5 Medical Conditions That Make Asthma Worse

How treating these conditions can improve asthma control

If your asthma is not being well controlled despite best efforts, there may be co-existing medical conditions standing in your way. Some may directly trigger an attack while others simply add to the burden of respiratory symptoms. It stands to reason, therefore, that by treating these conditions, you'll be better able to avoid attacks and sustain asthma control.

1

Man with indigestion
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Gastroesophageal reflux disease (GERD) is one of the most common conditions that may complicate asthma control. GERD occurs when stomach acid leaks back into the esophagus, causing irritation, reflux, and distress. There appear to be two different mechanisms for this:

  • Reflux overstimulates nerve lining in the esophagus and triggers bronchospasms (spasms of the airway passages).
  • When acid moves from your stomach into your lungs, the passages will automatically constrict, trigger a hypersensitive response.

Treatment with chronic and fast-acting GERD medications can help control the condition and help minimize reflux during an acid attack. ​Dietary and lifestyle changes can also help.

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2

Woman weighing herself
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Asthma is not only more common among overweight and obese people, it tends to be more severe and occur with greater frequency. The risk appears greatest among teens and older women.

Being physically active doesn't seem to help. Weight and weight alone can differentiate between able to sustain asthma control or not. Even gaining a mere five pounds can make a big difference, resulting in:

  • 22 percent poorer asthma control
  • 31 percent increased need for oral steroids
  • 18 percent reduction in the perceived quality of life

By contrast, weight loss with asthma results in improved lung function, decrease exacerbations, better quality of life, and reduce dependence on corticosteroids medications.

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3

Man Sleeping in Bed with Sleep Apnea Mask
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Obstructive sleep apnea (OSA) tends to be underdiagnosed in people with asthma. This is because, when asthma is diagnosed, we often associate all breathing problems with asthma and don't look any further.

Obstructive sleep apnea occurs when the upper airway partially or completely collapses when asleep, interfering with a person's ability to breathe, increasing the risk of both nocturnal and daytime attacks. Symptoms of OSA include:

  • Loud snoring
  • Excessive daytime sleepiness
  • Breath holding when sleeping (more often noticed by the bed partner)
  • Morning headaches

OSA is treated with continuous positive airway pressure (CPAP) which delivers air through a pressurized delivery system. This better normalizes respiration at night, thereby alleviating a trigger that can spur a nocturnal attack. 

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4

Woman with allergies
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Rhinitis (sometimes referred to as hay fever) seems a pretty obvious trigger for an asthma attack. Despite this, many people with asthma don't make the same effort to control their allergies as they do their asthma.

And in truth, the two go hand in hand. Whenever there is inflammation of the upper airway, there is a pretty good chance the lower airways will be affected, as well. ​

Moreover, rhinitis is not just related to allergies. There are non-allergic forms of the condition caused by hormonal changes (pregnancy rhinitis), viral or bacterial infections, environmental changes (vasomotor rhinitis), and even medication use.

For symptoms related to allergies, antihistamines and an intranasal steroid spray can help alleviate symptoms that can trigger an attack. If the cause is not related to an allergy, you may need to see a specialist who can run blood tests, skin tests, and nasal endoscopy ​to better pinpoint the cause.

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5

Dry Sinuses cause Sinus Pain
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Chronic sinusitis is characterized by nasal irritation, runny nose, post-nasal drip, nasal congestion, sinus pressure, or sinus pain that lasts more than 12 weeks. Chronic sinusitis can make asthma control far more difficult due to persistent, low-level inflammation that can affect both the upper and lower airways.

Despite popular belief, sinusitis is not just an allergic reaction. It can be caused by bacterial or fungal infection, a reaction to aspirin, or non-allergic inflammation (often evidenced by the presence of nasal polyps).

If antihistamines or decongestants are not able to treat sinus symptoms, see your doctor. In some cases, allergy shots may provide relief while certain infections may be treated with antibiotics or antifungals. While less common, nasal polyp surgery may be used if all other attempts to control non-allergic sinusitis fail.

Sources:

Alkahlil, M.; Schulman, E.; and Getsy, J. "Obstructive Sleep Apnea Syndrome and Asthma: What Are the Links?" Journal of Clinical Sleep Medicine. 2009; 5(1):71-78.

Feng, C.; Miller, M.; and Simon, R. "The united allergic airway: Connections between allergic rhinitis, asthma, and chronic sinusitis." American Journal of Rhinology and Allergy. 2012; 26(3);187-190.

Mastronarde, J. "Is There a Relationship Between GERD and Asthma?" Gastroenterology and Hepatology. 2012; 8(6):401-403.

Scott, H.; Gibson, P.; Garg, L.; et al. "Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial." Clinical & Experimental Allergy. 2013; 43(1):36-49.

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