We spoke to Janna Tuck, MD, an allergist in Cape Girardeau, Missouri and spokesperson for the American College of Allergy, Asthma and Immunology (ACAAI), about what to ask your physician about asthma. Become a more informed (and empowered!) patient by asking these questions during your next appointment!
1. Is it Definitely Asthma?
Patients are diagnosed with asthma based on their symptom history, says Tuck. But if you suspect that your coughing, wheezing, chest tightness, and shortness of breath indicate another condition, discuss your concerns; there are other ways to diagnose asthma. "In some people, it’s clear [that asthma is the correct diagnosis], so we give them an inhaler and see if their symptoms improve," Tuck explains. "In others, it’s not as clear, so we do a spirometry, a pulmonary [lung] function test to be sure. But the gold standard of asthma diagnosis is a methacholine challenge." Methacholine, an asthma trigger, constricts the airways when inhaled by asthmatics, signaling the condition.
2. What Kinds of Tests Will I Need?
Asthma patients are usually monitored by spirometry once a year. "It’s our best diagnostic tool for monitoring," says Tuck. This is important because "You may feel fine, but are still losing lung function... spirometry helps determine if someone is becoming sicker and needs a change in medications."
In addition, asthma patients are usually tested for allergies, since allergens can trigger asthma symptoms. "Children are more likely to have allergies and asthma," says Tuck. "In adults, those with asthma are more likely than the general population to have allergies, too."
3. What Are my Treatment Options?
There are two types of asthma treatments: One is quick-relief medications, which are used as needed via either an inhaler, which delivers a pre-measured spray of medicine, or a nebulizer, which administers the medicine as a fine mist through a mouthpiece or mask. Then there are long-term control medications, which are taken daily. Not every asthmatic will require daily medication, but every asthmatic should have a quick relief inhaler. You can’t predict when you will have an asthma attack.
4. Are There any Side Effects of Treatment?
Long-term control medications, such as pills and steroid inhalers, decrease daily symptoms and the severity of attacks. Side effects of steroidal inhalers include thrush of the mouth [a yeast infection]; inhalers may also increase risk of infection. But overall, they are generally well tolerated, says Tuck.
Side effects of quick-relief medications can include anxiety, restlessness, headache, jitters, and increased heart rate. "If a patient has heart disease, I watch them carefully," says Tuck. "Always talk to your doctor if you are experiencing problems with a medication because there are other options."
5. How Do I Use an Inhaler?
It's important to get this one right, since using an inhaler incorrectly results in less medicine in the lungs and more medicine in the back of the mouth. You may want to ask your doctor for a demonstration, and possibly a spacing device, which is a tube that attaches to the inhaler’s mouthpiece and allows you to inhale medication instead of spraying it directly into the mouth. Also, you may want to ask your physician to recommend educational materials, like videos.
6. How Often Will I Need an Inhaler?
It depends. Your asthma action plan, or guidelines for managing your condition, should include daily medications, if any, and when to use a quick relief inhaler. So, for example, you may be advised to use your inhaler before exercise to prevent an attack. The general rule is if you’re using your quick relief inhaler more than two or three times a week, tell your doctor—the condition may not be under control.
7. What Complementary Treatments Are Available?
Complementary treatments include allergy shots to prevent allergens from triggering symptoms and biologics, which are injections for moderate to severe asthma not controlled by inhalers.
8. Do I Need to Make Lifestyle Changes?
Smoking, for obvious reasons, will make asthma worse. If you smoke, ask your doctor for help in quitting smoking. Dust, mold, and pet dander may exacerbate symptoms, so ask about the best ways to protect yourself while at home.
While you may be tempted to use indoor plants to improve indoor air quality, Tusk advises against it: "Plants are not recommended as the dirt contains mold," she explains. Mold can prompt asthma symptoms.
9. Is it Safe to Exercise?
Yes! Cardiovascular exercise improves lung health, keeps weight down, and acts as an anti-depressant, says Tuck. Any activity is fine, though swimming can be problematic because of the chlorine in pools. "Chlorine is an irritant to airways," she explains. In fact, some studies suggest that chlorine exposure may increase the risk of developing asthma, according to the ACAAI.
Regardless of the exercise you choose, just remember that almost all asthmatics will see symptoms when participating in an unfamiliar activity. Also, if you have seasonal allergies, you will experience symptoms when exercising outdoors during peak pollen, ragweed, or mold season.
10. Do I Need to Eat a Special Diet?
Recent research has suggested a high-fiber diet can help reduce symptoms, but there’s no "asthma diet," maintains Tuck. "Asthma is a multifactorial disease and it is difficult to design a study to prove that something like diet makes a difference," she says. However, "Eating healthy food is always a good idea since it helps strengthen the immune system and a diet high in fiber is healthier for everyone."
One thing to consider: gastroesophageal reflux disease. "Asthmatics are more prone to acid reflux, so talk to your doctor if you have heartburn symptoms," cautions Tuck.
Janna Tuck, MD, reviewed this article.
Sources
Janna Tuck, MD. Allergy Partners of Cape Girardeau. Telephone interview. March 30, 2016.
"Chlorine Allergy: Overview." American College of Allergy, Asthma & Immunology. Accessed April 18, 2016.
"Thrush—Children and Adults." MedlinePlus. Page last updated September 10, 2015.
"Mold Allergy." Asthma and Allergy Foundation of America. Page reviewed October 2015.
