Chapter 5

Knowing Your Asthma Triggers

In This Chapter

Identifying what’s triggering your asthma symptoms

Avoiding inhalant allergens

Focusing on triggers in your home

Recognizing triggers in your workplace

Steering clear of food and drug triggers

Dealing with other conditions that can aggravate your asthma

W ater covers two-thirds of the world’s surface. If you have asthma, it may seem at times that the rest of the planet consists of nothing but asthma triggers. Throughout the world and in virtually every aspect of people’s everyday lives, countless precipitating factors — allergens, irritants, or other medical conditions — can induce asthma symptoms.

Avoiding or limiting your exposure to these precipitating factors is vital for managing your condition. Avoiding asthma triggers can help you experience fewer respiratory symptoms and potentially allow you to reduce your need for medication, especially rescue drugs such as short-acting beta ₂ -adrenergic (beta ₂ -agonist) bronchodilators. (See Chapters 14, 15, and 16 for details on asthma medications.)

Although certain triggers frequently dominate each individual’s asthma, controlling your condition often requires dealing with a host of precipitating factors — an especially common situation if you have allergic asthma, one of the most frequent types of asthma. Allergic asthma is usually associated with allergic rhinitis (hay fever) and/or allergic conjunctivitis (see Chapter 2 for details of allergic asthma).

If the prospect of dealing with a world full of asthma triggers seems daunting, don’t despair. Throughout this chapter, I provide information and tips, based on extensive experience and the latest research findings, that can help you — in consultation with your doctor — implement practical and effective measures for avoiding or reducing exposure to your asthma triggers.

Recognizing What Triggers Your Asthma

One of the most important steps you need to take to effectively manage your asthma is to identify what triggers the symptoms of your condition. These triggers (see Figure 5-1) include

Inhalant allergens, including animal danders, dust mite and cockroach allergens, some mold spores, and certain airborne pollens of grasses, weeds, and trees (see Chapter 10).

Occupational irritants and allergens, found primarily in the workplace, that induce occupational asthma (see the section “Working Out Workplace Exposures,” later in this chapter) or aggravate an already existing form of the disease.

Other irritants that you inhale, such as tobacco smoke, household products, and indoor and outdoor air pollution.

Nonallergic triggers, including exercise and physical stimuli such as variations in air temperature and humidity levels.

Other medical conditions, including rhinitis, sinusitis, gastroesophageal reflux disease (GERD), and viral infections; sensitivities to aspirin, beta-blockers, and other drugs; and sensitivities to food additives — particularly sulfites.

Emotional activities, such as crying, laughing, or even yelling. Although emotions aren’t the direct triggers of asthma symptoms — and clearly asthma isn’t an “emotional problem” — activities associated with emotions (happy or sad) can induce coughing or wheezing in people with pre-existing hyperreactive airways (see Chapter 2), as well as in individuals who don’t have asthma but who may suffer from other respiratory disorders. For example, your friend with a bad cold may say, “Please don’t make me laugh; if I do, I’ll start coughing.”

Evaluating triggers

In order to determine what triggers your asthma symptoms and your sensitivity levels to those triggers, your doctor should take a thorough medical history. Keeping an asthma diary (see Chapter 4) can assist in your doctor’s assessment by providing details of your symptoms and your exposures to potential triggers. Prepare to give your doctor specific information about the respiratory symptoms that you experience.

Figure 5-1: Common asthma triggers.

Testing for allergic triggers

Many asthma patients experience perennial (year-round) symptoms that worsen during particular seasons. Because such a wide range of triggers can contribute to perennial asthma episodes, provide your doctor with a record of the seasonal patterns of your symptoms. Your record contains valuable clues to help your doctor narrow down the factors that affect your condition.

For example, if your asthma consistently worsens during late summer and fall in the eastern parts of the United States, your physician may suspect ragweed or mold as a prime cause of the allergic reactions that aggravate your condition. However, doctors usually advise allergy testing (see Chapter 11 for a complete explanation of allergy testing) to investigate other possible causes and to confirm the diagnosis and determine appropriate treatment.

If you have persistent asthma (see Chapter 4) with year-round symptoms that occur primarily indoors, allergy testing can help your doctor identify several of the triggers, such as dust mites, that may be affecting you.

