Triggers are substances or situations that set off asthma symptoms, such as wheezing, coughing, shortness of breath or a feeling of tightness in the chest. The more you learn about your triggers, the better equipped you will be to control or avoid them.
Allergies affect about 80 percent of children and about 50 percent of adults with asthma. The most common allergens are dust mites, cockroaches, mold and pollen.
Dust mites are microscopic insects that feed off the dead skin cells that we shed daily. They thrive in dust-collecting fabric such as pillows, mattresses, bedding, stuffed animals, furniture upholstery, rugs and draperies. In other words, they are everywhere! The mite allergen is found primarily in the mite feces and carcasses.
Keeping a home dust-free can be a Herculean project, but here are some tips to help minimize the breeding grounds for those pesky mites. Since more time is spent in the bedroom than anywhere else in the home, focus your efforts there first.
Encase pillows and mattresses in allergen-proof covers. Highly effective and comfortable fabric covers have replaced the older nonporous plastic covers.
Wash bedding in hot water (130 degrees Fahrenheit or hotter) at least every two to three weeks. The mites repopulate every four weeks. Use a meat thermometer to check the temperature of the wash water. Caution: Water that is 130 degrees F is too hot for bathing or showering.
Keep indoor humidity less than 50 percent.
Buy washable stuffed animals and wash with bedding. For non-washable items, place them in a hot dryer or freezer periodically to kill the mites and denature the allergens.
Chemical treatments cannot be used on bedding and add little to dust mite control if the bed and bedding are dealt with.
Cockroaches have taken up permanent residence in some urban homes. The offending allergen is found in their feces and carcasses, which mix with the household dust, become airborne, and become a trigger for asthma. In addition to dust mite control, add these tips to your arsenal to reduce the presence of cockroaches:
Keep all food in tightly covered containers
Keep counter tops and floors free of crumbs and other food debris. Take out the trash often; keep trash containers tightly covered
Seal cracks and crevices in corners and around doors and pipes
Extermination: Cockroaches are amazingly hardy, and according to the Journal of Allergy and Clinical Immunology chemical extermination may not be able to eliminate all of them permanently. Let the exterminator know about children and pets living in the home, as well as asthma sufferers, so that they can make some chemical choices. Be out at the time the chemicals are used, and for several hours afterward, longer if the company suggests. Ventilate the home well before the person with asthma comes back in.
Mold is found both inside and outside the home, in warm, moist areas. Mildew is a form of mold. Mold spores are easily airborne; so following the pollen control tips can limit bringing the spores into the home.
Outdoor sources include hay or hayrides.
Indoor sources include:
Bathroom: Cleaning with a bleach solution around the sink, toilet and shower (especially the curtain) and using a venting fan can help keep mold to a minimum.
Basement. Using a dehumidifier can help reduce the moisture.
Refrigerator drip tray
Humidifiers and vaporizers
Pollen can be insect-carried or airborne. It is a fine, powdery substance that allows certain trees, grasses and weeds to reproduce. The airborne variety creates the most problems for allergy and asthma sufferers. Because the pollen particles are so small, they are easily inhaled, setting off an allergic response. Pollen enters the home through open windows, on clothing, and hair, and on the fur of our pets.
Asthma sufferers may find some types of weather conditions easier than others, depending on their triggers. As we inhale through the nose, the air is filtered, warmed and humidified in the upper respiratory area before it enters the lungs. Cold, dry air can trigger asthma symptoms, as the muscles around the airways constrict in reaction to the temperature of the air. If you need to be outdoors in cold weather, covering your nose and mouth with a scarf or mask can help raise the temperature of the air inhaled. A certain amount of humidity in the air makes it easier to breathe. Also, the more humid the air, such as after a rainstorm, the more airborne substances such as pollen "hang" in the air and the more mold growth is encouraged. Windy days can increase the levels of pollen, mold spores and other airborne irritants such as smoke. Stagnant air can increase the levels of smog and other air pollutants. Depending on your triggers, it may be best to exercise indoors, where weather conditions are less of a factor. When planning your daily activities, keep the weather conditions in mind as a factor in controlling your asthma.
