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Can Asthma Cause Fatigue?

For most of us, breathing is effortless, but for the more than 25 million people in the U.S. with asthma, it can be exhausting. Fatigue is especially prevalent in people with asthma, whose airways are narrower due to chronic inflammation. Try breathing through one of those tiny cocktail straws for two minutes and you’ll know what we’re talking about.

So how exactly does one problem lead to the next? Read on for the facts about how asthma and fatigue are connected and how best to tackle your asthma-related exhaustion.

The Link Between Asthma and Fatigue

It makes sense that anyone with a chronic illness likely experiences more fatigue than a person without such a condition, if for no other reason than the body is working harder to compensate for the effects of that particular disease. Fatigue—a feeling of tiredness, exhaustion, and sleepiness during the day—isn’t considered a cardinal symptom of asthma, but it can still have a major quality-of-life impact. A study in the Journal of Clinical Medicine found that fatigue is widespread in people living with asthma, particularly when they have frequent symptoms. “Severe fatigue was detected in almost 63% of the patients in the study, particularly among those who were older and had poorly controlled asthma,” notes Maureen George, Ph.D., an associate professor of nursing at Columbia University in New York City and a spokesperson for the Asthma and Allergy Foundation of America (AAFA).

Causes of Asthma Fatigue

Multiple issues can conspire to cause or worsen asthma fatigue. They include:

Narrow Airways

The airways of someone living with asthma are chronically inflamed, causing them to swell and produce excess mucous, which narrows the passageway through which air can pass. “It takes more muscular work to draw air in and out when the airways are smaller,” says Stephen Canfield, M.D., an allergist and immunologist at Columbia Doctors and assistant professor of medicine at Columbia University Medical Center in New York City.

Trigger Exposure

“Fatigue becomes worse when you’re exposed to an asthma trigger,” Dr. Canfield notes. “This invasion draws white blood cells into the walls of the airways to make immune hormones to fight off the allergen, as the brain tries to reserve energy for the battle. This leaves you fatigued, similar to if you had the flu.”

Asthma triggers vary from person to person and may include:

  • Air pollution and airborne irritants (cigarette smoke, strong fumes like paint or perfume, chemicals)
  • Allergens (dust mites, pollen, molds, pet dander)
  • Exercise
  • Respiratory infections
  • Some medicines
  • Strong emotions
  • Weather and temperature changes

Sleep Issues

“Having nighttime symptoms [that interrupt sleep] even when your asthma is under control during the day is commonly reported,” says Sean Duffy, M.D., associate professor of clinical thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. “Sleep disordered breathing—including sleep apnea—is also a common comorbidity with asthma.” (Sleep apnea is a disorder in which you stop breathing momentarily throughout the night.)

It seems like a no-brainer that interrupted sleep (whether from your asthma symptoms or a disorder like sleep apnea) will result in your being extra tired the next day. But in a cruel twist, inadequate sleep may also make asthma symptoms worse. A 2020 study in the Annals of Allergy, Asthma and Immunologyfound that people with asthma who slept five hours or less a night on average had more frequent asthma attacks, more overnight hospitalizations, and more coughing compared to those who got six to eight hours of sleep.

Poor Asthma Control

There’s no doubt about it—managing asthma is work. You’re going to be dealing with multiple medications including controllers (long-term daily maintenance meds for prevention) and quick-relief rescue meds to get your breathing under control when you feel an attack coming on. For some people, that gets complicated, but if you’re not vigilant, your asthma symptoms will get worse. “Most of the time fatigue is bad when asthma is not controlled,” Dr. Canfield says. How to know if your asthma is under control? A good benchmark is needing your rescue medicine once a week or less, and asthma symptoms that are mild enough not to wake you at night, says Dr. Canfield.

Recognizing an Asthma Flare

The first step in managing your asthma—and therefore fatigue—is to develop an asthma action plan, a written document prepared along with your doctor that describes three zones: green (well-controlled), yellow (caution), or red (emergency). Within each zone are recommended medications and actions to take for the symptoms you’re experiencing.

You’ll also likely have a peak flow meter—a handheld device you use daily to measure how well air is moving in and out of your lungs. You blow a quick blast of air into the mouthpiece and get a reading on a built-in scale. It’s so sensitive that it can measure narrowing in your airways hours or days before you experience symptoms. Everyone’s personal best peak flow number will vary, but there are ranges within each zone to use as a barometer.

According to the framework developed by AAFA, these are the signs and symptoms that characterize each zone:

Green (you’re good)

  • Breathing is good
  • No coughing or wheezing
  • Peak flow reading: 80% to 100% of your personal best number
  • Sleeping through the night
  • Working and playing normally

Yellow (it’s getting dicey)

  • Chest tightness
  • Cold symptoms
  • Cough
  • Exposure to a known trigger
  • Mild wheeze
  • Nighttime coughing
  • Peak flow reading: 50% to 80% of your personal best number

Red (danger)

  • Breathing is fast and hard
  • Nose opens wide
  • Peak flow reading: below 50% of your personal best number
  • Ribs show
  • Unable to talk well
  • Usual medicines aren’t helping

Asthma sounds scarily unpredictable, but there are usually early warning signs that an asthma episode may be imminent that you’ll learn to recognize. According to AAFA, these can include:

  • A decrease in your usual lung function as measured by a peak flow meter
  • Chest tightness
  • Coughing frequently, especially if it gets worse at night
  • Feeling extremely tired when exercising
  • Having a cold or allergy symptoms like nasal congestion, sneezing, sore throat, and headache
  • Neck or throat itchiness
  • Shortness of breath
  • Wheezing and coughing after exercising

How Asthma-Related Fatigue Is Treated

The best treatment for asthma-related fatigue is to get your asthma under control. The fewer symptoms you have, the less sleeplessness and fatigue you’ll experience. The other key is to avoid your asthma triggers as much as possible, says Dr. Canfield, so that airway irritation is kept to a minimum. Depending on your asthma, he says, that may include:

  • Avoiding dogs or cats
  • Covering your mouth and nose outside in cold weather
  • Keeping windows closed
  • Not smoking anything in any form
  • Running the air conditioner
  • Using an air purifier
  • Using a rescue inhaler before exercise

When to Contact Your Doctor

Taking steps like these and sticking carefully to your asthma action plan should help keep asthma-related fatigue manageable. However, “contact your doctor if your fatigue is so severe that it is interfering with your quality of life or poses a risk, such as drowsy driving,” advises George. It may take trial and error, but don’t give up: A diagnosis of asthma shouldn’t mean spending the rest of your life in a constant state of exhaustion, and with the right treatments and strategies, you won’t have to.SOURCES

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