Nocturnal or nighttime asthma, which often shows up as a nighttime cough, wheezing, and/or shortness of breath, that disturbs your sleep and may require you to use your short-acting adrenergic bronchodilator (see Chapter 14) can often be severe. Allergens in your bedroom, postnasal drip from allergic rhinitis (see Chapter 7), or chronic sinus problems (such as sinusitis; see Chapter 13) often trigger this condition. Other mechanisms that can trigger nocturnal asthma include

GERD

Airway cooling and drying

Increased bronchial airway hyperreactivity

A delayed reaction (known as a late-phase reaction; see Chapter 6) to allergens that you’ve been exposed to previously during the day

The circadian rhythm (also known as diurnal variation ), which is your body’s internal clock, may also affect your asthma, making you more susceptible to symptoms in the early morning hours (around 3 to 5 a.m.). During the late evening and early morning hours, a decrease in plasma levels of adrenal gland (glands above your kidneys) hormones, such as cortisol, a hormone produced by the cortex (outer layer) of the adrenal gland, normally occurs. At the same time, a decrease in plasma epinephrine and an increase in plasma histamine also occur.

Controlling Inhalant Allergens

Inhalant allergen triggers, also known as aeroallergens, are probably the most familiar asthma precipitants because they’re also associated with allergic rhinitis and similar conditions (see Chapter 7). If you have allergic asthma, reducing your exposure to inhalant allergens is the first and most important step to take — in consultation with your doctor — to manage your condition.

The following list details the most common inhalant allergens to look out for:

Animal allergens. Pet dander, which also may contain traces of saliva, is a potent trigger of symptoms for many people with asthma. Although household dogs and cats are the most common sources of these allergens, all warm-blooded animals, such as horses, rabbits, small rodents, and birds, produce dander — regardless of hair length — that can cause allergic reactions and aggravate your asthma. Urine from these animals is also a source of allergens. Animal dander also serves as a food supply (along with dead human skin scales) for dust mites, as I explain in Chapter 10.

Dust mites. Dust mites abound almost everywhere humans settle, and they thrive especially well in mattresses, carpets, upholstered furniture, bed covers, linens, clothes, and soft toys. Although eradicating these dusty denizens is virtually impossible, you can take practical and effective steps to minimize exposure to the allergens that dust mites produce.

See Chapter 10 for more dirt on dust mites, and Chapter 11 for details on measures to control these creatures.

Cockroaches. As if you need another reason to avoid cockroaches, exposure to allergens from cockroach droppings (yuck!) in house dust can trigger and aggravate your asthma symptoms. Studies show that inner-city children who unfortunately are exposed to high levels of cockroach allergens, especially in the bedroom, can develop increasingly severe asthma.

Many asthmatic patients of inner-city clinics have tested positive for cockroach allergens (through allergy skin testing) but have improved after immunotherapy with cockroach allergen extract. (See Chapter 11 for more information on allergy skin testing and immunotherapy.)

To control cockroach allergens in your home, include these key measures:

• Exterminate cockroach infestations. During the fumigation process, stay out of your home, and allow it to air out for several hours before re-entering. (This advice applies to anyone, regardless of whether or not you have asthma.)

• Clean your entire home thoroughly after extermination.

• Set roach traps.

• Seal any cracks or other conduits into your home to prevent reinfestation.

• Keep your kitchen clean by washing dishes and cookware promptly and by emptying garbage and recycling containers (including old newspapers) often, and avoid leaving food out.

Mold. The airborne spores that molds (fungi) release in typically damp areas of many homes, particularly from basements, bathrooms, air conditioners, garbage containers, and under carpeting, can trigger allergy and asthma symptoms when you inhale them. Mold can also thrive in leaf piles, compost heaps, cut grass, fertilizer, hay, and barns. Airborne mold spores are more numerous than pollen grains and don’t have a limited season. Depending on where you live, you may receive exposure to airborne spores during many parts of the year, based on levels of humidity.

See Chapter 10 for more moldy matters, including tips on translating mold counts and what you can do to reduce mold exposures.

Pollen. From spring through fall, many varieties of trees, grasses, and weeds release pollens that can trigger symptoms of allergic rhinitis and/or allergic conjunctivitis. These reactions can also affect your asthma, aggravating the underlying airway inflammation.

Many people primarily associate pollens with outdoor exposure. However, because most pollens are wind-borne, they can often make their way indoors and trigger allergy and asthma symptoms in your home.

See Chapter 11 for steps you can take to avoid excessive exposure to pollen, especially during periods of high pollination, and see Chapter 10 for more pollen particulars, including tips on pollen counts.

Clearing the Air at Home

Indoor environments at home, work, and school and in cars as well as other enclosed means of transportation can often provide far more significant sources of asthma triggers than the outdoors, because most enclosures concentrate irritants and allergens. Therefore, you should seriously consider the effects of indoor air pollution because it can induce or aggravate allergies and asthma.

