Miranda Curtiss, M.D., Ph.D.,
Photography: Lexi CoonSpring and fall allergies can wreak havoc on many. But for those living with asthma, allergies can cause a different set of problems.
Miranda Curtiss, M.D., Ph.D., an assistant professor with the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, says, while challenging, there are ways to manage and prevent certain allergic outbreaks while living with asthma.
She says one of the most highly effective and easiest ways to defend against seasonal allergies is to utilize nasal steroids and nasal antihistamines. Curtiss says both are well-supported by evidence-based medicine, inexpensive, highly effective and available over the counter or by prescription.
However, if symptoms worsen, there is another approach.
“Allergy shots can be helpful for patients with seasonal and year-round allergies,” Curtiss said. “However, these are a long-term investment that require planning to continue therapy for three to five years for maximal benefit. Asthmatics who want to start allergy shots need to have their asthma under good control first before starting shots.”
Curtiss adds that other ways to minimize allergy symptoms are to keep house or car windows closed and use central air conditioning or to reduce exposure during peak pollen conditions.
“Changing your clothes when possible and showering after entering the house can be helpful as well,” she said.
For people with allergies and asthma, day-to-day asthma symptoms can be influenced by seasonal changes in outdoor allergens — for those who are pollen- and mold-allergic — which themselves fluctuate with the growing season, humidity and wind, just to name a few.
Indoor allergens (dust mites, molds, cockroaches and pets) tend to be present year-round, but can also fluctuate with factors that affect outdoor allergens.
“Because these are perennial, it’s more difficult to notice how much they affect asthma and allergy symptoms, as compared to seasonal allergens; but they can have profound effects on asthma symptoms,” Curtiss said. “Overall, exposure to allergens seems to make allergic asthmatics more prone to have an exacerbation when they are sick with a viral infection.”
Signs of an asthma emergency (severe flare) that need urgent evaluation:
- Difficulty speaking due to shortness of breath
- Having to sit hunched forward; restless or agitated feeling
- Rapid breathing
- Rapid heart rate
- Low oxygen level
- Allergic reaction to a food, stinging insect or medication
Persistent asthma patients are less likely to have exacerbations and poor symptom control when they take their controller inhalers regularly, according to Curtiss.
“This is the absolute most important way for patients to protect themselves,” she said.
If a controller inhaler is too expensive, Curtiss encourages patients to talk with their doctors and pharmacists about what is on the formulary. Insurance formularies can change over time and impact controller inhaler cost.
“Often there is a lower-cost option that your pharmacist can suggest,” Curtiss said.
Curtiss also stresses that, in general, if an asthma patient is needing their rescue inhaler more than two times during the day per week or if they must use their rescue inhaler more than two times at night in a month, then their asthma is not controlled, and they need to talk to their doctor about stepping up their treatment.
“All asthma patients can protect themselves from severe exacerbations by paying attention to their symptoms each day and seeking help early at the start of a flare, when it’s more likely to respond to treatment,” she said. “If an asthma patient is using more than one rescue inhaler per month, this is a major red flag and needs an urgent evaluation by a specialist.”
To learn more about how to manage asthma, click here to schedule an appointment with UAB Medicine’s Asthma and COPD Clinic.