By AJ Fisher, M.S., C.S.C.S.
2021 Sports and Health Sciences Master’s Degree Graduate
and Daniel G. Graetzer, Ph.D.
Faculty Member, School of Health Sciences
Bronchial asthma (usually shortened to just “asthma”) is a chronic condition associated with inflammatory swelling and narrowing of the airways. It makes breathing difficult, and asthma symptoms often include wheezing, coughing, shortness of breath, and chest tightness.
Asthma is generally caused by a combination of genetic and environmental factors, according to The Life Today. Common triggers for asthma are allergens, irritants, physical stress (exercise) and psychological stress. Severe asthma – as well as persistent asthma – can be dangerous.
When symptoms happen, there are oral medications and asthma management actions that can help. A doctor-monitored asthma action plan goes a long way to help asthmatics.
Related: Stress Hormones and How Your Body Physically Reacts to Stress
‘Revving Up’ the Required Immunity to Asthma
According to the American Academy of Allergy Asthma and Immunology, the “hygiene hypothesis” theory promotes the concept that babies who are not exposed to enough microorganisms (such as bacteria) early in life will not sufficiently “rev up” their acquired immunity. Children raised in rural environments tend to have fewer allergy issues.
That lack of allergy problems may be due to increased early-life exposure to the outdoors and interaction with animals, compared to more sedentary city kids who often spend more time indoors.
Children with a history of severe viral infections such as the respiratory syncytial virus (RSV) are also more prone to develop asthma later in life, notes the Centers for Disease Control and Prevention (CDC).
A family doctor can order a blood test to check your immune system. They will check a person’s levels of a white blood cell called eosinophils along with an antibody called immunoglobulin E (IgE). If the levels are high, this may be a sign of severe asthma. To discover which allergens might be triggering asthma, the doctor may perform a skin test using a non-evasive technique.
Common and Widespread Asthma Triggers
According to the CDC, common asthma triggers include:
- Tobacco smoke
- Dust mites
- Outdoor air pollution
- Pests such as cockroaches and mice
- Pet dander
- Mold
- Exposure to cleaning and disinfection chemicals
- Sinus infections
- Pollen
- Acid reflux
- Physical exercise
- Some medicines
- Bad weather, such as thunderstorms or high humidity conditions
- Breathing in cold air – especially dry air
- Some foods, food additives and fragrances
- Strong emotions that lead to hyperventilation
Any of the triggers above may initiate a severe asthma attack in some people, so it’s best to avoid them to prevent asthma attacks and avoid any severe symptoms. However, avoiding asthma triggers is not always possible.
What Happens During Asthma Attacks?
The overly sensitive airways of asthmatic patients decrease airflow via bronchial hyperresponsiveness (BHR), notes VeryWellHealth. BHR is the hallmark of asthma, and bronchoprovocation testing is commonly used as a diagnostic technique. As the radius of pulmonary airways decreases during an asthma attack, hypoxia (low blood oxygen) begins, which stimulates a cascade of pulmonary and metabolic events.
Asthma attacks generally only minimally restricts someone’s ability to inhale ambient air, but it can greatly affect the ability to exhale air quickly and completely, says the University of Virginia School of Medicine. Due to swollen airways, people with severe asthma sometimes cannot expel enough air to speak a single sentence before they need to take another breath.
According to Healthline, the tightening of airways causes excess mucus to build up within those airways, which triggers wheezing or coughing in an attempt to clear the airways by expelling the mucus. For this reason, asthmatics often need a much longer recovery time after intense exercise to regain control over their airways.
During outdoor exercise, Healthline notes, the inhalation of cool and/or dry air often triggers or worsens symptoms. For asthmatics, walking or running on an indoor treadmill or track might be better than outdoor workouts, provided that indoor air is circulating adequately. Having quick relief inhalers on hand is vital.
Lightly Chlorinated Swimming Pools Can Help with Asthma Treatment
Healthline observes that swimming and water aerobics are often the best types of exercise for asthmatics. In a pool, asthmatics can inhale the warm, moist air just above the water’s surface, have a reduced exposure to allergens and can experience the pressure of the water environment on the chest.
However, heavily chlorinated pools can actually cause asthma-related symptoms in some susceptible individuals.
Start a Walking Exercise Regime
Exercise Is Medicine notes that some patients living with asthma have difficulty starting an exercise program because physical movement can trigger an asthma attack. Starting an exercise program with slow walking, however, enhances lung function in preparation for moderate-intensity exercise later.
Regardless of asthma severity, it is still important that asthmatics add a little daily exercise to their asthma action plan. The U.S. military promotes “Crawl-Walk-Run” training programs of progressive exercise, which are excellent for enhancing stamina and overall health.
How to Cope with Asthma
Some recreational and competitive athletes with asthma experience bronchospasms triggered by high levels of anxiety, says Cleveland Clinic. Hyperventilation (rapid and often uncontrolled breathing) increases the exhalation of carbon dioxide. In turn, an asthma sufferer experiences decreased carbon dioxide in the blood, resulting in an increased pH (potential hydrogen) level.
Healthline notes that airway pH is difficult to measure. But normal blood needs to be maintained in a slightly alkaline state (within a pH range of 7.35 to 7.45) to sustain life.
Respiratory alkalosis greater than a 7.45 pH may induce muscle spasms and nausea. The arteries may then constrict, causing dizziness or lightheadedness. Those symptoms can rapidly progress into chest pain, numbness, a tingling in the arms, extreme weakness, and mental confusion.
Feelings of tightness in the chest area can trigger panic attacks. Consequently, proper breath training is important to prevent symptoms, both physiologically and psychologically.
Related: Progressive-Intensity Exercise and Improving Breathing
Asthma Medications: How Is Asthma Treated?
