For people with asthma, the arrival of summer can coincide with a worsening of symptoms—the wheezing, chest tightness, coughing, and breathlessness that make their lives miserable. Not only does summer’s hot, humid weather aggravate this chronic pulmonary condition, but so does the higher presence of airborne allergens and irritants. For those with exercise-induced asthma, the otherwise healthy act of becoming more active in summertime can even trigger symptoms.
“When we think of seasonal allergies, symptoms such as sneezing, runny nose, congestion, and watery, itchy eyes usually come to mind. However, another disease that can go hand in hand with allergies is asthma, characterized by inflammation of the bronchial tubes, increased mucus secretion in the lungs, and narrowing of the airways, or bronchospasm,” says critical care pulmonologist James Tita, DO, Chief Medical Officer at Mercy Health – St. Vincent Medical Center.
According to Dr. Tita, not all allergy sufferers develop asthma and not all cases of asthma are allergy-related. Furthermore, some allergy sufferers mostly have upper-respiratory symptoms while some develop asthma and some experience both, though it’s not fully understood why this is the case. It’s also not known why some people have allergies as a child but then develop asthma later in life.
Dr. Tita further explains that the cells important in asthma are the so-called eosinophils. These white blood cells, which are a component of the body’s natural immune system, are also involved in the allergic response, thus seasonal allergies and asthma share a common pathway.
Among the common seasonal allergens that can cause asthma symptoms are the various tree, grass, and weed pollens produced in succession throughout the warmer months. Year-round triggers, such as pet dander and dust mites, can contribute to the problem as well. With respect to exercise-induced asthma, Dr. Tita says this form is likely related to inhaling cold air, for example when exercising early in the morning when it’s still cool outside. “There are also a number of people with regular asthma for whom exercise is a trigger, and the chlorine in swimming pools can act as an irritant that triggers asthma, as well,” he adds.
The good news is, while asthma cannot be cured, it can be managed very effectively like other chronic conditions such as hypertension and diabetes. “In fact, the vast majority of cases—about 95 percent—can be controlled with simple medications. I tell patients that with proper treatment, they should feel almost as if they don’t have asthma,” says Dr. Tita.
Avoidance of known triggers is the first line of defense against allergy-related asthma. For instance, people with pollen allergies can try to limit the time spent outdoors when pollen levels are high and those allergic to pet dander can banish furry pets from their home or at least restrict them from the bedroom. However, strict avoidance of allergy triggers is not always practical, so it’s important to seek treatment.
The appropriate treatment regimen for asthma will vary from patient to patient but often includes some form of long-term “controller” medication to reduce inflammation, such as an inhaled corticosteroid or oral leukotriene modifier, along with a “rescue” medication to manage bronchospasm, for example the fast-acting bronchodilator albuterol. Dr. Tita notes that patients with exercise-induced asthma can help keep flare-ups at bay by using their albuterol inhaler 30 minutes before exercising. These individuals can also benefit from doing a proper warm-up before beginning a workout.
He continues, “For the small group of asthma sufferers who experience symptoms despite these medications, a good alternative may be a class of drugs called biologics, which are directed at various points of the inflammatory cascade. The drug omalizumab, for example, blocks the action of the allergic protein IgE, sort of like the plastic plugs we put in electrical outlets to protect kids. There are other drugs that exert a similar effect on certain interleukins that activate the eosinophils.”
For patients with severe, persistent asthma, Dr. Tita also offers an innovative technique called bronchial thermoplasty. This outpatient procedure involves the use of radiofrequency energy to ablate smooth muscle in the bronchial tubes that has become thickened due to continual bronchospasm, thereby relieving some of the obstruction in the airways. Bronchial thermoplasty is performed under general anesthesia through a small, flexible tube called a bronchoscope, typically over the course of three sessions spaced three weeks apart.
With any asthma-treatment regimen involving medications, it’s critical to continue taking the prescribed medication on a regular basis. “People with asthma often discontinue their medications because they’re feeling better, but then their symptoms inevitably return. Asthma is a part-time disease that requires full-time treatment. It is possible to escalate treatment when patients are symptomatic and de-escalate treatment when they’re not, but they always need to be on some level of medication to keep those symptoms in check,” says Dr. Tita.❦