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| Asthma Triggers and
Management Asthma is a chronic lung disease that affects more than 17 million
Americans. Asthma is characterized by coughing, chest tightness, shortness of
breath and wheezing. If you have asthma, you can minimize your symptoms by
avoiding the factors that trigger your symptoms and by working with your
physician to develop an effective management and treatment plan.
Triggers of asthma
Asthma symptoms can be triggered by several factors, including:
 | allergens or irritants; |
| viral or sinus infections; |
| exercise; |
| reflux disease (stomach acid flowing back up the esophagus); |
| medications or foods; |
| emotional anxiety. |
Allergic rhinitis, or "hay fever," is considered a risk factor in
developing asthma; up to 78% of people with asthma also have allergic rhinitis.
Symptoms of both can be triggered by seasonal or year-round allergens—any
substance that triggers allergies. These can include airborne pollens and molds,
animal dander (dead skin flakes), house dust mite and cockroach droppings, and
indoor molds. If your asthma is triggered by allergens, it is important to do
your best to avoid exposure to them. See your allergist for recommendations on
control measures to help avoid allergens.
Some substances do not trigger allergies but can nonetheless aggravate the
nose and airways. These substances, called irritants, can trigger asthma.
Some examples include:
| Air pollutants such as tobacco smoke, wood smoke, chemicals in the air and
ozone; |
| Occupational exposure to allergens, vapors, dust, gases or fumes; |
| Strong odors or sprays such as perfumes, household cleaners, cooking fumes
(especially from frying), paints or varnishes; |
| Other airborne particles such as coal dust, chalk dust or talcum powder;
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| Changing weather conditions, such as changes in temperature and humidity,
barometric pressure, or strong winds. |
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Sinus Wash
Asthma Treatment Products
Compressors & Nebulizers
Peak Flow Meter |
All of these irritants can aggravate asthma, particularly tobacco smoke.
Several studies have reported an increased incidence of asthma in children whose
mothers smoke. No one should smoke in the home of an asthmatic.
Viral infections such as colds or viral pneumonia can trigger or aggravate
asthma, especially in young children. These infections can irritate the airways,
nose, throat, lungs and sinuses, and this added irritation often triggers asthma
flare-ups. Additionally, sinusitis—an inflammation of the hollow
cavities found around the eyes and behind the nose—can trigger asthma.
Symptoms of sinusitis can include wheezing, postnasal drip, cough, headaches,
sinus pressure or pain, or enlarged lymph nodes. Excess drainage of mucus into
the nose, throat and bronchial tubes caused by sinusitis can trigger or
aggravate asthma.
Strenuous physical exercise can also trigger attacks. Mouth breathing,
exercising in cold, dry air, or prolonged, strenuous activities such as medium-
to long-distance running can increase the likelihood of exercise-induced asthma
(EIA). For more information, please see the Tip brochure in this series
or speak to your allergist.
Gastroesophageal reflux disease (GERD), a condition in which stomach acid
flows back up the esophagus, affects up to 89% of patients with asthma. Symptoms
include severe or repeated heartburn, belching, night asthma, increased asthma
symptoms after meals or exercise, or frequent coughing and hoarseness. GERD
reflux treatment is often beneficial for asthma symptoms as well.
Some adults with asthma may experience an asthma attack as a result of taking
certain medications. These can include aspirin or other non-steroidal
anti-inflammatory drugs (NSAIDS) such as ibuprofen; and beta-blockers (used to
treat heart disease, high blood pressure or migraine headaches). Up to 19% of
adult patients with asthma experience aspirin or NSAID sensitivity. Before
taking any over-the-counter medications, those with asthma should consult their
physicians.
For about 6-8% of children with asthma, eating certain foods or various food
additives can trigger asthma symptoms. Culprits include milk, eggs, peanuts,
tree nuts, soy, wheat, fish and shellfish. If any of these foods trigger asthma
attacks, the best remedy is to avoid eating them.
Emotional factors alone cannot provoke asthma. However, anxiety and nervous
stress can cause fatigue, which may also increase asthma symptoms and aggravate
an attack. As with any other chronic health condition, proper rest, nutrition
and exercise are important to overall well-being and can help in managing
asthma.
Asthma management
Since asthma is a chronic disease, it requires continuous management
and appropriate treatment. According to the national Guidelines for the
Diagnosis and Management of Asthma (National Asthma Education and Prevention
Program, National Institutes of Health, 1997), asthma treatment has four main
components:
| The use of objective measures of lung function (such as peak flow meters
and spirometers) to assess the severity of asthma and to monitor the course
of treatment; |
| Environmental control measures to avoid or eliminate factors that trigger
asthma symptoms or flare-ups; |
| Medication therapy for long-term management to reverse and prevent airway
inflammation as well as therapy to manage asthma flare-ups; |
| Patient education to foster a partnership between the patient, his or her
family, and the physician and other health care providers. |
According to the Guidelines, there are six goals for the effective
management of asthma:
| Prevent chronic and troublesome symptoms; |
| Maintain (near) "normal" breathing; |
| Maintain normal activity levels, including exercise; |
| Prevent recurrent asthma flare-ups, and minimize the need for emergency
room visits or hospitalizations; |
| Provide optimal medication therapy with no or minimal adverse effects;
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| Meet patients’ and families’ expectations of satisfactory asthma care. |
You and your physician can work together on these goals to ensure that your
asthma is well-managed. Having asthma should not stop you from participating in
normal daily activities.
Medication Treatment
Well-managed asthma includes using proper medications. People with
asthma have inflamed airways which can become even more inflamed after exposure
to various triggers. The main purpose of asthma medications is to reduce this
inflammation. Some of these medications should be used on a daily basis as
instructed, even if you are feeling well. This is to prevent asthma flare-ups
and to ensure that airways are as open as possible. Make sure you follow your
physician’s instruction on the appropriate use and dosage of your prescribed
medications.
Medications used to manage and treat asthma include:
| anti-inflammatory agents such as cromolyn or nedocromil,
which stop the development of inflammation in the lungs, as well as help to
prevent it. |
| corticosteroids (not related to the steroids misused by some athletes), an
effective medication used in inhaled (topical) or oral (systemic) form,
depending on the severity of asthma. |
| bronchodilators, generally used as "rescue medications" to open
up the bronchial tubes so that more air can flow through. Bronchodilators
include beta-agonists, theophylline and anticholinergics, and come in
inhaled, tablet, capsule, liquid or injectable forms. Salmeterol is a
long-acting bronchodilator that, along with an anti-inflammatory medication,
is used for maintenance in the control of asthma symptoms. |
| anti-leukotrienes, which fight potent chemicals called leukotrienes
(lu-ko-try-eens) responsible for airway inflammation within the body. These
oral medications are fairly new and are used in the treatment of chronic
asthma. |
The better informed you are about your asthma triggers and management, the
less asthma symptoms will interfere with your activities. It is important to
avoid your triggers, work with your physician on a management plan, and take
appropriate medications as prescribed. Together, you and your allergist can work
to ensure that asthma does not interfere with your optimal quality of life. |
