When I was in school, I hated gym class. I hated it partly because as a kid I didn't possess the coordination or confidence to be much good at sports, but mostly because gym class was approximately 80 percent running, and for me running has always been synonymous with fiery chest pain and wheezing. During the annual mile run, I did a lot of gulping at the air and walking, saw a lot of bright lights and rainbows, and was usually able to finish in just under 15 minutes. For a whole decade I thought the kids running eight-minute miles just had a higher tolerance than I did for the pain of not breathing. Then, a few years ago, when I barely slept for two weeks straight because I felt like I wasn't getting enough air, I convinced myself that I was simply stressed out and imagining it. But when I casually mentioned it to my doctor at my annual exam, she scheduled me for a methacoline bronchial challenge, and guess what? I have asthma.
I suppose being diagnosed with asthma at the age of 23 falls into the category of "better late than never," but it makes me grateful I never passed out during a game of Red Rover, Red Rover. Because asthma—especially uncontrolled or improperly controlled asthma—can be a dangerous thing. People with asthma have chronically inflamed bronchial tubes in their lungs, which makes irritants in the air extra irritating. When irritants enter an asthmatic's lungs, muscles in the bronchial tubes contract and the lungs produce more mucus (read: how to get rid of mucus). This excess mucus clogs the already tightened space in the bronchial tubes, and since those same tubes are air's route in and out of the lungs, breathing becomes problematic. This explains the major symptoms of an asthma attack, which include tightness or pain in the chest, breathlessness, wheezing, and coughing—which is a natural enough response to having a bunch of mucus in the way of sweet, sweet oxygen. Because asthma messes with one of your major life functions, you really should be working with a doctor to keep it under control. There are quite a few medications that your doctor may use to treat your asthma, and those are described at the bottom of this page. But there are also things you can do on your own to minimize your asthma symptoms—which may in turn minimize your need for medication.
Preventing Asthma Attacks
Captain Obvious wants to make sure I mention that avoiding things that tend to trigger your asthma symptoms is a fantastic way of keeping asthma symptoms at bay. Obvious or not, this is sometimes harder than it seems, because first you have to identify your own triggers, and then you have to deal with the fact that a lot of common asthma triggers are difficult to avoid, or—worse—things you may enjoy. For instance, if you have asthma there's a good chance you'll have problems with things like animal dander, dust, pollen, cigarette smoke, respiratory infections such as the common cold (read: how to get rid of a cold), exercise, and strong emotions or stress.
Exercise is an important factor in managing asthma, which may seem counterintuitive if your asthma acts up when you exercise. But regular aerobic exercise ultimately strengthens your lungs so you can breathe more easily. Just remember not to push yourself too hard; start with lower-intensity exercise for shorter periods of time, and work your way up to longer, more difficult workouts as your lungs get stronger. It's also wise to keep a rescue inhaler nearby in case things get out of control.
Extreme temperatures and humidity can trigger asthma symptoms, so maintain as much control over the climate as possible. If you walk or exercise in cold weather, wear a mask or scarf over your mouth and nose to warm the air you breathe. In the summer, an air conditioner will keep the air cool and dry and reduce indoor pollen levels as a bonus. If you don't have air conditioning at home, try to close your windows on days when the pollen count is high, and consider investing in a dehumidifier.
Keeping your home clean will reduce your exposure to common asthma triggers like dust and mold. Vacuum carpets and furniture, wash curtains and bedding, and dust surfaces on a regular basis. If dusting and vacuuming stir up enough dust to irritate your lungs, try wearing a dust mask while you clean. Since many cleaning products contain chemicals that can aggravate asthma symptoms, you may also want to switch to more natural cleaning solutions and techniques. Finally, using dust-resistant pillow and mattress covers may keep your asthma from flaring up at night (read: how to get rid of dust).
If you have Gastrointestinal Reflex Disease (GERD) or frequent heartburn, controlling it may in turn ease your asthma symptoms. That's because when acid from your stomach backs up into your esophagus, your esophagus and lungs tend to recoil in horror and disgust. Actually, I don't think your esophagus and lungs can feel horror or disgust. But they do reflexively tighten up to avoid touching the acid, and the ultimate result of these muscle contractions is chest tightness and shortness of breath. A lot of people who have nighttime asthma symptoms—myself included—get asthma relief by taking a daily antacid like Prilosec OTC.
If you're experiencing asthma symptoms, it's a really bad idea to diagnose or attempt to treat yourself. For one thing, the symptoms of asthma can also show up when you have other medical issues, some of which are very serious. For another, if you aren't controlling your asthma properly, you can actually die. So I recommend consulting a doctor about your symptoms. When you do, the doctor may schedule you for either a spirometry test or a methacoline bronchial challenge. Both of these tests involve breathing into a machine that measures how much you can exhale, and how fast. If a breathing test confirms that you have asthma, the doctor won't be able to cure it, but she will probably prescribe at least two drugs to help you control your symptoms.
One type of prescription your doctor can give you for asthma is a long-term control medication, designed to prevent symptoms from flaring up in the first place. The most common of these fall into the category of inhaled corticosteroids. They reduce the inflammation of the bronchial tubes, making them less susceptible to irritation, and include drugs like fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), and beclomethasone (Qvar). Another type of long-term control medication are the long-acting beta-2 agonists (LABAs), which work for up to 12 hours to widen the bronchial tubes so air can flow through more easily. However, since they don't reduce the inflammation that leads to asthma attacks in the first place, they work best if used alongside another medication. Advair addresses this problem by putting the LABA salmeterol in the same inhaler with the inhaled corticosteroid fluticasone. Its effects are fantastic against asthma—unless they aren't; studies have shown that LABAs can sometimes promote severe asthma attacks, which can end in death. If you're already on Advair, Serevent, or Foradil, you may want to talk to your doctor about switching to a less risky medication. Another class of long-term asthma control drugs is the leukotriene modifiers, like Singulair. These block substances in the lungs that cause inflammation and, while less effective than inhaled corticosteroids, can ease mild asthma or boost the effects of another medication. Other less effective (and therefore less common) anti-inflammatory asthma drugs include cromolyn (Intal) and nedocromil (Tilade). Theophylline is a bronchodilator like the LABAs, but in pill form. Because it doesn't deliver the medication directly to the lungs, it is more likely to result in serious side effects, and is rarely prescribed.
The other medication your doctor will almost certainly prescribe if you are diagnosed with asthma is a quick-relief medication to reverse the effects of an asthma attack in progress. For most people, this means albuterol, which is a short-acting beta-2 agonist. In other words, it is a bronchodilator like the LABAs described above, but unlike those it takes effect in a matter of minutes and keeps your airways open for only 4-6 hours. Another common type of quick-relief asthma medication is ipratropium bromide (Atrovent), which is an anticholinergic medication that does basically the same thing as albuterol, but is slower-acting and longer-lasting. Sometimes, albuterol and ipratropium bromide are combined in a single medication.
If your asthma symptoms are triggered by allergens (read: how to get rid of allergies) and won't respond to any of the medications above, your doctor may opt to treat the allergy itself rather than trying to eliminate its symptoms. This may involve immunotherapy, in which you receive injections to make you less sensitive to your personal allergens, or—in severe cases—anti-IgE antibodies will be introduced to your immune system via injections of a medication called omalizumab (Xolair). This drug blocks the antibodies that your body produces to attack allergens, and when those antibodies can't attack, allergic asthma stays under control.