What makes asthma suddenly worse?

Asthma is a chronic disease that causes inflammation and narrowing of the airways in the lungs. The airway narrowing leads to wheezing, shortness of breath, chest tightness, and coughing. For most people with asthma, these symptoms are mild and can be managed with proper treatment and avoidance of triggers. However, sometimes asthma symptoms can suddenly worsen, leading to an asthma attack or exacerbation. Understanding what causes asthma to flare up can help people be prepared to treat symptoms quickly and prevent severe exacerbations.

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Common Triggers of Asthma Attacks

There are many potential triggers that can cause asthma symptoms to suddenly worsen. The most common triggers include:

Respiratory infections – Colds, flu, sinus infections, and other viruses are a major cause of asthma exacerbations. The infection causes increased inflammation and mucus production in the airways.

Allergens – Allergens like pollen, dust mites, mold, pet dander, and cockroach droppings can trigger the immune system and inflame the airways. Seasonal allergies are a frequent cause of asthma flares.
Irritants – Chemical irritants like smoke, air pollution, strong odors (perfumes, cleaning products), and cold, dry air can cause asthma symptoms.
Weather changes – Some people’s asthma worsens with changes in weather and humidity. Sudden temperature drops or thunderstorms with high winds can trigger asthma.

Exercise – Physical activity causes rapid breathing which can lead to airway narrowing in people with asthma. This is called exercise-induced asthma.
Emotions and stress – Strong emotions like anger, excitement, laughter, crying, and stress can alter breathing patterns and cause asthma symptoms.
Medications – Some medications like aspirin and NSAIDs, beta blockers, and certain arthritis medications can trigger asthma symptoms in sensitive individuals.

In many cases, people are aware of their own specific triggers based on past asthma attacks. However, even with good control of known triggers, asthma can still unexpectedly flare up.

Why Asthma Symptoms Can Suddenly Worsen

There are several reasons why asthma may suddenly worsen even with proper management:

Exposure to a new allergen or irritant – Coming into contact with an allergen or chemical irritant that a person has not been exposed to previously can trigger a sudden asthma attack. Examples include getting a new pet with dander the person is allergic to or walking through a building with strong paint fumes.

Not taking control medications properly – People who take daily controller medications like inhaled corticosteroids can have sudden asthma flares if they stop taking medication or reduce the dosage without consulting their doctor.
Aspirin and NSAIDs – People with aspirin-sensitive asthma can experience sudden and severe exacerbations shortly after taking aspirin or NSAID medications like ibuprofen.
Severe stress or intense emotions – High levels of stress or laughing/crying forcefully can alter breathing and trigger asthma even without exposure to other triggers.

Hormonal changes – Changes in hormones just before or during a woman’s menstrual cycle or during pregnancy can worsen asthma.
Gastroesophageal reflux disease (GERD) – Stomach acid backing up into the esophagus can cause asthma symptoms, especially at night.
Anxiety or panic attacks – Feeling anxious and having a panic attack with rapid, shallow breathing can mimic or trigger an asthma attack.

Unknown triggers or causes – In some cases, the trigger causing an asthma exacerbation is not easily identified. Even with a good action plan, asthma can still unpredictably worsen.

How to Tell if Asthma is Worsening

The early signs that asthma is worsening include:

Increase in common asthma symptoms – more frequent coughing, wheezing, chest tightness, or shortness of breath

Asthma symptoms at night – waking up with coughing, chest tightness, or wheezing
Increase in using quick relief inhaler medication to control symptoms
Peak flow meter readings decreasing by 15% or more from personal best level

Difficulty doing usual activities due to asthma symptoms

Paying attention to small increases in symptoms and medicating appropriately can prevent asthma from becoming severely exacerbated. Monitoring with a peak flow meter can also help determine if asthma is worsening before symptoms become obvious. Severe exacerbations require immediate medical treatment, so early intervention is key.

What to Do for a Sudden Asthma Flare Up

If asthma suddenly worsens, prompt action is needed to gain control before a severe and potentially dangerous exacerbation develops. Tips for managing a flare include:

Use quick-relief inhaler (short-acting beta agonist) as prescribed – This includes albuterol, levalbuterol, and pirbuterol inhalers. Using a spacer improves delivery.
Remove any potential triggers if known – For example, move indoors during pollen or pollution exposure.
Sit upright and try to stay calm – Use pursed lip breathing and relax as anxiety can worsen symptoms.