Some people suffer from exercise-induced asthma (EIA), meaning that they only experience symptoms when they exercise. For others, exercise is an additional trigger for asthma symptoms. True EIA occurs shortly after the exercise has been completed and usually will last 10 to 20 minutes, resolving spontaneously. It may be prevented by pre-treatment with a bronchodilator such as albuterol inhaler 10 minutes before the exercise. While exercise can bring about an increase in asthma symptoms, if we never exercise we become "deconditioned," and the slightest physical exertion is a challenge to the body. With exertion, the process of gas exchange in the lungs becomes more difficult. If our bodies are in good shape, we can exert ourselves more before our lungs need to work deeper and faster and likely have to breathe through the mouth, instead of the nose. This brings the air directly into the lungs, instead of being filtered, warmed, and humidified first, which can trigger an asthma attack.
Before starting any exercise program, check with your doctor about any restrictions. Then, start slowly. Depending on your condition, walking from one room of your home to another several times a day may be your starting point. For others, learning how to manage symptoms while undergoing Olympic-level training is the goal.
Exercising on a regular basis is always a challenge; so it is important to find an activity you enjoy. Sports that provide opportunities for periodic rest, such as tennis, gymnastics or golf, are better choices for people with asthma. Swimming is also an excellent sport since it occurs in a warm, moist environment, and the horizontal, non-weight bearing position is easier on the body. Sports that take place in cold environments, such as cross-country skiing and ice skating are not as good choices, since the cold air is breathed directly into the lungs and may trigger an attack. If you choose to exercise in a cold environment, cover your nose and mouth with a scarf or mask to increase the temperature and humidity of the air inhaled.
Strength training is another excellent form of exercise, as long as you learn to use the equipment safely and practice proper breathing techniques. While exercising indoors can prevent symptoms caused by freshly mowed grass or cold, dry air, exercising in a dusty gym can be a problem as well. Consider the environment in which the activity will take place, the cost (a gym membership, or just a pair of good walking shoes), as well as the sport itself.
Spending about 15 minutes in warm-up exercises and 15 minutes to cool down is important for everyone, but especially for those with asthma. Warming up properly gradually increases the heart and respiratory rate, and decreases the likelihood of EIA.
Before starting an exercise routine, your doctor may recommend using a peak flow meter, to check your lung function. If you are already experiencing symptoms, wait. The exercise could make your symptoms worse.
As you embark on an exercise program, keep a special calendar. Be sure to mark:
The type and amount of exercise
The amount and type of medication you took before, during and after exercise
Any symptoms experienced
Keeping track of this information can allow you to see your progress (e.g., an increasing amount of exercise with fewer symptoms, and perhaps less medication needed).
Having asthma should not prevent you from exercising, or even competing in sports. A study in the Journal of Allergy and Clinical Immunology found one in six Americans participating in the 1996 Olympics had asthma.
Airborne irritants are substances mixed with the air, such as fumes, vapors, dust and smoke. Cold air itself is considered an irritant. See weather and exercise for more information on how cold air affects asthma.
Airborne irritants are found both outdoors and indoors. Outdoor sources include:
Ozone, which can damage the lining of the lungs and lead to increased susceptibility to infections.
Sulfur dioxide, coming from the burning of sulfur-containing fuel. It irritates the airways and causes constriction. It can be a by-product of the burning of kerosene heaters, fossil fuel-burning power plants, and industrial boilers.
Nitrogen dioxide, from the burning of fuel from motor vehicles and power plants. It is also released with the use of gas stoves.
Carbon monoxide, from motor vehicle exhausts.
All these compounds, as well as others, form air pollution and smog. If you live in an area that gives alerts for high levels of smog, take heed and stay indoors during times with high pollution levels.
While many think of "airborne" as occurring only outside, the air we breathe indoors can be even more irritating to our lungs. As homes and offices become more energy efficient, the indoor air quality often suffers. There is even a name, "sick building syndrome," for buildings with poor air quality.
Tobacco smoke is the most common and deadly source of indoor air pollution. People with asthma need to live in a smoke-free environment. Their lungs are already challenged by other substances and conditions. Once inhaled, even as second-hand smoke, carbon monoxide competes with oxygen in the blood.
Tobacco smoke contains a multitude of poisons. Research has shown that children who live in homes with smoke have more frequent and longer hospitalizations.
Other sources of indoor airborne irritants include:
Smoke from a wood-burning stove or fireplace
Fresh paint -- Has the home been recently remodeled?
Aerosols -- hair sprays, deodorants, furniture polish, oven cleaners, etc.
Perfumes and perfumed products, such as room fresheners
Household cleaning products
Fumes and vapors from hobby and craft projects
While not all sources can be eliminated, some irritating products can be replaced by products that are less offensive to the lungs. Aerosol products often come in solid or liquid form. Scented products, such as laundry detergents, come unscented. Household cleaners are often very expensive and can be replaced by less expensive, less harmful products, such as warm water and soap, baking soda, vinegar, and oil-based furniture polish instead of the aerosol version.
