Breathing Room
Asthma may be common and chronic—but that doesn’t mean it isn’t serious, too.

By Alyson Black

If the rhythmic inhale-exhale pattern of life comes easily to you, consider yourself lucky: For more than 20 million Americans, the wheezing, coughing, shortness of breath, and chest tightness that define asthma often make breathing more of a chore than a natural process.

“You don’t need to have all of the symptoms,” says pulmonologist Robert Sussman, MD. “Any one symptom individually could be asthma. A lot of people are undiagnosed and are not getting treatment on a regular basis. Asthma is a common disease, but it is a serious disease. It needs to be treated.”

Common Causes

Asthma sufferers exhibit an inflammation of the lungs’ air passages, which results in a temporary narrowing of the airways. When this happens, it becomes difficult to breathe.

In fact, asthma is responsible for more than 2 million visits to hospital emergency rooms annually, and more than 5,000 people will die from asthma this year. Respiratory infections, common colds, and sinus infections are prime triggers of asthma attacks. In the summer, common spikes in asthma are often attributed to allergies: nearly 70 percent of asthmatics are allergic to grass, trees, or pollen; come fall, allergies to ragweed are to blame. Changes in weather can also have an effect. “When temperature changes, asthma tends to get worse—especially with cold weather,” explains Sussman. “During the first few colder days of fall, you’ll see more triggers.”

Year-round triggers include exposure to pets, dust mites, and roaches. Certain medications can make asthma worse, too; some asthmatics find their condition exacerbated by non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen. Beta blockers—used for hypertension and heart disease, but also in eye-drop form when prescribed for glaucoma—can worsen the condition, too.

Asthma & Exercise

As many as 85 percent of asthmatics find that their condition worsens with exercise. “But the fact that you may develop some asthma symptoms when you exercise is not a reason not to exercise,” says Sussman. “You just may need to treat your condition more aggressively. Exercise is beneficial in a lot of ways; we want people to exercise.”

Exercise-induced asthma (EIA), a respiratory difficulty that occurs a few minutes after the onset of aerobic exercise, is more common among children but affects people of all ages. Since those with EIA are not advised to avoid sports, it’s best to find alternatives that make it easier for asthmatics to manage their symptoms. Explains Michele Gilsenan, DO, program director of Overlook Hospital’s Primary Care Sports Medicine Fellowship, “EIA is more prevalent in winter-like weather and cold environments. Therefore, the athlete could avoid ice-skating sports or cross-country skiing. Or the athlete could do an anaerobic sport.”

For athletes who don’t want to give up on cold-weather sports, Gilsenan suggests other precautions. A longer warm-up period may do the trick, or an albuterol inhaler can be used 30 minutes beforehand as a pre-medication. Another option is to switch to nasal breathing. “The theory is that the air is warmed if it passes through the nostrils, and causes less chance of bronchospasm,” says Gilsenan.

Taking Control

For patients diagnosed with asthma, it is crucial to follow a medication regimen. Rescue inhalers are critical for coping with sudden-onset symptoms, but these fail to treat the cause of the symptoms: inflammation. “Using a rescue inhaler will make you feel better temporarily, but the underlying inflammation is actually getting worse,” explains Sussman. “You need to treat the cause, not just the symptoms.”

To that end, Sussman reports that many of today’s medications are effective agents in preventing inflammation and creating improved quality of life. “Unfortunately,” he says, “people often take their medicine for short periods of time, feel better, and stop. Non-compliance of medication is the single-most cause of asthma attacks and death.

“We have such incredibly good medication for asthma—much better than we had 10 or 15 years ago—but patients have to go to their doctor to be treated and continue to be treated. Asthma does fluctuate: What works for someone today may not be enough or may be too much six months from now. It is important for patients to understand that asthma is a chronic disease. It’s always there—there’s no curing it—but you can control it.”

Vital Signs

If your child complains of any of these symptoms—or if you notice them yourself—discuss this with your pediatrician. Your child may have asthma.

• Increased shortness of breath


• Coughing during activity, while laughing, or at night


• Difficulty exercising, not being able to keep up with other kids, or less energy during play


• Wheezing or whistling sounds


• Tiredness, or dark circles under the eyes


• Frequent headaches


• Waking at night with symptoms

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Overlook Hospital has been recognized as a Pulmonary Center of Excellence. For a referral to a pulmonologist, call (866) 470-4812.