What Is Asthma Exacerbation?

Asthma exacerbation is a serious complication that can be life-threatening

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Asthma is a chronic disease in which the airways become inflamed (usually in response to an environmental trigger or an allergen), making it difficult to breathe. It affects up to 25 million people in the United States.

Asthma exacerbations are very serious complications of asthma that can be life-threatening. Exacerbations usually involve an acute or severe episode, much like an asthma attack, which often sends people to the emergency room. At the same time, exacerbations involve a progressively deteriorating airway that is affected over time. Asthma exacerbations can lead to reduced lung function.

This article discusses the symptoms, causes, diagnosis, treatment, and prevention of asthma exacerbations.

Woman uses recuse inhaler

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Symptoms

Similar to typical asthma, symptoms of asthma exacerbation include:

  • Shortness of breath
  • Rapid breathing
  • Coughing, especially at night
  • Wheezing, whistling, or squeaky sound when breathing
  • Chest tightness
  • Skin tightness around the neck and chest when breathing

When Is Asthma an Emergency?

If any of the following occur, you may be experiencing a life-threatening emergency and need to seek immediate medical attention:

  • Fast breathing where the skin sucks in around the chest and/or ribs when inhaling
  • Lips, fingertips, and/or skin around the eyes turn blue, gray, or white in color
  • Severe shortness of breath
  • Severe wheezing or whistling sounds when breathing
  • An expanded chest that does not deflate when you exhale
  • A feeling of impending doom, dread, or panic

Causes

Asthma exacerbations are most commonly triggered by viral respiratory infections or allergen exposure.

Some of the common causes of asthma exacerbations include: 

  • Human rhinovirus (HRV): Viral respiratory infections caused by HRV are the most frequent trigger for exacerbations. Asthma exacerbations typically increase in school-aged children from September to December, when HRV is on the rise. 
  • Allergies: Patient risk factors, such as having a history of allergies, can increase your risk for a viral respiratory infection, which can trigger an asthma exacerbation.
  • Allergen exposure: Environmental allergens, including fungi and mold, will often provoke asthma exacerbations. There is a connection between emergency room visits for asthma exacerbations and the presence of high airborne concentrations of mold in a person's environment. A very high increase in the risk of respiratory arrest is associated with exposure to Alternaria, a type of fungus.
  • Bacterial infections: Bacterial infections may increase mucus in the lungs and cause airway inflammation, leading to an asthma exacerbation.
  • Pollutants: Pollutants like tobacco smoke or exposure to chemicals, such as diesel exhaust, can also cause asthma exacerbations by increasing airway inflammation.

Effect of COVID-19 on Asthma Exacerbation

A 2021 study found a significant reduction in asthma exacerbation rates since the start of the COVID-19 pandemic. This is due to the decrease in exposure to environmental allergens, reductions in office-related exposures (as the work environment changed for many people), a decrease in exposure to respiratory infections, and possible changes in overall stress levels.

Diagnosis

To diagnose asthma exacerbation, a healthcare provider will review your disease history of asthma. They will also assess the following clinical issues:

  • Increase in shortness of breath
  • Increase in coughing, especially while sleeping
  • Increase in wheezing
  • Increase in chest tightness
  • Progressive reduction in lung function that requires medical intervention
  • Decrease in exercise tolerance
  • Impairment of daily activities

Treatment

Treatment for asthma exacerbation often includes a rescue inhaler containing albuterol.

Your healthcare professional may also prescribe a course of corticosteroids for five to seven days after an asthma exacerbation.

Other treatments for asthma exacerbations may include:

  • Inhaled corticosteroids: Also known as ICS, these medications appear to reduce exacerbations by nearly 55%. For people who struggle with asthma control, significantly increasing the dosing of ICS may decrease the likelihood of an asthma exacerbation.
  • Oral corticosteroids: Medications taken by mouth to reduce inflammation in the airways. They may be used in combination with ICS.

Prevention

Completely preventing asthma exacerbations is not currently possible, though it is the goal.

Prevention of asthma exacerbation instead focuses on relieving immediate symptoms, while also working toward preventing any long-term narrowing of the airways or loss of lung function.

The following can also be used to help prevent the occurrence and severity of asthma exacerbation episodes:

  • ICS: Daily use of inhaled corticosteroids has been shown to improve disease control and reduce asthma exacerbations.
  • Patient education: Teaching patients about their asthma has been shown to improve overall disease maintenance.
  • Regular monitoring: Observing and keeping track of your asthma has been shown to be effective in reducing asthma exacerbation.

A Word From Verywell

Living with asthma exacerbations that come on unexpectedly can be scary. Despite your best efforts to follow an asthma treatment plan, asthma exacerbation cannot always be prevented and does occur even in well-controlled asthma cases. It may be helpful to find a support group or mental health professional to help cope with your asthma diagnosis. Studies repeatedly show that people with chronic illness who participate in support groups benefit in the long run.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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