Household irritants

The most significant irritant triggers of asthma in many households are

Tobacco smoke (see the next section)

Fumes and scents from household cleaners, strongly scented soaps, perfumes, glues, and aerosols

Smoke from wood-burning appliances or fireplaces

Fumes from unvented gas, oil, or kerosene stoves

Other sources of indoor air pollution include pollens and mold spores that get inside, especially on windy days when windows and doors are open. These allergenic materials can also infiltrate your home via your clothing and hair. In fact, if you have allergic asthma, you may wake up congested and wheezing in the morning because allergenic materials find their way into your house so easily. (The pollen or mold spores in your hair probably wound up on your pillow, so you spent the night breathing those allergens into your lungs.)

No smoking, please

As far as truly irritating irritants go, tobacco smoke is the No.1 indoor air pollutant. Secondhand smoke has been associated with an increase in the following adverse effects: persistent wheezing associated with asthma, hospital admissions for respiratory infections, earlier onset of respiratory allergies, decreased lung function, and even increased incidence of otitis media with effusion (inflammation of the middle ear; see Chapter 13).

Tobacco smoke frequently precipitates asthma symptoms in children. In fact, numerous studies show that parental smoking, especially by the mother, is a major risk factor in the development of asthma in infants, who are exposed to the smoke during the first few months of life. Therefore, don’t smoke and make sure that those people around you don’t smoke, especially if you have children.

Filters and air-cleaning devices

The quality of the air you breathe indoors largely depends on the condition of your heating, ventilation, and air-conditioning (HVAC) system, as well as the air and particles that circulate throughout it.

If you’re exposed to airborne allergens and irritants, such as animal dander, mold spores, pollen, and tobacco smoke, consider using air filters on your HVAC ducts to reduce the level of allergy and asthma triggers circulating through your home. Keep in mind, however, that these filters don’t remove substances that have already settled in bedding, carpeting, and furniture — especially dust mite allergens. Dust mite allergens are generally larger than other airborne allergens and irritants, and they usually fall from the air within a few minutes after being stirred up in dust or air currents.

The two types of air filtration systems often recommended by doctors for reducing indoor levels of airborne allergens and irritants are

High Efficiency Particulate Arrester (HEPA): These filters are designed to absorb and contain 99.97 percent of all particles larger than 0.3 microns (one-three hundredth the width of a human hair). If the unit truly operates at that level, only 3 out of 10,000 particles get into your indoor environment. Vacuum cleaners and air purifiers with HEPA and ULPA filters (see the next section for more information) can play a vital part in allergy-proofing your home.

Ultra Low Penetration Air (ULPA): This system filters more thoroughly than the HEPA process and is designed to absorb and contain 99.99 percent of all particles larger than 0.12 microns.

If your home doesn’t have a central HVAC system, you can purchase stand-alone HEPA and ULPA air cleaners for use in individual rooms. The appendix provides information on finding and purchasing these items.

Vacuum cleaning is also vital for reducing your exposure to allergens and irritants at home. However, many standard vacuum cleaners only absorb larger particles, and they allow many allergens to escape in the exhaust. This is often why you may experience asthma symptoms after housework: The vacuuming may actually have made matters worse for you by simply stirring up triggering substances that you then inhaled.

In order to avoid stirring up asthma triggers when you vacuum, ask your doctor whether she thinks investing in a vacuum cleaner that uses a HEPA or ULPA filtration process may work for you. You can find more information on HEPA- or ULPA-filtered vacuums in the appendix.

Working Out Workplace Exposures

Exposures to many types of chemicals and dust in workplace environments can induce different forms of occupational asthma. In many cases, people who have asthma but haven’t yet developed obvious symptoms of the disease may experience asthma episodes for the first time as a result of exposure to occupational triggers. Allergic and nonallergic triggers can play a part in occupational asthma, which may account for as many as 15 percent of all new asthma cases each year in the United States.

Targeting workplace triggers

Doctors and other healthcare professionals typically associate occupational asthma with exposure to the following workplace triggers:

Industrial irritants: These irritants can include chemicals, fumes, gases, aerosols, paints, smoke, and other substances you primarily find in the workplace. Tobacco smoke in the workplace can cause many asthma symptoms. Likewise, other irritants in the workplace can include perfumes, food odors, and even co-workers who use heavily scented perfumes and colognes.

Occupational allergens: Many occupations involve exposure to or contact with substances made of plant materials, food products, and other items that contain allergenic extracts that can trigger allergic reactions, thus inducing occupational asthma in sensitized people. For example, “Baker’s asthma” can occur in workers who receive constant respiratory exposure to the allergens contained in flour. (Eating the resulting baked food usually doesn’t produce symptoms in these workers, however.) Latex is another common occupational allergen, as I explain in the sidebar “Latex and your lungs.”

