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Asthma triggers can be found indoors or outside. They may be related to emotional or physical conditions. Many are inhaled, some are consumed.
Triggers may be additive: A child may experience a more profound worsening of symptoms if exposed to a second trigger within a short period of time. A child's individual trigger profile can also change over time, making regular visits to your specialist important.
The one thing all triggers have in common is that they are manageable, provided you recognize what your child's personal triggers are and either avoid them or proactively take measures to minimize their impact on your child's asthma.
Allergens: Tree, grass and weed pollen
Pollens are tiny airborne particles given off by trees, grass and weeds. Tree pollen peaks in the spring, grass pollen in midsummer. Weed pollen (ragweed) is present late summer into fall.
Keeping it in Check: Keep windows and doors shut during heavy pollen season (pollen counts are highest early in the day) and stay in air conditioning whenever possible. Avoid using fans that draw in outside air. Weeds should be cut and removed using weed killers. Also, indoor exercise is a good idea during the height of pollen season. Click outside/inside for a report on today's pollen counts.
Allergens: Outdoor mold
Outdoor mold is present in the environment from March to November; it diminishes with the first frost or snow cover. Mold spores peak however, midsummer until late fall.
Keeping it in Check: Avoid walking in uncut fields. Also, refrain from mowing grass or handling mulch. Avoid raking or jumping in fallen leaves and going on hayrides. And steer clear of barns, greenhouses, sleeping bags and musty summer cottages. Avoid using fans that draw in outside air; use air conditioning whenever possible. Click outside/inside for a report on today's mold counts.
Environmental: Weather changes, seasonal changes, sudden shifts in barometric pressure, cold air, high humidity, increased ozone, other pollutants
While winter can be a relief to some children who suffer from pollen or mold-related asthma symptoms, extremely cold air can increase symptoms in other children. Approaching storm fronts, and their associated changes in barometric pressure, can also influence asthma control.
Keeping it in Check: For cold air-sensitive children, wearing a ski mask or scarf over the mouth and nose warms and humidifies the air before it enters the lungs. When there is an increased ozone level, it is best to minimize outdoor activity and stay in air conditioning if possible. Also, be aware of approaching storms or sudden changes in temperature and, if necessary, adjust your asthma medications accordingly.
Allergens: Dust mites
Dust mites are microscopic insects that live in anything from bedding to carpets to stuffed animals.
Keeping it in Check: Keep the bedroom clean and avoid clutter. Use a vacuum cleaner with a HEPA filter regularly. During cleaning, your child should avoid the area, and for the 20 minutes following as well. Place dust-impermeable covers on mattresses, box springs and pillows. Wash bedding weekly in hot water (130ºF). Whenever possible, remove carpeting in the child's bedroom; hardwood or tile floors are best. Replace upholstered furniture with leather, vinyl, wood or plastic. Use only washable window curtains. And change furnace and air conditioner filters regularly.
Allergens: Mold spores
Mold can grow indoors in damp areas of the house such as the kitchen, bathroom or musty basement.
Keeping it in Check: Keep the humidity level in the bedroom below 50% to prevent mold growth. Dehumidifiers are a good idea in a basement and they must be cleaned frequently. Avoid living in or spending excess amounts of time in basements. Home air filtration systems and central air conditioning can also decrease exposure to allergens. Also, clean furnace filters frequently and fix all water leaks. Thoroughly dry clothes before storing them, clean moldy areas with fungicide or bleach, discard all moldy belongings and run the bathroom vent when showering or bathing.
Allergens: Pet dander
Most dogs and cats continually shed dander (dead skin), which is hard to remove from living areas. Waste and saliva from a furry or feathered friend can also cause asthma symptoms.
Keeping it in Check: Finding a new home for a pet-or not bringing one into the home in the first place-is advisable. If this is too drastic, keep the pet outdoors if possible, out of the child's room, or perhaps confined to a room with a polished floor and wipeable furniture. Wash your pet weekly in warm water. Keep a filter over air vents and steer the pet away from upholstered furniture and carpets. Before visiting a home with pets, take inhaled medication prescribed by your doctor-although that's not a firm guarantee symptoms won't be triggered. Children with asthma should avoid petting animals-but immediately wash their hands afterwards if they do.
Allergens: Cockroaches
Cockroaches, their skin, saliva and waste material, are significant allergens for some children.
Keeping it in Check: Discard spoiled food quickly, empty garbage daily and use roach traps. Utilize professional pest control if necessary. Also, vacuum thoroughly, wash dishes daily, and store food in sealed containers. Don't store paper bags, newspapers or cardboard boxes. And seal plumbing openings, cracks and crevices.
