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Myths and Misconceptions

Myth 1. Most children will outgrow asthma

Some children do seem to outgrow their asthma, but many do not.1 It is not possible to predict who will outgrow his or her symptoms. However, severe asthma is more likely to persist than mild asthma. In one study, 64% of children with mild asthma were symptom-free as adults.2 Only 15% of the children with severe asthma outgrew it. Boys are more likely than girls to outgrow their asthma.3

Interestingly, studies have shown that asthma symptoms reappear later in life.3 A study from Arizona showed that nearly two-thirds of people who were “newly diagnosed” with asthma at age 22 wheezed before the age of three. The families likely thought the children had outgrown their symptoms. However, it seems that adulthood asthma actually has its roots in early childhood.

Myth 2. People with asthma should not exercise

Nothing could be further from the truth! Regular exercise is recommended for people with asthma because of its many health benefits.4 If your asthma is well controlled, you should be able to participate in any normal activity, including exercise.1

It is true that exercise triggers symptoms for most people with asthma.5 Your health care provider may recommend using a short-acting beta-agonist (SABA) five to 20 minutes before exercising.6 This medication opens up the airways. Warming up for ten to 15 minutes may reduce your asthma symptoms.

You can work with your health care provider or respiratory therapist to come up with an exercise plan.

Myth 3. I do not need to take my inhalers when I feel okay

The National Heart, Lung, and Blood Institute strongly recommends taking your long-term control medications each day.1 Asthma is a chronic inflammatory disease. This means that even when you do not have any asthma symptoms, your airways are still inflamed. Long-term control medications reduce the inflammation. With less inflammation, your airways become less sensitive. This prevents symptoms from flaring up, improves your lung function, and reduces the risk of complications.1

It can be hard to remember or want to take your medication when you are feeling fine. Work with your health care provider to find the lowest dose you need to control your symptoms. Make taking your medication part of your daily routine, for example, before you brush your teeth in the morning or when you sit down to eat breakfast. Store your medication in the same place every time. On study showed that people were more likely to take their inhaler if it was stored in the bathroom instead of next to the bed.7

Myth 4. If treatment is not working, the patient must be doing something wrong

There are many reasons that asthma might not improve, even if you are taking your medication correctly.

One-half to two-thirds of people take their medication correctly.8 Often the people with the most severe asthma are the most compliant, because their survival depends on it. The fact is that response to treatment is variable from person to person and over time.1 If a person has uncontrolled asthma, it may be that:

  •  More medication is needed.
  • A different type of medication is needed.
  • Unidentified triggers are causing asthma to flare up.
  • Changes to the Asthma Action Plan are needed to help the patient respond appropriately to worsening symptoms.
  • The person has other conditions that need to be treated, such as GERD, COPD, obesity, or vocal cord dysfunction.

It is very common for people to use their inhaler incorrectly, which might mean that too little medication gets into the lungs.8 To be sure you are using your inhaler correctly, bring it to each appointment and review proper technique.

Not all people who take their medications incorrectly do so by choice or carelessness. Many find it difficult to afford medications or to find transportation need to get to medical appointments and the pharmacy.9,10 Bothersome side effects and the inconvenience of taking medications can be barriers as well.10 If you are having these problems, talk about with your health care provider, so that you ccan work together to find a solution.

Myth 5. Smoking does not affect my asthma.

Smoking increases the risk of developing asthma. Smokers with asthma have worse outcomes, such as more symptoms, lower lung function, and decreased response to medication.11,12

Despite these facts, it is not unusual for people to underestimate the effect of smoking on their health. In one survey, more than 40% of smokers with asthma did not believe that smoking had affected their health.13 More than 50% did not think they were at a risk of future health problems.

If you need help quitting smoking, ask your health care provider. You may also find helpful resources online at websites such as http://smokefree.gov/.

Myth 6. All asthma is the same

Although people often talk about “asthma” as if it were one disease, there are actually many different types of asthma. People with asthma react to different triggers, have different laboratory values and symptoms, and respond differently to asthma medications.

Asthma ranges in severity from mild to severe. Treatment is very different depending on the severity. Most people with mild to moderate asthma are able to control their asthma with inhaled corticosteroids. However, for about 5% to 10% of people with severe asthma, the typical medications are not enough.8 This type of asthma is not well understood. Misdiagnosis and under-treatment contribute to poor outcomes for some patients with severe asthma.14

Myth 7. Oxygen saturation always drops during an asthma attack.

