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Putting your finger on the asthma trigger
Gretchen W. Cook
ASTHMA MAGAZINE
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23
The microscopic dust mite is a common and potent allergen to which many people are sensitive.
It is a familiar holiday scene: candlelight sends a diffuse glow over the festive gathering of well-dressed, perfumed visitors. Live greenery decorates the mantle above a roaring fire. Simmering potpourri sends a holiday aroma wafting upwards. A large arrangement of fresh flowers adorns the buffet table. Delicious fragrances coming from the kitchen tell of a gas stove laden with more holiday boun-
What’s wrong with this picture? In the opening paragraph of this article, the holiday scene described many examples of common irritants and allergens. Do you know how many are in your home or workplace? Allergens: Mold from fresh greenery or cut flowers Dust collecting on greenery and other holiday decorations Moisture condensing on widows, a possible source of mold Animal dander, both an allergen and an irritant Cockroaches (surely not at the party!) Pollens from live flowers Irritants: Scented candles Smoke from a fireplace Perfumes Potpourri Alcohol burners beneath the chafing pans Gas range Cigarette-smoking guests
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ASTHMA MAGAZINE
ty. The excited dogs scurry underfoot, hoping to find a dropped cracker. The house is sealed tightly against the chilly weather, moisture condensing on the glowing windows. It is the perfect setting for a holiday party. Unfortunately, for someone with asthma and allergies, “it’s a recipe for disaster,” says Mark W. Millard, MD, medical director of Baylor Asthma and Pulmonary Rehabilitation Center. Why? Because this environment has the ingredients to deliver the powerful one-two punch of asthma triggers: airborne allergens and irritants. (See sidebar for details.) If you are like many people with asthma, you tend to lump all substances that exacerbate your symptoms into a single group and call it “allergies.” But there are important differences between airborne allergens and irritants, and how you respond to them. “Both allergens and irritants can make you short of breath, and if you have asthma, cause wheezing,” says Millard. “But the impact that allergens and irritants have upon your airways is very different.” Understanding the differences between these two types of asthma triggers and distinguishing between them can help people develop practical methods to reduce their exposure and better control their asthma. Allergens
Allergens are otherwise harmless organic substances that trigger a reaction of the immune system in people who have a sensitvity to them. Typical airborne allergens are molds, animal dander, dust mites, and pollen. When exposed to allergens, your body’s immune system may react, producing respiratory symptoms, such as chest tightness or wheezing, and nasal symptoms, such as discharge or swelling. “Interestingly, with allergens there are two problems,” says Millard. “One is the immediate impact. Within 2 or 3 minutes of exposure, people who are very allergic to the
November/December 2002
specific allergen will begin coughing, wheezing, or experience shortness of breath. But allergens have more than just an immediate impact; they can also have a later-phase reaction, and that late reaction often wakes people up at night and brings them to the emergency room.” According to Millard, a good asthma control plan will help reduce a person’s response to an allergen. “There are specific medicines, such as Intal and Tilade, that can actually block the triggering of an asthma attack from allergens. When inhaled before an allergen challenge, these medicines may block not only the immediate triggering of asthma symptoms but also the rebound [reaction] that often takes place 4 to 6 hours later.” If you are allergic to a particular substance, making changes in your environment to control or avoid contact with the allergen is very important. Some simple steps include: • removing carpeting and upholstered furniture (that harbor dust mites) from the bedroom of the person with asthma; • ensuring the home doesn’t have any water leaks that could result in mold growth; • removing pets from the home, or at least keeping them out of rooms used by the allergic person; • and enclosing pillows, mattresses and box springs in special dust mite-proof covers. If avoidance and the appropriate use of medications are not successful, another method for controlling allergies is immunotherapy (allergy shots), which makes your immune system less sensitive to your particular allergic triggers. Irritants
A big difference between allergens and irritants is that irritants can cause virtually anyone discomfort. “An irritant can affect almost anybody, whether they have allergies or not,” says Youngran Chung, pediatric pulmunologist in the Department of
