April 3, 2023
Asthma and autism are distinctly different medical conditions. Asthma is a chronic respiratory disease while autism is a developmental disorder.
Despite these differences, some research suggests there may be a connection between the two conditions. Multiple studies have found that autism spectrum disorder (ASD) can co-occur with certain immune-mediated conditions including asthma. Other studies have found children with asthma may have a slightly higher risk of developing autism compared to those without asthma. Research has also looked at common factors that may play a role in development of both autism and allergic diseases, such as maternal asthma and allergies, gut microbiome imbalance, diet, diabetes during pregnancy, exposure to air pollution, and sleep disturbances. There is also research that an asthma-autism link may begin during pregnancy with the use of certain asthma medications.
And there are studies, including a National Institutes of Health study of asthma and autism, that say there is no association at all.
Reviewed together, the research does NOT show there is a link between asthma and autism. Further, studies do not show that asthma can cause autism or autism can cause asthma. More research is needed to understand if there is a relationship between these conditions.
Asthma affects a person’s ability to breathe properly. It causes the airways in the lungs to become narrow and inflamed, making it difficult to breathe. Asthma can be triggered by various factors such as allergens (called allergic asthma), exercise and stress.
Autism, on the other hand, affects a person’s communication, social interaction and behavior. ASD is called a “spectrum” disorder because the symptoms and their severity can vary widely. Some with ASD may have mild developmental disabilities. They may be able to function well in everyday life. Others may have more severe symptoms that impact their daily functioning.
It’s important to speak with a healthcare professional for advice and guidance on living with asthma and autism. People with autism, especially children, may have difficulty understanding and managing asthma.
Can autism cause breathing problems?
Asthma and autism do not have a cause-and-effect relationship. However, researchers have identified common risk factors for both. These include genetics, immune dysfunction and environmental factors. Some studies have suggested that exposure to allergens and air pollution could increase the risk of developing both autism and asthma.
In addition, some children with ASD may have a nervous system disorder called hypersensitivity that slows the heart rate. This condition is sometimes accompanied by respiratory disorders, including childhood asthma.
It is also possible the relationship between autism and asthma is indirect. Some people with autism may have difficulty explaining their symptoms. This could make it harder to get the right diagnosis or find treatment. Some people with autism may have sensory processing issues that makes it harder for them to avoid asthma triggers or tolerate medications. This could worsen asthma.
Can asthma medication use during pregnancy cause autism in early childhood?
There is no clear evidence to suggest asthma medication use during pregnancy causes autism in children.
In 2016, Drexel University School of Public Health researchers examined the issue. The study found a small link between the use of certain asthma medications during pregnancy and increased risk of autism in children.
The drugs in question were beta2-agonist bronchodilators (called B2AR agonists in the study). Beta2-agonists come in short-acting and long-acting inhalers. They treat the noisy symptoms of asthma: coughing, wheezing and shortness of breath. These are life-saving medications for people with asthma. That’s what makes the study findings a particular concern for women. Will a pregnant woman have to choose between breathing and preventing her child from autism? Not so fast, say asthma specialists.
The study cited previous research about the effect of beta2-agonists on fetal brain development. Researchers turned their attention to autism spectrum disorders. They reviewed 10 years of records involving Danish children with ASD. Then they compared them to a control group without ASD. The researchers found the following:
- 3.7% of autistic children were born to women who used beta2-agonists during pregnancy.
- 2.9% of the control group – children without ASD – were born to women who used beta2-agonists during pregnancy.
The study concluded that B2AR use during pregnancy was associated with a slight increase in risk for ASD in children.
Researchers pointed out the increased risk was small. “Less than 1% of ASD cases can be attributed to prenatal B2AR-agonist drug exposure,” they wrote.
Some other points to consider about the Drexel study:
- The data about medication use was based on B2AR prescriptions filled. The study did not measure actual use of the medication. It did not differentiate between types of beta-agonists. These include quick-relief albuterol and levalbuterol and long-acting beta-agonists like salmeterol and formoterol. Each has its own action and effect on the blood and body.
- The study did not look at environmental risk factors. These might affect development of autism while also triggering asthma symptoms.
- A 2019 study examining parental asthma also found a slightly higher risk of childhood autism spectrum disorder. But it also found no evidence of an association between asthma medications during pregnancy and offspring ASD.
