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Q. What are “asthma triggers”?A. Asthma triggers are those substances or situations

that set off an asthma attack. The triggers that havebeen recognised are:

Pollens of different grasses, weeds, shrubs,trees, fungi that grow in abundance in moist airand moderate temperature, both inside andoutside the house.

House dust which contains in it the mites(Dermatophagoides pteronyssinus) that growabundantly in the mattresses, rugs and otherfurniture in the bed rooms.

Pets like cats and dogs.

Insects in the house, particularly the cockroaches.

Some of the food articles.

Besides the above, mental and physical stress andstrain can also precipitate an attack in predisposedpeople. Viral infections of the upper respiratorytract either precipitate or aggravate an attack ofasthma. Some irritants of the respiratory tractsuch as environmental pollution, tobacco smokeor sudden changes in weather, can also lead to anattack of asthma. Even physical exercise can actas a trigger.

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Q. How is a trigger recognized?A. Through keen observation by the patient over a

period of time. Detailed medical history, carefulexamination of environmental influences andallergy testing are the ways, available to the doctorfor discovering triggering factors.

Q. Do the skin tests reveal all that a patient isallergic to?

A. No. Tests only give indications about the thingsfor which the patient has been tested. There maybe other things against which the test are not done.

Q. Is it one trigger or more than one,responsible for an asthma attack ?

A. Often a combination of triggers precipitates anattack. That is one reason that asthma seems sounpredictable. At one time in a stressful situation,no asthma is experienced. At another time whenstress is experienced, the chest tightens andwheezing begins.

Heavy expossure to any one trigger can alsoprecipitate an attack.

Q. If asthma triggers work so unpredictably, whybother?

A. The reason is to gain better control of the asthma.

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If the patient or the child and parents are aware ofthe common triggers and can find ways tominimize their effect, the total impact of asthmacan be lessened. One goal of asthma managementis to eliminate as many triggers as possible.

Q. How can an asthma patient avoid indoortriggers?

A. House dust, moulds and pet animals occur mostlyin indoor environments. In order to avoid housedust and the mites that grow in it, the bed-roomof the patient should be as sparingly furnished aspossible. It should have no rugs or carpets. Thecurtains should be light, easily cleaned andwashable. The bed should have the mattress cover,pillow cover and the quilt made of cotton-synthetic material which does not generate dustor collect it. Since the mites grow in moderatetemperature and humid environment, the mattressshould be taken out and spread in the hot sun thewhole day so as to kill the mites. Mite-killingspray does a better job. While cleaning is beingdone in the room, the patient should go out of itor go out of the house.

The houses which are dark and humid,accelerate the growth of the fungi; such houses

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should be avoided by the patients. The pets, catsand dogs may be removed from the house and inno case should they enter the patient’s room.

Sleeping in an air-conditioned room whereinno outside air circulates, protects the patientfrom the pollens and other pollutants present inthe outside air. HEPA (High Efficiency ParticleArrestor) air filter installed in the room, clearsthe air of all the particulate matter.

Q. How harmful is cigarette smoke to a childwith asthma?

A. Cigarette smoke is very injurious to an asthmaticchild. A parent or anybody else who smokes in ahouse where asthmatic child lives, does him thegreatest harm.

Q. How can a patient with asthma avoid outdoortriggers?

A. Outdoor environments contain pollens, mouldsand other pollutants. Travelling in the country-sidedirectly exposes the patient to these triggers. If apatient has to travel, the window-panes may bepulled up. If the car is air-conditioned, it protectsthe patient immensely. Specially designed facemasks are helpful in case of those who drive two-wheelers. Working in the garden or even being in

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the garden, exposes the patient to lot of mouldswhich grow on and under the rotting leaves; thismay be avoided in a season when the patient isknown to get the symptoms, or a face mask wornwhen so exposed.

Q. How to deal with stress triggers?A. Rather than avoiding stress, one should learn to

live comfortably with stress. Learning to relaxat will is a useful technique for people whoseasthma is triggered in stressful situations. Thereare many different methods of doing this. Somepeople are able to control their stress byimagining a soothing and relaxing scene. Otherscan gain control over stress by doing calm andcontrolled breathing. Meditation, transcendental,yogic or any other is, very helpful.

Q. How to help a child in an emotional state fromgetting an attack ?

A. Try to analyze what is going on in the situation.What factors contribute to the situation? In whatways can the situations be dealt with differently?If the problem is recurring and causes disruptionfor the child and family, consider seekingprofessional help to learn new ways to cope withemotinally charged situations.

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Do not let the possibility of an asthma attackrestrict either the child’s fun or need fordiscipline. If the child knows that discipline willbe disregarded when an attack is threatened, thechild may learn to respond to discipline with anattack. If the child gets asthma each time she/hegets excited, try to help the child; moderate theexcitement and teach the child to relax. Let thechild learn her/ hhis own limits, and manage anyattacks that do result. If self-management is tobecome a reality, the child must develop an innersense of when to tone things down.

Q. How to protect an asthma patient fromrespirotory viral infectons?

A. The precautions that can be taken includefollowing good, general health practices such asgetting plenty of sleep, eating a balanced diet,getting regular physical activity, drinking plentyof fluids, avoiding situations where people maybe sick, and promptly taking care of any colds orinfections that do occur.

Q. Should an asthma patient participate inphysical exertion activities ?

A. All asthma patients should participate in regularphysical activity, in spite of the fact that exercise

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itself can induce an atack. One should start off ata comfortable level and work progressively towardmore difficult levels of strength and endurance.When the patient is unwell or in a pollen seasonor in very cold weather, special precautions maybe needed. With the proper medications andunderstanding of one’s own abilities, there is noreason why asthma should handicap a person’sphysical involvement.

Several Olympic athletes have had asthma andhave won world class competitions. The key toenjoyment and mastery over physical activitiesis by gradual learning of your limits and havinggood medical advice about medication andgeneral asthma management.

Q. Any recommendations about exercise inchildren with asthma?

A. If the child feels an attack coming on afterexercise in the school, she /he should be allowedto stop and rest and to follow other self-management steps. It is importanat for the teacherto understand that “short burst” sports are welltolerrated by children with asthma, whilesustained exertion, such as running laps, ispotentially dangerous.

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Swimming is excellent physical exercise forpeople with asthma. Any physical activity that aperson desires to try, should be tried with thenormal precautions and provisions for attackmanagement in case it is needed.

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