Other areas to consider: Are the furnace vents vacuumed and cleaned? Do you use adequate ventilation when dealing with any products that release fumes and vapors? If buying a new appliance, is it possible to switch from gas to electric? Do you use gas-powered lawn tools? Does the person with asthma sleep adjacent to the garage? There could be cracks through which automobile fumes enter.
Viral respiratory infections are a common trigger for an asthma flare-up. Children are more susceptible than adults because children have not yet built up an immunity against the host of viruses around. As they get older, their immunity increases and they succumb to fewer infections. A respiratory infection is often the trigger for a child's first bout with asthma.
The common cold and the flu are the most frequent sources of viral infections.
When the virus enters the respiratory tract, it affects the lining of the airways, and stimulates the nerve endings that cause constriction of the muscles surrounding the bronchial tubes. This results in bronchospasm, with coughing and wheezing. The virus also affects the mucus membrane lining the airways, and makes it more permeable to other irritating substances. The body responds to the virus by secreting chemicals that produce inflammation. Thus, the airways become inflamed and hypersensitive. Unfortunately for the person with asthma, while the symptoms of the viral infection may be over in a few days, the increased sensitivity of the lining of the airways can last up to two months, and result in increased asthma symptoms during this time.
Infections such as bacterial sinusitis and bacterial pneumonia can also trigger asthma, but are less common than viral infections. When the mucus in the bronchial tubes is not sufficiently cleared, it becomes a potential breeding ground for a bacterial infection. For this reason, the asthma attack can be triggered by a viral infection, but end with a bacterial infection that is treated with antibiotics. Viruses do not respond to antibiotics, and if used as a treatment can contribute to the person's becoming less sensitive to their effects. Stronger antibiotics (with potentially more side effects) will be needed to cure an infection.
A sinus infection (sinusitis) may be bacterial, and respond to antibiotics. It can make asthma symptoms worse. Check with your doctor if you have:
Congestion with pain over one side of the forehead or cheeks
Yellow or green nasal discharge
Facial pain radiating into the teeth
Post-nasal drip with sore throat and coughing, particularly nighttime cough
To prevent respiratory infections:
Get enough sleep
Eat a healthy diet
Drink plenty of fluids, especially water
Wash your hands often, especially after being in public places
Emotions and stress
Asthma is a physical disease, not a psychological one. The problem is the hypersensitive bronchial tubes. However, one's emotional state, and how one perceives and responds to stress can impact significantly on the frequency and severity of asthma symptoms. The force of air propelled through the bronchial tubes when laughing, crying or yelling can trigger asthma symptoms. Being angry, fearful or anxious can set up a stress response, and likewise trigger symptoms. How does this happen?
The body's protective response to stress is referred to as "flight or fight." When the body perceives a threat to its well-being (such an attack by a wild animal or seeing a figure in the shadows of an alley), it mobilizes its forces: the heart rate increases, the breathing becomes more rapid, moving oxygen faster in and out of the lungs, blood is diverted from the stomach and other internal organs to the leg and arm muscles in preparation for staying and fighting the attacker, or fleeing from the situation. But what happens when the threat perceived is a telephone call, an obnoxious driver or an unpleasant job situation? The body still revs itself up, but isn't able to physically discharge this excess energy and chemicals/hormones to deal with the situation.
This stress response was designed, not as an ongoing situation, but a periodic way to cope. The end result? The body exhausts itself, depleting its reserves, and the immune system is weakened. In addition, for the person with asthma, the increased respiratory rate can lead to hyperventilation, inflammation and irritation of the airways, resulting in an asthma attack. The changes in the oxygen and carbon dioxide levels can trigger bronchospasm. Having a disease, which at times leaves you fighting for a breath, is stressful. While stress doesn't cause asthma, it can greatly exacerbate its symptoms just like it does for high blood pressure or diabetes.
While everyone can benefit from learning stress-reduction techniques, it is particularly beneficial for people with asthma, and for their families. Sometimes it is helpful to have someone else talk you through a technique to decrease your breathing rate, or visualize a calming situation. Other techniques to learn through tapes, books or community education courses are meditation, visualization, yoga, tai chi, progressive muscle relaxation and time management. Gaining mastery over stress brings confidence. Confidence gives a sense of control and relaxation. Relaxation decreases symptoms, which decreases stress.