Your Doctor & Asthma Educator | Frequently Asked Questions 

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General Questions About Asthma

What is asthma?
Asthma is a chronic (long-term) inflammation of the lining of the airways of the lungs, which makes these airways contract easily. As a result, a person with asthma can experience difficulty breathing and often requires long-term treatment to control this inflammation.
Can asthma be cured?
No, not yet. However, it can be controlled, by using controller medication and by avoiding your allergic and non-allergic triggers.
What is airway remodelling?
Airway remodelling may occur when asthma is not treated or controlled effectively as long term airway inflammation may result in permanent changes in the airways. The actual structure of your airway walls can change causing blockage that can’t be completely reversed with treatment.

Asthma is defined as “a chronic inflammatory disease of the airways” and is characterized by reversible airway obstruction. Irreversible airway obstruction may develop due to the alterations in airway structure that occur with airway remodeling. Airway remodeling is an ongoing process in reaction to inflammation as the body activates a process in an attempt to repair the lungs in response to persistent inflammation. This leads to permanent structural and functional changes. Much as a skin wound leads to scar tissue formation (this has a different structure from surrounding skin); airway remodelling results in different airway characteristics. The cells (epithelial) that line the airway are damaged and the basement membrane underneath the epithelial cells becomes thicker. More blood vessels are formed and the amount of smooth muscle surrounding the airway increases. The airways loose elasticity, the walls thicken, and excess muscle results in bronchoconstriction and long term loss of lung function, a worsening of asthma and the development of fixed airflow limitation.

Airway remodelling may be, at least somewhat, reversible and preventable. The number of asthma exacerbations/loss of control episodes has been associated with greater decline in lung function and a higher risk of airway remodeling. Treatments for asthma may play a significant role by reducing asthma exacerbations resulting in preventing the decline in lung function and airway remodeling. It is extremely important for you to learn how and why your medications work.

The current treatment of asthma is aimed toward decreasing airway inflammation, reducing symptoms, and improving lung function. The use of controller/anti-inflammatory medications reduces the inflammatory process associated with asthma and thus results in less remodelling. A return toward normal airway structure has been found when proper and regular anti-inflammatory treatment is followed. You can find more information about Controllers here.

Why do more people have asthma now than in the past?
It seems there are more cases of asthma today because it is more correctly diagnosed than it was in the past.

That said, the overall incidence of asthma has been increasing. While researchers do not know exactly why, they do have several theories.

One theory suggests that more people develop asthma today because we spend more time indoors than people used to. Indoor air can contain a number of asthma triggers, such as smoke, dust mites and pet allergens. Additionally, in response to the oil crisis of the 1970s, modern homes are more tightly sealed than older homes. This means that indoor air doesn’t circulate with outdoor air the way it did in older, better-ventilated homes. As a result, people inside are exposed to greater amounts of indoor air and the triggers it may contain.

Other theories attempting to explain why asthma is on the rise include the suggestion that outdoor air pollution has a significant effect on asthma. There is also the possibility that because children today experience fewer infections, they are somehow more susceptible to developing asthma.

Why is my asthma worse at night?

There are several factors that may contribute to your experiencing more asthma symptoms at night:

  • The circadian rhythm causes certain natural hormones (similar to those in certain asthma medications) to be at lower levels at night. These lower hormone levels reduce the diameter of the airways slightly and may make it more likely that you experience asthma symptoms at night.
  • You could be inhaling dust mite allergens from your pillows, blankets and mattress while you sleep.
  • When you lie down, the distribution of gravity on your chest can put extra pressure on your lungs.

If you experience nighttime symptoms, it means your asthma is not being properly controlled. Discuss these nighttime symptoms with your doctor. You may also want to bring a copy of the How Much is Too Much? quiz to your next doctor’s appointment. The quiz can help you find out how well you’re managing your asthma symptoms.

