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Asthma Asthma
Triggers and Management
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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:
 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;
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| 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; |
| Changing weather conditions, such as changes in temperature and
humidity, barometric pressure, or strong winds. |
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.
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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.
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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;
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| 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:
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| 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; |
| 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.
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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. |
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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.
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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.
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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.
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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.
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