Mike Bradshaw, Breathing easy: controlling asthma triggers, Kansas State University, August 2003

Bradshaw, Michael H.

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Breathing Easy: Controlling Asthma TriggersMike BradshawExtension Specialist, Health and SafetyKansas State UniversityAgricultural ExperimentStation and CooperativeExtension ServiceWhat is asthma? Asthma is a chronic condition that occurswhen the air passages of the lungs andbronchial tubes become swollen, irritatedand inflamed. The muscles of the bronchialwalls tighten causing airways to narrow.This can lead to conditions from minorwheezing to severe breathing difficulty. Insome cases, breathing becomes so laboredthat the attack becomes life threatening. How serious is asthma?The National Heart, Lung, and BloodInstitute reports that about 17 millionpeople in the United States have asthmaand of these, 5 million are children. Everyyear, asthma causes roughly 2 millionemergency room visits with more than500,000 hospitalizations and 4,500 deaths.Asthma-related deaths vary substantially byage group with the elderly having thehighest death rate. What causes asthma?While little is known about the factors thatinfluence asthma’s development, we have agood understanding of the agents thatcontribute to the reoccurring attacks oncethe person has the disease. Airwayinflammation is caused from a reaction toviral infections like the common cold orinflammation from being predisposed toallergies. The immune system developmentseems to be key as to whether or not aperson develops asthma from beingpredisposed to allergies. Scientists believethat genetic factors characterized by theproduction of certain types of antibodiesmake a person more susceptible. Thisgenetic factor determines whether a personwill produce the type of antibodies that aremost associated with the allergic responsethat triggers asthma.A person with hay fever may have red, weepyeyes and an itchy nose from theinflammation caused by an allergen. Theperson who has lungs sensitized to allergensmay have tissue swelling of the lungs, whichsets up contraction of bronchial tubes. Thiscontraction of the muscles of the bronchialtubes reduces airflow and causes breathingdifficulty.Scientists describe a person’s geneticallyinherited susceptibility to becoming allergicas the most important predictor of a persondeveloping asthma. If neither parent hasasthma, a child has less than a 10 percentchance of developing the disease. When oneparent has asthma, the chance rises to 25percent; and when both parents have thedisease, the child has a 50 percent chance. Those who experience asthma associatedwith a cold that occurs from time to timeare classified as intermittent. They are thegroup of asthmatics who we say grow out of the disease. They do not seem to bebothered by asthma as they grow older.Those having symptoms at least twice aweek during the day or twice a monthduring the night are classified as persistent.These asthmatics are classified further asmild, moderate, or severe. The mild,moderate, or severe classifications help thephysician determine the type of treatmentfor the person. Regardless of the type ofpersistent asthma, the person should be ona treatment schedule. Persistent asthmacannot be cured, but most people canmanage their condition with a carefultreatment plan.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.2Family history is one of the best indicatorsin determining if a child’s asthma willpersist (long term). The disease is likely topersist in those whose asthma is triggeredby environmental allergens, tobacco smoke,exercise, seasonal changes, and whoexperience wheezing at night. They alsomay have other allergic symptoms such asallergic rhinitis or eczema (an itchy skincondition).Asthma TriggersEnvironmental substances and conditions,which lead to the actual onset of asthma,are called asthma triggers. Indoor- andoutdoor-inhaled allergens are some of themost common irritants that induce asthma.Household dust mites, cockroaches, danderfrom furred or feathered animals, fungi, andpollens are common allergens. Other substances and conditions that cancause an asthma attack may includetobacco smoke, industrial emissions,vehicle exhaust, ozone, sulfur dioxide, somefoods, food additives, and smog. Respiratoryinfections, exercise, hyperventilation,stress, and fear also can trigger an asthmaattack.In adults, the symptoms of asthma are lesslikely to be triggered by allergen such asdust mites, pet dander, and pollen.Symptoms are more likely to be triggeredby flu, colds, or other viral infections.Exercise, excitement, depression, anxiety,medications, cigarette smoke, cold air,perfumes, and chemical fumes also maytrigger an attack.Who is most likely to develop the disease? Scientists have identified factors that mayincrease a person’s chance of developingasthma. As you would expect, these factorsare closely related to some of the asthmatriggers above. These include: • Living in an urban area of a large city,where there is exposure to manyenvironmental pollutants• Exposure to secondhand smoke• Exposure to chemicals in paint, steel,plastics, and farm operations• Having one or both parents who haveasthma• A number of respiratory infections inchildhood• Low birth weight• Obesity• Reflux disease• Have allergies.TreatmentAsthma is treatable. Asthma attacks anddeaths can be prevented. New drugs and self-management plans have reduced the numberof deaths and trips to hospital emergencyrooms. When parents, patients, and doctorswork together to develop a plan, the risks ofseverity and possible death decreasesignificantly.There are two main categories of drugs usedfor asthma patients. Short-term (quick-relief) medications that relieve asthmasymptoms and long-term controllermedications that are used every day bypeople with persistent asthma. Who should go on long-termmedication?The rule of two is used to determine whoshould control their asthma with long-termmedication. People who use the quick-reliefasthma medicine more than two times aweek, wake up with asthma more than twotimes a month, or have to refill their quick-relief inhaler more than two times a yearshould consider using the long-termcontroller medications. The purpose of long-term medication is to control or reduce thechronic inflammatory changes in the lungsand avoid permanent damage to the lungs.