Is Asthma An Autoimmune Disease: An Overview

What is asthma?

Asthma is a chronic condition in which your airways (bronchial tubes) swell, resulting in constriction (narrowing). These tubes are the passages that allow air in and out of your lungs. So, when they tighten, it causes breathing difficulties.

According to the World Health Organization (WHO), an estimated 262 million people around the world have asthma.¹

For some individuals, asthma is a mild condition, and for others, it can be life-threatening.²

Often, asthma is categorized as either allergic or non-allergic.³

This distinction means that asthma may be set off by external allergic factors. For example, exposure to pollen, air pollution, fragrances, mold, or dust.⁴

Or, asthma may be triggered by non-allergic, internal factors,  such as heightened stress, viral infections, exercise, or breathing cold, dry air.⁴

The Asthma and Allergy Foundation of America reports that approximately 60% of individuals with asthma have an allergic form of asthma.⁵

During any allergic response, your immune system activates because it detects something foreign and potentially harmful.

Then, your body’s defenses release an antibody called immunoglobulin E (IgE).⁵

For individuals with asthma, excessive amounts of IgE will inflame the airways and can trigger an asthma attack.⁵

So, this connection between immune system regulation and allergic asthma has prompted disease experts and researchers to question whether or not asthma could be a form of autoimmune disease (in which the immune system attacks healthy cells).

However, at this time, specialists still classify asthma as an inflammatory condition, not an autoimmune disease. Here is an overview of what scientists currently understand about asthma.⁶

Symptoms and causes of asthma

Asthma symptoms generally include shortness of breath, a feeling of tightness in the chest, coughing, and wheezing.

Symptoms can come and go, often becoming worse at night or during physical activity.⁷ ⁸

Asthma can be triggered by viral infections, cleaning agents, and a variety of airborne allergens, like tree pollen.⁴

During an asthma attack, the muscles around the airways tighten, and their lining (epithelium) swells and fills with mucus.

Some liken experiencing an asthma attack to trying to breathe through a straw. In other words, when asthma flares up, breathing becomes extremely difficult.⁹

Researchers are still working to understand all the factors that cause a person to develop asthma, but it is usually attributed to a combination of genetics and environmental factors.¹

Common forms of asthma and triggers

Regardless of the trigger, the characteristic irritation and swelling of the airways that occurs with all forms of asthma results in similar symptoms.²

What is autoimmunity?

Your immune system continuously protects you from threats like disease and infection. Autoimmunity is when your immune response goes wrong and causes immune system antibodies to do their job incorrectly.¹⁰

For example, instead of attacking a virus, autoantibodies attack healthy cells. What is an autoimmune disease? How does it differ from other diseases? An autoimmune disease is a disorder that makes one’s immune system incorrectly attack part of the body as though it were something foreign or threatening, like a harmful bacteria.

The risk of having an autoimmune disease increases if a genetic family member also has an autoimmune disorder.¹⁰

According to the Global Autoimmune Institute, there are over 80 known types of autoimmune diseases.¹¹

Common examples include:

• Alopecia areata, which causes hair loss

• Hashimoto’s disease, which attacks the thyroid gland

• Type 1 diabetes (T1D), which stops the pancreas from producing enough (or any) insulin¹¹

Autoimmune diseases aren’t yet curable, but individuals living with these examples of autoimmune disorders are often prescribed medications that improve their quality of life. For example, corticosteroids, synthetic thyroid hormones, or insulin.¹²

Autoimmune disorders are generally progressive, meaning symptoms tend to worsen over time.

However, emerging research shows it may eventually become possible to reprogram a malfunctioning immune system on a cellular level.¹³

In contrast, asthma is an inflammatory disease involving an overactive immune system.

Oftentimes with asthma, the immune system will go into overdrive from a trigger that is not inherently harmful, such as pollen or dust.

Whenever possible, avoiding asthma triggers, such as tobacco smoke, can measurably reduce asthma symptoms.

Unless undiagnosed and unmanaged, asthma is usually intermittent, meaning that it flares up and then gradually resolves in the absence of the trigger(s).

Some people find that childhood asthma improves in adulthood.¹⁴

It is generally agreed that asthma does not cause the immune system to attack healthy cells in the same way that a classic autoimmune disorder does.

However, researchers are still exploring the relationship between asthma and autoimmune responses in the lungs, especially in cases of severe asthma that is unresponsive to treatment.¹⁵

The findings of specific lung biopsies from severe asthmatics suggest complex autoimmune mechanisms may at least contribute to the severity of asthma symptoms.¹⁴

How is asthma treated?

Asthma isn’t curable, but with the help of a qualified healthcare professional, you can control and manage it effectively. The individualized treatment plan a doctor can help you create is your Asthma Action Plan.

A typical plan for managing asthma usually involves:

• Getting to know and avoid triggers

• Learning the warning signs of an asthma attack

• Identifying effective preventer and rescue medications

• Knowing when to seek emergency medical help

Common asthma inhaler types

Your doctor will help determine the best kind of inhaler for you. The ideal inhaler will be both easy to use and deliver rapid relief from your asthma symptoms.

Reliever inhalers

Reliever or “rescue” inhalers relieve symptoms quickly in the event of an asthma attack. Most people with asthma carry a reliever inhaler with them at all times.

