Preventing Your Next Asthma Attack

Asthma is a condition in which the airways in your lungs become narrow, swell, and often produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing), and shortness of breath.

While asthma can not be cured, symptoms can be managed with the help of medications and knowing how to avoid your triggers.

Symptoms Associated with Asthma

Asthma symptoms will vary from person to person. You may notice that your symptoms increase only with certain activities such as exercise, or you may experience symptoms all the time. Be aware of the following asthma signs and symptoms including:

  • Shortness of breath
  • Chest tightness or pain
  • Wheezing when exhaling, which is a common sign of asthma in children
  • Trouble sleeping is caused by shortness of breath, coughing, or wheezing
  • Coughing or wheezing attacks are worsened by a respiratory virus, such as cold or the flu

Triggers that Lead to Asthma Flare-Ups

While there are various factors into what can trigger an individual’s asthma, some common asthma triggers include:

  • Smoking
  • Food sensitivities, such as dried fruits or foods high in preservatives
  • Exercise
  • Stress
  • Dust mites & insects
  • Allergies & pollen
  • Air quality & pollution
  • Pets
  • Strong odors or fragrant perfumes
  • Weather changes, such as high humidity or dry air

The most common of these triggers affect those suffering from exercise-induced asthma, which may be worse when the air is cold and dry.

For those people working in various manufacturing industries, they may suffer from occupational asthma triggers that are a result of their workplace and include irritants such as gasses, dust, and chemical fumes.

Allergy-induced asthma is also very common and is usually triggered by airborne substances. These irritants include things such as pollen, mold spores, cockroach waste, or pet dander. People with asthma need to keep their homes, especially the area where they sleep, clean and free of triggers that could provoke an asthma attack.

Preventing Your Next Asthma Attack

Preventing Your Next Asthma Attack

Common Treatments

Some people experience mild, infrequent symptoms and may only need quick-relief medications. Others suffer from frequent and persistent symptoms that require long-term controller medications.

Quick-relief or rescue medications will do just that, help you immediately in the event of an asthma attack. These types of medications are used to treat sudden asthma symptoms by relaxing the muscles around the airways of your lungs. Rescue medication sare commonly delivered by an inhaler but can also be in liquid form for use with a nebulizer. It is important to always keep your rescue inhaler with you.

Long-term or controller medications are the second type of medications used to treat asthma. Controller medications are taken daily, regardless of symptoms being present. Their job is to prevent future asthma attacks by reducing the inflammation in the airways over time. They can be given in the form of inhalers, pills, or even injections.

Whether your asthma diagnosis is new, or if you have been coping with it for years, it is important to be mindful of the associated triggers and symptoms that can lead to an asthma attack.

Be sure to contact your healthcare provider if you feel your medications are not controlling your asthma attacks. A severe asthma attack can be life-threatening. Signs of needing emergent asthma treatment include:

  • Rapid worsening of shortness of breath or wheezing
  • No improvement even after using a quick-relief inhaler
  • Shortness of breath when you are doing minimal physical activity

Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life.


pulmonary rehabilitation

Understanding Pulmonary Rehabilitation

Patients with chronic respiratory conditions such as Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Interstitial Lung Disease (ILD) often have difficulty with their activities of daily living due to shortness of breath. If you have been newly diagnosed with a chronic respiratory condition or suffer from other conditions such as pulmonary hypertension, cystic fibrosis, or have upcoming lung surgery​​​ your health care provider may have suggested Pulmonary Rehabilitation (PR). Like other respiratory conditions, COVID-19 can cause respiratory complications and lasting lung damage. Some people may also develop “long COVID,” which occurs when COVID-19 symptoms linger for weeks or months after acquiring the initial infection. Some people refer to this group as “long haulers.”

What is Pulmonary Rehabilitation (PR)?

Pulmonary Rehabilitation (PR) is a comprehensive rehabilitation program designed specifically for patients with lung disease that has been shown to improve quality of life and relieve shortness of breath. PR is a two-step program that includes education and exercise to help you learn more about your lungs and your disease.

