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Understanding And Managing Intermittent Asthma

Asthma is a chronic lung disease in which airways become inflamed and narrow, causing wheezing and shortness of breath. While symptoms vary widely between individuals, they share some common characteristics. If you experience asthma attacks, you often have symptoms at night, early morning, after exercise, or during cold weather.

You may also have allergies, sinus problems, nasal congestion, or other breathing issues.

According to the CDC, over 7.8%¹ of the U.S. population suffers from asthma. The majority of patients with asthma develop symptoms during childhood or adolescence, which in turn makes early detection challenging.

Intermittent asthma occurs mainly during low exposure to allergens (less than once per week), whereas persistent asthma occurs during high exposures to allergens. It has a distinct clinical presentation compared with other forms of asthma.

What is intermittent asthma?

Mild intermittent asthma means that you experience occasional attacks or flare-ups that last a short time. It occurs when your airways become inflamed and swollen and cannot open fully at random times throughout the day or night. The symptoms may occur at least twice weekly and last for several minutes or longer. 

Intermittent asthma causes shortness of breath, coughing, wheezing, and chest tightness; the symptoms can worsen over time. Your body has its built-in system of defense against inhaled irritants called the immune system. It releases cytokines (protein) to help fight off infection and inflammation. 

You may also get intermittent asthma if you have suffered from hay fever or seasonal allergies. In children, it may develop after a viral respiratory infection. You may need to take medicines for relief.

If you have asthma, your doctor can help you determine what's wrong and how to treat it. They can recommend ways to manage it that won't interfere with your daily life.

Classifications of asthma

Asthma has four categories based on severity. These classifications are determined based on the number of symptoms a patient experiences and how often they occur. 

Mild intermittent asthma

This type of intermittent asthma does not always require medical treatment. Symptoms are typically not bothersome and do not interfere with daily activities. 

Mild persistent asthma

You usually have moderate symptoms throughout the day and nighttime. Symptoms can sometimes improve but then relapse, causing the need to go back to seasonal medication dosage.

Moderate persistent asthma

This requires daily use of inhaled corticosteroids and leukotriene modifiers. Moderate persistent asthma patients have symptoms that occur only at night; however, the daytime symptoms cause problems like coughing, wheezing, or shortness of breath.

Severe persistent asthma

Severe persistent asthma requires daily use of high-dose inhaled steroids, long-acting beta-agonists, or oral corticosteroids. Severe persistent asthma has no symptom relief even though the patient receives treatment.

Asthma is unpredictable, and any change in your body's ability to breathe could lead to a life-threatening condition called acute airway obstruction.

Signs and symptoms of intermittent asthma

Intermittent asthma manifests by wheezing, coughing, chest tightness, phlegm production, and difficulty breathing at least twice a week. These attacks vary in frequency and severity over time. 

Wheezing

Wheezing is a whistling sound caused by the narrowing of the airways. As the muscles around your airways constrict, the air becomes trapped, causing wheezing sounds. Wheezing is the most noticeable symptom, but other symptoms can also help you determine whether or not you have asthma.

Bronchoconstriction

When the muscles around your bronchi tighten, this is known as bronchoconstriction. This reaction causes narrowing of the airways, resulting in chest tightness, and making breathing difficult.

Episodes of exacerbation

An exacerbation episode occurs when your asthma symptoms worsen over time. Some people experience worsening symptoms with high pollen levels and other environmental allergens. Other triggers for an episode of exacerbation can be due to a viral infection, excessive heat, or physical exertion.

Causes of intermittent asthma

Triggering factors are things that cause an attack. Common environmental triggers include exercise, stress, weather changes (such as cold air), certain food items, and exposure to dust, smoke, or allergens. Other causes of this condition include lifestyle choices and personal history. In some cases, specialists cannot establish the cause.

Risk factors of intermittent asthma

Allergens and pollen

The most common allergens that can cause asthma are pollen and dust mites. These substances can trigger an allergic reaction in people who have previously had exposure to them. Pollen is considered the primary trigger for seasonal respiratory allergies. This type of allergy occurs when people come into contact with grasses, trees, weeds, and shrubs. These plants produce pollen that contains allergens that cause the immune system to send out antibodies.

