Am I doomed?

November 5, 2009 2:01 PM

Does asthma always get worse over time?

I had bronchial asthma that went undiagnosed for 20 years despite many trips to many different specialists all of whom told me I did not have asthma. Guess what? I did! It was bronchial tho, and apparently, it doesn't manifest as wheezing, but in a chronic cough. Anyway, It got diagnosed 3 years ago. At the time, I had 68% lung capacity. Last week I was tested again and I was significantly worse. The doctor said it was because I wasn't using the right inhaler (because another doctor told me not to use it). Anyway, the new inhaler is great, works good, but, my question is this: Does asthma ALWAYS get worse over time? Can you keep your lungs at the same level, or, is it just the nature of the disease that it gets worse over time, and eventually, I'll need more steroids, more emergency inhalers, etc.

Secondly, is it bad to be exposed to allergens that trigger the inflammation over a long period? I mean my cats. I thought I could "tough it out" with them, until my latest tests showed a 20% decline in my lung function results. Now, I'm wondering, will this constant exposure, even WITH the steroids, antihistamines, inhalers, allergy pills, etc, be damaging over time?

Also, would it be better for me to live in better air? I live in Pasadena, CA, bad air quality. But my lung doc has never mentioned this could make it worse.

posted by generic230 to health & fitness (20 comments total)

I have allergy induced asthma, which isn't fully the same as yours, but I'll share my experience. Maybe it will help. Usual disclaimers apply, YMMV, IANYD, and so on.

I'm pretty severely allergic to most green things, and so suffer through spring and summer on a combination of treatments and their attendant side effects. Some of my symptoms have gotten worse, some better - but asthma isn't one of them. Or at least it's not noticeably changed.

I would imagine that it is possible for a chronic cough to cause damage and permanently diminish lung capacity. That said, I'd think that it's fairly rare - but IANAD.

From what I am told, it's not the best thing in the world to be exposed to allergen all of the time. It won't kill you, just make you miserable - which has it's own deleterious effects. So, between that and side effects from drugs to treat the symptoms it is generally best to avoid allergens if possible, but you don't, strictly speaking, have to.

I have found that by staying in some sort of decent shape that the asthma attacks are not as severe and my recovery from them is faster than when I am more sedentary. So I try to exercise more regularly.
posted by Pogo_Fuzzybutt at 2:20 PM on November 5

I guess all I can say is "not necessarily." I've asthma, allergies to enough things that saying "everything" is easiest, and lungs ravaged by lung infections that I catch way too easily -- but the severity of all of it varies wildly over time. In my ~38 years, there's been steady/severe (childhood) , sudden severe (mid-college, early 30s), near non-existence (late 20s, mid-teens), the current gradual trend of worsening, and steady/seasonal everywhere else. My lung capacity doesn't seem to indicate much of anything -- the only times I can remember it suddenly dropping were during lung infections (so I'd be at least concerned about that drop of yours).

There's plenty of "hacks" to breath better... do some research and try some. Nasal strips, vaporizers, neti pots and air cleaners are all things I use now that seem to help some; sticking my head in freezers, standing in bathrooms with the shower on full all-hot for hot steam, and every inhaler known to man are things I've used in the past that don't seem to help anymore. Your mileage will definitely vary!

Oh, and the cat thing... I've a bad cat allergy, and I have three cats. I'm ok with it as long as I'm careful: if I forget to take a Claritin one night, or let them get to my pillows even when I do, then I wake up feeling like I was hit by a convoy of trucks. Because they're cats, of course, this only makes them want to get to my pillows even more.
posted by Pufferish at 3:07 PM on November 5

I have allergies and asthma. My asthma is mostly allergy-induced, partly congenital. Here's what I have found: with allergy shots, maintenance medications, and proper allergen reduction, my lung capacity has gotten better. Now, I had allergy shots for about three years, and I still have to have allergy meds during certain times of the year. I also have to "up" my Advair dose in the fall and winter. My allergen triggers are dust and cats. We ripped up all the carpets, have very few curtains (and the ones we have can be washed), we wash all the bed linens regularly in and very hot water, and we had the ducts in our house cleaned (because they hadn't been cleaned since the house was built in 1965). We also have four cats. We had the cats before my allergies were diagnosed and we wanted to make sure we did everything we could to reduce their impact on me before we were reduced to finding them new homes. We rub them down with this stuff and it seems to work really well.