Your rehab team will often include:
  • Doctor
  • Nurse
  • Respiratory therapist
  • Physical therapist
  • Exercise Specialist
  • Dietitian

Overall, you will learn how to manage your breathing problems, increase your energy, and decrease your breathlessness. Typically, a PR program will be offered in a group setting, allowing you the opportunity to meet others suffering from similar conditions. A community environment allows you to speak with others with similar lung problems, get useful tips, and discuss topics that arise when dealing with a chronic condition.

What is the role of PR in the Treatment of COVID-19?

Some people who recover from COVID-19 may need pulmonary rehabilitation to help them resume normal activities after staying in the hospital, or following periods of prolonged isolation. Pulmonary rehabilitation can help those with decreased strength begin to move more, gradually building up their stamina. PR for those recovering from COVID-19 can help:

  • Restore function to the muscles
  • Reduce the likelihood of mental health conditions that may occur as a result of limited mobility
  • Enable people to return to their normal lives

Step ONE: Education

PR programs help patients to improve their exercise capacity which helps them get back to daily life. The education portion of the program will help you gain a better understanding on how to best manage your breathing problems so that your breathing is not in charge of you. You will also learn things such as how to pace your breathing with your activities, take your medications, and what questions to ask your healthcare provider.

Step TWO: Exercise

Step TWO is the exercise component. PR provides education on breathing techniques to help you cope with the symptom of breathlessness The exercise program is led by the PR staff; they will monitor you as you exercise to ensure your safety. The exercises are designed for your specific needs and will start at a level that you can handle. The amount of time you exercise will be increased in time and the level of difficulty will change based on your ability. As your muscles get stronger, you will be able to exercise longer, be less tired, and have less shortness of breath.


What you learn during PR should be used throughout life to avoid hospitalizations, complications, and other issues. Most importantly, it provides a support system by allowing patients to meet other people with the same experience. Pulmonary Rehabilitation forms an integral part of the comprehensive care of patients with respiratory conditions. Always consult with your doctor before starting a new exercise routine. People recovering from COVID-19 should also seek help if their symptoms are severe or suddenly worsen.



National Institues of Health

American Lung Association


5 Common Myths Associated with Asthma 

Asthma is a chronic condition that affects the airways in the lungs. Among children, asthma is a common condition however it affects people of all ages ranging from infants to the elderly.

While there are many things that can cause asthma such as genetics, environmental factors, and occupational exposures,  sometimes the exact cause cannot be determined. If you or someone you know has recently been diagnosed with asthma, it can be overwhelming.

Your healthcare provider can provide you with some great resources, and while the internet is a great source of information, take caution regarding some common myths associated with asthma. Read on to learn the truth to these common myths.

Myth #1: Asthmatics Should Avoid Exercise.

While many asthmatics experience exercise induced asthma, it does not mean that it should be avoided all together. This, in fact, is a myth. It is important to assess your individual risk factors and determine if your asthma is well controlled with an asthma-action plan. If your asthma is well controlled, you may enjoy activities such as a brisk walk, leisure biking, swimming, and hiking. Avoid exercising outdoors in colder weather months to avoid an asthma flare-up.

Myth #2: Asthmas Goes Away after Childhood.

While some children will experience asthma only in the early years of life, asthma does not just go away. A common misconception, but, in fact, a myth. A clear answer to this myth would be that, for some children, asthma can go into a hibernation state and never return. This is due to a person’s lungs growing and maturing and the lungs becoming less affected by triggers. Its important to know that while your asthma may not ever truly go away, your attacks can be well controlled if you are aware of your triggers.

Myth #3: No One Dies from Asthma.

This is alarmingly false. According to the World Health Organization (WHO), in 2016 there were 417,918 deaths globally due to asthma. Asthma is one of the major noncommunicable diseases, this means that asthma is not transmissible directly from one person to another. While asthma can be controlled with medication, it can cause deaths. It is important to seek treatment and not allow your symptoms to get worse. Ensure you continue your medications and asthma action plan set by your healthcare provider.

Myth #4 All You Need is Albuterol.

Albuterol sulfate is a common bronchodilator, which works by relaxing the muscles in the lungs, and makes it easier to breathe. The truth is albuterol is not the only medication available to treat asthma. Also, everyone with asthma does not take the same medication. Asthma can be treated with two types or medications: a quick-relief and long-term controller. A quick relief will control the symptoms of an asthma flare-up. A long-term medication will work by helping you have fewer and milder flare-ups.

