During an asthma attack, people literally struggle to get air into and out of their lungs. Airways narrowed by inflammation and muscle spasm can make every breath a challenge for the 14 million Americans who have this disease.
Although much attention is given to the medical treatment of these frightening attacks, too little attention is paid to preventing them. Avoiding the things that trigger attacks can help prevent breathing problems and, perhaps, reduce the need for medication. Although not everyone responds to the same triggers, the most common causes of asthma symptoms include exposure to dust mites, cat and dog dander, pollens, molds and airborne irritants such as cigarette smoke, chemical fumes and smog (air pollution). Here are some simple steps for reducing your exposure to these potential triggers.
Dust mites. These microscopic insects live in mattresses and bedding, carpets, upholstered furniture and soft toys--even in homes that are very clean. Large amounts of dust mite allergen can be breathed in while you move about in bed, walk across carpeted floors or sit on upholstered furniture.
Reduce your exposure by encasing your mattress, box spring and pillows in zippered plastic covers, and by washing bed sheets, pillow covers and blankets weekly in hot water and drying them on high heat. Stuffed animals should be washed regularly or stored overnight in sealed plastic bags in the freezer and brushed off in the morning. Carpets and upholstered furniture should be vacuumed weekly, using double layer vacuum bags or a high-efficiency filter (commonly referred to as HEPA filters) to trap the allergens. (Double-layer vacuum bags are inexpensive and can be purchased for almost any vacuum.)
Keeping household humidity levels below 40% will also help control dust mites, since they grow best in warm, humid environments. If you live in a high humidity area, consider attaching a dehumidifier to your central air-conditioning system or installing free-standing dehumidifiers in your bedroom and other rooms where you spend a lot of time.
Animal dander. If you have warmblooded pets (even birds), keep them outside to reduce the amount of dander or allergen that is deposited in your home. (Despite claims to the contrary, no breeds of dogs or cats are allergen-free.) If a pet must remain indoors, keep it out of the bedroom and off the furniture.
Smoke. Exposure to tobacco smoke can irritate and inflame the airways and trigger asthma attacks, so anyone who has asthma and smokes should quit. Nonsmokers should not allow anyone to smoke in their home, car or any other enclosed area where they spend time.
Pollens and mold spores. If you react to outdoor allergens such as tree, grass and weed pollens or mold spores, stay indoors with doors and windows closed as much as possible when pollen or mold counts are high. Using central air-conditioning and heating will lower the indoor levels of these allergens, but only if you change filters frequently (at least every six months). Free-standing room air-filtration systems containing HEPA filters can also be helpful in removing outdoor allergens that make it indoors.
Air pollution. Certain pollutants, such as ozone, sulfur dioxide, diesel and other particulates, can make airway inflammation worse and set off asthma attacks. You should monitor air pollution reports on a daily basis and avoid outdoor exercise when air pollution levels are high.
Influenza. Viral respiratory infections such as influenza can cause severe inflammation of the airways and are a common trigger of serious asthma attacks. If you have asthma, immunize yourself against influenza every year.
If you have recurrent breathing problems because of asthma and you aren't sure what is triggering your attacks, try to identify the specific things that are triggering your symptoms, so you can avoid them in the future. Keeping a detailed diary may be useful, because it can help you make a connection between the start of your symptoms and a particular exposure. Important information to include in your diary are the time and duration of your symptoms; where you were and what you were doing when the symptoms started; and what made the symptoms better or worse. Your doctor can use this information to help you identify the likely triggers, which can then be confirmed with appropriate testing. Avoiding those triggers should bring relief and may reduce your need for medications.
Next column: asthma medications.
Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at firstname.lastname@example.org. Their column appears the second and fourth Mondays of the month.