Because I have the congenital aspect of the asthma, I won't be able to ever live medication-free. But there are times of the year I can be on very low doses. My lung capacity now is much, much better than it was when we didn't know why I couldn't breathe. My peak flow is back in the normal range, where before I was in the red zone all the time.
posted by cooker girl at 3:08 PM on November 5

I had diagnosed chronic, severe asthma. Congenital, allergy and exercise induced. I have been in the ICU 8 times in my lifetime. I was on steroids, had a machine inhaler and learned to inject myself with epinephrine so I didn't have to go to the hospital so often.

I also have not had to use any medication in the last 8 years (I'm 38) nor have I had any asthma symptoms other than when I am in a room with a massively shedding cat. It can go into a remission. I am just one piece of anecdata but there it is.
posted by Sophie1 at 3:18 PM on November 5

My father's asthma went away. Mine got better after college and then was much worse when I moved to a (moldy!) tropical island (I stayed on Symbicort and that kept it under control), and is now better (almost no meds) now that I'm back. My lung capacity has never improved, however.
posted by ropeladder at 3:58 PM on November 5

I've been diagnosed with exercise-induced asthma (as well as a boatload of allergies) since I was about 8 or so. Just this past summer, I went in to see a specialist, which I hadn't done in 10 years or so, and my lung capacity was actually better than the average female my age and race. I solely attribute that to the fact that I'd started an exercise regimen, though. Also, I was no longer allergic to cats and dogs... an absolute blessing, as I'm quite the animal lover. (I actually got two cats when I thought I was still allergic to them.)

Bottom line is, your body will change with time. You may not always be allergic to the same things, and your lungs may not always function in the same way. If you don't already, however, I'd start some sort of exercise program to get your lungs as fit as they can be. In my case, it was rather hard as I'd have to take bursts of my inhaler virtually every time I'd exercise, but it got easier the fitter my lungs became.

If you're allergic to your cats, I'd recommend banning them from your bed and bedroom, at least. And if you're allergic to cats, I'm going to guess that you're going to be allergic to dust mites, as many folks with allergies are. I got mattress covers and allergy resistant pillows to help control the mites and their allergic poo particles.

OR... if you get desperate, I just heard this topic on the RadioLab podcast mp3 about parasites. The segment related to this man's struggle with asthma/allergies and the hookworms that cured him is very interesting to me, though I did get quite queasy when I thought about actually doing something like that.
posted by asranixon at 4:08 PM on November 5 [1 favorite]

Yeah, everything's kind of a crap shoot. Some? allergists believe nowadays that if you get shots for X period (and I am unclear on exactly how long this period is) that you can supposedly 'cure' or definitely improve your response to the allergens - permanently - as a result of having had the shots. Mine believes that some people improve as a result of them, and others will always need them.

Then you've got the theories they're tossing around now about how possibly keeping kids free from anything possibly allergenic as kids can cause them to develop allergies whereas possibly exposing them to environmental allergens at a young age might prevent them from becoming sensitized to them.

I've been on allergy shots since I was 4 years old and am in the 30's now; I went off them once when I was in my 20's to see what would happen, and I was miserable for a year. I also had moderate asthma as a kid, which for whatever reason has gone away about 95%. (Of course, I now have a litany of other health ailments, but at least not that one). Also of note, I used to be much more allergic to animals, and now I am not very allergic to them at all. But I didn't grow up with any pet of any kind, didn't live on/near a farm. Now I have cats, but I certainly would never have gotten them if I was allergic. Many people say that they can tolerate their cats except for x/y conditions, or some kind of cats with z hair length, etc etc. I know you can wash them with different kinds of anti-allergen gloves periodically that are available from pet stores. But on the other hand, the people who have bad allergy to cats that I know have some of the worst allergic response I've seen to anything that is considered a typical airborne allergy... they walk into a room where cats live and within 30 seconds have tearing eyes and/or can't breathe.

Another thing you might consider is diet. I haven't looked into it to carefully, but (clear-cut food allergy notwithstanding), I have heard some folks talking about how different kinds of diets might affect allergic/asthmatic response.

as Pogo and pufferish say, being in better shape helps, and YMMV on therapeutic tools.
posted by bitterkitten at 4:15 PM on November 5

I was diagnosed with adult onset asthma at the age of 27, and for years it was inhalers, steroids, and hospital stays. 15 years later, I can get by with one rescue inhaler and careful assessment of my breathing when I exercise - I also try to avoid the things that make me wheeze (certain perfumes and second hand smoke).