Myth #5: Asthma is Easy to Diagnose and Treat.

The truth is asthma can be difficult to diagnose. The reason being that asthma mimics other diseases and often there are similar symptoms, making it difficult to make the diagnosis. Asthma is underdiagnosed and undertreated which creates a substantial health burden globally and to individuals and their families. If you suffer from asthma, and you have a long family history of asthma, it may be easier to diagnose. For some, a series of test may be needed to make the diagnosis.


Asthma is estimated to have affected more than 339 million people in 2016 according to WHO. It is a common condition, and it is important to have facts and understand the misconceptions and myths associated with it. Asthma can be treated and controlled so that a person can enjoy their day-to-day life!


Respiratory Health Among First Responders

This year marks the 19th Anniversary of the September 11th attacks of 2001. Immediate deaths involved those at the World Trade Center (WTC) in New York City (NYC), the Pentagon, and the passengers on board the four aircrafts, which included Shanksville, Pennsylvania, and Arlington County, Virginia. Of the 2,977 lives lost that day, 343 firefighters and 71 law enforcement officers perished. As the day approaches, we pause to remember the victims, the families, and survivors affected by this horrific event.

New York City Firefighters

Firefighters work at the site of the World Trade Center terrorist attack in New York City on September 11, 2001.
Photo: Mark Lennihan/Associated Press

With specific regard to the WTC and ground zero, the information provided by the NYC Commissioners office states that the rescue and recovery clean-up of the 1.8 million tons of wreckage took 9 months to complete. Firefighters, Emergency Medical Technician (EMT), law enforcement officers, and volunteers joined in the effort to recover and rebuild, putting their respiratory health at risk in the process.

Firefighters are regularly at an increased risk of developing respiratory conditions due to occupational exposures. In fact, researchers have found an increased prevalence of chronic obstructive pulmonary disease (COPD) among nonsmoking workers. According to the Centers for Disease Control and Prevention (CDC), nonsmokers account for an estimated 26 -53% of COPD cases attributed to occupational exposures. Inhalation of occupational elements can lead to short- and long-term effects on the respiratory system. During the “knockdown” phase, firefighters are actively fighting the fire. During the “overhaul” phase, firefighters have extinguished the fire, and embers and smoldering flames have subsided. Consequently,  both lead to exposure to toxins and respiratory irritants such as sulfur dioxide, aldehydes, and hydrogen chloride.

The World Trade Center Health Program was implemented to manage the ongoing health effects of the 9/11 attacks. As of December 2017, the program has reported asthma, COPD, various cancers, and gastroesophageal reflux disease (GERD) to be the most common conditions they treat. Air pollution experts suggest that along with pulverized building materials and electronic equipment, first responders were also inhaling things such as burning jet fuel, plastics, metal, and fiberglass. Under normal circumstances, firefighters are not exposed to this magnitude of inhaled pollutants.

The events of 9/11 highlight the essential need for firefighters to use self-contained breathing apparatus (SCBA). The use of an SCBA can prevent or slow the progression of developing respiratory conditions such as asthma and COPD, prevent inhalation of pulmonary irritants, and reduce the risk of smoke inhalation injuries. The significance of COPD among firefighters is like that of a problem in developing countries where household air pollution is a concern. According to the World Health Organization (WHO), 25% of deaths attributed to COPD involve low- and middle-income countries and are due to the exposure to household air pollution. Women who are exposed to high levels of indoor smoke and are twice as likely to develop COPD as compared to women that use cleaner fuels and technologies.

Lung disease among firefighters is studied routinely. Schermer TR, et al. set out to compare occupational exposures, use of respiratory protective devices, and their association with health-related quality of life among metropolitan firefighters. A cross-sectional cohort analysis of the South Australian metropolitan fire-fighter was performed. The questionnaire involved 570 participants and analyzed respiratory symptoms, medical conditions, occupational tasks and exposures, and the consistency of respiratory protection. Of the results reported, 91% of firefighters that participated reported relevant occupational exposures in the last year. Asthma accounted for 4% and COPD for 7% as a diagnosis based on criteria answered in the questionnaire. Firefighters with asthma reported they had been sick due to occupational exposures twice as often as those with COPD, emphysema, or chronic bronchitis.

