COPE SPRING IRRITANTS AVOID ALLERGENS · allergic asthma? One way to prevent asthma attacks is to...

Spring 2020 ALLERGIC ASTHMAFocus on

HOW TO COPE WITH

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5 SURPRISING

ASTHMA TRIGGERSPG. 7

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Number of

asthma-related

missed school

days each year.

Number of genes

that may be linked

to allergic asthma.

SOURCES: Asthma and Allergy Foundation of America, Genetics Home Reference, American College

of Asthma, Allergy and Immunology, Adolescent Medicine: State of the Art Reviews

B Y T H E N U M B E R S

By Sonya Collins

Facts & Stats

Reviewed by Michael W. Smith, MD

WebMD Chief Medical Editor

50%Percentage of adults

whose asthma is allergic asthma.

>25

8%

MILLIONNumber of people in the

U.S. who have asthma.

Number of children with

allergic asthma who are

allergic to cockroaches.

Percentage of kids with asthma

who have the allergic type.

Times a dog should

be bathed per

week to reduce

allergen exposure

for the family.

Percentage of

people in the U.S.

who have asthma.

Number of

asthma-related

lost workdays

each year.

1

3

2x

235 MILLION

>10013.8 MILLION

50%Percentage of

children with asthma

who “outgrow” it—

though it can return

later in life.

90%

Number of people who have asthma worldwide.

14.2MILLION

WebMD Focus On is not responsible for advertising claims. WebMD Focus On (ISSN 1553-9946) is published by WebMD LLC and may not be reproduced in whole or in part without written permission of WebMD LLC. All rights reserved. All editorial content is reviewed by our board-certified physicians, is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. WebMD does not endorse any specific product, service, or treatment. Always seek the advice of your health care provider with any questions regarding a medical condition and never disregard professional medical advice or delay seeking it because of something you have read in WebMD Focus On. If you think you have a medical emergency, call your doctor or 911 immediately. 2020 WebMD LLC. All rights reserved. G

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Reviewed by Neha Pathak, MD

WebMD Medical Editor

Questions for Your DoctorD I S C U S S I O N G U I D E

LEARN MORE AT YOUR NEXT VISIT

By Stephanie Watson

Not sure what sets off your allergic asthma symptoms or how to treat episodes of wheezing? Use these questions as a guide to talk with your allergist or asthma specialist.

1. What triggers my

allergic asthma?

When you’re diagnosed with allergic asthma, it means that some type of allergen triggers your asthma symptoms. Several diff erent substances can provoke your immune system to react, including mold, dust mites, pet hair or dander, pollen, and cockroaches. When you’re exposed to these substances, your immune system releases a type of antibody called immunoglobulin E (IgE) along with other chemicals that cause infl ammation. Both make your airways swell up. To identify your triggers, keep a daily diary of your symptoms, noting what you were doing every time you started to wheeze. Share this diary with your doctor at each visit.

2. How will you

diagnose me?

Based on your symptoms, a spirometry (a breathing test) is used to diagnose asthma, then an allergist uses a

FENO test (which measures infl ammation in the lungs) to confi rm allergic asthma. Skin tests will determine what type of allergy you have. During a skin test, a small amount of several possible allergens will be placed just under the skin of your forearm or back. Aft er about 20 minutes, your skin will be checked for red bumps, which are a sign that you’ve had a reaction to the substance. The blood test looks for antibodies your body produces in response to allergens.

3. How do you treat

allergic asthma?

One way to prevent asthma attacks is to avoid your

allergy triggers. You can take medicines to treat both the allergic reaction and the wheezing it provokes.

Inhaled steroids are the mainstay therapy for allergic asthma. Leukotriene inhibitors block the chemicals your body releases during an allergy attack that cause airway constriction.

Anti-IgE therapy stops IgE and prevents the allergic cascade seen in asthma. They are used if you have severe and persistent allergic asthma and high blood levels of IgE.

Allergy shots gradually expose your immune system to increasing amounts of your trigger to increase your

tolerance to it. By preventing the allergic reaction, you’ll avoid asthma attacks, too.

4. Can any alternative

treatments relieve my

asthma symptoms?

