Some substances do not trigger allergies but can nonetheless aggravate the nose and airways. These substances, called irritants , can trigger asthma. Some examples include:

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:

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.

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:

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.