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.3Long-term Preventive MedicationsCorticosteroids (which are anti-inflammatory medicines) inhaled, delivermedicated relief directly to airways andhave fewer side effects. The long-actingbeta2-agonist medications can help preventattacks for patients with persistent asthmaand prevent symptoms on a long-termbasis.Leukotrien inhibitors also reduce theinflammation of asthma and are effective insome patients. Antihistamines are alsoused. In some difficult cases, the patientmay take two types of inhalers and two tothree other oral medications.Quick-Relief MedicationsThe quick-relief medications immediatelyrelieve the discomfort of chest tightness,coughing, and wheezing. Short-term reliefmedications relax muscles surrounding theairways. Other short-term reliefmedications relieve the inflammation orswelling in the airway. Medications aretaken with an inhaler, syrup form, ortablets. Quick relief medicines include theshort-acting bronchodilators, which maybe all that is necessary to treat people withmild, intermittent asthma.Preventing an Asthma AttackMany physicians believe that a well-educated and conscientious patient can beeffective in keeping symptoms undercontrol. Knowing that inflammation in thelungs can be there without symptoms ofdisease also is helpful. Many patients use apeak flow meter to measure how well thelungs are functioning. The meter measureshow well lungs are able to expel air. Thesimple device is used to monitor how wellthe lungs are functioning although nosymptoms are present. The faithfulmonitoring of the lung capacity is all thatsome need to keep asthma attacks fromoccurring. Other suggestions to prevent anasthma attack include: • Develop a plan with a physician.• Treat attacks early.• Use air conditioning to reduceenvironmental allergens. Air conditioningdecreases humidity and reduces dust miteexposure.• Maintain 40 to 50 percent humidity inthe home.• Encase pillows, mattresses, and boxsprings in washable dust-proof covers.• Wash bedding once a week in hot water.• Replace synthetic pillows every two tothree years.• Replace bedding with synthetic materialsuch as Dacron.• Change air filters according tomanufacturer instructions. Consider usinga small-particle filter in ventilation system.• Reduce pet dander. Regularly bathe pets.Avoid pets with fur or feathers.• Clean your home once a week. Wear adust mask while cleaning because it stirsup particles.• Wear eyeglasses, not contacts, whenpollen count is high. Otherwise, pollenparticles can get underneath contactlenses.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.4Appreciation is expressed to:Carmen Eichman for her writtencontributionReviewed by James Gardner, M.D., Primary CarePhysicians of ManhattanSharolyn Flaming Jackson, Riley CountyExtensionLinda Coffman, Shawnee CountyExtensionResources for Parents:1. American Academy of Allergy, Asthma,and Immunology 611 East Wells StreetMilwaukee, WI 53202(800) 822-ASTHMA or (414) 272-6071Internet: www.aaaai.org2. Center for Disease Control and Prevention, National Center forEnvironmental Health, Air Pollutionand Respiratory Health Branch:www.cdc.gov/nceh/airpollution/asthma/3. National Institutes of Health, NationalHeart, Lung, and Blood Institute,National Asthma Education andPrevention Program:www.nhlbi.nih.gov/about/naepp/index.htm4. American Lung Association (ALA)www.lungusa.org5. Asthma & Allergy Foundation of America(AAFA)www.aafa.orgBrand names appearing in this publication are for product identification purposes only. No endorsement is intended, nor is criticism implied of similar products not mentioned.Publications from Kansas State University are available on the World Wide Web at: http://www.oznet.ksu.eduPublications from Kansas State University may be freely reproduced for educational purposes. All other rights reserved. In either case, credit Mike Bradshaw., Breathing Easy: Controlling Asthma Triggers, August 2003.Kansas State University Agricultural Experiment Station and Cooperative Extension Service , Manhattan, KansasMF-2597 August 2003It is the policy of Kansas State University Agricultural Experiment Station and Cooperative Extension Service that all persons shall have equal opportunity and access to its educationalprograms, services, activities, and materials without regard to race, color, religion, national origin, sex, age, or disability. Kansas State University is an equal opportunity organization.These materials may be available in alternative formats.Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended. Kansas State University, County Extension Councils, Extension Districts, andUnited States Department of Agriculture Cooperating, Marc A. Johnson, Director.Outdated Publication, for historical use. CAUTION: Recommendations in this publication may be obsolete.

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