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Common Triggers that provoke asthma
- Allergens
- Irritants
- Exercise
- infections
- Occupational
- Environmental
- Medications
- Co-morbid conditions
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Allergens
- Outdoor Allergens
- -tree, grass, and weed pollen
- -molds
- Indoor Allergens
- -Dust mites
- -cockroaches
- -pets
- -mold
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Irritants
Tobacco smoke, outdoor air pollution, indoor air pollution
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What initiates inflammation?
- Allergic asthma- Allergens- innate and adaptive immune response- asthma symptoms
- Exposure of a person who has asthma to inhalant allergens to which the person is sensitive increases airway inflammation and symptoms then, add in exposures to irritants may cause asthma to worsen
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Synergistic effects causing asthma
Allergic Asthma and irritants
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What are other triggers to asthma? (Not allergens or irritants)
- Exercise
- Co-morbid conditions: rhinitis/sinusitis, allergic bronchopulmonary aspergillosis, GERD, OSA, obesity, chornic stress/depression
- Medications: NSAIDS, sulfites, anesthetic agents, anesthetic agents, beta blockers
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Major irritant: environmental tobacco smoke
- Increased asthma symptoms
- decreased lung function
- greater use of health services
- contributes to increased wheezing and infections
- maternal smoking associated to increased risk of developing asthma in infancy and childhood
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Irritant: Occupational Exposure Risks
- Exposure to chemicals, temperature, or dusts
- -chemicals, cold, heat, dust
- Work related symptoms
- -immediate or several hours after exposure, worsening can persist after exposure, may see improvement on days off
- Confirmation
- -Serial peak flow measurements both at work and away from work can be helpful
- Management
- -Early recognition is important for complete resolution
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Trigger: Medication Sensitivities- NSAID's
- As many as 21 percents of adults and 5 percent of children with asthma have reported to experience aspirin-induced asthma
- NERD: NSAID-exacerbated respiratory disease
- Aspirin caused a fall in FEV1 of >20% in 9% of adults and 11.0% of children
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Trigger Medication Sensitivities- Anesthetics
- Post surgery
- -Bronchoconstriction occurred during induction of anesthesia by propofol in two patients with allergic diseases
- Recommendation
- -patients with asthma evaluated prior to surgery
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Identify factors contributing to asthma symptoms- indoor/home
- 80% of US population is exposed to house-dust mites
- 60% to cat or dog
- Important to combine skin testing with medical history and symptoms
- Assists with the target education
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Identify Factors contributing to asthma-indoor/school
- 80% of US exposed to house-dust mites
- 60^ to cat or dog
- Educate on the host potential
- mouse and rat allergen exposure in school
- old unfuled heaters produce nitrogen dioxide
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Identify factors contributing to asthma- work place
- Early recognition is important
- occupational asthma suggested by correlation between asthma and work
- symptoms may persist
- symptoms may latent for a period of time
- serial peak flow records at work and away from work can confirm the association between work and asthma
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4 Key Components to the Diagnosis and Management of the Asthma Patient
- Component 1- Measures of assessment and monitoring
- Component 2- Control of factors contributing to asthma severity
- Component 3- pharmacologic therapy
- Component 4- education for a partnership in asthma care
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Behavior and environmental modifications- smoke, mites, dander, cockroaches
- Second hand smoke- smoking cessation, avoid, no smoking at day care, common sense
- Dust mites- covers on pillows and mattress, wash (130 degrees), remove carpet in bedroom, keep stuffed toys out of bed
- Animal dander- keep out of home, remove upholstered furniture, keep out of bedroom
- Cockroach- keep all food out of bedroom, keep food and garbage in closed containers, don't leave food out
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Behavior and environmental modifications- mold, odors
- Indoor Mold
- -fix leaking faucets, pipes or other sources of water; clean moldy surfaces, dehumidify basements if possible
- pollen and outdoor mold
- -close windows, take increase anti-inflammatory medicine before allergy season
- Smoke/Strong odors/Sprays
- -do not use wood burning stove, kerosene heater, fireplace, unvented gas, stove or heater, stay away from strong odors
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Behavior and environmental modifications- exercise, virus, chemicals
- Exercise or sports- warm up, check air qulaity, specialist
- Viral respiratory infections- RSV, rhinovirus, influenza (flu vaccine)
- Chemicals- awareness, work with employer
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Immunotherapy
- May be considered when:
- Clear link between exposure and symptoms, allergen is unavoidable, symptoms occur throughout the majority of the year, difficulty controlling symptoms with pharmacologic management
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Effectiveness of eqipment for reducing exposure
- Air cleaners, vacuum cleaners (HEPA filter/dust mask)
- Humidifier- caution- ideal level 30-50%, elevated levels encourage dust mites
- Allergen impermeable covers
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