Our medical textbooks teach us that asthma and COPD are two distinct disorders however there is increasing evidence that many patients may have features of both, now referred to as Asthma-COPD overlap (ACO).  Asthma is classified by having intermittent symptoms early on and has an effective response to inhaled medication therapy. COPD however is generally is associated with a late-onset, a patient typically has a slow progression of symptoms, poor response to inhaled therapy, and often associated with long-term smoking. COPD patients are prescribed long term oxygen therapy (LTOT) manage their symptoms whereas most asthma patients are not. Patients with ACO have a decline in the quality of life and higher mortality compared with patients who have either isolated-COPD or isolated asthma.

Firefighters at ground zero after the attacks at the World Trade Center

Firefighters at ground zero in New York City shortly after the attacks on the World Trade Center (WTC). September 11, 2001.

In a similar 2016 study by Aldrich TK et al., lung function trajectories in WTC firefighters over the course of 13 years were observed. Information was collected from 10,641 WTC-exposed NYC firefighters. Significant findings revealed that on average, firefighters lost 10% of their lung function after 9/11, and >10% developed new obstructive airway disease. The data also revealed that there was a little recovery in lung function over a span of the first 6 years. First responders, those arriving at ground zero the morning of 9/11 had a significant pulmonary function test (PFT) results, having an FEV1 < lower limit of normal as compared to those that arrived toward the end of the day. Of those studied, Aldrich et al. did separate the subjects into never smokers, current smokers, and previous smokers. Current smokers had existing lung function damage, but the significance of the findings is that 65% of the firefighters never smoked yet make up the 10% of those who have a new diagnosis of obstructive disease. Smoking cessation plays a significant role in any patient population however extremely imperative in the firefighter population. While the damage caused by the WTC exposure is immutable, focusing on improving PFT metrics can monitor the progression of the long-term respiratory conditions.

The National Institute for Occupational Safety and Health (NIOSH) is a federal agency and organization that conducts research and makes recommendations to prevent work-related injuries and illnesses. According to NIOSH, mortality from lung cancer, heart disease, and COPD are three diseases traditionally associated with firefighting. Based on previous research collected, current smokers may tend to overlook signs and symptoms of COPD which could lead to delay in care and treatment of lung damage. As with our current COVID-19 pandemic, great importance is placed on the use of personal protective equipment (PPE). NIOSH Respiratory Protection Week is September 8-11, 2020. Their focus for the last 101 years has been to compile resources and determine proper respiratory protection and maximize the availability of respiratory protection in addition to designing innovative respirators.  

The International Association of Fire Fighters (IAFF) is another key organization among firefighters. Information provided by the IAFF suggests that depending on when a diagnosis is made of COPD and how aggressively firefighters can change exposures and behaviors, further decline in lung function can be decreased with appropriate PPE. As mentioned before from what we know with the events of the 9/11 attacks, the use of SCBA equipment by firefighters can slow the progression of respiratory diseases by preventing inhalation of pulmonary irritants and reduce the risk of smoke inhalation injuries. Beyond that, specific attention to the consistent use of respiratory protection devices in employees who have underlying chronic respiratory conditions is equally important.

Among the common respiratory conditions firefighters face, cancer is among the highest diagnosed within the profession. In 2010, NIOSH published a study that included nearly 30,000 firefighters who were employed from 1950 – 2009. Findings suggested that compared to U.S. population rates, firefighters had a 9% increase in cancer diagnosis and a 14% increase in cancer-related deaths. This information is consistent with a cancer diagnosis that has been trended from the WTC Health Program. Each year more firefighters have lost their life due to various types of cancer, linked back to the exposure of the 9/11 attacks.

The dedication and bravery the multitude of first responders from 9/11 and all firefighters today exhibit should never be forgotten. Integrity, respect, and compassion are qualities these men and women display daily all while risking their lives and health. Let us pause to commemorate the lives of those we lost that day and join in the effort to bring safety awareness to this vulnerable population who is at increased risk of developing respiratory health issues and fatal conditions.