Why do I experience asthma symptoms when I laugh or cry?
If laughing or crying brings on symptoms, your asthma is not being properly controlled. Talk to your doctor or an asthma educator about ways to better control your asthma.
A friend suggested I move to a different part of the country. Should I?
Asthma occurs everywhere, so moving generally will not help. Usually your house, not your geographic area, is the most important consideration for people with asthma. The home can contain triggers like old carpets full of per allergens and dust mites and mould. But, if there is one particular asthma trigger that is a big problem in your area, moving somewhere where it is low or absent may help.
Are there different types of asthma?

All asthma is characterized by long-term inflammation, an increase in mucous, and “twitchy” airways. However, asthma has been called by different names according to when and how it develops. These names include:

  • Bronchial asthma
  • Childhood asthma
  • Adult-onset asthma
  • Occupational asthma
  • Allergic asthma
  • Non-allergic asthma
  • Mild asthma
  • Moderate asthma
  • Severe asthma
  • Intermittent asthma
  • Persistent asthma
  • Silent asthma
  • Fragile asthma
  • Coughing asthma
  • Viral-induced asthma

No matter what kind of name it’s given, asthma is almost always managed by taking appropriate medications as directed and avoiding environmental triggers.

Is there any way to prevent asthma from occurring in the first place?
Possibly. People with a family history of certain disorders (including asthma, allergies, eczema, food allergies and anaphylaxis) and who are planning to have children should reduce asthma triggers in the home both before and after their children are born. Research suggests that exposure to certain indoor triggers – like pet allergens (particularly cats), smoke or dust mites – in the first few years of life may increase the likelihood of asthma developing.

What’s more, children with another allergic disorder may be more likely to develop asthma as well. In cases like these, exposure to common asthma triggers should be minimized as much as possible. Under no circumstances should a child (or anyone else for that matter) be exposed to secondhand smoke. Known causes of occupational asthma should also be avoided.

Do children outgrow asthma?
In most cases, asthma is a life-long condition. Occasionally, people with asthma will enjoy long periods in which they do not experience symptoms. Often, children who have asthma find that their symptoms disappear during adolescence but return when they reach adulthood.

Questions About Asthma, Allergies and Symptom Triggers

Is asthma an allergy?
Asthma and allergies are related but they are not the same thing. An allergy is a reaction to a substance that is usually harmless. These substances can be inhaled, injected, swallowed, or touched. A person who is exposed to an allergen may react with irritation and swelling in specific areas of the body such as the nose, eyes, lungs or skin.

An example of an allergic reaction of the skin is called eczema, an itchy rash commonly found in the creases of the arms, legs and neck.

An allergic reaction in the nose is called rhinitis or hay fever. Common symptoms of allergic rhinitis are itchy, runny nose, stuffiness, sneezing, ear blockage and watery eyes.

In the lungs, an allergic reaction manifests itself as asthma. Although allergens are common asthma triggers, many experience asthma symptoms with non-allergic triggers such as smoke, cold air or exercise.

Do milk products make asthma worse?
Milk and other foods do not generally cause asthma symptoms unless a person is allergic to them. If you do have food allergies that contribute to asthma symptoms, do not eat those foods.

If you’re told you can’t eat certain foods, it’s important to make sure you’re getting the nutrients you need from other, non-allergic products. Ask your doctor or a dietitian how you can control your asthma symptoms and still enjoy a healthy, balanced diet.

When I exercise, my asthma symptoms get worse. Should I stop?
Everyone benefits from some form of exercise. If exercise makes your asthma symptoms worse, it means your asthma is not well-controlled. Tell your doctor so changes can be made so that you can exercise without experiencing symptoms.

