Asthma: A Complete Guide for International Patients in Shanghai

Introduction

Asthma is one of the most common chronic respiratory conditions in the world, affecting more than 300 million people globally. It is a disease of the airways characterized by chronic inflammation, reversible airflow obstruction, and airway hyperresponsiveness — causing recurrent episodes of wheezing, breathlessness, chest tightness, and cough.

For international patients and expatriates living in Shanghai, asthma deserves particular attention. Shanghai’s air quality — with its seasonal PM2.5 spikes, ozone pollution, and high humidity — is one of the most significant environmental challenges for asthma sufferers. Relocating to Shanghai can trigger new-onset asthma in previously unaffected individuals, or significantly worsen pre-existing asthma. Understanding how to manage asthma effectively in this environment is essential for quality of life and safety.

This guide provides a comprehensive overview of asthma — from understanding the condition and recognizing triggers to treatment, monitoring, and accessing specialist respiratory care in Shanghai.

What Is Asthma?

Asthma is a chronic inflammatory disease of the airways (bronchi) characterized by three key features:

• Airway inflammation: The lining of the airways is chronically inflamed, making them swollen, sensitive, and prone to narrowing
• Airway hyperresponsiveness: The airways overreact to triggers that would not affect non-asthmatic individuals, causing bronchoconstriction (tightening of the airway muscles)
• Reversible airflow obstruction: Narrowing of the airways causes airflow limitation that is typically reversible — either spontaneously or with treatment — distinguishing asthma from COPD

During an asthma attack (exacerbation), the airways narrow due to a combination of bronchoconstriction, mucosal swelling, and mucus plugging, making it difficult to breathe — particularly to exhale.

Types of Asthma

• Allergic (atopic) asthma: The most common type, particularly in children and young adults. Triggered by allergens such as house dust mites, pollen, pet dander, and mold. Often associated with other atopic conditions (eczema, allergic rhinitis, food allergy).
• Non-allergic asthma: Not driven by allergen sensitization. Triggers include respiratory infections, cold air, exercise, stress, and irritants. More common in adults.
• Exercise-induced bronchoconstriction (EIB): Airway narrowing triggered by physical exercise, typically occurring 5–10 minutes after starting exercise. Can occur in people with or without underlying asthma.
• Occupational asthma: Caused or worsened by workplace exposures to dusts, chemicals, or fumes. Relevant for expats working in manufacturing or laboratory environments.
• Aspirin-exacerbated respiratory disease (AERD): Asthma worsened by aspirin and NSAIDs, often associated with nasal polyps.
• Severe asthma: Asthma that remains uncontrolled despite high-dose inhaled therapy. Requires specialist evaluation and may benefit from biologic therapies.
• Cough-variant asthma: Chronic cough as the predominant or sole symptom, without classic wheeze or breathlessness. Frequently misdiagnosed.

Symptoms

Classic asthma symptoms include:

• Wheezing — a high-pitched whistling sound when breathing, particularly on exhalation
• Shortness of breath (dyspnea)
• Chest tightness or pressure
• Cough — often worse at night or early morning, and with exercise

Symptoms are typically episodic, variable, and often worse at night or in the early morning. They may be triggered by specific exposures or occur spontaneously.

Seek emergency care immediately if: you have severe breathlessness at rest, cannot complete sentences, your lips or fingernails turn blue, your reliever inhaler is not working, or your peak flow is below 50% of your personal best. This may indicate a life-threatening asthma attack.

Common Triggers

Identifying and avoiding your personal triggers is a cornerstone of asthma management. Common triggers include:

Allergens

• House dust mites (a major trigger in Shanghai’s humid climate)
• Cockroach allergens (prevalent in urban environments)
• Pet dander (cats and dogs)
• Mold and fungal spores (worsened by Shanghai’s high humidity)
• Pollen (seasonal — spring and autumn peaks in Shanghai)

Air Pollutants & Irritants

• PM2.5 and PM10 particulate matter: Shanghai experiences significant air pollution episodes, particularly in winter and during temperature inversions. Fine particles penetrate deep into the airways and trigger inflammation.
• Ozone (O3): Ground-level ozone peaks in summer and is a potent airway irritant
• Nitrogen dioxide (NO2) from traffic
• Tobacco smoke (active and passive)
• Strong odors, perfumes, cleaning products, and chemical fumes
• Incense and cooking smoke

Respiratory Infections

• Viral upper respiratory infections (common colds, influenza, COVID-19) are the most common trigger for asthma exacerbations in both children and adults

Physical & Environmental Factors

• Cold air and sudden temperature changes (common in Shanghai’s winters)
• Exercise
• High humidity
• Stress and strong emotions
• Gastroesophageal reflux disease (GERD)

Medications

• Aspirin and NSAIDs (in AERD)
• Beta-blockers (including eye drops)

Diagnosis

Asthma diagnosis is based on a combination of clinical history, symptom pattern, and objective lung function testing:

• Spirometry: The cornerstone of asthma diagnosis. Measures airflow and lung volumes. Key findings in asthma include reduced FEV1/FVC ratio (obstructive pattern) and significant bronchodilator reversibility (improvement in FEV1 of ≥12% and ≥200 mL after a short-acting bronchodilator). Available at all major Shanghai hospitals and respiratory clinics.
• Peak expiratory flow (PEF) monitoring: A simple handheld device that measures how fast air can be expelled. Variability in PEF of >10% over time supports an asthma diagnosis and is useful for monitoring at home.
• Bronchial provocation testing: Methacholine or exercise challenge to confirm airway hyperresponsiveness when spirometry is normal but asthma is suspected.
• Fractional exhaled nitric oxide (FeNO): A non-invasive test measuring airway inflammation. Elevated FeNO supports eosinophilic airway inflammation and predicts response to inhaled corticosteroids. Available at leading Shanghai respiratory centers.
• Allergy testing: Skin prick testing or specific IgE blood tests to identify allergen sensitization. Guides allergen avoidance and immunotherapy decisions.
• Chest X-ray: To exclude other causes of respiratory symptoms (pneumonia, pneumothorax, heart failure).
• Full blood count: Eosinophil count is relevant for severe asthma biologic therapy eligibility.

Asthma Severity & Control

Asthma management is guided by two key concepts:

• Severity: Assessed retrospectively based on the treatment required to achieve good control. Classified as mild, moderate, or severe.
• Control: Assessed prospectively based on current symptom frequency, reliever use, activity limitation, and lung function. Classified as well-controlled, partly controlled, or uncontrolled.

The goal of treatment is to achieve and maintain well-controlled asthma with the lowest effective dose of medication.

Treatment

Asthma treatment follows a stepwise approach, guided by the Global Initiative for Asthma (GINA) guidelines. Treatment is stepped up when control is inadequate and stepped down when control is sustained.

Reliever Medications (for acute symptom relief)

• Short-acting beta-2 agonists (SABAs) — e.g., salbutamol (albuterol): The classic “blue reliever inhaler.” Provides rapid bronchodilation within minutes. Used for acute symptom relief and before exercise. Available in China (brand name: Ventolin and generics).
• Low-dose ICS-formoterol (e.g., budesonide-formoterol): Per updated GINA 2023 guidelines, low-dose inhaled corticosteroid (ICS) combined with formoterol is now the preferred reliever for adults and adolescents, used as needed. This approach (MART — Maintenance And Reliever Therapy) reduces exacerbation risk compared to SABA-only relief. Available in China.

Controller Medications (for long-term prevention)

• Inhaled corticosteroids (ICS): The most important controller medication. Reduce airway inflammation, prevent exacerbations, and improve lung function. Examples: budesonide, fluticasone, beclomethasone. All available in China. Must be taken daily, even when symptom-free.
• Long-acting beta-2 agonists (LABAs) — e.g., formoterol, salmeterol: Always used in combination with ICS (never as monotherapy in asthma). ICS/LABA combination inhalers (e.g., budesonide/formoterol, fluticasone/salmeterol) are the standard of care for moderate-to-severe asthma. Available in China.
• Leukotriene receptor antagonists (LTRAs) — e.g., montelukast: Oral tablets that reduce airway inflammation. Useful as add-on therapy or in patients who cannot use inhalers. Available in China.
• Long-acting muscarinic antagonists (LAMAs) — e.g., tiotropium: Add-on bronchodilator for patients not controlled on ICS/LABA. Available in China.
• Theophylline: An older oral bronchodilator, less commonly used due to narrow therapeutic window and side effects, but still available and used in China.

Biologic Therapies for Severe Asthma

For patients with severe, uncontrolled asthma despite high-dose ICS/LABA, targeted biologic therapies offer transformative outcomes. Eligibility is based on the patient’s inflammatory phenotype (eosinophilic, allergic, or type 2 high):

• Omalizumab (anti-IgE): For severe allergic asthma with elevated total IgE. Approved and available in China.
• Mepolizumab, benralizumab (anti-IL-5/IL-5R): For severe eosinophilic asthma. Availability in China is expanding.
• Dupilumab (anti-IL-4Rα): For severe type 2 asthma, including those with comorbid atopic dermatitis or chronic rhinosinusitis with nasal polyps. Approved in China.
• Tezepelumab (anti-TSLP): The broadest-spectrum biologic, effective across asthma phenotypes. Availability in China is growing.

CMCS can assist with accessing biologic therapies and navigating insurance pre-authorization in China.

Allergen Immunotherapy (AIT)

For patients with allergic asthma sensitized to specific allergens (particularly house dust mites), allergen immunotherapy — administered as subcutaneous injections or sublingual drops/tablets — can modify the underlying allergic disease and reduce long-term medication requirements. Available at allergy and respiratory departments in Shanghai.

Asthma Action Plan

Every asthma patient should have a written Asthma Action Plan — a personalized document that specifies:

• Daily controller medications and doses
• How to recognize worsening asthma (based on symptoms and/or peak flow readings)
• What to do when symptoms worsen (step up reliever use, add oral steroids)
• When to seek emergency care
• Emergency contact numbers (in Shanghai: 120)

Ask your respiratory specialist to provide a written action plan at your next appointment. CMCS can assist with translation into English if your plan is provided in Chinese.

