Why Some Asthma Patients Don’t Respond to Inhalers Alone

Why Some Asthma Patients Don’t Respond to Inhalers Alone

From the breathtaking Sierra Nevada mountains to the lush orchards of almond trees, life in Fresno certainly provides beautiful backdrops. All of the resulting agricultural dust, pollen, and even emissions trapped in the valley’s bowl aren’t easy to handle when you have asthma.

Over 19% of Fresno’s residents have asthma. Of those people, 21.3% are aged 17 or younger, and 18.6% are 18 or older. It’s much higher than the national average of 8.6%. Life in Fresno, while full of things to do both indoors and out, also presents unique challenges for managing asthma.

When you’re diagnosed with asthma and prescribed a quick-relief and daily maintenance inhaler, you often think that’s it. This will keep your asthma managed. The reality is that many patients still experience chest tightness, coughing fits, and wheezing. Those alarming symptoms bring them to urgent care or one of Freno’s hospitals.

Sometimes, inhalers aren’t enough. They’re not cures, only aids, and treatment plans often need adjusting while you work with a respiratory specialist to understand what is happening and what treatments would work better for you.

How Inhalers Work

Have you ever stopped to think about how inhalers work? It’s key to understanding why some patients need more than inhalers to manage asthma. 

Asthma occurs when the muscle bands around your airways tighten (bronchoconstriction) and inflammation sets in, producing excess mucus. Asthma inhalers target those two issues.

• Daily Maintenance Inhaler (inhaled corticosteroids): The medication helps ease the inflammation and swelling.
• Rescue Inhaler (bronchodilators): Medications that relax the muscles around the airways, making it easier for you to breathe during an asthma attack.

These two inhalers work well for uncomplicated asthma, but sometimes they’re not enough. Sometimes, your body mounts an aggressive immune response that is more powerful than the treatments offered through daily maintenance and rescue inhalers. That’s why some Fresno-area residents still find it hard to breathe despite their inhalers.

Top Reasons Why Your Inhalers Don’t Help as Much as They Used To

When your inhalers stop helping as much as they used to, it often comes down to one of these issues.

Central Valley Itself

Fresno sits in a valley surrounded by tall mountains. That creates a bowl where air often gets trapped, making particulate matter an issue. The poor air quality occurs year-round.

• Spring and Summer: Pollen from trees and grasses mix with pollen from the area orchards.
• Late Summer and Fall: Wildfire smoke that comes down from the mountains.
• Winter: Agricultural dust and soot from burning, residential wood smoke, and Tule fog.

Because your lungs are constantly exposed to poor air quality, particulate matter, and pollen, the impact on your airways is significant. As levels increase, your standard asthma management plan is no longer enough.

Dependency on Oral Steroids

If your primary care provider (PCP) prescribed oral steroids more than twice in the past year, your asthma may have become dependent on oral steroids, and that’s not good. It’s a sign that your asthma maintenance plan is ineffective. Oral steroids are not designed for long-term use and can worsen the situation.

Oral steroid dependency can lead to problems like higher blood sugar levels, bone density loss, cataracts, and weight gain. Your body’s natural steroid production declines, and your immune system weakens. Mood swings and glaucoma are other potential issues.

Eosinophilic Asthma (Type 2)

Asthma isn’t just a singular disease. Experts now recognize different subtypes (phenotypes). One of the more common phenotypes is eosinophilic asthma, and it requires a different approach. It’s more common in adults and affects up to 10% of patients with asthma.

Eosinophilic asthma occurs when your immune system overproduces eosinophils, a type of white blood cell. The cells cause severe swelling and can lead to structural changes, such as nasal polyps. Because it involves the production of eosinophils rather than a response to pollen or other environmental factors, this type of asthma is harder to treat with inhalers.

Irritant-Driven (Non-Allergic) Asthma

Allergens aren’t the only triggers for asthma attacks. If you experience triggers such as chemical fumes, extreme temperature fluctuations, or ozone, life in Fresno can be challenging. Non-allergic asthma isn’t always responsive to traditional asthma inhalers. New approaches are needed.

Other Health Issues Impacting Your Asthma

Your respiratory system starts at the nose and goes down to your lungs and diaphragm. Because it covers so much area, sometimes underlying health conditions trigger asthma attacks.

• Chronic Rhinosinusitis: Continuous drainage of mucus from your sinuses into your throat and past your vocal cords irritates the linings. You end up with a chronic cough that inhalers cannot fix.
• Gastroesophageal Reflux Disease (GERD): Small amounts of stomach acid work their way into the esophagus and irritate the respiratory lining. This causes bronchospasm that resembles an asthma attack. Control of the stomach acid is required, as asthma inhalers won’t help.
• Obstructive Sleep Apnea (OSA): OSA occurs when the airway collapses at night while you’re sleeping. It puts extra pressure on the lungs as your body tries to get enough oxygen. This can increase inflammation and worsen asthma control at night.

Poor Inhaler Technique

Inhalers need to be used correctly in order to be effective. Delivering medication via an inhaler requires coordinated physical mechanics. The Asthma and Allergy Foundation of America reported that about 92% of patients with asthma use their inhalers incorrectly.

If you’re not using your medication properly, it won’t reach the bronchial tubes. Learning how to use your inhaler under a doctor’s instruction is important.

When to See an Allergy and Respiratory Specialist in Fresno

When should you see an allergist and respiratory specialist at Premium Allergy & Respiratory Center? Follow the “Rule of Two.” 

• Asthma symptoms have woken you up more than twice in a week.
• You’ve had to use your rescue inhaler more than twice in a week.
• You’ve already had more than two rescue inhaler refills within 12 months.

Also, consider seeing an allergist if your daily life is being severely impacted. If you’ve had to give up your daily walks, missed too much school or work, or stopped going outside, it’s time to see a doctor.

Your PCP can treat generic symptoms with inhalers and other prescription medications. You need to see an allergist. Allergists can find your specific triggers and help change how your immune system responds. The tests you undergo usually include:

• Blood Panels: Blood tests that look at the immunoglobulin E (IgE) levels and eosinophil counts in your blood.
• Environmental Allergy Testing: Skin prick testing that pinpoints the exact allergens that trigger your body’s immune response.
• Exhaled Nitric Oxide Testing: A breath test that measures allergic inflammation.
• Precision Spirometry and Lung Function Testing: A breath test that measures how much air you displace and how fast you do it.

The more information that’s available, the better it is to find a specific, effective asthma treatment plan. Allergists offer more than a PCP offers by offering:

• Biologics: Engineered monoclonal antibodies given through an injection that help suppress your immune system’s overreaction.
• Immunotherapy: A slow, managed introduction to an allergen that helps the body learn how to properly respond to the allergen. Immunotherapy is given through allergy shots, sublingual drops, or dissolvable tablets.

You don’t have to hide inside or reduce your daily routines. Premium Allergy & Respiratory Center is accepting patients and can help you find an effective asthma action plan.