I see this pattern in my West Springfield office almost every week. A patient walks in convinced their asthma is “just how it is.” They’ve been on the same inhaler for years. They reach for the rescue inhaler a few times a week. They’ve come to accept the nighttime cough, the wheeze on cold mornings, the steroid burst once or twice a winter when things get really bad.
When I tell them that their symptoms aren’t something they just have to live with, and that better control is often possible with the right evaluation and plan, they’re often surprised.
The piece almost everyone is missing is allergies and their effect on asthma.
The connection most people don’t know about
Asthma and allergies are so closely linked that allergists treat them as part of the same disease process. Up to 80 to 90 percent of children and about half of adults with persistent asthma have underlying allergic triggers driving their symptoms. That means most of the asthma patients I see have a hidden, identifiable cause for their flare-ups, whether pollen, dust mites, pet dander, or mold, that no one has tested for.
If that trigger isn’t identified and addressed, the disease will never be fully under control, despite carefully prescribed inhaler regimens. This results in treating downstream symptoms while the upstream cause keeps firing.
What “uncontrolled” actually looks like
Patients often don’t realize their asthma is uncontrolled because they’ve adjusted their lives around it. A few questions I ask in my office that you can ask yourself:
- Do you use a rescue inhaler (albuterol) more than twice a week?
- Do you wake up at night with coughing, wheezing, or shortness of breath?
- Have you needed oral steroids like prednisone even once in the past year?
- Have you visited an ER or urgent care for asthma in the past year?
- Have you missed school, work, or exercise because of breathing symptoms?
If you answered yes to any of these, treatment for underlying triggers may improve your quality of life. Uncontrolled asthma drives more ER visits, more hospitalizations, more steroid exposure (which has its own long list of side effects), and over time can cause permanent changes in the airways.
The triggers hiding in plain sight
Allergens are the most common culprit, but they’re not the only ones. Two conditions I check for in patients with asthma are chronic sinus inflammation and acid reflux (GERD). Both can flare asthma, and both often go undiagnosed for years. Your nose, sinuses, and lungs are all part of one connected airway, and inflammation in any part of it tends to drive inflammation in the rest.
For patients here in the Pioneer Valley, the seasonal pattern often points us in the right direction. Tree pollen peaks in April and May, grass in June, ragweed in late August and September. The long Western Mass winters, with sealed-up homes and forced-air heat, push patients toward indoor allergens like dust mites, mold from older basements, and pet dander concentrated in indoor air. If your asthma worsens at predictable times of year or in specific environments, that history alone tells us a great deal before we even start testing.
How we evaluate and treat asthma in our office
An allergy and immunology evaluation for asthma is more than just an inhaler refill. In our office, that visit usually includes:
- A detailed history to map your symptoms against seasons, environments, and exposures
- Skin or blood testing to identify your specific allergic triggers
- Evaluation for sinus disease, reflux, and other contributing conditions
- Practical environmental guidance you can actually use at home
- A discussion of immunotherapy (allergy shots or sublingual tablets), the only treatment that changes the underlying allergic disease rather than just suppressing symptoms
- For patients with more severe asthma, consideration of biologic therapies
Biologic medications, given as injections every few weeks, can dramatically reduce flare-ups, reduce or eliminate the need for oral steroids. These aren’t first-line treatments, but for the right patient they can be life-changing.
When to reconsider your asthma care
If you’ve been managing asthma for years and your symptoms have plateaued, or you’re using a rescue inhaler more than you’d like, please don’t accept that as your baseline. There is almost always more we can do, and finding the allergic and inflammatory drivers behind your symptoms is usually where that work starts.
You can request an evaluation through our self-scheduling tool or by calling our West Springfield office at 413-707-7720. For many patients, more effective asthma management is possible.
Dr. Jackie Garrett