So, in my case, it got better rather than worse. I changed my diet radically to get rid of my GERD and that seemed to help a lot. Some say it's connected, but I dunno - it worked for me.
posted by patheral at 5:15 PM on November 5

I was diagnosed with Asthma at about 22yo. 5 years later, we pulled out all the wall-to-wall carpets, and had wooden floors. Not had Asthma since then (38 yo now - and no medication at all).

Everyone is different though...
posted by lundman at 5:33 PM on November 5

When I am regularly getting more exercise, I find that my asthma is generally less of a problem. Caffeine exacerbates my asthma. I've been putting hyssop in a lot of my teas lately, and it has actually seemed helpful. So it seems to me that there are factors other than age that play into how bad the asthma is than age.

It seems like geographical location makes a difference. Here is a pollen and mold count map that seems interesting.

Also: We're all doomed (;
good luck!
posted by aniola at 6:46 PM on November 5

Asthma all of my 43 years and it's gotten better. Getting in shape really helps. When I raced road bicycles and was in amazing cardiovascular shape, I never had attacks. Now Advair almost totally eliminates all attacks.

Control your allergies and get in shape and you'll see a huge difference.
posted by DieHipsterDie at 6:48 PM on November 5

As you have seen from the above answers, there is no simple one-size-fits-all rule about asthma. I am approaching 70 years of age with a life-long history of asthma. What I am about to say probably does not describe you. That said, it gives a direction you should follow. I was having chronic asthma problems with serious coughing that was worse during the two pollen seasons each year. My GP kept helping me with different medications and approaches to my problem. I went to a pulmonologist who sent me on to a cardiologist who sent me to the surgeon who replaced the Mitral Valve in my heart. My cough disappeared and my asthma symptoms diminished.

Am I suggesting you need heart surgery? NO.

I am suggesting that you need the kind of comprehensive whole-body approach that starts with a complete physical. Also, since I assume you are dealing with a specialist now, you need to discuss with that specialist whether there could be other aspects of your overall health that are impacting upon your asthma.

I'm guessing you already know the answer to your question about allergens. Anything you do to aggravate your symptoms is bad for you. Anything you take for those symptoms is an effort to overcome the bad things you have already done. Kind of a vicious cycle. That said, we all make choices. If the cats are important to you and you can make adjustments to accommodate them, more power to you. We have three indoor dogs, numerous barn cats and several equines. I have made the adjustments to be able to coexist with them all.

Best wishes.
posted by Old Geezer at 8:39 PM on November 5

A side note: lung function is a very dynamic thing. Once you get on the right medication, right lifestyle, etc., your lung function will probably return to normal in a few weeks (100% for the "average" person). If you're exposed to triggers or stop your medication, it can deteriorate in a matter of days or weeks.

One long-term effect of untreated or undertreated asthma is airway remodeling, in which chronically constricted parts of your lung will just shut down. When that happens, it's forever, and your condition gets a new name: COPD.

The clinical picture of asthma has changed a lot in recent years, and is still changing. I'm not a doctor and don't have asthma, but I know two things:
1) To manage asthma, you will need to make lifestyle adjustments to avoid your triggers.
2) It is possible for you to feel great nearly all of the time, for you to avoid any long-term effects on your lungs, and to stay out of the ER. You just need some discipline, a good doctor and a good plan.
posted by hammurderer at 8:40 PM on November 5

Geography definitely matters.

I had no asthma as a kid growing up in CO, but after I moved to SF a host of new allergens/getting a bit older/who knows meant that I started having a chronic cough, which after a couple years was also diagnosed as asthma. After trying a bunch of steroid inhalers, I tried singulair which worked great for me for several years. Most of the decade I lived in CA was fine.

Then I moved to Boston, and something awful grows here. Several somethings awful, I think, giving the timing. I've been back on steroids as well as the singulair, but I don't need the steroids for more than a couple weeks during the bad times (June, and right now).

So basically there's plenty of things that can make it worse, or better. It doesn't always get worse with time, it doesn't always get better. If you're really interested in tracking it, get your own peak flow meter and see how various changes help (e.g. if you're away from the cats for a few days, are you suddenly more healthy? Is your peak flow noticeably worse when the air is particularly bad? If you're good about getting more exercise for a week, what happens?etc..)
posted by nat at 8:55 PM on November 5

I had asthma as a kid; I never had attacks, but it manifested in other ways, such as coughing and breathlessness. I used to have a hard time exercising. Over the years I kept going to gym class :) and started getting involved in physical activity and athletics, basically acting like I didn't have asthma. I stopped taking albuterol and eventually stopped taking the other meds, too. Now I just notice it when the air quality is bad (there's a meter you can check online) or if it's really cold.

