Asthma’s Effect on the Respiratory System

If you have asthma or have a close family member with the condition, one thing becomes perfectly clear when symptoms kick in: The ability to breathe can quickly become compromised. In fact, although there are multiple types of asthma, they all have at least one thing in common—an effect on the body’s respiratory system, causing inflammation in the lungs as well as constriction of the smooth muscles in the airway, notes Kanao Otsu, M.D., an allergist and immunologist at National Jewish Health in Denver, CO.

That doesn't mean lifelong damage to the respiratory system is inevitable, however—especially if asthma is well-controlled. "In most milder cases of asthma, there is no permanent damage to the airways, and the inflammation and constriction are reversible," says Dr. Otsu. On the other hand, when asthma progresses, that is not typically the case. "With more severe or uncontrolled asthma, there may be long-term issues and scarring in the airways," she adds.

Because of this, it's important to recognize the ways asthma can affect your respiratory system and take steps to manage the condition in a way that reduces flare-ups. If you have asthma, these are some ways it can affect your body—plus, top tips for preventing flare-ups.

The respiratory system has numerous components, and asthma may affect all of them in some way. Here's what this system involves and how asthma might have an impact, according to Dr. Otsu:

• Mouth: With breathing challenges, there's a tendency to breathe through the mouth, which can dry out the mucus membranes there; that may increase risk of cavities as well as an oral yeast infection, called thrush.

• Nose: Many people with asthma also have issues with their nose and sinuses due to inflammation and swelling within the sinus cavity. This can lead to chronic congestion that makes breathing even more difficult.

• Larynx: Also called the voicebox, this can become hypersensitive when you have asthma, leading to increased cough or vocal cord dysfunction, which can make it hard to breathe.

• Trachea: Also called the windpipe, this is a smooth muscle that brings oxygen to your lungs. Similar to other airways, it can become inflamed and constricted due to asthma. That might reduce how much oxygen you can take into the body, reducing the amount that reaches the lungs.

• Airways: These are comprised of both the small airways (bronchioles) and large airways (bronchi). During an asthma attack, the muscles lining both types of airways can contract, causing them to narrow and become inflamed. If there's also an increase in mucus, which is common with asthma, the bronchioles may get blocked.

• Lungs: With asthma there is always at least some swelling within the lungs due to inflammation. That can worsen breathing and make it difficult to take deep breaths. If you're coughing or wheezing, that can exacerbate inflammation and mucus production.

Asthma is a chronic respiratory disease, says Daniel Kim, D.O., a family medicine specialist at Medical Offices of Manhattan in New York City. During an asthma attack, the airways in the lungs narrow and swell, making it challenging for air to move freely. Wheezing, coughing, shortness of breath, and tightness in the chest are all symptoms of this inflammation.

"People with asthma may experience asthma attacks when their airways become even more inflamed and congested as a result of exposure to triggers, including allergens, irritants, exertion, or respiratory infections," says Dr. Kim. "These attacks cause the muscles surrounding the airways to constrict, and extra mucus production further restricts airflow. Improved breathing is made possible by prompt treatment with medication that opens the airways and reduces these symptoms."

Depending on the severity and frequency of asthma flare-ups, more permanent damage can occur, says Dr. Otsu. This can lead to the development of chronic obstructive pulmonary disease and a condition called bronchiectasis, in which inflammation leads to scarring.

Although asthma mostly affects the respiratory system, it can also have an impact on other parts of the body. According to Dr. Kim, that includes:

• Digestive System: Because of pressure fluctuations that can occur during an asthma attack, when breathing difficulties occur, some people may develop gastrointestinal problems or problems swallowing.

• GERD: Studies show that anywhere from 30% to 90% of people with asthma also have gastroesophageal reflux disease, or GERD. Acid reflux seems to trigger asthma symptoms, and vice versa. (More on this below.)

• Heart and Circulatory System: Ongoing inflammation and airway narrowing can strain the heart and raise blood pressure.

• Mental Wellbeing: Research in Brain, Behavior & Immunity found that people with asthma are three times more likely to develop anxiety and depression than those without the condition.