Alternative therapies like acupuncture, herbal supplements, and breathing exercises have been studied for asthma. Although these therapies help some people feel better, there isn’t enough evidence to prove they eff ectively treat asthma. Don’t try any new treatment without fi rst checking with your doctor, because it could cause unexpected side eff ects.

5. Which asthma

symptoms should I

worry about?

You should be able to manage your allergic asthma at home with the medicines your doctor prescribes. Call your doctor if you continue to have asthma attacks, even with treatment. Get medical help right away if you can’t catch your breath, your peak fl ow meter readings are low, or a rescue inhaler doesn’t improve your wheezing.

Learn how to Help Your Child With

Asthma at WebMD.com/childasthma.

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Weather Asthma symptoms can change with the forecast. Weather impacts asthma in several ways. Cold, dry air narrows the airways, while heat and humidity create the ideal environment for dust mites to breed. You may notice the effects of cold most when you exer-cise because you breathe in through your mouth, which doesn’t humidify the air as well as your nose.

There’s also a phenomenon known as “thunderstorm asthma.” Humidity before or during a storm makes pollen particles break apart in the

air. “Because the particles are so small, you can breathe them deeper into your airways —deeper than they would normally go,” Metz says.

Emotions

A scary, thrilling, or romantic movie can be a rollercoaster ride when you have asthma. Intense emotions—whether sadness, happiness, or fear—can alter your breathing. In addition, with anxiety, depression, and stress, “dif-ferent stress hormones can be activated, and they can affect the airway by causing the muscles around the air tubes to constrict,” Metz says.

Pain relievers

Before you pop an over-the-counter NSAID pain reliever like aspirin or ibu-profen to relieve a headache or sore back, consider the effect it could have on your asthma. “Most people can tolerate them without prob-lems, but there are some people who are susceptible to them,” Metz says. “[The medicine] causes chemical changes that can lead to airway constriction.”

If you notice asthma symptoms within a few hours after taking one of these medicines, ask your doctor to recommend



Unusual AttacksT R I G G E R T I P S

THESE SURPRISING IRRITANTS COULD LEAVE YOU WHEEZING

By Stephanie Watson

Everyone with asthma has different environmental foes—substances that make their airways tighten and set off bouts of symptoms like shortness of breath, wheezing, and chest tightness.

Some asthma prompts are reliably common. “Three major triggers are allergens such as pollen, dust mites, animal dander, and mold; irritants like cigarette smoke, perfume, and fragrances that irritate the airways; and infections, particularly viruses,” says Gregory Metz, MD/AE-C, a board-certified allergist at Oklahoma Allergy and Asthma Clinic. Then there are a few unusual instigators that you may not expect to bring on symptoms.

a pain reliever, such as acetaminophen, that won’t affect your breathing.

Cold drinks

A milkshake might seem like the perfect choice on a hot day, but beware of icy beverages. Intense cold can stimulate nerve endings in your throat and set off a coughing spell, though it should be short-lived.

Acid reflux

A heavy or highly acidic meal before bed could lead to a flare-up in people with reflux. Acid backup from the stomach irritates the airways. Over time, con-stant irritation makes the airways even more sensitive to environmental irritants like allergens or smoke.

The easiest way to figure out what affects your asthma is to keep a symptom journal. “Write down what you were exposed to and what you were doing at the time,” Metz says. In addition to avoiding your triggers, you can take medicine to control airway inflammation. “If your airways are inflamed, they’re going to react more to these exposures,” says Metz.

Learn more about Understanding Adult-

Onset Asthma During Allergy Season at

WebMD.com/adultasthma.

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Trigger TestQ U I Z

HOW MUCH DO YOU KNOW ABOUT ASTHMA TRIGGERS? TAKE THIS QUIZ TO FIND OUT.

By Stephanie Watson

Answers: 1. True. In addition to allergens, asthma can be triggered by exercise, nighttime, and exposure to irritants at work.

2. True. Allergens like dust mites and mold cause an immune system response that sets off asthma symptoms such as wheez-ing and coughing. Other symptoms will depend on your trigger. Pollen and dust cause respiratory symptoms like sneezing and a runny nose.

3. False. Allergic asthma causes typical asthma symptoms, such as diffi culty breathing and wheezing.

4. True. Allergic asthma can also get worse at night when you’re exposed to triggers, such as pet dander or dust mites in the bedroom.

