1. An overview of asthma triggers
DR. JALAL MOHSIN UDDIN
D.T.C.D
F.C.P.S (Pulmonology)

2. What is trigger of asthma ?
A trigger is anything that irritates the airways and causes the symptoms of asthma.
Normal healthy person is not bothered by those triggers but when an asthma patient comes into contact with them there is broncho-constriction and excessive mucous secretion resulting asthma episode.
Unhealthy indoor environment for asthma patient

3. Everyone's asthma is different and you may have several triggers.
An important aspect of controlling your asthma is avoiding your triggers.
It may be impossible to avoid all of your triggers, but once you've identified them, there are things you can do to help you to reduce unnecessary symptoms and better control of your asthma.

4. Why identify asthma triggers?
To prevent some asthma attacks.
To reduce the frequency and severity of some attacks.
The patient is trying to control his asthma without removing trigger factor.

5. How to identify asthma trigger
It can be difficult to identify exactly what triggers your asthma.
Sometimes the link is obvious, for example when your symptoms start within minutes after coming into contact with a cat or dog.
But some people can have a delayed reaction to an asthma trigger.
1) By monitoring lung function (eg.peak expiratory flow) of the patient. Lung function will be impaired when the patient is around a specific trigger.
2) By being tested for allergies. If you have allergies, the substances to which you are allergic can trigger asthma symptoms.

6. 1) Detection of trigger by monitoring the lung function :
A trigger may not always cause symptoms. But it can still narrow the bronchial tubes of susceptible persons, which makes the lungs work harder.
To identify triggers that do not always cause immediate symptoms, we should measure peak expiratory flow (PEF) throughout the day.
PEF will drop when your bronchial tubes narrow, so the PEF will drop when the patient is near the things that trigger symptoms.
Measure your PEF when you are around common irritants such as pollens and smoke to see if they are triggers.

7. 2) Be tested for allergies :
Skin or blood testing may be used to diagnose allergies to certain substances.
Skin testing involves pricking the skin on your back or arms with one or more small doses of specific allergens. The amount of swelling and redness at the sites where your skin was pricked is measured to identify allergens to which you react.
If your PEF drops when you are near an allergen, consider being tested for this allergen.

8. What are the asthma triggers ?
What may be the advices of a physician regarding control of asthma trigger ?

9. Tobacco Smoke
Tobacco smoke is unhealthy especially for people with asthma.
“Secondhand smoke” is smoke created by a smoker and breathed in by a second person. Secondhand smoke can trigger an asthma attack.
quit smoking.
If you have asthma, people should never smoke near you, in your home, in your car, or wherever you may spend a lot of time.
Trigger
Intervention

10. Smoke : Smoke of biomass fuel
It can be very difficult if you are exposed to any kind of smoke regularly as like as cigarette or any tobacco smoke, barbecue, bonfire or chimney smoke can be a trigger for asthma and make asthma symptoms worse.
Smoke from burning wood or other plants is made up of a mix of harmful gases and small particles. Breathing in too much of this smoke can cause an asthma attack
Smoke of biomass fuel

11. Dust Mites : Dust mites are tiny bugs that are in almost every home.
If you have asthma, dust mites can trigger an asthma attack.
To prevent attacks, use mattress covers and pillow covers to make a barrier between dust mites and yourself.
Bed linens should be washed every 2 weeks in hot (at least 130°F) water to kill any mites present.
Thorough and efficient vacuum cleaning of carpets can help, but, ultimately, carpeting should be removed
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Intervention

12. Outdoor Air Pollution :
Outdoor air pollution can trigger an asthma attack. This pollution can come from factories, cars, and other sources.
There’s strong evidence linking the development of asthma with residence near roads with heavy traffic and particularly with vehicles such as diesel-fuelled buses and lorries
People of the developed countries usually pay attention to air quality forecasts on radio, television, and the Internet and check their newspaper to plan their activities for when air pollution levels will be low.
If pollution levels are high avoid strenuous exercise outside
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Intervention

13. Pets :
Furry and feathery animals are a common trigger of asthma symptoms.
For animal allergy, complete avoidance is the best option.
Bathe pets every week
keep them outside as much as you can.
If you have a furry pet, vacuum often.
If your floors have a hard surface, such as tile, mop them every week.
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Intervention

