Trigger factors

Difference between trigger and causeDifference between trigger and cause

Trigger factors

1. infections2. house dust mites (HDM)3. pollen and spores4. animals5. exercise6. cold air

6. Drugs7. Foods8. pregnancy and menstruation9. Emotions10. Deep inhalation

Trigger factors

InfectionsInfections ☞commonest & important

Respiratory tract infections -acute bronchitis -simple cold -viral infections

Don’t treat infections and forget asthma (incorrect response)

Trigger factors

House Dust MiteHouse Dust Mite

Trigger factors

80% of asthmatic children are sensitive to it

Beddings, carpets, furniture's, soft toys

Present even in most clean houses

You can not eradicate ,but can reduce count

Vacuuming, covering mattresses and pillows

House Dust MiteHouse Dust Mite

Trigger factors

Pollen and sporesPollen and spores

Grass pollen, plants

Seasons (late spring and early summer)

Related more to hayfever than

asthma

Trigger factors

AnimalsAnimals Cats, dogs, horses, small rodentsBirds CockroachHair, saliva, urine, feaces, shed skin

Trigger factors

ExerciseExercise Breathlessness during exercise Asthmatics have narrowing of airways

Trigger factors

ExerciseExercise

Few minutes after exercise stopped →breathlessness

Trigger factors

ExerciseExercise

Trigger factors

ExerciseExercise

Cooling and drying effect of inspired air

Asthmatics tolerate swimming (warm & humid air)

Trigger factors

Just Going outdoor in cold day can make some

people with asthma cough and wheeze

Cold airCold air

Trigger factors

Deep inhalationDeep inhalation

Any Sharp intake of breath can bring on symptoms for

some people with asthma e.g. fit of laughter

Trigger factors

Trigger factors

DrugsElderly polypharmacyB blockers

1) eye drops (timolol) in glaucoma2) oral (atenolol, metoprolol, propnanolol)

aspirin and NSAIDs (5% of adult onset asthma)

Trigger factors

Trigger factors

Foodsuncommon trigger

more in atopics

milk, eggs, nuts, eggs, fish, Tartrazine, alcohol,

sulfur dioxide

Trigger factors

Trigger factors

Pregnancy and menstruation

Role of thirdMay worsen premenstrual

Trigger factors

Trigger factors

EmotionsStress

Psychosocial factors

Asthma is worrying disease→aggrevate emotional

stress

Controlling symptoms relieve emotional problems

Trigger factors

Other trigger factorsSmokeDustFumesRegurgitation of food (Reflux)

Trigger factors

How to avoid triggers ?

Trigger factors

Triggers avoidance • Viral infections impossible to avoid

• action plan (self management )

Trigger factors

Triggers avoidance - Pollens

Remain indoors when count is high

Close windows

Trigger factors

Triggers avoidance - HDM

Impossible to eradicate but you can reduce count:

Vacuum cleaner with high efficacy filter (HIPA)

Covering mattress, pillows with protective covers

Changing feather pillows, woolen blankets to synthetic ones

Wash bedding weekly (55 ◦ C)

Vacuum mattress regularly

Trigger factors

Triggers avoidance - HDM

Impossible to eradicate but you can reduce count:

Replace curtains with blinds or light washables

Replace carpets with vinyl or wooden flooring and rugs which can be shaken outdoors

Place soft toys in freezer (6 hours) – then do vacuum

Trigger factors

Commonest allergic disease in clinical practice

80% of asthmatics have association with rhinitis

Rhinitis can trigger asthmatic attack → drip on Throat →

cough which trigger asthma

Association – Asthma and Rhinitis

Trigger factors

Under diagnosed

So … always search for rhinitis in asthmatic patients

Rhinitis treatment will improve asthma control

Treatment: combination of non sedating AH+

topical nasal steroids

Association – Asthma and Rhinitis

Asthma management across agesAsthma and rhinitis

Treating nasal rhinitis may improve asthma symptoms

(Prieto et al,1994)

Oral + inhaled steroids doses should be considered for

systemic side effects risk

Association – Asthma and Rhinitis