Managing asthma well allows this woman to breath deeply next to a climbing vine with yellow and white flowers.

Managing Asthma Triggered by Seasonal Allergies

Posted by jsavage on Apr 03, 2023
By Dr. Jonathon Savage, DO, Emergency Physician

As winter turns to spring, many of us begin to experience allergy symptoms. For those of us with asthma, springtime can feel suffocating when the allergies flare. We have a stuffy nose from allergies plus chest wheezing and tightness from asthma. While we may not be able to rid ourselves entirely of symptoms, there are several things we can do to help us with managing asthma and getting us feeling better.

What is the association between allergies and asthma?

Both allergies and asthma result from a triggering of the immune system. With allergies, the triggering is almost always caused by something that we have been exposed to. However, with asthma that is not always the case. Asthma attacks can be triggered by many of the same things that trigger allergies but it can also be caused by emotions, exercise, or just cold air not necessarily containing any allergens.

What is it about springtime that makes dealing with asthma flare-ups more likely?

During the early spring, trees begin to pollinate, followed by grass and then ragweed. All of this pollen can be a trigger for those with allergies to them. For those with asthma, the resulting allergy can stimulate the reaction in our airways making asthma significantly worse. While they exist in most climates, in warmer and more humid ones, molds and fungi are commonly associated with allergies that can then trigger a worsening of asthma.

What are the symptoms of allergies?

Common symptoms of allergies include: sneezing, coughing, itchy and watery red eyes, itchy nose and throat, sore throat, tiredness, stuffy nose, sinus pressure, and headache. Some of these symptoms might make you feel like you have a sinus infection, which you can read more about in our other post called "Can't Take the Pressure? How to Care for Sinus Infection or Inflammation"

What are the symptoms of asthma?

Trouble breathing with chest tightness, wheezing, and coughing are the most common symptoms of an asthma attack. For those experiencing a more severe attack, the inability to breathe can lead to anxiety, dizziness, and sweating. If things continue to worsen, and oxygen levels drop, an asthmatic could become confused, pass out, or in severe circumstances die. Dealing with asthma quickly can help prevent things from spiraling out of control.

Are there different categories of severity of asthma?

Yes, asthma is usually broken into intermittent asthma and persistent asthma. Intermittent(coming-and-going) type of asthma often has long periods in between asthma attacks where there are no symptoms at all.

Persistent asthma is when there are symptoms that occur more than two days a week, when you awaken at night with asthma symptoms more than three times per month, when you use your inhaler(if you have one) more than 2 times per week, or when you have limited ability to carry out normal activity because of your asthma. Persistent asthma is also graded by severity levels of mild, moderate, and severe.

What can be done to lessen the allergy symptoms that make asthma symptoms worse?

Some people consider moving to a different location when they are experiencing bad allergies. This may help some people but does not help many because allergens are present nearly everywhere.

However, several other lifestyle changes may be helpful:

  • Keep an eye on daily pollen and other allergen levels. These levels can be found online and they are also usually reported on the news. If levels are high, consider staying inside that day.
  • If you do go outside during high pollen count days, taking a shower and washing clothes helps rinse off the allergens that may have been brought into your house.
  • If you stay inside, try and keep the doors and windows closed to keep the allergens from getting inside.
  • Use air conditioning with a HEPA filter if available. These filters are rated based on MERV "Minimum Efficiency Reporting Value". The higher the MERV rating, the smaller the particles(allergens) that can be filtered. HEPA filters are those with MERV 17-20 ratings. Be careful though, because some air conditioning systems cannot handle these filters because of the extra work and stress that is put on the system due to the higher filtering.

Can medications for allergies help decrease asthma symptoms?

Treatment of allergies may help decrease some of your overall symptoms from the allergies but they are NOT treatments that should be used for managing asthma. Many people do experience allergy symptom relief with antihistamines, decongestants, and steroid nasal sprays. Some people. get relief from getting allergy shots which help them develop tolerance to the allergens. But if you have asthma, the medications used to treat it are different than what you would use for allergies.

Which medications are used for managing asthma?

The three most common categories of medications used to manage asthma are:

  1. Beta-agonists: This category includes the commonly prescribed medication albuterol. Albuterol starts to have an effect within minutes and is therefore often known as the "Rescue Inhaler". It is called short-acting because it starts to wear off within 6 or so hours. There are also long-acting beta-agonists lasting 12-24 hours which are often used as an addition to albuterol for those with moderate to severe asthma. These should never be used as the only medication for asthma treatment and are not considered a "Rescue Inhaler" for when you are trying to stop or improve a severe asthma attack.
  2. Anticholinergics: This category includes ipratropium which helps relax the muscles in the lungs.
  3. Corticosteroids: Commonly known as steroids, they help to decrease inflammation of the airways. For people with persistent asthma, being on inhaled corticosteroids is associated with a decrease in the frequency and severity of asthma symptoms which leads to an improvement in the ability to function and carry out normal activities. On the contrary, coming off of inhaled steroids is associated with a worsening of asthma.

There are several other types of medications used to treat asthma for longer-term or harder-to-treat asthma but these are much less commonly used than the three categories above.

How do I know if I have asthma if I have not already been diagnosed with it?

The diagnosis of asthma is usually initially made by a good history. There are several physical exam findings and tests that can also be used to confirm the diagnosis. On occasion, it may be necessary to get blood work or pulmonary function testing done. Sometimes, the signs and symptoms might suggest other causes that require a different type of work-up. Examples include X-rays, Echocardiograms, or CT-scans for concerns about pneumonia, cancer, blood clots in the lungs, or heart failure.

If you are having symptoms you think might be asthma, get seen by a doctor for an evaluation. The most common types of doctors who can help you make the diagnosis are primary care doctors, pediatricians, urgent care and emergency doctors, and lung specialists(pulmonologists).

Can I be seen by an online doctor for managing asthma?

Yes. While it may be better to be seen in-person if you do not already have a diagnosis of asthma, seeing an online doctor can get a good history about your symptoms which is the most important part of making the diagnosis. The online doctor can also help determine if it the symptoms might be due to some other causes. With some telemedicine services, such as ours at Care on Location, any initial labs, x-rays, and other tests can also be started, depending on the patient's location.

A telemedicine service can also help you determine if you might have persistent asthma and whether or not you might benefit from being on an inhaled corticosteroid. If you would, the medical provider can send it over to a pharmacy of your choice.

When should I consider going to the Urgent Care or ER rather than waiting for an appointment or getting seen online?

Here are some of the reasons you should get seen as soon as possible:

  • You have a history of asthma and the rescue inhaler or nebulizer treatment is not working after it normally would(usually 1 or 2 puffs or nebulizations)
  • You are unable to speak in full sentences
  • Confusion or passing out
  • Persistent symptoms even at complete rest, without exerting yourself at all.
  • Skin turning blue, white, or gray
  • New or concerning symptoms

Telemedicine tune-up visits can help keep you healthy

Whether it is allergies or something else that has your asthma flaring up, a medical visit can help make sure you are on the right treatment track and managing your asthma appropriately. Don't wait until things get worse. The worse it gets, the harder it becomes to treat, and your risk of an ER visit or hospitalization increases. Go to our appointment scheduler now.

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