Pediatrics, Loyola University. “Typically an irritant is a substance that causes irritation to tissue inside a person’s lungs and can increase asthma symptoms or cause asthma exacerbations. But the main difference is, it’s not an immunologic response. Once the person gets away from the irritant, the symptoms tend to stop.” Common irritants include manmade and natural substances, such as perfumes and other substances with strong odors, wood smoke, cigarette smoke, household cleaning products, newsprint ink, and construction byproducts, such as saw dust, dry wall dust, paint and caulk fumes, and outdoor pollutants such as diesel particles and ozone pollution. Surprisingly, even such everyday items as a gas range can give off fumes or odors that are irritate the lungs. “Even cooking with strong spices” can send irritants aloft, according to Chung. From this list, you can see that irritants are present everywhere—from your cleaning products to the newspaper you read. For most people, irritants cause only minor discomfort or inconvenience. But for people with asthma, airborne irritants can aggravate their already-inflamed airways, resulting in a worsening of their asthma symptoms. “People with asthma have what we call ‘twitchy’ airways,” says Chung. “Their airways tend to be easily inflamed, so exposure to an irritant increases the already-present airway inflammation and can cause more problems. People with asthma need to realize that benign triggers that only mildly bother other people may bother them a lot more.” “How much irritants bother you really depends upon how inflamed your airways are,” says Millard. “If your airways are inflamed, then almost any [irritating substance] can trigger an asthma attack. It’s sort of like putting alcohol on a first-degree burn: it hurts.” Irritants are easier to avoid than allergens, according to Millard. “You can’t change the great outdoors and
you can’t change the amount of pollen in the air, but you can eliminate and avoid many irritants that can trigger asthma symptoms.” For example, use an electric range instead of gas, don’t purchase perfumed or scented products, avoid known irritants, such as cigarette smoke, and don’t use toxic-smelling cleaning products in the house when the person with asthma is present. Potent irritants can be pervasive and long-lasting. “While it is understood that there should be no smoking around the person with asthma,” explains Chung, “even the presence of a heavy smoker can cause problems because the smoke lingers on hair and clothes.” In addition to avoidance, it is imperative to establish and maintain an asthma management regimen. “If your asthma is under good control, in other words, if the inflammation in your airways is controlled then irritants don’t have the same kind of impact,” says Millard. Education and Asthma Management
“Education is a big part of managing reactions to both allergens and irritants,” says Chung. “There’s a natural tendency to stop taking medicines when you feel good.” But many medications known as “preventive” or “controller” drugs have to be taken regularly over the long term, even when you are feeling better. If you have persistent asthma, one of the most important elements in your asthma management plan is the use of controller medications. “It’s very important that people with asthma be on the right medications,” says Millard. “This [may] involve an antiinflammatory. The cornerstone of asthma therapy is the use of inhaled corticosteroids, which work to reduce inflammation of the airways. When inflammation is reduced, airways tolerate both irritants and allergens better.” When inflammation is out of control, exposure to an asthma trigger can cause serious asthma exacerbations.” ASTHMA MAGAZINE
C o n s t ruction bypro d u c t s , such as saw dust and paint and caulk fumes, can be bothers o m e respiratory i rr i t a n t s .
When is asthma out of control? According to the NIH’s Guidelines for the Diagnosis and Treatment of Asthma, the use of a fast-acting bronchodilator 3 or more times a week is an indication that a controller medication is needed—airways are inflamed and asthma is out of control. Because you have no way of knowing when the next allergen or irritant exposure many take place, it is important to have a thorough understanding of asthma triggers and how to keep your asthma well-controlled. While your body’s physical response to allergens and irritants may seem similar on the surface, these two types of asthma triggers act on the airways in vastly different ways. Arming yourself with information and knowing your own responses to allergens and irritants can help you develop strategies that keep your asthma in check. Gretchen W. Cook is a freelance writer in Jackson Mississippi, who specializes in family and health topics. She was diagnosed with asthma at age 6. Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no.: 78/1/130111 doi:10.1067/mas.2002.130111
to subscribe call 1.800.654.2452
|
25
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
23
The microscopic dust mite is a common and potent allergen to which many people are sensitive.
