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Diabetes and Asthma: Is There a Link?

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Diabetes and Asthma: Is There a Link?

Diabetes can affect many parts of the body, including the heart, kidneys and nerves. What you may not know is that diabetes can also affect your lungs and can impact how well you breathe. Several lung conditions are linked with having diabetes, such as COPD (chronic obstructive pulmonary disease), pneumonia and tuberculosis. Another common lung condition that may be attributed to having diabetes is asthma.

What is asthma?

The American Lung Association defines asthma as “a lung disease that makes it harder to move air in and out of your lungs.” When you have asthma, the airways in the lungs are swollen or inflamed, and may lead to mucus production, making it hard for you to breathe. The airways are more sensitive to triggers such as the weather, pollution, pet dander, smoking, dust or chemicals.

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Asthma affects people of all ages, and it can start in childhood. It may go away, but then reappear later in life. While asthma is a chronic condition that can be life-threatening, it can be managed with the right treatment plan, allowing people to live an active and healthy life.

What causes asthma?

It’s not entirely clear what causes asthma. Asthma tends to run in the family, but environmental factors can also be involved. Here’s what we know about possible causes:

  • Genetics: If a parent has asthma, it’s more likely that any children will develop it.
  • Allergies: Allergies and asthma can go hand-in-hand; pollen, dust mites, pet dander and even food allergies can cause asthma.
  • Environment: Mold, dampness, secondhand tobacco smoke and air pollution are linked with asthma.
  • Respiratory infections: Viral infections, especially during childhood, can lead to asthma, including pneumonia and even the common cold.
  • Obesity: Both children and adults who are overweight or obese have a greater risk of getting asthma, possibly due to inflammation that occurs from having excess weight.

African Americans and Puerto Ricans have a higher risk of asthma than people of other races or ethnicities. In children, boys are more likely to have asthma than girls, although in adults, women are more likely to have asthma than men.

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What happens during an asthma attack?

Struggling to breath is a scary experience for anyone, and having asthma puts you at risk for an “asthma attack” (also known as an asthma “flare-up”). During an asthma attack, the airways in the lungs swell and shrink. Mucus production is also increased, which can clog the airways. And, the muscles around the airways tighten up (called bronchospasm). The result is that less air can get in and out of your lungs, making it difficult to breathe.

What are the symptoms of asthma?

Asthma varies in terms of severity and whether a person is exposed to allergens. Some people have asthma symptoms every day, while others have symptoms much less often. Symptoms can vary from person to person, as well. Typical signs and symptoms of asthma include:

  • Chest tightness, especially during cold weather or exercise
  • Coughing, especially early in the morning or at night, with or without mucus
  • Shortness of breath
  • Wheezing, or a whistling sound when you breath out

Other conditions can cause similar symptoms, but with asthma, there are usually patterns. For example:

  • Symptoms and come and go over time or within the same day
  • They can start or worsen if you have a viral infection, such as a cold
  • Symptoms are triggered by exercise, cold weather, allergies and even laughing or crying
  • They’re worse in the morning or at night

How is asthma diagnosed?

Your healthcare provider will evaluate your symptoms, obtain a health history, do a physical exam and likely do some tests, such as a lung function test and a chest X-ray.

If you’ve been having breathing symptoms, it helps to keep a record of what they are, when they occur and what might be causing them to trigger. Bring your record to your appointment. In addition, let your provider know about any allergies you have, as well as a family history of asthma, allergies and eczema. Tell your provider about home or work exposure to environmental factors that can worsen asthma, such as pets, pollen, dust mites, tobacco smoke and chemicals that you are exposed to at work.

The National Heart, Lung and Blood Institute lists the pulmonary tests that your provider may order include:

  • Spirometry: A device called a spirometer is used to measure the amount and speed of air that you blow out.
  • Bronchoprovocation tests: These tests measure how your lungs react to specific exposures such as allergens or medicines.
  • Peak expiratory flow test: This test measures how fast you can blow our air using maximum effort.
  • Fractional exhaled nitric oxide test: This measures the level of nitric oxide in your breath when you breathe out.
  • Allergy skin or blood tests: If you have allergies, these tests can indicate specific allergens, such as pollen, that cause your immune system to react.