5. False. When chemicals irritate and infl ame the lungs, setting off asthma symptoms, it’s called occupational asthma.

1. You can have more than one asthma trigger.

True False

2. Dust mites and mold can trigger allergic asthma symptoms.

True False

3. Allergic asthma causes diff erent symptomsfrom other types of asthma.

True False

4. Symptoms of allergic asthma sometimes get worse at night.

True False

5. Exposure to chemicals at work can cause allergic asthma.

True False

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Reviewed by Neha Pathak, MD

WebMD Medical Editor

SPRING INTO

ACTION

ABUBAKR CHAUDHRY,

MD, shares how you can be best prepared for an allergy-induced asthma fl are this season.

KNOW YOUR TRIGGERS.

Watch the daily pollen counts for your particular allergen.

PAY ATTENTION TO SYMPTOMS.

Call your doctor if you have congestion, wheezing, shortness of breath, or diffi culty breathing when walking.

PEN A PLAN.

Create a plan with your doctor to help assess the severity of your symptoms and suggest what to do to escalate treatment.

USE A PEAK FLOW METER.

Record a baseline reading and then note subsequent readings when you’re not feeling well. This will help your doctor tailor your treatment and guide your asthma action plan.

Springtime is a season of blooming fl owers, buzzing bees … and allergies. If you deal with seasonal allergies in spring, many of the triggers for these allergies also trig-ger asthma. The most common spring allergens that are highest from February to May are tree and grass pollen. These tiny pollen grains travel by wind, making it easy to inhale them as you go about your daily life.

“Allergy-induced asthma occurs when natural antibodies recognize these environmental substances mistakenly as harmful agents,” says Abubakr Chaudhry, MD, medical director of clinical education at Northside Hospital and pulmonologist at Pulmonary and Critical Care of Atlanta. “This leads to a release of chemicals that cause symptoms like runny nose, congestion, watering eyes, and wheezing.” This allergic reaction is what produces asthma symptoms.

Although other allergens such as pets, mold, and some foods also initiate allergic asthma, they tend to be perennial—in steady supply all year. They may also pop up when you’re not expecting them. You can predict when seasonal allergies will hit, which means you can meet this spring with a plan in place.

An ounce of preven-tion is worth a pound of cure, so make every eff ort to block allergens before they can set off a reaction. “In patients who suff er from seasonal allergies, we encourage watching the pollen counts and helping tailor therapy before it causes asthma symptoms,” says Chaudhry.

Good spring practices include using a saline nasal irrigation in the morning and evening to wash out your passages. It’s also a good idea to change your clothes before you get in bed and wash your sheets regularly to prevent allergen overload.

Your medications may also need adjustment while allergen loads are high. Though allergy shots are sometimes helpful, Chaudhry notes they can take about 3–5 years to be eff ective. “We add

S E A S O N S M A R T S

LEARN MORE ABOUT THE LINK BETWEEN THE SEASON AND YOUR SYMPTOMS

By Rachel Reiff Ellis

Spring Allergies and Asthma



medications known as leukotriene modifi ers to help ease symptoms,” says Chaudhry. Newer agents such anti-immunoglobulin E, IgE therapy, or medi-cations that decrease the number of antibodies that cause allergic reactions can help relieve allergy and asthma symptoms as well. These are used when your asthma medications, spe-cifi cally inhaled steroids, don’t control your asthma.

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“There’s a big misconception with pet owners that if they’re not having symptoms around their pets,

they’re not allergic to their pets.”



every 2–3 days and set out traps or call a pest service to help get rid of roaches you already have.

Pets. One of the hardest pills to swallow as someone with allergic asthma and furry family members is the fact that your pet can set off your symptoms. “There’s a big misconception with pet owners that if they’re not having symptoms around their pets, they’re not allergic to their pets,” says Ramey. But unfortunately, he says, if you have an indoor pet, their allergen is everywhere in the house. “Cat allergen, for example, is very sticky, and so if you sit somewhere where the cat’s been, you carry that allergen with you all day long,” says Ramey.

If rehoming your pet or keeping them strictly outdoors is out of the question, Ramey encour-ages good pet allergen practices: Don’t sleep with them or let them in your bedroom and consider getting allergy immuno-therapy (allergy shots).

