Non-drug interventions for asthma

Picture of a woman relaxing (PantherMedia / Andy Nowack)

Medication is important in the treatment of asthma, to prevent asthma attacks and keep the condition under control. But many people would like to do more than just take medication. Some of the additional things that can be done have been scientifically proven to help, whereas others have not.

A lot of people use special breathing techniques to try to cope better with asthma attacks. If someone reacts to certain asthma triggers, they can try to avoid them as best as possible. Regular exercise and appropriate levels of sport can help you keep fit and prevent asthma symptoms. One of the main things you can do is stop smoking – or not start smoking in the first place.

Many people with asthma also try out “alternative” treatments like herbal medicine or acupuncture. But it's often not clear whether, and how well, these approaches work and what side effects they might have.

What kind of breathing exercises could help in asthma?

People with asthma can choose between many different breathing exercises and techniques. They are meant to have a general relaxing effect, and also help to maintain calm, controlled breathing during asthma attacks.

Relaxation and breathing techniques such as those practiced in yoga may help to prevent asthma symptoms and improve your overall wellbeing. But there are only a small number of studies on the use of these techniques in people with asthma, and those studies aren't very good quality. Although they suggest that the techniques might help, these findings should be interpreted with caution.

Certain techniques are meant to help people breathe more easily during serious asthma attacks. These include techniques to help you breathe calmly and in a controlled way during an attack, or at the beginning of an attack. Panic and fear can lead to rapid and shallow breathing (hyperventilation) in such situations. Most people can still inhale (breathe in) quite well during asthma attacks, even during more severe ones. Exhaling (breathing out) can be a problem, though. Patient education can help people learn how to use breathing techniques such as “pursed-lip breathing,” which involves slowly breathing out through tightly pressed ("pursed") lips.

Can you do exercise and sports despite having asthma?

Sports and physical activity are important for most people who have asthma. Regular physical activity helps improve the performance of your heart and lungs. It increases the uptake of oxygen and the amount of air that is exhaled when you breathe out.

Because physical exertion is a relatively common asthma trigger ("exercise-induced asthma"), many affected people think they ought to avoid exercise. But special asthma treatment can prevent problems due to physical activity. Research suggests that sports and exercise can actually reduce asthma symptoms in the long term. There is also some evidence that interval training can prevent exercise-induced asthma. In interval training, high-energy exercise is alternated with periods of rest.

It's important to choose physical activities that match your level of fitness, though. This may mean, for example, taking a break or doing something less strenuous if you notice signs of breathing difficulties. Warming up before doing sports, and gradually increasing the intensity, helps too. It's also important to have reliever '("rescue") medication on you so you can react quickly if you do have an asthma attack. Sometimes using reliever medication before physical exertion can help as well.

How can you avoid things that trigger allergies?

People who have asthma that is caused by an allergy can generally prevent asthma attacks by avoiding allergy triggers. But this isn't always possible. For instance, it's easier to avoid animal fur and certain foods than it is to avoid things like pollen. People who are allergic to dust mites might be able to prevent allergic reactions by making various changes in their home. These include wiping the floor with a damp cloth, using mite-proof mattress covers, regularly washing your bedding at temperatures above 55° C (130°F), and removing “dust traps” such as upholstered furniture and rugs.

Individual interventions like using special mite-proof mattress covers or dust mite sprays haven't been proven to prevent asthma symptoms, though. There is also not enough research on whether the type of bedcovers you use (filled with feathers or something else) makes a difference. And it's not known whether things like special air filters can help prevent asthma problems due to animal-related allergies.

What role does tobacco smoke play?

Smoking tobacco, in any form, can cause a number of medical conditions or make them worse. People with asthma have oversensitive airways, so it's particularly important for them to stop smoking, or not start smoking in the first place. When cigarette smoke is inhaled, many substances other than nicotine and tar get into the airways. Some, such as heavy metals and pesticides, are toxic. Just like other triggers, the substances in cigarette smoke can make the inflammation in the linings of the airways worse, causing the airways to become even narrower.

Besides this, cigarette smoke can lead to chronic bronchitis over time – even in passive smokers, including children who are exposed to cigarette smoke at home. Having parents who smoke is one of the main risk factors for asthma. If teenagers who have asthma start smoking, their symptoms usually get worse.

Smokers will know how difficult it is to quit smoking. There are several therapies that can help make quitting a bit easier.

Does your weight affect the severity of asthma?

Being very overweight (having a body mass index, also called “BMI,” over 30) can make asthma worse in some people. But only a few studies have looked at how losing weight affects asthma symptoms. Their findings suggest that losing a lot of weight can help keep asthma under control.

In the studies that found this positive effect, people followed a low-calorie diet under the guidance of experts. Other studies also looked at the effects of exercise programs or appetite-suppressing medication. The people in the studies lost at least about ten kilos on average. Unfortunately there were some problems with the quality of the studies, and side effects were not considered enough. This means that it is currently not possible to draw reliable conclusions about the advantages and disadvantages of these measures, or about how long their effects last.

Does complementary medicine help?

Many people with asthma use alternative or complementary medicine. Common approaches include homeopathy, herbal products and traditional Chinese medicine (TCM) treatments like acupuncture. But there is a lack of evidence that complementary medicine approaches work.