“A number of factors can worsen asthma, including prolonged exposure to dust, pollen, mold, pollution, and other irritants in the air,” says Sharon R. Rosenberg, MD, co-director of the asthma and COPD program at Northwestern University’s Feinberg School of Medicine in Chicago. But for some people, asthma gradually worsens without any exposure to triggers. Symptoms get worse as inflammation builds over time, explains Guha Krishnaswamy, MD, director of allergy and clinical immunology at Wake Forest Baptist. “The mucus membranes become more swollen, smooth muscle becomes a little twitchier, and the airways produce thick mucus,” he says. These changes lead to worsening asthma symptoms. Anyone who has asthma needs to be on the lookout for signs that the condition is getting worse. The reason is simple: Uncontrolled asthma can be a severe, life-threatening disease. Signs of Worsening Asthma Here are six signs your asthma may be getting worse:

  1. Increased difficulty breathing. “You may notice more shortness of breath during normal activities,” Dr. Krishnaswamy says. For example, if you used to be able to carry a grocery bag from your car to your kitchen with ease and now you are huffing and puffing, that could be a sign of worsening asthma.
  2. A drop in peak flow meter readings. “For people with asthma, a peak flow meter is like a blood pressure cuff for people with high blood pressure — it gives you an objective measurement of your condition,” Krishnaswamy says. Chronically lower peak flow meter readings can indicate that your asthma is getting worse.
  3. Exercise limitations. If you’re lacking the motivation you used to have for working out, or you’re experiencing decreased stamina or trouble breathing during exercise, your asthma may be getting worse.
  4. Using a quick-relief inhaler more often. “I saw this happen with my own mother,” Krishnaswamy says. “She was breathless and needing to use her rescue inhaler more and more frequently.” If you need to use quick-relief medicine more than twice a week, your asthma isn’t under control, according to the National Heart, Lung, and Blood Institute.
  5. Waking up at night with coughing or wheezing. “Attacks at nighttime that wake you up at 2 in the morning with coughing and wheezing and reaching for your rescue inhaler are a sign your asthma is poorly controlled or getting worse,” Krishnaswamy says.
  6. Having to disrupt your normal routine because of asthma. During times of high stress, you might experience a flare that causes you to miss school or work. “Maybe you’re having a stressful morning — your child is sick — and your asthma worsens, then it quickly reverses once the stress has passed,” Krishnaswamy says. But if your asthma symptoms are keeping you home from work or school on a regular basis, the condition is likely getting worse. What to Do If Your Asthma Is Getting Worse If you experience any of these symptoms of worsening asthma, call your doctor so he or she can make changes to your asthma management plan. “Your physician will make sure you are on an appropriate asthma management regimen and give you the right rescue medications to use when your symptoms get worse,” Dr. Rosenberg says. He or she may also change your medication types, dosages, or frequencies, as needed. In addition, everyone with asthma should have an action plan for controlling flares and exacerbations, she says. The Centers for Disease Control and Prevention offers sample asthma action plans online. Remember, if you have chronic asthma, it’s important to stick to your treatment regimen, no matter how good you feel. “Too often, people will ease up on their controller medications and use their rescue inhaler instead,” Krishnaswamy says. “But if you have persistent asthma, you need persistent therapy.”
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