ASTHMA COMPLICATIONS

Asthma is a serious chronic inflammatory disease that places persons with asthma at risk for multiple complications.

Disrupted Quality of Life

Asthma, to varying degrees, has an impact on physical, psychological, and social well-being. A perceived negative impact is more pronounced among those with severe or poorly controlled asthma. Although asthma places a high burden on children, the relative importance of asthma’s impact increases with age, particularly in elderly women.

Poorly controlled asthma can result in psychological problems, including isolation, stress, anxiety, and depression.
Asthma is responsible for a high number of missed school and/or work days. It can cause early permanent disability and premature death. In fact, asthma can be associated with significant limitations on physical, social, and professional/student aspects of living.
People with asthma experience a financial burden, including decreased earning capacity triggered by absenteeism. This may be followed by difficulty in being able to afford prescribed and over-the-counter medications.
Functional limitation is characterized by a decline in ability to complete daily activities and other types of physical activities.
Medication side effects related to the use of oral corticosteroids may include weight gain, sleep disturbance, and neuropsychiatric symptoms. Relationships and sexual intimacy are also affected by medications used in severe asthma.
Persistent coughing is a major quality of life issue. Chronic cough and symptoms of depression are closely related, and improvement of cough correlates with improved depression scores. Isolation due to fear of severe coughing in public places and negative effects on relationship with family members and coworkers can also result. The greatest impact has been observed in women 65 years of age and older.

Often these impacts are not addressed during standard asthma consultations. Pharmacologic and nonpharmacologic interventions such as education sessions, written asthma action plans, active symptom monitoring, physical activity, and psychological interventions may promote living well with severe asthma (Stubbs et al., 2019; Hin & Kim, 2020).

Respiratory Complications

Persons with asthma have a high risk for developing other respiratory problems.

People with moderate to severe or uncontrolled asthma are more likely to be hospitalized from SARS-CoV-2 infection and COVID-19. The mortality rate for COVID-19 patients with underlying asthma (7.8%) has been found to be significantly higher than that of other patients (2.8%). Patients with severe asthma showed significant prolonged duration of admission compared to those with mild asthma (Choi et al., 2021).

Individuals with asthma are at increased risk for severe disease and complications from influenza. Influenza can affect the lungs, causing inflammation and narrowing of airways, which can trigger symptoms or an asthma attack. Asthma is the most common medical condition among children hospitalized with the flu and one of the more common medical conditions among hospitalized adults with the flu (CDC, 2021c).

A very serious complication is status asthmaticus (SA), a significant medical emergency that requires immediate and aggressive treatment. This is a severe asthma attack of either slow or sudden onset in which symptoms continue and respiratory function declines despite treatment. SA can range from mild to severe and can lead to prolonged hospitalization or respiratory failure and ultimately death. As many as 1.5% of people hospitalized for status asthmaticus do not survive (Loengard, 2019).

Patients with asthma are at higher risk for serious illness, complications, and even death related to pneumonia. Asthma may make the lungs more receptive to infection by pneumococcal bacteria, and corticosteroids may increase the risk due to suppression of the immune system (AAFA, 2021h).

Another serious respiratory complication is secondary spontaneous pneumothorax. This can be caused by increased airway pressure or as a result of mechanical ventilation. Superimposed infection can also occur in intubated patients. Patients may require a chest tube and aggressive antibiotic therapy for a superimposed infection (Saaden, 2020).

A rare complication of an acute exacerbation of asthma is pneumomediastinum. It is an uncommon event, and the mean age of affected patients is 11 years. This is a condition in which air enters the central compartment of the thoracic cavity. It is considered a self-limiting condition that usually resolves with successful management of asthma. However, morbidity and mortality are high when it is associated with pneumothorax. During a serious attack, the combination can prove fatal (Carolan, 2019).

Complications Related to Asthma Medication Use

Iatrogenic (drug-related) Cushing’s syndrome can develop with the prolonged use of corticosteroid medications for treatment and control of asthma. Signs and symptoms of this condition include:

Weight gain, especially in the face, supraclavicular region, upper back, and torso
Skin changes, including purpose stria, easy bruising, and other signs of skin thinning
Proximal muscle weakness
Menstrual irregularities and decreased libido in women
Decreased libido and impotence in men
Psychological problems, including depression, cognitive dysfunction, and emotional lability
New or worsening hypertension and diabetes mellitus
Difficulty with wound healing
Increased infections
Osteopenia and osteoporotic fractures
Steroid acne
Immunosuppression with slow wound healing and increased infections
Growth retardation in children
(Nguyen, 2020)

Complications related to inhaled corticosteroids include:

Thrush (candidiasis), oral or esophageal, which can be prevented by using a spacer and rinsing, gargling, and spitting after use
Dysphonia (hoarse voice), which is common with the use of inhaled corticosteroids and may be due to myopathy and spasm of laryngeal muscle, mucosal irritation, or laryngeal candidiasis; reversible when treatment is withdrawn
Cough and throat irritation, sometimes accompanied by reflex bronchoconstriction
Unusual complications, such as perioral dermatitis, tongue hypertrophy, and increased thirst
(Saag et al., 2021)