What’s The Connection Between Diabetes And Asthma?

What is asthma?

Asthma is a chronic condition affecting the lungs. Inflammation and swelling narrow your airways intermittently, making it difficult for air to flow in and out of your lungs. Your airways become hyperreactive to things in the environment, including smoke, dust, chemicals, and pet dander. 

When you breathe in these triggers, the airways' interior may swell, narrowing the space for air to flow through. The muscles surrounding your airways may tighten, making breathing harder. 

Asthma affects about 1 out of 13 people¹ in the U.S. It can start at any age, but most people develop asthma during childhood. It is the most common chronic disease in children in resource-rich countries.

Some children may outgrow asthma as they grow older, but it may reoccur later in life. Other people develop asthma for the first time during adulthood. 

Most common types of asthma

Allergic asthma

Allergic asthma affects about 60% of patients with asthma in the U.S. Common allergens include pollen, dust mites, cockroaches, irritants in the environment such as smoke, mold spores, perfumes, and foods such as eggs and milk. 

Allergic asthma can also be seasonal, so you’ll experience symptom flare-ups at particular times of the year or in certain conditions. Your symptoms may appear or worsen during winter when there are more flu viruses around or during spring when there is pollen in the environment. 

Non-allergic asthma

Non-allergic asthma is less common than allergic asthma and accounts for about 10–33%² of asthma cases. Allergens do not trigger this type of asthma. Respiratory infections such as flu, medications such as aspirin, or environmental factors such as cold, stress, and humidity can cause non-allergic asthma.

Exercise-induced asthma

Exercise-induced asthma happens when symptoms appear or worsen during or immediately after strenuous activity. Shortness of breath is common for many after strenuous exercise.

However, the shortness of breath you experience with exercise-induced asthma can occur alongside other symptoms such as wheezing, coughing, and chest pain. 

Occupational asthma

If you have occupational asthma, your symptoms may worsen while working. You may notice improvements when they are off duty. Occupational asthma accounts for up to 15% of asthma cases in the U.S. due to exposure to insecticides, aerosols, or other harmful substances.

Some people may experience symptoms within 24 hours, while others experience symptoms after months or even years. 

Adult-onset asthma

Asthma usually starts in childhood. However, it may occur for the first time during adulthood in some people. This type of asthma is called late-onset or adult-onset asthma.

Risk factors of adult-onset asthma include female hormones, smoking, stressful life events, or even occupational asthma. 

What is the connection between diabetes and asthma?

Most studies³ demonstrate a connection between diabetes and asthma. For example, one study found that asthma prevalence was higher in patients with diabetes than in those without it. The study looked at 78,000 adults with type 1 and 2 diabetes.

Although some studies have not demonstrated such associations, this may be related to population-level interactions between the immune system and the environment. 

Another study⁴ reveals that children and young adults who have diabetes may be at higher risk of developing asthma. This may affect their ability to manage their diabetes, as asthma makes it harder to control blood sugar.

72% of people in the study who were treating their asthma had good glycemic control, whereas 31% who left their condition untreated had poor glycemic control. 

What are the risk factors related to both asthma and diabetes?

Obesity is a risk factor for both diabetes and asthma. The prevalence of obesity among people with type 2 diabetes is one of the potential reasons for a higher incidence of asthma. Additionally, people with diabetes have increased insulin resistance and metabolic syndrome, two conditions that can increase the risk of asthma. 

The intricate relationship between our immune system and the environment may be another factor behind asthma and diabetes. The “hygiene hypothesis” may explain the increased risk for both.

Studies proposed that childhood exposure to infections and certain germs can help the immune system develop, but the hygiene hypothesis is contentious.

Symptoms and complications of asthma

Wheezing is the whistling or squealing sound that occurs during expiration. It is the most common symptom of asthma. However, asthma has other symptoms, including:

• Shortness of breath

• Rapid breathing

• Coughing, especially during exercise, when laughing, or at night

• Difficulty speaking

• Fatigue

• Chest tightness

• Anxiousness or panic

• Difficulty sleeping

Even when you manage asthma well, occasional flare-up symptoms such as coughing, fatigue, throat clearing, chest tightness or pain, and trouble sleeping may still occur. Using quick-acting treatments such as a rescue inhaler can improve the situation, but you may need medical attention if the symptoms persist or worsen.

Some symptoms indicate an asthma emergency, and you should seek medical intervention if you experience them. These symptoms include: 

• Gasping for air

• Dizziness

• Pale or blue lips or fingernails

• Severe breathing difficulty

• Difficulty talking or walking

What are the complications of asthma?

Proper asthma management is important to avoid complications such as:

• Constant asthma flare-ups that make you leave work or school 

• Respiratory failure. This often occurs if the narrowing and thickening of bronchial tubes become permanent

• Irreversible airway obstruction from a decline in lung function and persistent inflammation. This obstruction resembles chronic obstructive pulmonary disease (COPD) and may progressively worsen, limiting your activity.

How to manage asthma?

Medication

Asthma medication falls into two categories: Preventers and relievers. Relievers help when symptoms occur, while preventers reduce the sensitivity of the airways to triggers, reducing inflammation. 

