Struggling For Air

Asthma affects about 2.4 million Canadians. Although the majority of asthma cases are diagnosed in children, rates in adults have been increasing for years. The reasons for this are not yet clear, but multiple factors are likely at play.

What is adult asthma?

“Adult-onset asthma” is defined as asthma that begins once someone is beyond their teens. The most common symptom is difficulty breathing. The most obvious difference between childhood asthma and adult-onset asthma is age of onset.

Adult-onset asthma also tends to be more severe, progresses more quickly (lung function deteriorates more quickly), and has more persistent symptoms. Although allergies are an underlying issue in many adult asthma cases, it is less common than among children.

Inside the lungs of someone with asthma, airways suffer from one or more of inflammation, increased mucus production, and spasms. These events cause the airways to narrow, making it harder to breathe.

Symptoms

• shortness of breath
• wheezing
• coughing
• tightness in the chest
• In severe cases, the inability to breathe properly can be fatal.

Risk factors

Many factors are believed to increase the risk of adult-onset asthma, including the following.

Gender

Women are more likely to develop asthma than men. Although the reasons are not entirely understood, hormonal changes have been shown to affect lung function in women, and women with asthma can experience fluctuations in symptoms with their menstrual cycle.

Women with a history of long-term estrogen use have been shown to have an increased risk for adult-onset asthma. Pregnancy and menopause have also been associated with changes in lung function and correlate with the onset of asthma symptoms in some women.

Childhood abuse, domestic or sexual violence

Children exposed to regular physical or psychological abuse have been shown to have a higher risk of asthma as adults. The risk of asthma for all members of a household has been shown to increase in a home where domestic violence is present.

A survey of US women found a significant increase in risk of asthma episodes among women who reported a history of sexual violence. These are just a few of the links that have been made between adult-onset asthma and a history of abuse.

Psychological stress

Stress is thought to increase the reactiveness of airways to airborne irritants, which could play a role in both causing asthma and aggravating existing asthma. In a study of more than 9,700 adults, increased perceived stress was associated with an increased risk of adult-onset asthma diagnosis.

The risk of hospitalization due to asthma as well as the amount of medication used to treat asthma occurrences were also shown to increase with higher psychological stress.

Workplace environment

A 2012 study of British Columbians found that workers regularly exposed to wood dust or animals were more likely to develop asthma symptoms. Damp and moldy workplaces have also been linked to increased risk of adult-onset asthma.

Second-hand smoke

There is about a two-fold increase in asthma risk for adults exposed to second-hand smoke compared to those not regularly exposed to smoke. However, in one study of those with a genetic predisposition to asthma (a parent with asthma), the risk of asthma was found to increase more than 12-fold when they were exposed to second-hand smoke.

Air pollution

Separate studies have linked both traffic pollution and frequent use of indoor cleaning sprays to an increased risk of adult-onset asthma. Second-hand smoke has also been linked to increased asthma-related hospital admissions.

Vitamin D

Having insufficient vitamin D levels is associated with severe symptoms for asthma patients. Lower vitamin D levels are also associated with decreased response to steroids used in the treatment of asthma.

Triggers

Asthma symptoms can be triggered by many factors. Among the most common are pollution, scented products, weather changes, and stress. Exercise, infections, and allergies are also culprits for some people.

Scented products

Up to 30 percent of people report that they experience adverse health effects or irritation from scented products. Exposure to perfume has been shown to increase the body’s release of histamine, one of the main chemicals contributing to allergy and asthma symptoms. Among individuals with respiratory symptoms related to perfume, this histamine release appears to be even greater.

Allergens

Allergens that trigger asthma symptoms are commonly those that can trigger hay fever symptoms in others. These can include animal dander, dust mites, mold, and pollen. Increased pollen counts have been linked to increased asthma-related hospital admissions.

Pollution, smoke, stress

These risk factors are also associated with increased hospital admissions for asthma symptoms.

Treatments

Prescription medications

The standard approach to asthma involves two categories of medications: those that are preventive (for long-term control of symptoms) and those that are used when symptoms occur (sometimes called “rescue medications”).

Most asthma medications are inhaled and dispensed using “puffers” that allow asthmatics to release and inhale small amounts of medicine into their airways.

Preventive medications are taken daily and are more focused on controlling chronic airway inflammation. Inhaled steroids are a common example.

Rescue medications (bronchodilators) are aimed at immediately relieving symptoms and help to relax muscle spasms in the airways. They are used only as needed.

Psychological interventions

Preliminary research shows that interventions that could offer some benefit for asthma symptoms, particularly when stress and/or abuse are part of an individual’s history, include

• relaxation therapy
• biofeedback
• cognitive behavioural therapy

Trigger avoidance

Avoiding triggers such as enclosed areas where particulate matter may be high, not smoking, and using HEPA (high efficiency particulate air) filters in the home help prevent asthma episodes.

Supplements

While not a replacement for standard medical care, some nutrients may be helpful additions to asthma management. Examples of potentially useful supplements include vitamin C, magnesium, and essential fatty acids.

Vitamin C: For those with exercise-induced asthma, increased vitamin C intake may have some protective effect. For those using inhaled steroids as part of their asthma treatment, some evidence suggests that vitamin C may help to offset side effects of steroids, as well as decrease the dose required for positive effects.

Magnesium: Magnesium is frequently used by natural health practitioners to help relax muscle spasms, such as those occurring in asthmatic airways. In a study of adult asthmatics, six and a half months of magnesium supplementation was associated with improved asthma control and reduced reactivity of airways, compared to placebo.

Fish oil: The potential for fatty acids found in fish oil to reduce inflammation has also made fish oil supplements of interest in the natural treatment of asthma. In a small study of adults with exercise-induced asthma, three weeks of supplementation with fish oil was shown to significantly improve symptoms.

Frequent dietary fish intake (at least weekly) has also been correlated with fewer reported asthma symptoms in adults. At least one study has also reported decreased use of asthma rescue medication in those using a combination of gamma-linolenic acid (GLA) and eicosapentaenoic acid (EPA) daily over four weeks.

Asthma by the numbers

• 50%: the estimated increase in worldwide asthma rates every 10 years, particularly in adults
• 500: the number of adults in Canada who die from asthma-related complications each year
• 80%: the percentage of asthma deaths each year that could be prevented with proper education and management of symptoms
• 60: the estimated percentage of asthmatics in Canada who do not have their condition properly controlled