It is a familiar holiday scene: candlelight sends a diffuse glow over the festive gathering of well-dressed, perfumed visitors. Live greenery decorates the mantle above a roaring fire. Simmering potpourri sends a holiday aroma wafting upwards. A large arrangement of fresh flowers adorns the buffet table. Delicious fragrances coming from the kitchen tell of a gas stove laden with more holiday boun-
What’s wrong with this picture? In the opening paragraph of this article, the holiday scene described many examples of common irritants and allergens. Do you know how many are in your home or workplace? Allergens: Mold from fresh greenery or cut flowers Dust collecting on greenery and other holiday decorations Moisture condensing on widows, a possible source of mold Animal dander, both an allergen and an irritant Cockroaches (surely not at the party!) Pollens from live flowers Irritants: Scented candles Smoke from a fireplace Perfumes Potpourri Alcohol burners beneath the chafing pans Gas range Cigarette-smoking guests
24
|
ASTHMA MAGAZINE
ty. The excited dogs scurry underfoot, hoping to find a dropped cracker. The house is sealed tightly against the chilly weather, moisture condensing on the glowing windows. It is the perfect setting for a holiday party. Unfortunately, for someone with asthma and allergies, “it’s a recipe for disaster,” says Mark W. Millard, MD, medical director of Baylor Asthma and Pulmonary Rehabilitation Center. Why? Because this environment has the ingredients to deliver the powerful one-two punch of asthma triggers: airborne allergens and irritants. (See sidebar for details.) If you are like many people with asthma, you tend to lump all substances that exacerbate your symptoms into a single group and call it “allergies.” But there are important differences between airborne allergens and irritants, and how you respond to them. “Both allergens and irritants can make you short of breath, and if you have asthma, cause wheezing,” says Millard. “But the impact that allergens and irritants have upon your airways is very different.” Understanding the differences between these two types of asthma triggers and distinguishing between them can help people develop practical methods to reduce their exposure and better control their asthma. Allergens
Allergens are otherwise harmless organic substances that trigger a reaction of the immune system in people who have a sensitvity to them. Typical airborne allergens are molds, animal dander, dust mites, and pollen. When exposed to allergens, your body’s immune system may react, producing respiratory symptoms, such as chest tightness or wheezing, and nasal symptoms, such as discharge or swelling. “Interestingly, with allergens there are two problems,” says Millard. “One is the immediate impact. Within 2 or 3 minutes of exposure, people who are very allergic to the
November/December 2002
specific allergen will begin coughing, wheezing, or experience shortness of breath. But allergens have more than just an immediate impact; they can also have a later-phase reaction, and that late reaction often wakes people up at night and brings them to the emergency room.” According to Millard, a good asthma control plan will help reduce a person’s response to an allergen. “There are specific medicines, such as Intal and Tilade, that can actually block the triggering of an asthma attack from allergens. When inhaled before an allergen challenge, these medicines may block not only the immediate triggering of asthma symptoms but also the rebound [reaction] that often takes place 4 to 6 hours later.” If you are allergic to a particular substance, making changes in your environment to control or avoid contact with the allergen is very important. Some simple steps include: • removing carpeting and upholstered furniture (that harbor dust mites) from the bedroom of the person with asthma; • ensuring the home doesn’t have any water leaks that could result in mold growth; • removing pets from the home, or at least keeping them out of rooms used by the allergic person; • and enclosing pillows, mattresses and box springs in special dust mite-proof covers. If avoidance and the appropriate use of medications are not successful, another method for controlling allergies is immunotherapy (allergy shots), which makes your immune system less sensitive to your particular allergic triggers. Irritants
A big difference between allergens and irritants is that irritants can cause virtually anyone discomfort. “An irritant can affect almost anybody, whether they have allergies or not,” says Youngran Chung, pediatric pulmunologist in the Department of
