[For detailed information, see In-Depth Report #77: Allergic rhinitis and chronic nasal congestion and In-Depth Report #05: Asthma in children and adolescents.]
Treating and Preventing Medical Conditions that Trigger Asthma
Preventing and Treating Respiratory Infections. Respiratory infections, including the common cold, can act with allergies to worsen asthma. People with asthma should try to minimize their risk for respiratory tract infections. Washing hands is a very simple but effective preventive measure.
There has been some question concerning influenza vaccinations because of some reports that vaccines may worsen asthma. Recent and major studies have reported, however, that the vaccination is safe for adults and children. It is also very important for patients to reduce their risk for respiratory diseases. Still, 90% of patients with asthma remain unvaccinated. Patients with asthma should ask their doctors about the flu vaccine and also whether they should receive the vaccination against pneumococcal pneumonia.
Zanamivir, a new drug used for treating influenza, is now considered safe for patients with asthma 12 years of age or older. In one study, patients with asthma who were treated with zanamivir experienced fewer flu symptoms and had improved lung function. [See In-Depth Report #94: Colds and influenza.]
Treatments for GERD. Treating gastroesophageal reflux disease (GERD) with drugs that reduce acid may reduce symptoms of both conditions in some patients who also have asthma. Not all such patients report improvement, and these drugs do not appear to have much effect on actual lung function. Studies suggest that this approach works in only certain patients, with one study suggesting that such individuals with asthma tended to be overweight and to have severe GERD in the lower part of the esophagus. [See In-Depth Report #85: Heartburn and gastroesophageal reflux disease.]
Managing Hormonal-Related Asthma. Women who suspect that menstrual-related changes may influence asthma severity should keep a diary recording their menstrual dates and times of asthma attacks. In some cases, adjusting medications in anticipation of menstruation may help prevent attacks. Some small studies have suggested that hormonal drugs called gonadotropin-releasing hormone (GnRH) analogues may help women with severe premenstrual asthma. Such drugs reduce or suppress estrogen levels, however, and can have severe side effects. More research is needed to determine if the disadvantages outweigh the benefits.
Dietary Factors
Weight Loss. People who have asthma and who are overweight may help reduce asthma symptoms with weight loss.
Fruits, Vegetables, and Whole Grains. Healthy foods are important for lung function. Specific foods that may be important for healthy lungs contain antioxidants (deep green and yellow-orange fruits and vegetables), selenium (fish, red meat, grains, eggs, chicken, liver, garlic), plant chemicals called flavonoids (apples, onions), and magnesium (green leafy vegetables, nuts, whole grains, milk, and meats).
Vitamin D. There may be an association between a lack of vitamin D and asthma. Some research suggests that children are less likely to develop asthma at a young age if their mothers consume a high intake of vitamin D during pregnancy. Vitamin D is available from dietary sources or vitamin supplements.
Fish Oil. Omega-3 fatty acids, found in cold water oily fish and in supplements (preferably DHA-EPA, which are the important compounds in fish oil) have anti-inflammatory effects. Some evidence suggests they may be helpful for people with asthma, although it is weak.
Caffeine. Caffeine has properties that are similar to theophylline, a drug used to treat asthma. A major analysis of studies reported that caffeine improved lung function for up to 4 hours after consumption. (People who are going to have their lung function tested should avoid drinking coffee, tea, or other caffeinated beverages for at least 4 hours beforehand.)
Alcohol. In adults, some research suggests that alcohol intake may influence allergy severity. One study found that as little as one drink a day is enough to worsen dust mite allergies.
Role of Food Allergies. Although 67% of people with asthma believe their symptoms are aggravated by food allergies, studies indicate that this belief may be true in only 5% of cases. The primary suspects are monosodium glutamate, or MSG (found in some canned soups, cheese, and certain vegetables), and sulfites (preservatives in wine and foods that include processed frozen potatoes and tuna). Contrary to what many people believe, dairy products do not appear to worsen asthma symptoms in people who are not already allergic to them.
Exercise
Asthma is no reason to avoid exercise. Historically, about 10% of US athletes who participate in the Olympics have asthma. Some studies indicate that long-term exercise even helps control asthma and reduce hospitalization. Patients should consult their doctors before embarking on any exercise program, however. Uncontrolled asthma can be dangerous and, in rare cases, fatal for athletes, even some with mild asthma. Use of the inhaler is extremely important.
People who enjoy running should probably choose an indoor track to avoid pollutants. Swimming is excellent for people with asthma. Yoga practice, which uses both stretching, breathing, and meditation techniques, may have particular benefits. One study reported that two-thirds of patients who practiced yoga regularly were able to reduce or stop taking their asthma medications.
Exercise-induced asthma is a limited condition that has specific recommendations.
Reducing Stress and Mood Disorders
People with asthma have no higher rate of anxiety or depression than the general population. However, such emotions interact with the effects of asthma and its treatments in important ways:
- Negative emotions can discourage compliance with medication and the ability to cope
- Poor control of asthma symptoms, in turn, increases the risk for negative emotions
- Stress and depression have been associated with more severe symptoms and even an increased risk of fatal asthma attacks
Some evidence suggests that stress reduction techniques, a positive attitude and relaxation techniques can be very helpful in the long-term management of asthma. [See In-Depth Report #31: Stress.]
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