Oxygen saturation (SaO2 or O2 sat) is measured with a pulse oximeter, usually placed on the tip of your finger. Oxygen saturation is a measure of how much oxygen your blood is carrying at that point in time. Many patients and doctors believe that oxygen saturation always drops during an asthma attack. In fact, experience shows that it is possible to have normal or near-normal oxygen saturation even in the middle of a severe asthma attack.15

Some basic biology can explain why this happens. Put simply, oxygen-poor blood flows to the lungs. It picks up oxygen from the air you have breathed in, and then the oxygen-rich blood travels away from the lungs to the rest of the body. The transfer of oxygen from the air to the blood takes place in the alveoli. Alveoli are little sacs at the end of the airways, surrounded by very small blood vessels (Figure).

Alveoli, little sacs at the end of the airways, surrounded by very small blood vessels

Image can be purchased from: http://www.dreamstime.com/stock-image-alveoli-digital-illustration-colour-background-image35688251; unsure of pricing.

Asthma is a disease of the airways, not the alveoli. The alveoli continue to work well in people with asthma. Although airway narrowing means that less air reaches the alveoli, once the air has arrived, it can pass into the blood. It can take a long time for SaO2 to drop in patients with asthma. When it does fall, it may be an indication of respiratory failure.

Unfortunately, normal SaO2 levels may be misinterpreted by emergency department personnel as a less serious attack or anxiety attack.

Written by: Sarah O'Brien | Last Reviewed: May 2016.
  1. National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
  2. Tai A, Tran H, Roberts M, et al. Outcomes of childhood asthma to the age of 50 years. J Allergy Clin Immunol. 2014;133:1572-8.e3. http://www.ncbi.nlm.nih.gov/pubmed/24495434
  3. Stern DA, Morgan WJ, Halonen M, et al. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet. 2008;372:1058-1064. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/18805334/
  4. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014. Accessed 11/12/14 at: www.ginasthma.org.
  5. Krafczyk MA, Asplund CA. Exercise-induced bronchoconstriction: diagnosis and management. Am Fam Physician. 2011;84:427-434. http://www.aafp.org/afp/2011/0815/p427.pdf
  6. Parsons JP, Hallstrand TS, Mastronarde JG, et al; American Thoracic Society Subcommittee on Exercise-induced Bronchoconstriction. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013;187:1016-1027.
  7. Brooks TL, Leventhal H, Wolf MS, et al. Strategies used by older adults with asthma for adherence to inhaled corticosteroids. J Gen Intern Med. 2014;29:1506-1512. http://www.ncbi.nlm.nih.gov/pubmed/25092003
  8. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43:343-373.
  9. Lawson CC, Carroll K, Gonzalez R, et al. "No other choice": reasons for emergency department utilization among urban adults with acute asthma. Acad Emerg Med. 2014;21:1-8. http://onlinelibrary.wiley.com/doi/10.1111/acem.12285/pdf
  10. Peláez S, Bacon SL, Aulls MW, et al. Similarities and differences between asthma health care professional and patient views regarding medication adherence. Can Respir J. 2014;21:221-226. http://www.ncbi.nlm.nih.gov/pubmed/24712015
  11. Paulose-Ram R, Tilert T, Dillon CF, Brody DJ. Cigarette smoking and lung obstruction among adults aged 40–79: United States, 2007–2012. NCHS Data Brief, No. 181. January 2015. Accessed 1/13/15 at: http://www.cdc.gov/nchs/data/databriefs/db181.pdf
  12. Polosa R, Thomson NC. Smoking and asthma: dangerous liaisons. Eur Respir J. 2013;41:716-726. http://erj.ersjournals.com/content/41/3/716.full.pdf
  13. Wakefield M, Ruffin R, Campbell D, et al. Smoking-related beliefs and behaviour among adults with asthma in a representative population sample. Aust N Z J Med. 1995;25:12-17. http://www.ncbi.nlm.nih.gov/pubmed/7786238
  14. Holgate ST, Polosa R. The mechanisms, diagnosis, and management of severe asthma in adults. Lancet. 2006;368:780-793. http://www.ncbi.nlm.nih.gov/pubmed/16935689
  15. Personal communication, Stephen Gaudet, RRT [1/30/15].