Asthma and Allergy Network

Five Signs Your Asthma Is Getting Worse

By Kellie Carroll, MPA, RRT-NPS, AE-C

Asthma is a chronic disease that can get better or worse depending on several factors, such as overall health, stress, and exposure to environmental triggers at home, work, or school. Since your level of asthma control can change over time, it’s important to know when your asthma is getting worse.

Here are five signs to help you identify whether your asthma is getting worse:

  1. Increased asthma symptoms. Chest tightness, wheezing, coughing, and shortness of breath are common asthma symptoms. An increase in symptoms can be defined as having symptoms more often, having more severe symptoms, or both.
  2. Decreased peak flow measurements. Since asthma may get worse slowly over several weeks or months, people with asthma can adapt to being short of breath, which makes it difficult to know when asthma symptoms are getting worse. Peak flow measurements provide an easy to follow number to track asthma severity. Peak flow meters are most useful for trending your level of asthma control when measurements are recorded regularly over time.
  3. Activities limited by asthma. Worsening asthma symptoms can cause more missed days of school or work. Your exercise and other physical activities may also be limited by increased asthma symptoms. For example, you may have to use your quick-relief inhaler more often at the gym or see your child use his inhaler more often at soccer practice. It could also be as simple as noticing more chest tightness or coughing after doing every day activities, like walking up the stairs.
  4. Increased inhaler use. Using your quick-relief inhaler more frequently or feeling like it doesn’t help as much as it has in the past is a common sign of worsening asthma. It’s easy to lose track of how often you use your inhaler. A medication journal can help track how often you are using your quick-relief inhaler and provide clues about what is causing your symptoms. If your medication journal shows you are using your quick-relief inhaler only in the evenings after spending time outside in the yard, your asthma trigger is likely to be an outdoor trigger, like grass or tree pollen.
  5. Waking up at night. Waking up at night due to asthma symptoms, most commonly coughing or wheezing, is a sign of poor asthma control. If your asthma symptoms are bad enough to wake you up at night, you should communicate with your doctor and asthma management team.

As you can see, several factors can contribute to worsening asthma symptoms. If you think your asthma is getting worse, follow your asthma action plan and ensure you are taking all your medications correctly. Many asthma medications, such as inhalers, require a proper technique to ensure all the medicine reaches your lungs where it can work to manage and prevent asthma symptoms. Ask your asthma management team to help you use your inhalers properly to make sure you’re getting the correct amount of medication.

If you’re not sure about your level of asthma control, an Asthma Control Test, or "ACT," can help. The test involves answering short questions about symptom severity and frequency. ACT results provide the foundation for a discussion with your doctor and asthma management team about your level of asthma control.

Kellie Carroll is a member of the American Association for Respiratory Care from Missouri, where she currently serves as a respiratory therapist at Children's Mercy Kansas City.