14. Colds & viral infections :
Colds and viral infections are very common triggers of asthma. They are also almost impossible to avoid.
Flu vaccination :These are normally available every autumn. Flu vaccination should be repeated every year.
People who are regularly taking steroid tablets should receive pneumococcal vaccination.
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Intervention

15. Emotions :
Stress or even a fit of laughter can trigger asthma symptoms, as can depression, financial problems, bereavement and extreme work- related stress.
Strong emotions can lead to very fast breathing, called hyperventilation, that can also cause an asthma attack.

16. Exercise
Some people with asthma find that exercise triggers their asthma symptoms.
However, exercise is good for everyone, including people with asthma.
Tips on exercising with asthma
Increase your fitness levels gradually.
Always have your reliever inhaler with you when you exercise.
If exercise triggers your asthma, use your reliever inhaler immediately before you warm up.
Ensure that you always warm up and down thoroughly.
If you have symptoms when you exercise, stop, take your reliever inhaler and wait until you feel better before starting again.

17. Food
Most people with asthma do not have to follow a special diet. But, in some cases, certain foods, including cow's milk, eggs, fish, shellfish, yeast products, nuts, and some food colourings and preservatives, can make symptoms worse.
There is no reliable medicine for food allergies. The only treatment is avoiding the offending food.

18. Hormones
Some women find their asthma can be affected around puberty, before their periods, during pregnancy and during menopause.
Take extra preventer medicine during the week before your period.
Some women who experience very severe asthma attacks before their period may benefit from progesterone hormone therapy given either as a tablet or by injection.
Due to hormonal fluctuation, asthma may becomes troublesome in menopause.

19. Medicines
These medicines include aspirin and non-steroidal anti- inflammatory drugs (NSAIDs) for example, Ibuprofen and Naproxin. They can cause asthma attacks in about 1 in 10 adults with asthma. Reactions are much less common in children.
Other medicines that can sometimes lead to asthma attacks include beta-blockers.

20. Weather
Cold air, a sudden change in temperature, windy or hot, humid days, bad weather, such as thunderstorms and poor air quality are all known triggers for asthma.

21. Moulds
Moulds release tiny seeds called spores into the air, which can trigger asthma symptoms in some people. Humidity, the amount of moisture in the air, can make mold grow. Spores are released when there is a sudden rise in temperature in a moist environment.
Ensure the house is well ventilated.
Avoid areas (such as gardens or compost) that may contain mould spores.
An air conditioner or dehumidifier will help you keep the humidity level low.
When showering or cooking, keep internal doors closed to prevent damp air from spreading through the house and use extractor fans.
Try not to dry clothes indoors, store clothes in damp cupboards or pack clothes too tightly in wardrobes.
Fix water leaks, which let mold grow behind walls and under floors.

22. Pollen
Pollen can trigger asthma symptoms in some people. Pollen is a powder-like substance produced by certain types of trees, grasses, weeds and flowers.
Reduction of outdoor exposure during the season in which a particular type of pollen is present can be somewhat helpful.
Pollen counts tend to be higher on dry, sunny, windy days. Outdoor exposure can be limited during this time.
Keeping the windows and doors of the house and car closed as much as possible during the pollen season can be helpful.
Taking a shower after outdoor exposure can be helpful by removing pollen that is stuck to the hair and skin.

23. Cockroach Allergen
Cockroaches and their droppings can trigger an asthma attack.
Get rid of cockroaches in your home by removing as many water and food sources as you can. Cockroaches are often found where food is eaten and crumbs are left behind.
At least every 2 to 3 days, vacuum or sweep areas that might attract cockroaches.

24. Other Triggers
Infections linked to respiratory syncytial virus (RSV) can trigger an asthma attack.
Sinus infections, breathing in some chemicals and acid reflux can also trigger attacks.
Bad weather, such as high humidity, breathing in cold, dry air;
and some food additives and fragrances can also trigger an asthma attack.

25. Asthma and its trigger factors are coming as waves, our patient should be well trained to overcome this danger.
THANK YOU ALL AND HOPE FOR THE BEST.