Patients with asthma may have a general understanding of substances that can initiate and/or aggravate their symptoms. Ideally, avoidance of these triggers would benefit patients the most. However, avoidance is not always possible and it is important to teach patients ways to decrease exposure. Skin testing for substances known to exacerbate asthma can assist patients in identifying allergens and in working on avoidance issues that will provide the most benefit for that individual patient.
There are a number of allergens that may exacerbate asthma. These include, but are not limited to, animal dander, dust mites, cockroaches, and pollens. While animals such as dogs and cats can often worsen asthma, patients may be unaware of the effects because they have lived with this exposure for extended periods of time. Ideally, pets should be removed from the home; however, if families are unwilling or unable to comply, pets should be kept out of the asthmatic’s bedroom.
Dust mites are present in the cleanest of homes and are impossible to eliminate completely. Ways to reduce exposure to dust mites include the use of dust mite-proof mattress and pillow encasings. Sheets and blankets can also be washed weekly in water >130°F to kill mites and their eggs. Carpets, stuffed animals, and excessive pillows should be removed from the bedroom. Dust mites live off water in humid air; therefore, reducing humidity in the home to <50% may decrease exposure. In homes with cockroaches it is best to remove these insects from the home with motel type insecticide traps.
Outdoor and workplace allergens including pollens and molds are sometimes difficult to avoid. Patients with seasonal allergies should be educated to reduce exposure to the outdoors during this time and may require increased or added drug therapy to control symptoms. Patients should be educated to avoid other irritants that may exacerbate asthma. Exposure to tobacco smoke, pollutants, fireplaces, wood-burning stoves, cleaning products, and perfumes may aggravate conditions and should be minimized.
Other asthma triggers often overlooked by the patient should be addressed. Two disease states that frequently exacerbate asthma symptoms include rhinitis and gastroesophageal reflux disease (GERD). Treating these conditions can decrease and/or eliminate symptoms of asthma. Sulfite allergies may also exacerbate asthma, therefore patients should be told to monitor the effects of foods such as wines, beer, shrimp and dried fruits.
If patients experience symptoms after exposure to these products, then future avoidance is warranted. Patients are often unaware that medications may exacerbate their asthma. Beta-blocker therapy, including eye drops, and nonsteroidal anti-inflammatory drugs are two common medications that cause difficulty. Patients should be made aware of all these triggers and work to reduce and/or eliminate exposure.
Albuterol
Epinephrine
Metaproterenol
Cortisone
Prednisone
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