Reliever inhalers contain a bronchodilator medication. It works by dilating  (opening) the airways.

Some reliever inhalers spray a metered (measured) dose, while others activate when you inhale strongly through the mouthpiece opening.

Preventer inhalers

Preventer inhalers deliver inhaled anti-inflammatory corticosteroids right to the lungs.

These drugs are long-acting and gradually reduce inflammation in the airways over time.

Your doctor will direct you on the frequency and dosage depending on how mild or severe your asthma symptoms are.

It’s vital to note that corticosteroid inhalers will not help or provide immediate relief if you are already having an asthma attack.¹⁶

Taken as directed, a preventer inhaler can help reduce reliance on your reliever inhaler and lead to fewer total asthma attacks.

Inhaled corticosteroids may also eliminate the need for high-dose oral steroids, which pose a greater risk of serious side effects, such as elevated blood sugar, weight gain, loss of bone density, and increased risk of infections. (Please consult your doctor for a complete list of potential side effects).¹⁷

Combination inhalers

Combination inhalers combine a preventer inhaler and a reliever inhaler. However, they are intended for use every day, not just when you have asthma symptoms. (You will likely still need to carry a fast-acting reliever inhaler).¹⁸

The bronchodilator in a combination inhaler is slower-acting, and these inhalers are typically used when corticosteroids alone are not fully controlling your asthma.

Putting both in one inhaler may make it easier to comply with your medication routine.

Injection medications for asthma

Omalizumab is sometimes prescribed for those with severe uncontrolled asthma who are unresponsive to inhaled steroid medications.¹⁹

This medication is a human monoclonal antibody (moAb) that gets injected under the skin.

This type of biologic drug is made in a laboratory and works to stimulate your immune system. It will bind to a specific receptor on cells in the lungs.¹⁹ ²⁰

Omalizumab is always given in a doctor's office the first time because it can induce a severe allergic reaction. You may be instructed on how to administer subsequent doses at home.

Benralizumab is a similar biologic drug used to treat eosinophilic asthma, which is characterized by high white blood cell count (eosinophils) in the lungs.²¹ ²²

Again, the first dose is typically given by a doctor, but you may be able to do subsequent injections at home with training.

Typically, you will be reassessed at least once a year to see if you need to continue treatment.

Take asthma medication as prescribed

If you have been prescribed asthma medication, take it exactly as directed.

Sometimes individuals with asthma don't comply with their treatment regimen and end up needing to use a rescue inhaler more often or having more acute symptoms.²³

Identifying asthma triggers

 A crucial step toward controlling asthma is identifying your triggers.

Most asthma patients are triggered by allergens, which may or may not be easy to stay away from. Exercise is also a common trigger.

Keeping a diary and making notes about your symptoms can help. You can also talk to your doctor about testing for common allergens.

A skin prick test (also known as a scratch test) will confirm whether or not you are allergic to certain substances, such as pet dander or pollen. Reduce your exposure to allergens as much as possible. This might mean staying inside on high pollen count days or not having pets.

If you cannot avoid an allergen, ask your doctor if wearing a mask is appropriate. Consider immunotherapy shots if you are allergic to something hard to control or prevent, such as dust mites.

Each allergy shot targets one particular allergen, reducing your allergic response and lowering the risk of an asthma attack brought on by that allergen.

Avoiding smoke

If you have asthma and smoke, talk to your doctor about developing a quit plan.

Avoid hanging out with people who smoke. Secondhand smoke, cooking smoke, wildfire smoke, and even traces of smoke on clothing can trigger asthma attacks.²⁴

Ask your doctor about effective ways to mitigate the effects of smoke, such as wearing a high-quality mask or using an air purifier indoors.

Allergy-proofing your home

Indoor allergens can be a significant trigger of asthma. Here are some suggestions from the Allergy and Asthma Foundation of America for allergy-proofing your home:

• Wash bedding regularly in hot water and tumble dry on high heat to kill dust mites

• Vacuum regularly

• Consider replacing carpet with hardwood or a low-pile carpet

• Replace curtains and blinds with roll-down shades. If you have curtains make sure they are washable

• Use an air purifier

• Cover pillows, mattresses, and box springs in allergen-resistant or plastic covers

• Wash stuffed toys in hot water and tumble dry on high heat

• Wear a mask while doing housework

• Reduce mold by using a dehumidifier and fixing plumbing leaks

Get vaccinated

Since asthma can sometimes be triggered by a viral infection, get all recommended vaccinations when you are due for them, including your annual flu shot.²⁵

When to visit a doctor

If you have asthma, aim to have routine check-ins with your doctor.

If the frequency or intensity of your asthma symptoms changes, or you need your rescue inhaler more than usual, contact your doctor. These changes may indicate that your medication type or dosage needs adjustment.

Always inform your doctor of times you experience a sudden asthma attack or if you’re unsure what triggered your asthma.

The lowdown

Asthma is an inflammatory condition, not an autoimmune disease, although there are some indications that some forms of asthma may have an autoimmune component. Asthma is caused mainly by your immune system overreacting, as happens with an allergic reaction. However, not all forms of asthma are allergic types.

There are many asthma subtypes. Asthma is generally manageable by identifying and avoiding triggers as much as possible. While asthma is not progressive, it is also not yet curable. Following your asthma action plan is the best way to manage your asthma.