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What Makes Asthma Worse

Airways of people with asthma are often chronically inflamed (swollen). Therefore, the airways are sensitive to things that make asthma worse. These, either singly or together, cause symptoms in people with asthma. Identifying and controlling or treating things that make asthma worse is essential to good asthma management.

Things that make asthma worse include: irritants, allergens, infections, weather, exercise, emotions, gastroesophageal reflux and hormonal changes. These vary from person to person.


Common airway irritants include smoke (e.g. tobacco smoke, smoke from wood-burning or kerosene stoves and fireplaces), aerosol sprays, strong odors (e.g. perfumes, cologne, gasoline fumes), dust and air pollution. These substances found in the environment can irritate sensitive airways. Cigarette smoke is a very serious asthma trigger - do not allow smoking in your home or car and always look for non-smoking sections in public areas.


A variety of allergens can make asthma symptoms worse. It is important to note that not all people with asthma have allergies. Reliable and valid allergy tests are available and a board-certified allergist can guide you through this process. Common allergens include animal dander, saliva and urine from feathered or furry animals, dust mites (a major component of house dust in humid climates), cockroaches, indoor and outdoor molds, pollens, foods and chemicals. If you are allergic to any of those substances, making changes in your environment to control or avoid contact with the allergen is very important. Ask your healthcare provider about environmental control.


Infections can also make asthma worse. Common cold viruses, respiratory infections, sinusitis and influenza frequently cause an increase of asthma symptoms. Your healthcare provider may recommend an annual flu vaccination.


Exercise or physical activity can make asthma worse; for some it may be the only cause of asthma symptoms. However, exercise is important for everyone and should not be avoided. For many people, using a pre-treatment medication 10-15 minutes before exercise allows them to exercise without experiencing asthma symptoms. Discuss pre-treatment before exercise with your healthcare provider.


There is not one best weather climate for people with asthma. However, there are certain types of weather that may cause problems for some people with asthma in any climate. Some weather situations that may make asthma symptoms worse include: extremely hot or cold temperatures, windy conditions, changes in the humidity or barometric pressure.


Emotions do not cause asthma, but can make asthma worse. Strong feelings can lead to changes in breathing patterns. Times of "good" stress and "bad" stress can cause problems for people with asthma. However, it is important to express your emotions and good asthma management can minimize the effect of stress.

Changes In Breathing Patterns

Sneezing, laughing, holding your breath or sleep disorders may cause changes in breathing patterns which may make asthma worse. It is not always possible or desirable to avoid these situations; however, good asthma management may minimize these effects.

Hormonal Changes

Some women with asthma have increased symptoms at a particular time during their menstrual cycle, such as pre-menstruation, or during pregnancy. This worsening results from a change in the balance of hormones that is occurring at that time. Your healthcare provider may adjust asthma medications during that time to reduce your symptoms.

Gastroesophageal Reflux

Gastroesophageal reflux, or GER, occurs when the acidic contents of the stomach flow back up into the esophagus. This stimulates a reflex that may cause asthma to worsen. Symptoms of heartburn and breathing difficulty at night can indicate GER. Your healthcare provider can discuss preventive measures to reduce these symptoms. Read more about gastroesophageal reflux disease.


As you can see, there are a number of factors that can make asthma worse. It is helpful to think about your last asthma episode; did you experience any of the situations described in this information? Please discuss this information with your healthcare provider who can help you identify what makes your asthma worse and teach you ways to control or avoid exposure to them.

Contact Information

Allergy and Inflammation - Research
Department of Medicine
Beth Israel Deaconess Medical Center
Center for Life Science, 9th floor
330 Brookline Avenue
Boston, MA 02215