1. Trigger control to enhance asthma management Seminar Training Primary Care Asthma + COPD 03- 2015 D.Anan Esmail

2. airway obstruction InflammationHyperresponsiveness chronic lung disease Asthma

3. Identifying and avoiding asthma " triggers “ essential in preventing asthma flare- ups

4. triggersRespiratory infectionsInhaled allergensrespiratory irritantsPhysical ActivityFood allergensHormonal fluctuationsMedicationsEmotional state

5. triggersRespiratory infections

6. RESPIRATORY INFECTIONS very common asthma triggers

7. RESPIRATORY INFECTIONS Viral infections were the presumed cause

8. RESPIRATORY INFECTIONS Colds and Influenza Bronchitis ear infections sinus infections pneumonia

9. Patient Recommendations

10. wash hands

11. avoid people with infections

12. Vaccination influenza virus yearly pneumococcal vaccination

13. N-95 Protect yourself from respiratory infections

14. triggersInhaled allergens

15. Animal allergens pets and pests Indoor

16. Animal allergens Cats, dogs, rodents, birds Indoor

17. House-dust mites arid or high altitude regions Indoor

19. Cockroaches

20. fungi (mold, mildew) Indoor

21. plant allergens tree, grass, pollen outdoor

22. Patient Recommendations

23. Animal allergens Remove animals from the home or at least from the sleeping area

24. House-dust mites Wash bed linens and blankets weekly in hot water and Dry its in a hot dryer or sun

25. House-dust mites Acaricides or or Tannic acid Tannic acid

26. Cockroaches Clean the home

27. Cockroaches Use pesticide spray

28. fungi (mold, mildew) RRRReduce dampness in the home CCCClean any damp areas frequently

29. plant allergens Close Windows Doors Close Windows and Doors Stay at home

30. triggersrespiratory irritants

31. cigarette smoke

32. respiratory irritants fireplace smoke, Ashes

33. respiratory irritants aerosol sprays, Perfumes

34. respiratory irritants cleaning fluids, and powders

35. respiratory irritants cooking odors

36. respiratory irritants shower steam

37. respiratory irritants desert dust

38. respiratory irritants traffic fumes

39. respiratory irritants air pollution

40. Occupational allergens exposure to allergens in the workplace

41. Occupational allergens toluene diisocyanates trimellitic anhydrides wood dusts

42. Temperature And Weather the inhalation of cold and dry air appears to increase bronchoconstriction

43. Temperature And Weather play a role in exercise-induced asthma

44. Patient Recommendations Avoid respiratory irritants

45. triggersPhysical Activity

46. Exercise is a potential asthma trigger that should not be avoided

47. Physical Activity Aerobic exercise strengthens the cardiovascular system may lessen the sensitivity to asthma triggers

48. Patient Recommendations Avoid exercising outdoors in extremely cold weather

49. Patient Recommendations Consult your clinician about taking medication prior to physical activity

50. triggersFood allergens

51. RARELY cause isolated asthma without other symptoms in contrast to inhalant allergens

52. Food allergens patients may exhibit asthma symptoms as part of food-induced anaphylaxis

53. Food allergens allergic patients reacting to steam, vapors, from the cooking or processing of foods

54. Food allergens Wheat allergic patients reacting to inhaled flour

55. Food allergens ingestion of foods that are treated with sulfites to prevent spoilage and discoloration

56. Food allergens Sulfite sensitivity (rare) present with isolated asthma symptoms

57. Patient Recommendations

58. 58

59. triggersHormonal Fluctuations

60. menstrual cycle and pregnancy affect the frequency and severity of asthma symptoms

61. Hormonal Fluctuations Perimenstrual asthma Worsening of asthma symptoms prior to or during menstruation 20 to 40 % of women with asthma

62. Hormonal Fluctuations Pathophysiology is unclear

63. Hormonal Fluctuations Pregnancy one-third experience aggravate asthma one-third experience no change one-third experience symptomatic improvement

64. triggersMedications

65. Medications medications can aggravate asthma: Nonselective beta blockers Aspirin and NSAIDs

66. Medications ACE inhibitors cause cough (mistaken for increased asthma symptoms)

67. Patient Recommendations Check with a clinician before taking any new medications that may contain drugs that aggravate asthma

68. triggersEmotional Factors

69. greater rates of asthma exacerbations in patients with asthma

70. Emotional Factors Parental depression and stress are associated with more severe asthma in children

71. Patient Recommendations

73. triggersRespiratory infectionsInhaled allergensrespiratory irritantsPhysical ActivityFood allergensHormonal fluctuationsMedicationsEmotional state

75. Guidelines recommend allergen immunotherapy in patients for whom: Guidelines recommend allergen immunotherapy in patients for whom:  There is clear evidence that exposure to an unavoidable allergen results in symptoms  Symptoms occur all or most of the year  There is difficulty in controlling symptoms with pharmacologic management

76. Leukotriene receptor antagonists appeared protective against perimenstrual worsening of asthma in several small series Leukotriene receptor antagonists appeared protective against perimenstrual worsening of asthma in several small series