You can sometimes identify the allergens that trigger asthma through allergy testing. 

Pets

Pets are known to cause asthma by introducing allergens into the house. Pet hair, dander, saliva, and urine contain protein fragments that act as antigens. They can irritate and inflame the airways.

Tobacco smoke

Tobacco smoking increases the risk of developing asthma. Research² shows that those exposed to tobacco smoke had reduced lung function than non-smokers. Those who smoked only once were less likely to develop asthma.

Genetics

Your genetic predisposition plays a significant role in your susceptibility to asthma.³ A hereditary pattern may exist in families where one sibling suffers from an allergic disease while other family members are unaffected. In addition, specific genes have links to an increased risk of developing allergies, such as IgE and IL-4.⁴

Viruses

Viral infections like colds and flu can cause asthma symptoms. Many viruses, particularly those associated with respiratory diseases, can exacerbate asthma. Viral infection can occur at any age but is common among infants, young children, teenagers, and adults who already have asthma.

Diagnosis

The diagnosis of asthma often begins with a physical examination. A doctor might ask about your medical history and conduct a lung function test. Your doctor may order blood tests to check for other conditions that could contribute to asthma.

The diagnosis of intermittent asthma can be challenging. Asthma symptoms may vary from day to day or even hour to hour. This factor makes it hard to diagnose and treat.

Physical exam

A physical exam can help identify the cause of your symptoms. Your doctor will check your lungs for signs of asthma, look at the inside of your mouth and ears, examine your eyes, listen to your heartbeat and pulse rate, and test your reflexes. They might also ask how often you exercise and what medications you take. The tests may include auscultation (listening for breath sounds) and skin and blood tests. 

These tests constitute a physical exam to identify the cause of your symptoms. In addition to these tests, they may offer feedback regarding lifestyle changes that may help improve your condition.

Spirometry

The first step in diagnosing intermittent asthma is to assess lung function.⁵ These tests measure the air exhaled over a certain period and compare this against typical values. There are two lung function tests: spirometry (which measures how fast we breathe) and peak flow measurements (which measure air flow rate). 

Spirometry (also known as pulmonary function testing)⁶ tests how well your lungs breathe. You get a mouthpiece to breathe through and a spirometer. As the lung empties, air enters the spirometer causing it to fill up. As you exhale, the device reads the volume of air you can blow into the tube and calculates the flow rate and thus the volume of air moving out of your lung over time.

Peak flow meters have long been considered the gold standard for measuring pulmonary function tests; however, they cannot be used to diagnose asthma. You can instead use a peak flow meter to track your asthma symptoms at home if you've been diagnosed with asthma. They help assess the effectiveness of treatment and monitor patients who have recovered from an acute asthma attack.

Management and treatment

Treatment and management of intermittent asthma may vary depending on the severity of the attack. Medications and emergency care are necessary if breathing becomes compromised. If you have mild intermittent asthma, you may benefit from using an intranasal corticosteroid spray⁷ to reduce inflammation in your nose and throat.

Short-acting beta-2 agonist

Short-acting beta-adrenergic receptor agonists (SABA) are drugs that treat acute episodes of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD). They are common in prescriptions for adults who experience asthma attacks.

Salmeterol

Salmeterol is a short-acting beta-2 adrenergic receptor agonist⁸ helpful in treating asthma. Beta-2 adrenergic receptors are located throughout the body and play an essential role in regulating blood pressure, heart rate, inflammation, and airway tone. Salmeterol improves lung function and reduces inflammation.

Budesonide

Budesonide is a glucocorticoid steroid drug that belongs to the corticosteroid class of drugs. Glucocorticoids are anti-inflammatory agents that block the action of certain chemicals called cytokines.⁹ These cytokines help regulate many immune system functions, including inflammation. By inhibiting these cytokines, budesonide reduces swelling and other symptoms associated with allergies and autoimmune disorders.

Salbutamol (albuterol)

This short-acting beta 2 adrenergic receptor agonist is used to treat bronchospasm associated with asthma episodes. This medication¹⁰ works by relaxing muscles in the airways with constrictions due to spasms.