Reliever medication 

Reliever medication opens the airways quickly. You take it for immediate relief when experiencing an asthma flare-up or emergency. However, you should use this medication carefully because overuse can lead to side effects such as a rapid heart rate and tremors. 

Excluding the use of reliever medication before exercise, you should see your healthcare provider to review your asthma if you need to use a reliever more than twice a week. 

Preventer medication 

Preventer medication reduces your airways' sensitivity, thus reducing swelling and inflammation. You should take your preventer medication as prescribed over the long term to effectively reduce the risk or severity of any flare-ups. 

Inhaled corticosteroids are among the most commonly used preventer medication. It goes straight to the lungs where it’s needed, with a low risk of systemic side effects. Even a low dose of this medication can control symptoms in most patients, especially adults.

Children who need a regular preventer medication can use inhaled corticosteroids or a non-steroid preventer tablet. Your doctor can advise the best type of medication for your child depending on their age, symptoms, and how easy it will be to administer correctly. 

Combination therapy 

If you use a preventer medication but you still experience regular asthma symptoms, you may need to boost your medication. You may need a combination therapy where you take a second medicine while using an inhaled corticosteroid. However, your prescription should be a combination that works for you or your child at the lowest effective dose. 

Inhaler devices for asthma medication

Inhaler devices make asthma medication work more effectively. Your doctor can help you decide on the best inhaler device, but the three main types available include:

1. Metered-dose inhaler (puffer)

This aerosol canister releases the medication as a fine mist as you press it down. If you use this canister, ensure you always shake it before use. You should always place a spacer with your puffer. 

2. Autohaler

This aerosol canister releases the mist automatically when you begin to breathe in via the mouthpiece. It is good for children and people who struggle coordinating a puffer. 

3. Dry-powder inhalers 

This inhaler device contains the medication as a dry powder instead of the liquid in the aerosol inhalers. It requires you to take a deep breath to release the medicine into the lungs. Therefore, it might be difficult to use when experiencing shortness of breath. 

Additional mechanisms for drug delivery

If you have a severe asthmatic case, you may need additional types of medication delivery. The doctor may prescribe the following additional devices to assist with medication delivery:

1. Spacers 

This device resembles a clear tube, allowing more medication to reach the lungs and reducing potential side effects. You attach it to the metered-dose inhaler to ease your inhalation of the medicine.

Fire a single puff of the medication into the spacer, take a slow deep breath, and hold your breath for about five seconds or as long as you feel comfortable. If you are administering the medication to a child, let them take four breaths in and out before you fire the next puff into the spacer. 

2. Nebulizers 

You can also opt for a nebulizer which serves the same function as a puffer with a spacer. Nebulizers were popular among asthma patients in the past. They are still available because they are cheaper and easier to use while reducing the side effects of the medication. If you wish to switch to a nebulizer, speak to your doctor. 

What should I do to avoid worsening my asthma?

1. Identify asthma triggers

Identify your asthma triggers and find ways to avoid them. Triggers include cold air, stress, smoke, molds, exercise, and air pollution. Keep track of all times you experience asthma symptoms and identify the emotional and environmental factors around you. This can help you identify what might have caused an asthma flare-up. You can also talk to your healthcare provider about allergen tests. 

If you’re sensitive to smoke, stay away from the trigger by limiting your exposure to any source of smoke, such as fireworks, incense, and tobacco. If you smoke, seek medical advice on how to quit. 

Avoid getting close to people with flu or cold since catching it can worsen your symptoms. If you have exercise-induced asthma, you can prevent asthma attacks by using an inhaler before the exercise or by breathing through a loose-fitting scarf or mask if exercising in cold, dry conditions.

2. Get flu vaccinations

Contracting the flu can worsen asthma symptoms. You can ensure your safety by getting a flu shot every year for protection against the virus.

3. Go for immunotherapy allergy shot

Allergy shots can prevent allergy symptoms and stop your condition from worsening. The idea is that if your body gets used to the allergen, it'll respond less when exposed.

4. Take your asthma medications as prescribed

Asthma medications aim to prevent symptoms and attacks. You should use your prescribed medication even when you don't have symptoms. They keep asthma under control by easing inflammation in the airways, reducing potential flare-ups.  

Tips for controlling diabetes and asthma

Controlling diabetes and asthma may require you to manage each condition separately. You can control diabetes by eating a healthy diet, exercising regularly, weight management, and taking any prescribed diabetes medication. Weight management avoids obesity, a risk factor for asthma. 

Controlling asthma involves avoiding allergens and sticking to your medication even when you don't see symptoms. 

If you have diabetes and asthma, both conditions benefit from medications. Metformin, a drug that treats type 2 diabetes, may improve asthma symptoms. It may also reduce the number of asthma-related emergency room visits if you have concurrent asthma and diabetes.

Other studies show that GLP-1 receptor agonists, another group of diabetes medications, may benefit patients with asthma. These medications aid blood glucose control, may improve asthma symptoms, and reduce inflammation in the lungs and airways. 

The lowdown

If you have asthma, you can live a healthy and active life provided you control and manage your symptoms. As there is a connection between diabetes and asthma, managing diabetes can improve your asthma symptoms if you have both conditions.

For example, controlling your weight can reduce obesity, a risk factor for diabetes and asthma.