Physical stimuli: These stimuli include conditions in your workplace, especially variations in temperature and humidity, such as heat and cold extremes or air that’s especially dry or humid.

Diagnosing and treating workplace triggers

Your physician should distinguish between asthma that results from exposure to certain substances in the workplace, school, or other frequented locations (other than your home) and a pre-existing condition that is aggravated by occupational allergens and irritants. This determination is vital to developing appropriate and effective methods of avoiding or reducing your exposure to occupational substances that may affect your asthma.

Diagnosing your occupational asthma is important for your long-term health and the effective management of your disease. The sooner you can effectively avoid or reduce your exposure to triggers at work, the better you can control your asthma.

In diagnosing a case of occupational asthma, your doctor may first need to assess the following factors:

The pattern of your symptoms. Symptoms that improve when you’re away from work strongly suggest that your problem is indeed work-related.

Your co-workers. Do your co-workers suffer from similar symptoms?

The degree of exposure. Did your first noticeable asthma episode at work occur after a particularly significant exposure, such as a spill of chemicals or other industrial substances?

Depending on your condition’s severity, your doctor may prescribe medications that control your asthma symptoms at work. In most cases, however, for this treatment to be effective, your doctor will probably advise you to find ways of avoiding or at least reducing your exposure to workplace triggers.

Latex and your lungs

Latex is increasingly a part of the environment in most medical facilities, due to the need for more aggressive infection control. This rubber compound is found particularly in medical gloves and other medical equipment, such as latex ports in intravenous tubing for administration of fluids and medications.

Because many surgical gloves contain cornstarch powder that’s coated with latex allergen, healthcare workers often inhale airborne allergen latex particles. These exposures can result in allergens from the rubber compounds sensitizing medical personnel. Thus, latex has become one of the most frequent causes of occupational allergy and asthma in the healthcare industry. In addition, patients being treated in medical facilities can also receive exposures and be sensitized to latex.

These exposures can lead to serious symp- toms of allergic rhinitis, asthma, urticaria (hives), angioedema (deep swellings), and, in extreme cases, anaphylaxis (a potentially life-threatening reaction that affects many organs simultaneously).

The allergens in many natural rubber latex products (including condoms and diaphragms) typically cause Type I immediate hypersensitivity IgE-mediated reactions. (I explain this mechanism in Chapter 6.) For this reason, the FDA now requires labeling of all medical devices or packaging containing natural rubber latex. Parents should be aware that latex-sensitive children can be at risk for severe respiratory reactions from rubber balloons.

If you’re at risk for allergic reactions to latex exposure, make sure that any physician who treats you knows this fact so that you can, ideally, receive medical/dental care in a latex-free environment — a setting in which no latex gloves are used and no latex accessories (such as catheters, adhesives, tourniquets, and anesthesia equipment) come into contact with you. Similarly, if your occupation involves contact with latex, find out what you can do to avoid or minimize your exposure to this allergen. In healthcare settings, powder-free latex gloves and non-latex gloves and other medical articles are increasingly becoming available. Using these alternative products can often substantially reduce the risk that you may suffer an allergic reaction to latex.

Additionally, wear a MedicAlert bracelet or pendant to alert medical personnel not to use latex articles in the event that you’re unconscious or unable to communicate during a medical emergency. (The appendix provides information on obtaining these bracelets and pendants.) If you’ve experienced a serious allergic reaction to latex, also ask your doctor whether an emergency epinephrine kit, such as an EpiPen or Twinject, with an injectable dose of epinephrine, is advisable for you.

Avoiding Drug and Food Triggers

Some people with asthma also suffer from sensitivities — sometimes potentially life-threatening — to certain foods and medications. In the following sections, I explain the most significant sensitivities that can adversely affect your asthma and what you can do to avoid them.

Aspirin sensitivities

Approximately 10 percent of asthma patients experience some level of sensitivity to aspirin, aspirin-containing compounds (such as Alka-Seltzer, Anacin, and Excedrin), and nonsteroidal anti-inflammatory drugs (NSAIDs). If your medical history includes nasal polyps and sinusitis in addition to asthma and aspirin sensitivity, use acetaminophen-based products such as Tylenol instead of aspirin or NSAIDs for the relief of common aches and pains.

