What to do when illness makes your asthma worse

Most of the time, your asthma symptoms don’t bother you…until you get sick. Then, next thing you know, you’re waking up in the middle of the night coughing and wheezing nonstop. It’s called a viral-induced asthma flare, and it occurs when your condition is exacerbated by a respiratory illness. Luckily, there are effective treatments, besides using your inhaler in the wee hours, that will have you breathing easily—and sleeping through the night—again.

Can a virus make asthma worse? 

Studies show that viral infections cause asthma symptoms to worsen. One of the most common triggers of an asthma attack is viral or bacterial infections, like a cold, flu, pneumonia, or sinus infection. When you are sick, your airways become inflamed and narrowed—making it more challenging to take in air. Respiratory viruses often cause an increase in mucus, which can also make breathing difficult.

Shortness of breath is a symptom of COVID-19, and for people with asthma it can be even worse. People with asthma are at higher risk for severe illness if they catch the novel coronavirus, according to the Centers for Disease Control and Prevention (CDC), for many of the same reasons other respiratory illnesses exacerbate symptoms.

What are the symptoms of a viral-induced asthma flare?

“An asthma flare-up is bronchospasm and inflammation of the lungs,” says Pierrette Mimi Poinsett, MD, a medical consultant at Mom Loves Best. “Respiratory infections including viruses can trigger asthma flares.” The symptoms of a viral-induced asthma flare-up are similar to regular asthma symptoms, and can include:

• Wheezing
• Coughing
• Chest tightness
• Shortness of breath
• Fatigue
• Nasal congestion
• Headache
• Sinus pain

It’s a good sign that it’s viral-related if your asthma is typically well-controlled, and these signs appear alongside a viral illness. 

Asthma symptoms occur on a spectrum from mild to severe. A serious asthma attack can be life-threatening, so it’s important to recognize the symptoms. If you develop signs such as difficulty breathing, flaring of the nostrils, difficulty talking or walking, and/or bluish tint to lips, skin, or nails, call 911 and seek medical help immediately. 

What makes asthma worse? In addition to viral illness, some other common triggers of an asthma flare-up are:

• Exercise
• Stress
• Irritants in the air like smoke
• Weather—cold temperatures or allergy season
• Medications like beta-blockers
• Gastroesophageal reflux

When an asthma flare-up occurs, it could take several days or weeks before your bronchial tubes are no longer constricted, depending on how severe the condition is.

What helps asthma when you are sick?

There are no treatments specifically for viral-induced asthma symptoms, but there are a number of treatments that can alleviate cough, chest tightness, and wheezing. The best way to manage asthma is prevention and long-term control that stops attacks before they happen. 

First, develop an asthma action plan with your healthcare provider before you get sick. This is a very specific document that is based on your numbers when you breath into a peak flow meter and symptoms. There are three zones: green, yellow, and red. 

1. Green zone is the level where you do not have symptoms and your peak flow is at its highest (peak flows are monitored over two to three weeks to determine personal best peak flow). Peak flows are measured daily to monitor your current zone.
2. Yellow zone is notable for decreased peak flow and the onset of symptoms.
3. Red zone is notable for severely decreased peak flow and severe symptoms. It is an emergency zone that indicates the need to contact your healthcare provider or go for emergency care. 

Each zone should have corresponding medications that are recommended to help control your asthma. “Frequently being in the yellow or red zone is a sign of severe asthma,” Dr. Poinsett says.

What are the types of asthma medications that help when you’re sick?

“Asthma medications are divided into two major classes: long-term control medications and quick-relief medications,” says Dr. Poinsett. 

Long-term control medications are also known as anti-inflammatory, controller, or maintenance medications. These medications reduce the swelling in the lung and mucus production. Long-term control medications are taken regularly—even without symptoms—for optimal effect. These can include inhaled corticosteroids, oral medications, and combination inhalers.

Quick-relief medications are also known as rescue medications and are used to treat acute symptoms of asthma when you are in the yellow or red zone.

Your action plan when sick may be a combination of the two. For example, your healthcare provider may recommend you start using a steroid inhaler at the first signs of a viral illness to prevent a flare. “Medications like albuterol relax the muscle spasm and lead to better air entry to the deep parts of the lungs,” says Sumana Reddy, MD at Acacia Family Medical Group in Prunedale, California. Short-acting rescue inhalers like these can help when your asthma acts up when you are sick—and you may need to use them more frequently than usual. 

Your healthcare provider may recommend a nebulizer, which is medicine given through a mask to help get medication to your lungs while you are sick. You might also need an oral steroid like prednisone, depending on the severity of your symptoms. 

RELATED: Albuterol side effects

How can I stop or prevent my asthma from getting worse?

“Following an Asthma Action Plan is the best way to monitor asthma,” Dr. Poinsett advises. 

In addition, you can take steps to avoid your triggers. If illness makes your asthma flare, that can include:

• Washing hands often
• Wearing a mask when you are near people who may be sick
• Maintaining a distance of at least 6 feet from sick people
• Getting a flu shot annually to prevent illness
• Starting additional treatment measures at the first sign of illness

You should discuss with your healthcare provider if your asthma is getting worse beyond when you’re sick since you may require an adjustment in your medication. It is important to take your medication on a regular basis as prescribed to prevent flare-ups from happening.