So, yes, it can go away, or at least become much less of a problem. Constant exposure to allergens could be part of the issue in your case. I had allergy problems, too, but after spending some time away from the allergens I can now be around them without a problem. ymmv.

My life is a lot less emotionally stressful than it was when these were problems for me -- maybe something to consider?
posted by ramenopres at 9:01 PM on November 5

Re: environment. When I got sick while visiting a very dirty city, I started coughing and didn't stop. That's normal even in my hometown, but this was extreme. Eventually I tracked down a generic version of the powerful steroid I had taken as a kid in emergencies. When I moved to a cleaner city, the coughing stopped. Environment definitely, definitely makes a difference, and I have a suspicion that, while some things will set everyone off to some degree, certain locations will affect certain people more severely.
posted by ramenopres at 9:05 PM on November 5

Asthma does not always get worse over time. My story is a little like Sophie1's, although I'm neither allergic nor exercise-induced. And I know my lung functions now are better (some days, better than normal), as opposed to 18 years ago. I still take Advair, use a PRN inhaler when I need it (which is not very often) and have a pretty rigorous sinus care routine. But compared to how I used to be, I am symptom-free.

The three biggest things that changed my asthma:

-Learning to take control of it as a kid
-Advair (started back when you had to take the two components separately)
-More recently, regular exercise that forced me to breathe deeply. Those things may or may not work for you.

A few things you might pay attention to/investigate:

1) Find out if you react negatively to aspirin. Some asthmatics are sensitive to it, and you may be. Learn to take something else, if you are.

2) Do you have sinus problems? Frequent sinus infections? Some asthmatics have what's called triad asthma. Learning how to treat the other things that go with asthma can have a dramatic impact on your ability to breathe.

3) Find a good pulmonologist. Lots of GPs now are pretty good with asthma, but someone who really knows what's up will help. Along those lines, you might try to find a good allergist, who can help you identify triggers.


I'm sorry you've been diagnosed with it. In lots of ways, we (well, some people) minimize asthma as a disease, but a bad attack can be one of the scariest things you'll experience.
posted by Gorgik at 11:21 PM on November 5

The Buteyko treatment just got some press in the NY Times. I had never heard of it before.

http://www.nytimes.com/2009/11/03/health/03brod.html

From the article, it trains you to breathe differently. Breathe through the nose and not as deeply when short of breath. And breathe through the nose all the time: at rest, at play, and asleep. The problem with asthma attacks is not a lack of oxygen but too much carbon dioxide blown off. They also tell you to keep taking your asthma meds as you need them.

Anecdotally people are off their steroids at age 57.

http://www.buteykocenterusa.com/

They just opened in 2009 in Woodstock NY. Some clinical trials seem to have been done in Australia and England but I don't know where to look for the info not from a Buteyko provider.

This website gives more info on breathing technique, though he needs a new webdesign:

http://www.normalbreathing.com/index.php

He also uses some short-hand jargon that was hard for me to pick up at first but I now understand.

Hope this helps, and sorry if it doesn't apply to your situation. I don't have asthma but I'm always interested in drug-free solutions to medical problems.
posted by GregorWill at 11:53 PM on November 5

As near as anyone can tell, I came out of the womb with asthma. Many of my earliest memories involve not being able to breathe. My asthma was severe throughout childhood, but back in the 70s they didn't have the meds that they have now so it was much more of a crapshoot. As an adult, it's gotten better because a) way better medication and b) a better understanding of my own limitations. One limitation I refuse to accept is my allergy to fur bearing critters and so in order to survive with a houseful of animals (7 cats/1 dog) I take my medication like clockwork. I take Advair, which is awesome for me, Xopenex, Singulair and Zyrtec. Some days when nature is being particularly active, I take Benadryl too.

Your lung function doesn't necessarily have to get worse. I think that if I was in your position at the moment, I would aggressively medicate myself. What are your symptoms like? Are you constantly short of breath? Is your cough still present with your medication? Do you have other health issues besides the asthma?
posted by crankylex at 6:36 AM on November 6

FWIW, my asthma has improved significantly from when I was a kid (now in my mid-30s).
posted by Chrysostom at 7:37 AM on November 6