What is the important message from the widely reported Drexel study? Pregnant women with asthma should continue to take their quick-relief and long-acting beta-agonists as prescribed. Untreated asthma during pregnancy can pose health risks to both mother and fetus. It can affect the mother’s oxygen levels and that of the placenta and baby. It can also lead to premature birth and/or low birth weight.
The Drexel study provides preliminary data that is interesting but unconvincing, says board-certified allergist Stephen Tilles, MD, past-president of the American College of Allergy, Asthma & Immunology (ACAAI). “While we wait for more data to emerge about ASD and beta-agonists, it is imperative that allergists not alter their approach to managing asthma in pregnancy,” Dr. Tilles says.
Pregnant women with asthma should work together with their healthcare team. It is normal to have questions or concerns about the use of medication during pregnancy. Talk with your healthcare provider about the impact of medications on your child’s development.
Are people with autism spectrum disorders more likely to have allergies?
Researchers have used data from the U.S. National Health Interview Survey (1997 to 2016) to examine autism spectrum disorder and allergies.
One study using the data found an association between autism and common allergic conditions, including food allergy.
Another study using the same data focused on autism and food allergies. It found the following:
- 11.25% of children with ASD had a food allergy, compared to 4.25% of children without ASD who had a food allergy.
- 18.7% of children with ASD reported respiratory allergies, compared to 12% of children without ASD.
- 16.8% of children with ASD reported skin allergies, versus 9.8% of children without ASD.
There is no cause-and-effect relationship between allergies and ASD. Both conditions are complex. They are caused by a variety of factors. One risk factor is genetics. Another risk factor is the environment.
Some scientists think autoimmune diseases may affect the brain and allergic response. The gut microbiome may also play a role. Future research will help establish the association between ASD, allergies and immune function.
Practical tips for managing asthma and allergies if you or your child has autism
Managing asthma and allergic conditions can be a challenge for people with autism spectrum disorder. This is often due to sensory processing differences and communication difficulties. With the right tools, people with autism and their families can successfully manage asthma and allergies. Here are some practical tips.
Create a visual schedule for medication and check-ups
A visual schedule can provide a sense of structure and predictability. It can also make it easier to remember when to take daily asthma controller medication or attend doctor appointments. Use a visual aid such as a calendar, chart or planner to keep track of medication and check-ups. A color-coded Asthma Action Plan may be especially helpful for people with autism. Pictures or symbols may help people with autism understand foods they need to avoid.
Social stories are short stories that teach people with autism about situations or behaviors. Create a social story that explains:
- asthma and allergy symptoms;
- what triggers asthma flares;
- what triggers a severe allergic reaction; and/or
- how to use an inhaler, epinephrine auto-injector, or other medication.
This can help reduce anxiety and confusion around managing asthma and allergies.
Use technology to track asthma
Many smartphone apps and wearable devices are available. These can help people with autism and asthma track their symptoms and medication use. Some apps provide reminders when it’s time to take medication or go to a doctor appointment. These tools can be particularly helpful for people with autism who may struggle with remembering to take their medication or communicate their symptoms.
Develop a routine
People with autism often thrive on routines and predictability. Create a routine that includes taking a daily controller medication at the same time each day. Schedule doctor appointments at the same time of the month. Developing a routine can help reduce stress and anxiety. It can also increase follow-through on treatment plans and dietary restrictions.
Educate yourself and your loved ones
Get a better understanding of asthma and allergies. Knowing the symptoms and treatment can help people with autism feel more in control. It can also help loved ones better support and advocate for people with autism.
Identify and avoid triggers
Asthma triggers can vary from person to person. Triggers can include pollen, mold, dust mites, pet dander, cold air, exercise and stress. Work with your doctor to identify and avoid triggers that may worsen asthma symptoms.
Make sure to always keep emergency asthma inhalers or epinephrine on hand. Keep a spare set in your car, at work or at school, if necessary. It can also be helpful to have a medical ID bracelet that indicates your diagnosis.
RUTHIE MARKER, MSRC, RRT, RRT-NPS, AE-C, LSSYB, a respiratory therapist with more than 13 years of experience working in adult critical care, neonatal care, and patient education. She joined Allergy & Asthma Network to support the Not One More Life coaching program as a Spanish-speaking Asthma Coach. Ruthie has worked as a respiratory therapist in Texas all of her career and has supported COVID-19 efforts in Maryland and Arkansas.