Some potential triggers, like exercise and tree pollen allergies, are well-established asthma risk factors, and you’re probably familiar with them — even if you can’t always take the steps needed to avoid them. But other possible asthma triggers are less obvious, and you may have overlooked or misunderstood them. Beyond the realm of triggers, it’s also possible that problems with your diagnosis or treatment might be leaving you ineffectively treating your symptoms. But it’s important to get to the bottom of what’s causing your symptoms in order to take control and breathe better. Here are nine surprising reasons your asthma might not be adequately controlled.
1. You may have another health condition exacerbating your asthma.
Certain health conditions can contribute to your asthma symptoms. Environmental allergies are the most obvious example. But another, sometimes overlooked, condition that can aggravate asthma is gastroesophageal reflux disease (GERD), according to Kanao Otsu, MD, MPH, an allergist and immunologist at National Jewish Health in Denver. Another condition that can make asthma worse is obstructive sleep apnea, in which your upper airway becomes blocked while you sleep. Many people have this condition and don’t know it, so it remains untreated, Dr. Otsu says. Obesity can also aggravate asthma, since “you have all this tissue that’s weighing on your lungs,” Otsu notes. “And so it becomes difficult to breathe while you’re exerting yourself.” As a result, people tend not to move as much, and their lungs become deconditioned to physical activity. Two other related conditions that can both aggravate asthma and mimic its symptoms are tracheomalacia and bronchomalacia. People with these conditions “have airways that are floppy,” says Otsu. “They kind of clap when you breathe in and out.” If you’re struggling to keep your asthma symptoms under control, it’s important to work with your doctor to rule out any underlying conditions that may be contributing to your symptoms.
2. Strong emotions can trigger asthma symptoms.
In people with anxiety disorder, a panic attack can trigger an asthma attack because of the hyperventilating that often occurs, Otsu notes. But even strong emotions that don’t belong to any particular disorder can also contribute to asthma symptoms. These include being upset or stressed, or even laughing hard or crying. It’s not always possible to avoid these emotions and reactions, of course, but it can help if you take steps to reduce stress through adequate sleep, lifestyle modifications, relaxation techniques, and exercise.
3. Misconceptions about your pet.
For both cats and dogs, “there are breeds out there that are sold as hypoallergenic,” says Otsu. “But if you ask an allergist, they’ll tell you that there’s no such thing.” It’s true that certain dog breeds don’t shed, and that certain cat breeds produce less fur and dander. But you can still develop allergic and asthma symptoms from exposure to these animals. That’s because allergens are still found in the saliva and skin of cats and dogs. “Unless you have a dog that doesn’t salivate or has no skin, [hypoallergenic] is a misnomer,” Otsu notes.
4. Changes in weather.
Going from warmer to colder air or from drier to humid air can trigger asthma, says Otsu. This can happen when you go outside from a controlled environment, or simply as the weather changes on its own each season. While you can’t control the weather, you can try to limit your time outdoors when the weather could be a trigger. For example, if heat and humidity are triggers for you, try to stay inside in an air-conditioned environment whenever possible. And when it’s cold out, cover your nose and mouth with a scarf when you go outside to help warm up the air you breathe into your lungs.
5. Changes in hormones.
Going through hormonal changes at different stages in life — namely puberty, pregnancy, and menopause — can aggravate asthma in women, says Otsu. But this doesn’t apply to all women, and some women even experience improvement in their asthma during pregnancy, according to Otsu. Doctors don’t fully understand the role hormones play in asthma, but if you’re going through a period of hormonal change, it’s worth considering the possible effects this may have on your asthma control.
6. The medications you’re taking.
The most common example of a drug interfering with asthma control is beta blockers, which are prescribed to treat certain cardiovascular conditions. That’s because albuterol — a widely prescribed drug to treat asthma symptoms as needed — is a beta agonist, which means its action can be directly blocked by beta blockers, Otsu notes. There may also be lower-level interactions between drugs for asthma and for other conditions, so it’s important for every doctor you see to know about your asthma and what medications you’re taking to manage your symptoms.
7. The foods you eat.
Food allergies can trigger asthma in some people, although they more commonly trigger anaphylaxis — a potentially life-threatening reaction that can cause breathing difficulties as well as hives, vomiting, diarrhea, and abdominal cramping. But even if you don’t have any food allergies, you may be sensitive to sulfites, a preservative found in certain foods and medications that can trigger asthma symptoms. Common sources of sulfites include wine, beer, shrimp, dried fruits, wine vinegar, and maraschino cherries. If you suspect that the food you eat may be triggering your asthma symptoms, talk to your doctor about keeping a food and symptom diary to help you determine which trigger foods to remove from your diet.
8. You may actually have a more severe type of asthma.
If you can’t adequately control your asthma, it may have simply gotten worse — or it could have been worse than recognized all along. “People can have asthma that appears pretty straightforward, but in reality, it’s really severe,” Otsu notes. This may be because of inadequate treatment earlier in the course of the disease, which can lead to permanent damage in the lungs. In these cases of asthma, “instead of reversible disease, it’s become more chronic and fixed,” says Otsu. “The traditional asthma medications aren’t going to help as much.” It’s possible you may also have a more severe type of asthma, such as eosinophilic asthma, which can be more difficult to control. If you’re having trouble controlling asthma symptoms, be sure to talk to your doctor, who can perform a simple blood test to see if you have this type of asthma, which can be treated with newer asthma medications.
9. Your symptoms aren’t actually caused by asthma.
It’s common to think you’re having an asthma flare, but in reality, the symptoms are not due to asthma, according to Otsu. “A lot of patients have symptoms of chest tightness and wheezing, and think that these symptoms must be an asthma flare,” Otsu says. But it’s possible for these symptoms to be caused by another respiratory or throat ailment, she says, such as vocal cord dysfunction. Especially when someone is diagnosed later in life, Otsu notes, a patient might never see an allergist or pulmonologist for the right kind of testing, and simply be diagnosed with asthma by a primary care doctor based on symptoms. In these cases, if it’s not actually asthma, treating with a daily inhaler won’t be effective. And sometimes, “more medication gets added onto their original medication because [doctors assume] their asthma must be severe,” says Otsu. If you’re doubtful about your asthma diagnosis, ask to be referred to an allergist or pulmonologist, who can help you pinpoint the cause of your symptoms.