SABAs are inhaled medications that relax smooth muscle in the airways. Specialists often prescribe them alongside long-acting beta-agonists (LABAs),¹¹ such as formoterol. These combinations are SABA/LABA inhalers because they act on both types of receptors.

Monitor symptoms

A common symptom associated with intermittent asthma is difficulty breathing. To ease this problem, you should try to keep your lung capacity at the highest level possible. You can do this through proper nutrition, a fitness routine, and regular exercise.

Here are some tips on how to monitor your symptoms:

Know your limits 

Start by learning what activities make your symptoms worse.¹² You know your limits. Notice when something makes you feel like you cannot breathe.

Track your symptoms 

A great way to know if you have asthma is to track your symptoms. In addition, you can ask your doctor about ways to help control them. You might want to look into inhaled steroids, anti-inflammatory inhalers, allergy shots, and oral medications.

Understand your medications

One of the biggest mistakes people make is taking medication too soon after waking up. If you have any medication, wait until your lungs have had rest before taking it. This way, you don't risk compromising your respiratory function.

Keep breathing right

Don't forget about deep breaths. Relax and slow down when you're particularly stressed or struggling to catch your breath. Deep breathing exercises help open your lungs and clear your mind.

Bronchodilators

Bronchodilators work by relaxing the smooth muscle cells in the airways,¹³ allowing them to open up and expand. This action helps increase airflow through the lungs. Using bronchodilators can reduce symptoms, decrease the need for rescue medication, and lessen the risk of hospitalization. They can also prevent attacks from occurring.

Do you still need an inhaler for mild asthma?

You may get a prescription for inhaled corticosteroids to treat intermittent asthma. These medications reduce bronchial hyperactivity by reducing the number of inflammatory cells in the respiratory tract. An oral steroid is also effective in controlling lung function. 

An inhaler is proper when symptoms occur only intermittently. You may experience wheezing or difficulty breathing during exercise, in cold weather, in dry air, and sometimes at night. Such attacks usually require treatment.

Can intermittent asthma be prevented?

Fortunately, there are lifestyle modifications that can help prevent asthma attacks. Many experts recommend controlling your environment to minimize exposure to known allergens. To keep allergens in control, you can eliminate exposure to these substances through;

  • home cleaning

  • washing bedding and clothing in hot water

  • steam cleaning carpets and rugs, shower curtains, and other surfaces where allergens accumulate 

Prevention includes avoiding known trigger sources and practicing good hygiene. If an attack occurs, seek medical attention immediately.

When to visit a doctor

If you have been prescribed medication, keep taking it. Your doctor may suggest changing your dosage or frequency if necessary. Talk to your doctor about any other treatments you plan to try. Do not stop taking your prescription without consulting your physician first. Discuss all your treatment options before starting any home remedies.

The lowdown

Asthma is a disease that causes inflammation of the airways and can lead to shortness of breath, chest tightness, coughing, and wheezing. In some cases, asthma can cause life-threatening complications. You can manage your condition well with medications and lifestyle changes when you have asthma. However, sometimes, you will need additional treatments.

  1. Most recent national asthma data | Centers for Disease Control and Prevention

  2. Cigarette smoke and adverse health effects: An overview of research trends and future needs (2007)

  3. Asthma | World Health Organization

  4. Genetic risk factors for the development of allergic disease identified by genome-wide association (2015)

  5. Lung function tests | Asthma and Allergy Foundation of America

  6. Clinical application of spirometry in asthma: Why, when and how often? (2015)

  7. Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: A meta-analysis (2012)

  8. Salmeterol | National Institute of Health: National Library of Medicine

  9. Budesonide inhalers | NHS

  10. Salbutamol | National Institute of Health: National Library of Medicine

  11. Long-acting beta-agonists (LABAs) | American Academy of Allergy, Asthma & Immunology

  12. Assess and monitor your asthma control | American Lung Association

  13. Bronchodilators | University of Virginia: School of Medicine

Other sources:

Have you considered clinical trials for Asthma?

We make it easy for you to participate in a clinical trial for Asthma, and get access to the latest treatments not yet widely available - and be a part of finding a cure.

Joining community groups and exercise programs for my condition made me feel empowered – but I want to be part of finding a cure.
Peter, 64

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