Identifying And Taming Triggers - Asthma

Even before asthma is diagnosed, many people who have asthma can recognize triggers that set off their breathing problems. Certain triggers are obvious — being around animals, exercising or coming down with a cold or virus. It makes sense that things that stimulate inflammation, such as allergies, can make asthma symptoms worse.

Finding some triggers may take a bit of detective work. If you don't know what triggers your asthma, think about your past few asthma attacks:

What were you doing at the time of a flare-up? Did you just finish vacuuming or raking leaves? Were you over at a friend's house?

Are your breathing problems worse indoors or outdoors? During the day or at night? At home or at work? In damp, moldy rooms, such as basements?

Did you move into a new home or start a new job?

Have you recently started taking a new drug?

Have you noticed your asthma is worse after eating any particular foods?

Do you have heartburn, allergies or sinus problems?

Is your asthma a year-round problem? If not, what part of the year is best? What part is worst?

Based on your answer to these questions, your doctor may be able to help you identify your most problematic asthma triggers. If these questions don't clarify what might be triggering your asthma and you are having trouble tracking down your triggers, try recording in a notebook or diary how your breathing feels throughout the day. Note where you go and what you do. You and your health-care provider may be able to see some patterns that point to your triggers.

Once you've identified the things that might be triggering your asthma, it's time to launch a three-pronged defense:

Remove your triggers.
Avoid coming in contact with them.
Pretreat yourself if you think you'll be exposed to a trigger.

Triggers can be anything from house dust (and the proteins that are shed by the tiny dust mites that live in it) to a variety of foods or drugs. Here are a few ways to remove some common asthma triggers from your home:

• Clean out areas in the home where mold and dust can collect. (Ideally, have someone without asthma or allergies do this.) Vacuum rugs and carpets at least once or twice a week. Dust and clean other things that collect dust, such as Venetian blinds, draperies or cloth-covered furniture.

Use special covers for your mattress and pillows that can protect you from exposure to dust mites. Change sheets and pillowcases at least once a week and wash them in water hotter than 130º F.

Keep pets outside. Better yet, don't have pets that trigger your asthma.

Keep stuffed animals out of the bedroom or wash them weekly in hot water to kill dust mites.

If you smoke, stop.

Start a campaign to eliminate cockroaches at home. Never leave food out. Buy traps or poison baits if you have a serious problem.

Clean moldy areas with solutions containing bleach.

Before taking expensive steps that are advertised to help asthma, talk with your health care professional about what might help you. Dehumidifiers or central air conditioning may help make the air less hospitable to mold. Vacuum cleaners are available with special filters that trap dust particles. These filters, also found in air purifiers, are called high-efficiency particulate air (HEPA) filters. These investments are not necessary for every person who has asthma, but they may be recommended if your asthma can't be controlled easily.

Some triggers can't be removed, such as materials that are built into your home itself or a partner who smokes. If your asthma has a trigger that you can't eliminate, you need to try to avoid the trigger instead. Here are a few tips on taking evasive action:

Avoid cigarette smoke. This may be as simple as moving from one room to another or as difficult as helping a family member to quit. If someone in your home smokes, ask him or her to smoke outside or to smoke only in a particular room that you don't need to go into.

Keep an eye on pollen counts and air pollution readings. If pollen or air pollution aggravates your asthma, stay inside — if you can — on days when these are bad. Also keep the windows and doors closed during allergy season.

If you must go outside, don't plan strenuous activities. Because pollen counts are usually highest in the morning and drop throughout the day, plan your outdoor activities for later in the day.

Reassign home tasks. If you have a seasonal allergy or an allergy to mold, let someone else mow the lawn or rake the leaves. If house dust stirs up your asthma, hand off the dusting and vacuuming jobs.

Change how you do certain activities. If exercise aggravates your asthma, try swimming instead of riding an exercise bike or running on a treadmill. The humid air around a pool is less likely to trigger airway tightening during exercise. Stretches that warm you up before exercise and help you cool down afterward may also help you avoid triggering asthma during exercise.

Avoid cold air. Keeping the air you breathe as warm and humid as possible by covering your nose and mouth with a scarf on cold or windy days can help prevent cold-induced asthma symptoms.

Get allergy shots. If year-round allergies to things such as mold or house dust trigger your asthma, allergy shots may help. Although you can take steps to reduce the levels of mold and dust inside your home, sometimes allergy shots are the only way to really get control of your symptoms.

Get a flu shot. Viral infections such as the common cold or influenza (the flu) often trigger asthma attacks. A flu shot can help you avoid this very unpleasant trigger. Find a way to remind yourself when it's time to have your flu shot each year. For example:

Mark a date on your calendar for your flu shot.

Link the flu shot with an important date or ritual in late fall. (Most offices and hospitals start vaccinating in October or November and carry through until early March.)

Make your flu shot part of your preholiday planning in November.

If these simple measures don't improve your asthma, referral to an allergy specialist can help. A specialist can test you for allergies using blood samples and skin-prick testing. If these tests find specific allergies, allergy shots can help calm the immune system's overboard response to these triggers and so may dramatically improve your asthma.

You don't live in a bubble, so you can't always avoid the things that trigger your asthma. Maybe you're visiting friends who have cats or planning to ski for a few hours. If you can’t realistically avoid a known trigger, using one of your asthma drugs about 30 to 60 minutes beforehand can help prevent an attack. Your doctor will tell you which drug to take (usually albuterol or cromolyn) before exposing yourself to the trigger or exercising (if you have exercise-induced asthma). If the trigger is something you're allergic to, such as pollen or cat hair, taking an antihistamine before coming in contact with the trigger also will help. Although pretreatment often can help you avoid breathing problems, make sure you know what to do next if you start having symptoms during your exposure.