology in 2007, 56 percent of asthma cases in the U.S. can be linked to allergies. In the survey, asthmatic people ages 6 to 59 underwent skin-prick tests for 10 common allergens. High on the list of culprits: cat, mold, white oak, dust mites, and cockroach. But irritants like cigarette and secondhand smoke, smoke from fireplaces or wood-burning stoves, fragrances, dust, cleaning products, traffic fumes, air pollution, and even pain relievers such as aspirin, ibuprofen and acetaminophen can provoke an attack. GERD, or gastroesophageal reflux, has been linked to asthma as well.

Because of this, a cornerstone of asthma treatment is identifying and avoiding triggers. "For some people they're obvious," says Dr. Edelman. "For others, it can be difficult." To narrow down the list: Keep a log, noting when asthma symptoms occur and what brought them on. Other people may need to get rid of all possible triggers and then reintroduce them one by one to identify possible culprits.

People With Asthma Shouldn't Exercise.

Nothing could be further from the truth. Olympic athletes like marathoner Paula Radcliffe and track star Jackie Joyner-Kersee excelled in their sports despite having asthma. In fact, being in shape means "less burden is placed on your lungs during activity," explains Dr Edelman. Physical activity also helps you maintain a healthy weight, reducing your asthma risk or, if you already have the disease, helping you breathe easier. An analysis of studies published in the American Journal of Respiratory and Critical Care Medicine in 2007 reported that the incidence of asthma increases by 50 percent in people who are overweight or obese. Researchers at Emory University in Atlanta found that obese patients with asthma were 66 percent more likely to have continuous symptoms, 36 percent more likely to miss work, and 52 percent more likely to have moderate or severe persistent asthma than people who weren't heavy. While the cause and effect isn't clear, one theory is that a hormone produced by fat cells contributes to airway inflammation.

Working out makes you wheeze? Ask your doctor about using a quick-relief medication beforehand. And cover your mouth with a scarf if you exercise in cold weather.

People With Asthma Can't Get the Flu Shot.

False. The Centers for Disease Control and Prevention (CDC) reports only one-third of adults with asthma get a yearly flu shot. That means two-thirds are at risk for upper respiratory infections that can bring on an asthma attack. Research suggests that some people think the shot will either give them the flu or provoke an asthma episode. But according to the CDC, the flu shot is safe and an annual must-get for everyone who has asthma.

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