Pediatrics, Loyola University. “Typically an irritant is a substance that causes irritation to tissue inside a person’s lungs and can increase asthma symptoms or cause asthma exacerbations. But the main difference is, it’s not an immunologic response. Once the person gets away from the irritant, the symptoms tend to stop.” Common irritants include manmade and natural substances, such as perfumes and other substances with strong odors, wood smoke, cigarette smoke, household cleaning products, newsprint ink, and construction byproducts, such as saw dust, dry wall dust, paint and caulk fumes, and outdoor pollutants such as diesel particles and ozone pollution. Surprisingly, even such everyday items as a gas range can give off fumes or odors that are irritate the lungs. “Even cooking with strong spices” can send irritants aloft, according to Chung. From this list, you can see that irritants are present everywhere—from your cleaning products to the newspaper you read. For most people, irritants cause only minor discomfort or inconvenience. But for people with asthma, airborne irritants can aggravate their already-inflamed airways, resulting in a worsening of their asthma symptoms. “People with asthma have what we call ‘twitchy’ airways,” says Chung. “Their airways tend to be easily inflamed, so exposure to an irritant increases the already-present airway inflammation and can cause more problems. People with asthma need to realize that benign triggers that only mildly bother other people may bother them a lot more.” “How much irritants bother you really depends upon how inflamed your airways are,” says Millard. “If your airways are inflamed, then almost any [irritating substance] can trigger an asthma attack. It’s sort of like putting alcohol on a first-degree burn: it hurts.” Irritants are easier to avoid than allergens, according to Millard. “You can’t change the great outdoors and
you can’t change the amount of pollen in the air, but you can eliminate and avoid many irritants that can trigger asthma symptoms.” For example, use an electric range instead of gas, don’t purchase perfumed or scented products, avoid known irritants, such as cigarette smoke, and don’t use toxic-smelling cleaning products in the house when the person with asthma is present. Potent irritants can be pervasive and long-lasting. “While it is understood that there should be no smoking around the person with asthma,” explains Chung, “even the presence of a heavy smoker can cause problems because the smoke lingers on hair and clothes.” In addition to avoidance, it is imperative to establish and maintain an asthma management regimen. “If your asthma is under good control, in other words, if the inflammation in your airways is controlled then irritants don’t have the same kind of impact,” says Millard. Education and Asthma Management
“Education is a big part of managing reactions to both allergens and irritants,” says Chung. “There’s a natural tendency to stop taking medicines when you feel good.” But many medications known as “preventive” or “controller” drugs have to be taken regularly over the long term, even when you are feeling better. If you have persistent asthma, one of the most important elements in your asthma management plan is the use of controller medications. “It’s very important that people with asthma be on the right medications,” says Millard. “This [may] involve an antiinflammatory. The cornerstone of asthma therapy is the use of inhaled corticosteroids, which work to reduce inflammation of the airways. When inflammation is reduced, airways tolerate both irritants and allergens better.” When inflammation is out of control, exposure to an asthma trigger can cause serious asthma exacerbations.” ASTHMA MAGAZINE
C o n s t ruction bypro d u c t s , such as saw dust and paint and caulk fumes, can be bothers o m e respiratory i rr i t a n t s .
When is asthma out of control? According to the NIH’s Guidelines for the Diagnosis and Treatment of Asthma, the use of a fast-acting bronchodilator 3 or more times a week is an indication that a controller medication is needed—airways are inflamed and asthma is out of control. Because you have no way of knowing when the next allergen or irritant exposure many take place, it is important to have a thorough understanding of asthma triggers and how to keep your asthma well-controlled. While your body’s physical response to allergens and irritants may seem similar on the surface, these two types of asthma triggers act on the airways in vastly different ways. Arming yourself with information and knowing your own responses to allergens and irritants can help you develop strategies that keep your asthma in check. Gretchen W. Cook is a freelance writer in Jackson Mississippi, who specializes in family and health topics. She was diagnosed with asthma at age 6. Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no.: 78/1/130111 doi:10.1067/mas.2002.130111
to subscribe call 1.800.654.2452
|
25