A variety of medications and asthma treatment options are available to manage and sometimes prevent symptoms. According to the National Heart, Lung and Blood Institute, these asthma treatments take various forms.
Quick-Relief Medicines
Short-acting beta-agonists, such as albuterol, are rescue inhalers that provide fast relief during an asthma attack. These quick-relief medicines work by relaxing the muscles around the airways, making it easier to breathe when a person encounters an asthma trigger.
Long-Term Control Medicines
Short-acting beta-agonists offer quick relief but there are other asthma medications that can be taken daily to help prevent symptoms and control inflammation. They include inhaled corticosteroids, long-acting beta-agonists (which also help with nighttime asthma symptoms), leukotriene modifiers, and long-acting muscarinic antagonists.
Combination Inhalers
These inhalers contain both inhaled corticosteroids and long-acting beta-agonists to help control symptoms.
Oral Corticosteroids
These asthma medicines – some of which come in pill form – are used for short periods to treat severe asthma symptoms. They help reduce inflammation but can have side effects such as weight gain and a sore throat if the medicine is used for extended periods.
Biologic Therapy
These medications target specific immune system pathways involved in asthma. They are typically prescribed for patients with severe asthma that is difficult to control with other treatments.
Allergy Shots
Allergy shots can help improve asthma symptoms by reducing patient sensitivity to allergens.
Bronchial Thermoplasty
Bronchial thermoplasty is an asthma treatment procedure that uses heat to reduce the smooth muscle in the airways, making them less likely to constrict and cause asthma symptoms.
Personalized Asthma Treatment Plan
A personalized treatment plan created with the help of an asthma specialist often helps patients manage their condition, avoid triggers and understand when to seek medical help.
The Effects of Inhalers and Prescription Medications
Over-the-counter (OTC) quick-relief medicines such as Primatene Mist (epinephrine), Asthmanefrin (racepinephrine), and Vicks’ Sinus Inhaler help control minor forms of allergy- induced asthma flare-ups, according to GoodRx.
While these asthma medicines can relieve symptoms, they do not alleviate the underlying causes of asthma and generally cannot effectively halt an asthma attack after it has started.
Prescription medications for asthma control such as Albuterol open up the airways and are generally taken 15 minutes before exercise, according to Drugs.com. Long-term treatments to control symptoms of asthma (not for sudden asthma attacks) include oral corticosteroids and leukotriene modifiers to control airway inflammation and swelling.
Comorbidities in Asthmatics
According to Asthma.net, there are various asthma comorbidities. They include:
- Cardiovascular disease
- Gastroesophageal reflux disease (GERD)
- Hay fever (allergic rhinitis)
- Hypertension
- Obesity
- Anxiety
- Depression
- Obstructive sleep apnea
- Diabetes mellitus
All of these comorbidities can exacerbate symptoms and increase attack frequency and severity. Exercise-induced bronchoconstriction (EIB) is common in most children with asthma, according to the American Association of Family Physicians. However, appropriate exercise training of at least two 60-minute sessions per week for three months has been shown to relieve EIB in some individuals safely and to treat asthma more effectively, according to Cleveland Clinic.
If asthma and its related comorbidities are not effectively managed, the direct and indirect economic burden on the U.S. healthcare system is likely to exceed $100 billion annually, observes the American Academy of Pediatrics.
Biologics – the proteins that target specific immune system biochemical pathways – have also shown promise during early stages of drug development trials. However, they are very expensive.
Science Daily notes that a recent breakthrough that may eventually lead to improved asthma therapies is discovery of the critical role of a specific protein (Caspase-11). It may soon become a promising target for drug designers.
Natural Remedies for Improved Breath Control
People living with asthma know how important it is to monitor their symptoms during and after exercise and to stop exercising immediately if they experience excessive breathing difficulty. According to WebMD, there is currently no cure for asthma, but there are several herbal and natural remedies that can enhance breathing control.
Yoga is now commonly used to assist patients in learning how to control their breathing, according to Healthline. Breathing exercises usually feature in a yoga treatment plan. Intermittent hypoxic training (IHT) is another useful technique that has been used as a form of asthma treatment.
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About the Authors
Adrienne “AJ” Fisher, M.S., C.S.C.S., learned her bachelor of science and master of science in sports and health sciences from American Public University. She maintained a 4.0 GPA, which earned her an academic scholar award. Her capstone project, “Intermittent Hypoxia with Exercise, Voluntary Breathing, and Rest: Potential Benefits for Physical and Mental Performance, Injury Prevention, and Heart Rate Variability” is available online and was written under the guidance of Dr. Daniel Graetzer.
AJ serves on the University’s Sports and Health Sciences advisory board and is a personal trainer for high-profile celebrities in NYC, L.A., and London. She has also worked with clients such as Adidas, Reebok, and Marvel in movies such as “Black Panther, Wakanda Forever.”
AJ combines her former career as a Broadway entertainer with her research in breath-work and hypoxic training in HYPOXiX fitness programming, which integrates breathing patterns that restore core strength and optimize the nervous system, body composition, and brain function.
Daniel G. Graetzer, Ph.D., received his B.S. from Colorado State University/Fort Collins, a M.A. from the University of North Carolina/Chapel Hill and a Ph.D. from the University of Utah/Salt Lake City. He has been a faculty member in the School of Health Sciences, Department of Sports and Health Sciences, since 2015. As a regular columnist in social media blogs, encyclopedias, and popular magazines, Dr. Graetzer greatly enjoys helping bridge communication gaps between recent breakthroughs in practical application of developing scientific theories and societal well-being.
NOTE: The preceding article is for informational purposes only and does not replace a professional medical diagnosis or endorse specific treatments or products. Consult a healthcare provider for accurate diagnosis and individualized care since each person’s medical condition is unique and treatments may vary.
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