Monitoring Asthma at Home

• Peak flow meter: A simple, inexpensive device for daily monitoring of lung function. Helps detect early deterioration before symptoms become severe. Available at Chinese pharmacies.
• Symptom diary: Record daily symptoms, reliever use, and potential triggers. Invaluable for your specialist.
• Air quality monitoring: Check Shanghai’s AQI daily using apps such as AirVisual or the Shanghai Environmental Monitoring Center. On high-pollution days (AQI >150), limit outdoor activity, wear an N95 mask outdoors, and keep windows closed with air purifiers running indoors.

Living with Asthma in Shanghai

Air Quality Management

Air quality is the most significant environmental challenge for asthma patients in Shanghai. Practical strategies:

• Invest in a high-quality HEPA air purifier for your home and bedroom — run it continuously
• Monitor the AQI daily and plan outdoor activities on low-pollution days
• Wear a well-fitted N95 or KN95 mask on high-pollution days outdoors
• Keep windows closed during pollution episodes and use air conditioning with HEPA filtration where possible
• Avoid outdoor exercise during peak pollution hours (early morning and evening in winter)

Humidity & Allergen Control

• Use a dehumidifier in summer to reduce house dust mite and mold growth (target indoor humidity 40–50%)
• Wash bedding weekly in hot water (≥60°C) to kill dust mites
• Use allergen-proof mattress and pillow covers
• Address any visible mold in your apartment promptly

Medications in China

Most essential asthma medications are available in China, including salbutamol inhalers, ICS/LABA combinations (budesonide/formoterol, fluticasone/salmeterol), montelukast, and omalizumab. Bring a sufficient supply of your current inhalers when relocating, along with a letter from your doctor specifying the generic drug name and device type. Inhaler device types available in China may differ from those in your home country — your respiratory specialist can advise on equivalent options.

Specialist Care in Shanghai

Respiratory medicine departments at Zhongshan Hospital, Ruijin Hospital, and Shanghai Chest Hospital have experienced pulmonologists and dedicated asthma clinics. Allergy departments at Ruijin Hospital and Huashan Hospital offer comprehensive allergy testing and immunotherapy. Navigating these systems in Chinese can be challenging — CMCS provides full support.

How China Medical Concierge Shanghai (CMCS) Can Help

Managing asthma in Shanghai — with its unique air quality challenges and complex healthcare system — requires the right support. CMCS provides:

• Specialist matching: Connecting you with experienced pulmonologists and allergists at Shanghai’s leading hospitals
• Appointment booking: Priority scheduling and full administrative coordination
• Medical interpretation: Professional interpreters for all consultations, spirometry sessions, and allergy testing
• Medication access: Guidance on obtaining your prescribed inhalers and medications in China, including biologic therapies
• Insurance coordination: Liaising with your international health insurer for specialist consultations, investigations, and biologic therapy approvals
• Asthma action plan translation: Ensuring your action plan is available in English for use in emergencies
• Air quality guidance: Practical advice on managing asthma in Shanghai’s air quality environment

📩 Contact CMCS today for a free initial consultation.

Frequently Asked Questions

Will Shanghai’s air quality make my asthma worse?
It can. Shanghai experiences significant air pollution episodes, particularly in winter, with elevated PM2.5 levels that are a well-established trigger for asthma exacerbations. With proactive management — HEPA air purifiers, daily AQI monitoring, N95 masks, and optimized medication — most patients can manage their asthma effectively in Shanghai. CMCS can help you establish a comprehensive asthma management plan tailored to the Shanghai environment.

Can asthma be cured?
There is currently no cure for asthma, but it can be very effectively controlled. With appropriate treatment, most patients can achieve a normal or near-normal quality of life with minimal symptoms. Some children with mild asthma experience remission in adolescence, though asthma can recur in adulthood.

Are my inhalers available in China?
Most essential asthma inhalers are available in China, though brand names and device types may differ. Bring a sufficient supply when relocating and carry a letter from your doctor with the generic drug name. CMCS can assist with identifying equivalent medications available in Shanghai.

What should I do during an asthma attack in Shanghai?
Use your reliever inhaler (salbutamol or ICS-formoterol) immediately. Sit upright and try to stay calm. If symptoms do not improve after 4–6 puffs over 20 minutes, call 120 or go to the nearest emergency department. Follow your written Asthma Action Plan. CMCS clients can contact our 24/7 emergency line for immediate support.

Is asthma treatment covered by international health insurance?
Yes. Asthma diagnosis, specialist consultations, spirometry, allergy testing, and prescription medications (including inhalers and biologics) are typically covered by international health insurance. Coverage for biologic therapies varies by policy. CMCS can verify your coverage and manage the authorization process.

My child has asthma — how do I manage it at school in Shanghai?
Ensure your child’s school has a copy of their Asthma Action Plan (translated into Chinese if necessary) and that teachers know how to recognize and respond to an asthma attack. Your child should carry their reliever inhaler at all times. CMCS can assist with translating medical documents and coordinating pediatric respiratory specialist care.