Questions About Medication and Asthma

Can allergy medicines help my asthma?
Perhaps. Doctors use antihistamines, decongestants, non-steroidal and corticosteroidal medications to manage allergic reactions. If the allergic reaction is in the airway, corticosteroids are used to reduce the inflammation. If nasal symptoms are present, then antihistamines, decongestants and nasal steroid sprays may be prescribed. Keeping the nasal passages clear allows you to breath through your nose, which helps filter, warm and humidify the air you breathe into your lungs. Proper management of rhinitis often improves asthma control.
I'm pregnant. Should I stop taking my asthma medication?
No. Poorly controlled asthma is a much greater risk to your baby. Remember, you’re breathing for two.

Most asthma medication is generally safe to take during pregnancy but, as always, you should be taking the lowest amount of medication that controls your asthma. Discuss any concerns with your doctor – he or she can explain the risks and benefits in greater detail. Keep in mind that when you’re pregnant, it’s more important than ever to avoid your personal asthma triggers as well as any source of tobacco smoke.

I'm feeling better. Can I stop taking my medication?
Never stop taking your medication unless your doctor tells you to. If you stop taking your medication against your doctor’s advice, you may make your asthma worse.
Can I become dependent on, or addicted to, my asthma medication?
No. It is not true that the more asthma medication you take, or the longer you take it, the more you’ll need. Asthma medication is not addictive and you do not have to keep taking more to get the same effect. Using more medication for symptom relief may mean your asthma is getting worse and that controller medication is needed.
My symptoms aren't that bad. Can't I just put up with them instead of taking medication?

Medication is an important part of controlling asthma. If asthma is not well-controlled, it can lead to serious consequences, including:

  • A decrease in your overall quality of life (trouble sleeping, the inability to enjoy regular exercise, time missed from school or work)
  • A greater chance of experiencing a severe, life-threatening asthma attack (every year, about 500 Canadians die from asthma)
  • Long-term, uncontrolled airway inflammation that can lead to permanent damage of the lungs
I do not experience 'asthma attacks.' Why do I have to take medication every day?
Keeping your asthma under control doesn’t just mean never having an asthma attack. Well-controlled asthma is defined as the absence of any regular symptoms. Try the How Much is Too Much interactive quiz to gauge how well you’re currently managing your asthma. Remember, taking your medication is an important part of keeping your asthma under control, and will reduce the likelihood that inflammation will damage your lungs over time.
I only have mild asthma. Do I still have to take daily medication?
Mild asthma can still cause regular symptoms that can limit the quality of your life. It can also mean long-term inflammation in your airways, which may cause permanent damage to your lungs if not well-controlled. Consequently, your doctor may prescribe daily anti-inflammatory medication, even if you only have mild asthma.

Mild asthma is sometimes classified as “mild intermittent,” meaning that symptoms are mild and occasional, and “mild persistent,” meaning the symptoms are mild but occur regularly. Of these two types, “mild persistent” is more likely to require a low dose of daily anti-inflammatory medication.

Can alternative therapies help my asthma?
Although many people try alternative therapies, and many practitioners claim that they help, alternative therapies have not been conclusively shown to be effective in treating asthma.

Here’s what The Canadian Asthma Consensus Report, 1999, a supplement to The Canadian Medical Association Journal 1999; 161 (11 Suppl) has to say on the subject: “There is no objective evidence of any benefit, apart from placebo effect, from the more frequently used unconventional therapies such as acupuncture, chiropractic, homeopathy, naturopathy, osteopathy and herbal remedies.”

If you do decide to try an alternative therapy, tell your physician first, and make sure you continue to take your controller medication as directed. Bear in mind that, in addition to the fact that alternative therapies have not been properly tested, they also haven’t been tested for side effects. Most herbs do not have to be tested for benefits or side effects because they’re classified as food products. And remember, just because something is called “natural” doesn’t mean that it’s healthy. Cyanide, uranium and viruses are all perfectly “natural.”

Can I donate blood if I take asthma medications?
Most asthma medications do not prevent people from donating blood. As long as you are not experiencing asthma symptoms, you are likely able to donate. To discuss whether your asthma medications may prevent you from donating blood, please contact Canadian Blood Services.