Mold. Mold can be a tricky trigger to contain, mainly

because it can be hard to figure out exactly which one you’re allergic to. “There are a lot of differ-ent molds out there,” says Ramey. “You could be allergic to just one type of mold, and if that mold isn’t in your house, then it may not be playing a big role in your asthma.” Mold can be both an indoor and an outdoor allergen, but either way, it has to become airborne to trigger symptoms. “So, if mold is growing in the air conditioning vents or the ductwork and is swirl-ing around and you’re allergic to mold, that can sometimes trigger your asthma,” says Ramey.

If you’ve tested positive for a mold allergy and your house tests positive for mold, it may be worth investing in a profes-sional mold-removal service. In the meantime, keep humidity low and check for water leaks that could be helping mold grow under floors and behind walls.

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The first and most impor-tant step to “trigger-proof-ing” your home is to see an allergist and identify exactly what causes your asthma symptoms to flare. “Getting allergy-tested is the best way to help you figure out what to do—and not spend a lot of money doing things that probably aren’t going to help you,” says John Ramey, MD, allergist-immunologist at National Allergy and ENT in Charleston, South Carolina.

Once you’ve nailed down the likely culprits, you can start protecting yourself from them. Here are the most common asthma trig-gers that lurk in the home.

Dust mites. These tiny insects typi-cally live in fabrics like your sheets and bedding. Every home has them. “Dust mites are problem-atic because the dominant place you get exposure is in bed while you’re sleep-ing,” says Ramey. Most people spend 6–8 hours in bed at night, so that’s a lot of trigger time.

Your best bet is to use special dust mite covers on your mattress, box spring, and pillows. “They’re woven

“Getting allergy-tested is the best way to help you figure out what to do—and not spend a lot of money doing things that probably aren’t going to help you.”

so tightly together the dust mites can’t crawl through them,” says Ramey. You should also wash all bed-ding—sheets, comforters, blankets, pillowcases—once a week in hot water (at least 130°F), which helps kill the dust mites.

Humid air promotes dust mite populations, too. A humidity gauge can help you get a reading on

how much moisture is in your house. “Dust mites are shown not to live if you keep the humidity below 50%,” says Ramey. Any room in your house over 50% should have a dehu-midifier to dry out the air.

Pests. The critter that often causes the most issues for people with allergic asthma is the

cockroach. But it’s not the roaches themselves that bring on allergies. “People who are allergic to cockroaches are actually allergic to their feces,” says Ramey. Dust in rooms where cockroaches have been will have their poop in it, and that will trigger asthma.

Don’t give cockroaches easy access to water and food. Vacuum and dust

H E A L T H S M A R T S

MAKE YOUR HOUSE A HAVEN FROM ASTHMA TRIGGERS

By Rachel Reiff Ellis

Tips for Home

GO THE EXTRA MILE JOHN RAMEY, MD, shares tips on how to expand your protection beyond the walls of your house.

FOLLOW THE POLLEN COUNT

so you know when what you’re allergic to is high.

LIMIT TIME OUTSIDE

during your most allergic seasons.

SHOWER OFF

as soon as you come inside.

KEEP WINDOWS CLOSED

so pollen doesn’t seep into your home.

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WebMD Senior Medical Editor

T R A C K I N G T O O L

USE THIS WORKSHEET TO GIVE YOU AND YOUR DOCTOR MORE INSIGHT INTO YOUR ALLERGIC ASTHMA

By Stephanie Watson

Triggers and Symptoms

One of the best ways to gain more control over your allergic asthma is to track your symptoms and learn your triggers. Scan or copy this form and use it to track your symptoms, record what you were doing before they started, and describe how you treated each flare-up. Then, share it with your doctor at every visit.

SYMPTOMS (SHORTNESS OF BREATH, WHEEZING, COUGH)

WHAT YOU WERE DOING WHEN THEY STARTED

POSSIBLE TRIGGERS (POLLEN, DUST, PETS, MOLD, ETC.)

PEAK FLOW READINGS

MEDICINE(S)/DOSE YOU TOOK

DID THE MEDICINE RELIEVE YOUR SYMPTOMS? (YES/NO)

MON. TUES. WED. THURS. FRI. SAT. SUN.

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