Irritants: Tobacco smoke, wood smoke, strong fumes such as paint, perfumes, or cleaning products.
Cigarette smoke is one of the most common asthma irritants and is a major cause of symptoms. Children with asthma can be extremely sensitive to fumes.
Keeping it in Check: It is vital that no one smokes in a home or car where a child with asthma is present. Non-smoking sections of public areas and hotels should be sought out. Aerosol sprays, perfumes and strong cleaning products should be avoided. It's best to clean when the child is out of the house, and then the area should be ventilated.
Laughing, crying, stress or extremes of emotion
Showing strong emotions or intensely crying or laughing can trigger respiratory symptoms in children with asthma. Stress can lead to changes in a child's breathing pattern and can therefore worsen an asthma episode once it has been triggered-which in turn creates more stress and, consequently, more symptoms.
Keeping it in Check: If laughing, crying or extremes of emotion are followed by coughing or other symptoms, an adjustment of maintenance medication may be in order. Having the right kind of asthma medication plan and creating a calm environment in a stressful situation is advised. Managing stress to begin with, getting enough sleep and eating right are among the best defenses when combating triggers.
Upper respiratory infections
Upper respiratory infections are especially common when each new school year begins. Children routinely pass germs among one another, causing colds, flu and ear infections.
Keeping it in Check: Wash hands regularly throughout the day. If exercise appears to worsen symptoms, consider decreasing exercise until the upper respiratory infection or cold improves. A yearly flu vaccination (if not egg-allergic) is also strongly advisable.
Underlying sinusitis
Sinusitis (an inflammation of the mucus membranes that line the sinus cavities) can make a child's asthma worse, especially at night. It seems to be especially prevalent in children with asthma at the change of seasons.
Keeping it in Check: Sinus care is a significant part of a child's overall asthma management plan. Bring sinusitis or sinus infection symptoms to a doctor's attention quickly, as additional treatment can lead to a decrease in asthma symptoms.
Gastroesophageal Reflux Disease (GERD)
There is a known link between asthma and GERD. Even small amounts of acid can significantly increase resistance in the airways. Nighttime asthma symptoms are especially associated with GERD. It's important to mention any possible symptoms to doctors as they may be due to underlying GERD.
Keeping it in Check: Avoiding food or liquid in the two or three hours prior to bedtime is advisable. Elevating the head of the bed by putting blocks under the mattress may be useful. Keeping the child's doctor informed is also vital, since he or she may suggest additional measures or medicines if simple methods prove ineffective.
Hormonal changes (menstruation)
In some patients, asthma aggravation is related to menstruation. Birth control pills could also have an effect.
Keeping it in Check: It's important to make hormone-related information part of the discussion with an asthma specialist while planning strategies.
Exercise
The vast majority of kids and teens with asthma-as many as 90 percent-exhibit symptoms when they exercise. During exercise, you tend to breathe in large amounts of cold, dry air quickly through your mouth. By bypassing the warming benefits of the nose, cold air can trigger symptoms, leading to Exercise-Induced Asthma (EIA); as well as the coughing and chest-tightening sensation associated with the disease due to Exercise-Induced Bronchoconstriction (EIB).
Despite the symptoms associated with EIA and EIB, exercise is crucial for children. They benefit enormously from activity, not just in terms of physical conditioning but in mood, attitude and social skill development as well. Exercise also promotes maintaining a healthy weight, improved lung function, and improved conditioning. It can also lead to greater self-esteem and confidence. A diagnosis of asthma should not be an excuse to sit down but rather an incentive to improve asthma control.
Keeping it in Check: For some children, taking asthma medication prior to strenuous activity will help. Pacing oneself, doing a warm-up and starting slowly are essential. Certain sports are less likely to cause EIA, such as walking or jogging. Also, if you're exercising outdoors on a cold or windy day, wearing a scarf or mask over your nose and mouth will warm and humidify the air entering your lungs. Breathing through your nose instead of your mouth will also help.
Click on Exercise and Asthma for more details.
Food
There are many common food allergies, and although most don't adversely affect asthma, it's important to be aware of them and look for symptoms.
Keeping it in Check: Certain allergenic foods such as nuts, eggs, milk, seafood and peanuts can be removed from a child's diet if you suspect that they are triggers. But it is important for your child to be allergy tested before a long-term dietary change is instituted. A consultation with an allergist will help you make an informed decision.
Medication
Certain medications can set off symptoms. Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, or beta blockers, which are used to treat high blood pressure, heart disease and migraines, may cause an increase in asthma symptoms.
Keeping it in Check: It's important to check with a child's doctor before trying any new medication-and that includes anything over the counter.
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