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 :

  1. allergens or irritants;
  2. viral or sinus infections;
  3. exercise;
  4. reflux disease (stomach acid flowing back up the esophagus);
  5. medications or foods;
  6. 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:

  1. air pollutants such as tobacco smoke, wood smoke, chemicals in the air and ozone;
  2. occupational exposure to allergens, vapors, dust, gases or fumes;
  3. strong odors or sprays such as perfumes, household cleaners, cooking fumes (especially from frying), paints or varnishes;
  4. Other airborne particles such as coal dust, chalk dust or talcum powder;
  5. 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.

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:

  1. 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;
  2. Environmental control measures to avoid or eliminate factors that trigger asthma symptoms or flare-ups;
  3. Medication therapy for long-term management to reverse and prevent airway inflammation as well as therapy to manage asthma flare-ups;
  4. 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:

  1. Prevent chronic and troublesome symptoms;
  2. Maintain (near) “normal” breathing;
  3. Maintain normal activity levels, including exercise;
  4. Prevent recurrent asthma flare-ups, and minimize the need for emergency room visits or hospitalizations;
  5. Provide optimal medication therapy with no or minimal adverse effects;
  6. 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:

  1. anti-inflammatory agents such as cromolyn or nedocromil , which stop the development of inflammation in the lungs, as well as help to prevent it.
  2. 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.
  3. 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.
  4. 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.