What are the most common types of asthma?

Asthma symptoms can be similar from person to person, but the causes and triggers can vary. It’s important to know what type of asthma you have in order for you and your provider to come up with an effective management plan. The American College of Allergy, Asthma & Immunology list the following as the most common types of asthma:

  • Adult-onset asthma: This is asthma that occurs during adulthood. It may occur due to certain triggers such as getting a pet, working around certain chemicals, or having a viral infection.
  • Allergic asthma: Certain allergens, such as pollen, dust and pet dander can trigger asthma symptoms and attacks. An allergist can help to determine what allergens trigger asthma symptoms and determine the best way to treat the allergy or allergies.
  • Exercise-induced bronchoconstriction (EIB): This is asthma that can occur as a result of physical activity; symptoms may appear within a few minutes after starting exercise and can continue 10-15 minutes after you stop. Certain medications, such as beta2-agonists, inhaled corticosteroids and montelukast, are used to prevent and treat EIB, as well as trying to avoid triggers and trying to breathe through your nose while exercising.
  • Nonallergic asthma: This is asthma that is triggered by nonallergens, such as respiratory infections, exercise, stress, medications and the weather. Medication is often prescribed, as well as identifying and finding ways to avoid triggers.
  • Occupational asthma: This is asthma that is caused and triggered by airborne irritants at your job, such as chemical fumes, dust or other irritants. Certain workers are at risk of developing this type of asthma: bakers, laboratory workers, metal workers, farmers, woodworkers and drug manufacturers. Prevention and treatment involve environmental interventions, behavior changes and medication.

How is asthma treated?

The treatment of asthma typically involves the use of a combination of long-term control medicines (e.g., inhaled or oral corticosteroids, inhaled beta-agonists, leukotriene modifiers, theophylline) and quick-relief medicines (e.g., short-acting beta agonists, long-acting muscarinic antagonists). Immunotherapy, or allergy shots, may be recommended to reduce your body’s response to allergens. Also, you can take lifestyle measures to help prevent and treat symptoms, such as allergy-proofing your home, avoiding tobacco smoke, and limiting exposure to chemicals, mold, etc.

What is the link between diabetes and asthma?

A study published in the journal Diabetes Care in 2010 found that, out of 78,000 adults with either type 1 or type 2 diabetes, the incidence of asthma, as well as COPD, pulmonary fibrosis and pneumonia was higher compared to adults without diabetes. It’s thought that people with diabetes have impaired lung function, which is a chronic complication of diabetes.

One potential reason for a higher incidence of asthma in those with type 2 diabetes is the prevalence of obesity. Obesity is a major risk factor for type 2 diabetes as well as asthma. However, obesity aside, people with diabetes may have a higher risk of asthma due to insulin resistance and metabolic syndrome, both of which are associated with asthma. Interestingly, metformin, a medication commonly used to treat type 2 diabetes, is associated with a reduced risk of asthma exacerbations.

Some researchers also speculate that a cause of reduced lung function in people with diabetes is inflammation. Whatever the cause, lung function can worsen as blood glucose levels increase.

Takeaways

  • If you haven’t been diagnosed with asthma, but you have symptoms related to asthma, let your primary care provider know so that you can be tested for possible asthma.
  • If you have asthma but continue to have symptoms, talk with your primary care provider, allergist or pulmonologist, as your treatment plan may need to be adjusted.
  • Reduce asthma symptoms by taking asthma medication as prescribed, cleaning your home regularly (such as using mattress and pillowcase covers to prevent dust mites and vacuuming with a HEPA filtration vacuum cleaner), not smoking and avoiding tobacco smoke, and limiting exposure to pollution and certain kinds of weather.
  • Work with your diabetes care team to help you manage your diabetes, especially since some medications used to treat asthma can impact blood glucose levels.
  • Keep up to date with all of your vaccines, including the flu and pneumonia vaccines.

Want to learn more about diabetes and lung health? Read “Diabetes and Lung Health” and try your hand at our “Diabetes and Your Lungs” quiz.

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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