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Can Allergies Make My Breathing Worse?

Allergies can have tremendous impact on a person’s breathing. A very common symptom associated with allergies is nasal congestion. This results in increased work of breathing. The structures and lining of the inside of the nose help warm, moisten and filter the air we breathe. But, these functions of nose result in a lot of resistance to airflow. At rest, much of the work we have to do to breathe goes into overcoming the resistance that this causes. Worse yet, if there is inflammation in the nose, as commonly occurs with allergies, it can become much more difficult (or even not possible) to breathe through the nose. At that point, while still able to breathe through the mouth, most people will find breathing much more difficult.

Many people find that nasal decongestant pills provide help, at least partially, in this situation. These decongestants, frequently cause side-effects and the benefit they provide is far from complete for most people. Unfortunately, decongestant sprays for the nose tend to provide only very limited benefit, especially because if used for more than just a few days, they may make nasal congestion worse and/or become habit forming. Steroid nasal sprays tend to be very helpful for most people experiencing most nasal allergy symptom, including stuffy nose. Even though antihistamine pills are usually not very helpful for nasal congestion, certain antihistamine nasal sprays can be quite helpful. While probably not as effective overall as steroid nasal sprays, the antihistamine nasal sprays typically work more quickly and are more effective is used on an “as needed” basis.

Most people with asthma find that their asthma symptoms, including breathing tightness, coughing and wheezing, worsen when their allergies flare up. This occurs because the same type of inflammatory changes that occur in the mucous membranes in the nose, in response to allergy, also occur in the mucous membranes that line the airways within the lungs in the individual with asthma (at least in the majority of people with asthma who have an allergic basis to their disease). This can result in increased mucous production within the airways, tightening of bands of muscle surrounding the airways and other changes, all resulting in narrowing or constriction of the airways a person is trying to breathe through. Worse yet, these changes with asthma will usually occur in conjunction with nasal congestion and other symptoms. Treatment of acute symptoms involves bronchodilator medications (albuterol or levalbuterol), which work quickly to relax and open the airways. In situations where asthma symptoms are frequent or persistent, inhaled steroid medications are usually very helpful in terms of providing, and maintaining, control of underlying inflammatory changes.

Antihistamine medications alone typically are not adequately helpful in asthma. Leukotriene modulators and anticholinergic medications may be helpful in many routine circumstances as well.
Often, when allergies worsen, other breathing disorders can be adversely impacted as well. Many people with obstructive sleep apnea find they have difficulty using their CPAP devices due to increased nasal congestion and mucous production. This can make sleep apnea much more difficult to treat unless allergies are brought under good control.

Allergies can even worsen breathing problems from vocal cord dysfunction. Vocal cord dysfunction is a condition which results in the vocal cords pulling together (rather than opening) while breathing. It is a common occurrence in people with asthma and exercise-included asthma. It is characterized by breathing difficulty, usually with exercise, often felt in the neck or high in the chest, primarily during the breath in. Many things that can irritate the vocal cords can worsen vocal cord dysfunction. Among these, an increase in postnasal drainage (postnasal drip) due to allergies will often lead to more difficulty with vocal cord dysfunction. Although breathing exercises are helpful, it is critical to control underlying contributors, in this case, any underlying postnasal drainage, that may be driving the process.

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