Drink plenty of fluids – Stay well-hydrated, especially if cough and mucus production increase.
If using a peak flow meter, monitor readings – Readings below 50% of personal best indicate a medical alert.
Follow asthma action plan – Adjust medications per written instructions if asthma is not improving.

Seek medical help promptly if necessary – Call doctor right away if symptoms are unimproved or get worse.
Get emergency care for signs of a severe attack – Difficulty speaking, blue lips or fingernails, drowsiness, or severe shortness of breath signal an emergency.

Having an individualized written asthma action plan prepared by a doctor helps guide treatment of worsening symptoms. Without improvement, escalation of care should not be delayed.

Preventing Future Asthma Flare Ups

While some exacerbations seem to come out of the blue, many can be prevented by identifying and controlling asthma triggers. Ways to reduce flare ups include:

Take control medications as prescribed – Inhaled corticosteroids, long-acting bronchodilators, biologics, and/or oral leukotriene modifiers help prevent symptoms.
Get recommended vaccines – Pneumonia and annual flu vaccines lower infection risk.

Avoid known allergens or irritants – Consider allergy testing and immunotherapy treatment if needed.
Use bronchodilator before exercise – Pre-treat with inhaler 15 minutes before physical activity.
Monitor air quality and pollen counts – Limit outdoor exposure during high pollution or pollen days.

Maintain healthy lifestyle – Eat a balanced diet, exercise regularly, reduce stress, and get enough sleep.
Treat sinus infections promptly – See a doctor for antibiotic treatment if needed to clear sinus congestion.
Manage GERD if present – Avoid trigger foods, eat smaller meals, and take medications to reduce reflux.

Avoid smoking and secondhand smoke – Smoking and vaping worsen asthma.
Carry rescue inhaler – Have medication available at first sign of symptoms worsening.

Despite best efforts, asthma attacks will still occur in some people. Having an asthma action plan ensures the ability to act quickly when symptoms flare up to gain rapid control and prevent hospitalization.

When to See an Asthma Specialist

Consulting with an asthma specialist may be beneficial if you:

Need to use quick relief inhaler more than 2 days a week
Wake up with asthma symptoms more than twice a month

Have asthma symptoms while taking control medication
Have had a life-threatening asthma attack
Have asthma attacks affecting quality of life and ability to work/attend school

Have other medical conditions like sinusitis or reflux that may worsen asthma
Need to go to urgent care or the ER for asthma flares multiple times a year
Miss more than 3 days of work/school a year due to asthma

Asthma and allergy specialists have extensive experience managing difficult-to-control asthma cases. They can perform specialized breathing and allergy tests to better identify triggers and select optimal therapy. Research shows people treated by specialists have better symptom control and improved quality of life.

Emergency Warning Signs of a Severe Asthma Attack

Severe asthma exacerbations are potentially life threatening and require emergency treatment. Go to the emergency room or call 911 immediately if you or someone you know with asthma has:

Very rapid breathing and inability to catch breath

Chest retractions – skin sucked in under ribs or collar bone during breaths
Hunched forward posture trying to breathe easier
Trouble walking or talking due to shortness of breath

Lips or fingernails turning blue or gray
Confusion, drowsiness, or loss of consciousness
Peak flow meter reading below 150

No improvement despite initial rescue inhaler use

Waiting too long for care when asthma is severely worsening can be fatal. Immediately get help by calling emergency services, seeing a doctor right away, or going to the nearest emergency room.

Key Takeaways

Common triggers like infections, allergens, weather changes, and irritants can suddenly worsen asthma control.

New exposures, inadequate medications, underlying conditions, and unknown factors also may unexpectedly exacerbate asthma.
Increasing asthma symptoms, night waking, more medication use, and reduced peak flow signal worsening asthma.
Use a quick relief inhaler, avoid triggers, and follow an action plan when asthma flares up.

Make sure to seek emergency care if asthma continues to severely worsen and initial treatment is ineffective.
Preventing attacks involves trigger avoidance, control medication adherence, managing underlying conditions, and maintaining a healthy lifestyle.
Seeing an asthma specialist can help gain control if your symptoms are not well managed with standard treatments.

The Bottom Line

Asthma is an unpredictable disease and periodic worsening of symptoms often occurs even with proper management. Paying attention for early signs of deterioration and acting promptly to increase treatment can prevent asthma exacerbations from becoming emergencies. Understanding your own specific triggers and being ready to remove yourself from exposure is also key for gaining rapid control when asthma unexpectedly worsens. Working closely with your primary care doctor and asthma specialist ensures you have the necessary medications, knowledge, and plans in place to resume your normal activities quickly after a flare up.