• Musculoskeletal System: Frequent coughing and heavy breathing can increase risk for back pain, according to research in the European Spine Journal, which found that those with asthma or chronic obstructive pulmonary disease had higher prevalence of lower back pain.

It's important to note that some diseases can also worsen asthma, rather than the other way around, adds Dr. Otsu. These include obstructive sleep apnea and chronic sinus disease. No matter what conditions you have, she emphasizes that treatment should include managing those issues in addition to your asthma.

Although there are many types of asthma, there are several prevention strategies that can minimize their impact, says Dr. Kim. If you’re looking for ways to lessen the challenges that asthma poses, start here:

Create a Customized Asthma Management Plan

How your asthma is treated depends on its severity, symptoms, frequency, and progression. For example, you may experience new triggers due to allergies that can worsen your asthma, or you might find a certain medication is becoming less effective. Keeping on top of your asthma management is key for protecting your respiratory system and your overall health.

Identify and Avoid Triggers

There can be a wide range of triggers that exacerbate asthma, including pollen, dust mites, pet dander, exercise, and cold air. Even strong odors like perfume or exposure to secondhand smoke might be factors, says Dr. Kim. Keep a log of these potential triggers and how they affect you to help prevent future flare-ups.

Maintain a Clean and Well-Ventilated Living Space

Even if outdoor allergens are your main trigger, indoor irritants can still worsen your asthma effects and strain your respiratory system, says Dr. Kim. In addition to regular cleaning to reduce dust and dirt, avoid harsh cleaning agents or aerosol sprays that can irritate your airways, use mattress coverings that block dust mites, and keep pets out of your bedroom. It can also help to invest in an indoor air-filtration that uses a HEPA filter, which is designed to remove the majority of dust, pollen, mold, bacteria, and many other airborne particles, according to the U.S. Environmental Protection Agency.

Manage Your Weight

If you are carrying extra pounds, you may see an improvement in your asthma symptoms by reaching a healthier weight. Research in the Journal of Allergy and Clinical Immunology notes that both children and adults who have obesity and asthma tend to have more severe forms of asthma and poorer disease control than those without obesity. Those researchers noted that nearly 60 percent of adults with severe asthma in the U.S. have obesity. According to Dr. Kim, carrying more weight can put more pressure on the lungs and chest wall, which can affect lung expansion and may lead to more inflammation.

"Keep in mind that it's crucial to collaborate closely with your physician in order to create a personalized plan that meets your unique needs and to periodically evaluate and modify it as required," says Dr. Kim.

While asthma’s influence on the respiratory system seems fairly obvious, there’s also another system that can have an impact on your asthma. Acid reflux (often thought of as heartburn) can lead to gastroesophageal reflux disease, or GERD, which affects the digestive system. But it can also significantly impact the lungs, since acid from the stomach can flow upward and irritate the airways, causing damage to the tissues in the respiratory system. GERD is common among those with asthma—one estimate shows more than half of patients with asthma also have GERD, and other estimates suggest that might be as high as 75%.

Because of its effect on the lungs, as well as the digestive system and even your oral health, managing GERD is crucial. That could involve a range of treatment options, according to Joseph Shami, M.D., agastroenterologist at Gastroenterology Associates of New Jersey in Woodland Park, NJ. Some common approaches include:

• Taking over-the-counter and prescription medications to prevent symptoms

• Consistent low-impact exercise, another booster for both GERD reduction and asthma symptom management

• Healthy sleep habits, since research indicates that sleep difficulties can worsen GERD

• Revamped food choices, and especially eliminating fried food and highly processed options that can increase inflammation

• Stress reduction, which can improve both GERD and asthma

• Use of probiotics and fermented foods, to introduce more beneficial bacteria in the gut

By addressing issues like GERD, as well as managing triggers more effectively, you can reduce the effects of asthma on your respiratory system, says Dr. Otsu. In some cases, such as with severe asthma, you may have some long-term difficulties with your lungs, but for asthma that's well-controlled, it's possible to keep your lungs healthier and functioning well.