Possible reasons asthma is not under control

Asthma that is not well controlled can interfere with work, school, relationships, responsibilities, and many other important aspects related to quality of life. Persistent symptoms like difficulty breathing, chest tightness, coughing, and wheezing can also be a burden on mental and emotional health.

According to the American Academy of Allergy, Asthma and Immunology, signs of uncontrolled asthma include:

• You experience asthma symptoms two or more times per week
• You use your rescue inhaler more than two times per week
• You wake at night with asthma symptoms more than two times per month
• You have visited an emergency department or urgent care for asthma symptoms in the past year
• You’ve had to adjust and/or reduce your daily activity level because of asthma symptoms

Below, we look at a few common reasons that asthma may not be under control:

Low adherence to treatment

Low adherence to asthma treatment is considered one of the most common contributing factors to asthma control. If your symptoms are not well controlled, a good place to start is by reviewing instructions for all medications you are taking with your healthcare provider.

If you are having difficulty following a treatment or dosing schedule for any reason, tell your healthcare provider. Always be honest, ask for an explanation whenever you need one. Cost, side effects, dissatisfaction, and lack of knowledge about how a treatment works are some of the most common factors for low adherence.

Improper inhaler technique

Technically, improper inhaler technique can be considered a type of unintentional nonadherence, but it’s so common that it deserves its own section. Studies have found that the majority of people make at least one error when using an inhaler.

Using an inhaler is a skill. Like any skill, it can take some practice to get it right, and it helps to get feedback from a qualified instructor. Review your inhaler technique with your healthcare provider. Your pharmacist is also an excellent source of information about this aspect of asthma management as well as other questions about your medications.

If you aren’t already, consider using a spacer, a chamber that attaches to an inhaler and helps you get more medicine into your airways. There are a variety of spacers available, and your healthcare provider can help you decide which one might work best for you.

Exposure to asthma triggers

A trigger is anything that worsens asthma symptoms. Identifying and avoiding triggers is a key component of asthma management. Continued exposure to triggers can mean asthma is not under control, even if you’re adhering to treatment. Common triggers include things like pollen, mold, dust mites, pet dander, and poor air quality. It’s important to check your home and work environments for potential triggers.

Emotional stress, physical activity, and some medications (like aspirin in some instances) can trigger symptoms, and should also be discussed with a healthcare provider. Smoking worsens asthma, and anyone who smokes should quit.

Keeping a symptom journal can help you identify asthma triggers and patterns in your symptoms. Also, review all medications you are taking with a healthcare provider, including prescription medications, over-the-counter medications, and supplements (including herbal products).

Other health conditions

Asthma can coexist alongside other conditions. Other conditions can cause symptoms that can overlap or be misdiagnosed as asthma. Symptoms can also have a bidirectional relationship—meaning another condition could be making asthma symptoms worse, or asthma could be making symptoms of the coexisting condition worse.

As with the other considerations on this list, a healthcare provider will be your best source of information. Careful evaluation can identify or rule out any coexisting health concerns that may be contributing to symptoms.

Severe asthma

Between 5 and 10 percent of asthma patients have severe asthma, where asthma symptoms are not well controlled, even after treatment and addressing the factors listed above.

A person with severe asthma will require treatment that involves higher doses of inhaler medications as well as medications for long-term control. People with severe asthma may be candidates for biologic therapies, medications that target underlying inflammatory processes in the body associated with asthma. Biologics are administered as infusions.

In addition to having clear instructions on how to take each medication you are prescribed, always discuss precautions and potential side effects with a healthcare provider.