In the decade between 1990 and 2000, the cost of asthma care increased by 54%, according to Family Practice News (October 1, 2000). Some authors at the time suggested that greater attention to diet, lifestyle, and supportive therapies might help reduce long-term costs. Concerns were also raised about medication use, particularly inhaler overuse. An article in Family Practice News (April 15, 1993) reported that asthma-related deaths could potentially be reduced by as much as 50% if physicians monitored overuse of beta-agonist inhalers. Ideally, an inhaler should last about one month, yet prescriptions were often written with unlimited refills, making it difficult for clinicians to track actual usage. Other medications may also contribute to asthma attacks. Research published in the Annals of Allergy (June 1992; 68:453–462) suggested that medications may account for up to 10% of asthma attacks, with nonsteroidal anti-inflammatory drugs (NSAIDs) responsible for roughly two-thirds of these drug-induced reactions. Other medications, including muscle relaxants, beta-blockers, and certain antibiotics, were also identified as potential triggers.

Diet has historically received less attention in conventional asthma management, despite evidence suggesting it may influence symptoms. A large study published in the European Respiratory Journal (2009; 33:33–41) examined dietary patterns in 54,672 French women. Among the participants, 1,063 had asthma, and 206 experienced asthma attacks at least once per week. The researchers found a strong association between frequent asthma attacks and adherence to a “Western” dietary pattern characterized by pizza, cured meats, sweets, and other processed foods. Dietary fat composition also appears relevant. Research published in the European Journal of Clinical Nutrition (2005; 59(12):1335–1346) found that omega-3 fatty acids were particularly helpful in reducing exercise-induced bronchospasm. Earlier review work in the Australian and New Zealand Journal of Medicine (1994; 24:727) suggested that low omega-3 intake, high omega-6 intake, and increased use of margarine may have contributed to rising asthma rates. The authors noted that asthma prevalence has historically been lower in Scandinavian and Mediterranean regions, where diets tend to include more omega-3 fatty acids and olive oil and less omega-6 fat.

Nutrient status has also been examined in relation to asthma. A review published in Clinical and Experimental Allergy (2000; 30:615–627) reported that magnesium supplementation reduced bronchial reactivity and noted magnesium’s mild bronchodilating effects. Vitamin C intake has been associated with reduced exercise-induced asthma, and vitamin C levels are often lower in people with asthma. A review in Thorax (2009; 64(7):610–619) examined antioxidant intake and asthma, concluding that relatively low dietary intakes of vitamins A and C were associated with significantly increased odds of asthma and wheeze. Similar observations were reported earlier in the American Journal of Clinical Nutrition (1995; 61(Suppl.):625S–630S). Additional research published in Thorax (May 2006; 61:388–393), involving 1,030 participants, found that dietary vitamin C and manganese intake were inversely associated with asthma symptoms.

Overall, this body of research suggests that diet is a relatively simple and inexpensive factor that may influence asthma symptoms. Omega-3 fatty acids, magnesium, manganese, and antioxidant nutrients—particularly vitamin C—have repeatedly been linked with measures of asthma control in observational and interventional studies. Despite this, dietary and nutritional considerations have historically received limited emphasis in routine medical care for asthma.