A more serious form of aspirin sensitivity is the aspirin triad. This condition affects aspirin-intolerant patients who have asthma and chronic nasal polyps as well as a history of sinusitis. If you suffer from the aspirin triad, adverse reactions to aspirin, aspirin-containing compounds, NSAIDs, and newer prescription NSAIDs, known as COX-2 inhibitors, including celecoxib (Celebrex) and rofecoxib (Vioxx), can result in severe or potentially life-threatening asthma attacks.

I strongly advise anyone with this level of sensitivity to wear a MedicAlert bracelet or pendant. This device alerts medical personnel not to administer any medication to which you are sensitive if you’re unconscious or unable to communicate during a medical emergency. See the appendix for more information on MedicAlert bracelets and pendants.

Beta-blockers

Doctors frequently prescribe oral beta-blocker medications, including Inderal, Lopressor, and Corgard, to treat conditions such as migraine headache, high blood pressure, angina, or hyperthyroidism, and beta-blocker eye drops for eye conditions, such as glaucoma. If you have one of these disorders and you also have asthma, know that taking beta-blockers can worsen your asthma symptoms by blocking the beta ₂ -adrenergic receptor sites in your airways that cause bronchodilation, thus making your asthma less responsive to beta ₂ -adrenergic (beta ₂ -agonist) bronchodilators.

Occasionally, taking beta-blockers can trigger asthma episodes in susceptible individuals who haven’t previously experienced any respiratory symptoms.

Because beta-blockers may trigger asthma symptoms, make sure that any doctor you consult for any of the conditions I mention in this section knows that you have asthma and/or has your complete medical history. If beta-blockers aren’t advisable, your doctor may prescribe alternative forms of medication therapy, such as other families of anti-hypertensives or other types of anti-migraine drugs.

Sensitivities to sulfites and other additives

Sulfites are often used as antioxidants to preserve beverages, such as beer and wine, and foods like dried fruit, shrimp, and potatoes. These antioxidants are also often used in salad bars and in guacamole. Exposure to these food additives can trigger severe asthma symptoms — including potentially life-threatening bronchospasm (constriction of the airways) — in as many as 10 percent of people who have severe persistent asthma when these individuals inhale sulfite fumes from treated foods. Severe asthmatics who require long-term treatment with oral corticosteroids (see Chapter 15) are more likely to be sulfite-sensitive and may be especially at risk for severe adverse reactions to these additives.

If you’re sensitive to sulfites, avoid consuming beer, wine, and processed foods. Also, carry rescue medication, such as an EpiPen, Twinject, and/or a short-acting inhaled bronchodilator, with you in the event that you unintentionally ingest food or liquids that contain sulfites. Eating more fresh foods, instead of processed foods, particularly fruits and vegetables, is a good idea anyway, regardless of whether or not you have asthma.

Tartrazine (FDC yellow dye No. 5), used in many medications, foods, and vitamin products, has been reported to possibly cause adverse reactions in asthmatics. If you’re sensitive to this food additive, check the labels on liquid medications, such as cough syrups and other liquid cold and flu remedies, to see whether they contain tartrazine or sulfites. When in doubt, ask your pharmacist.

Food allergies

Some people with asthma develop hypersensitivities to certain foods. However, although certain foods have the potential to cause anaphylaxis, they don’t appear to significantly increase the underlying airway inflammation that’s characteristic of asthma in most patients.

If your infant or young child has food allergies, your child may have a tendency to develop other allergy-related problems. In this case, your doctor should evaluate your child for possible signs of asthma and other atopic diseases, such as allergic rhinitis and atopic dermatitis.

If you’ve experienced an episode of anaphylaxis, ask your doctor whether an emergency epinephrine kit, such as an EpiPen (or EpiPen Jr. for children under 66 pounds) or Twinject, is advisable for you. Wear a MedicAlert bracelet or necklace in case you’re unable to speak during a reaction. The appendix provides more information on obtaining these items.

If you’re hungering for details on food allergies, turn to Chapter 8.

Other Medical Conditions and Asthma

In addition to the triggers that I discuss previously in this chapter, certain activities, illnesses, and syndromes can also induce your asthma symptoms or make them worse. Managing these precipitating factors is as vital to effectively controlling your asthma as is avoiding allergens and irritants.

Rhinitis and sinusitis

Poorly managing allergic and nonallergic forms of rhinitis can lead to sinusitis. This infection of the sinuses can also aggravate your asthma symptoms, especially if it isn’t responsive to repeated courses of antibiotic treatment. If so, sinus surgery may be necessary to treat sinusitis and reestablish control over asthma symptoms. Studies show that asthma patients who effectively manage their rhinitis and/or sinusitis can significantly improve their asthma symptoms.

Because your respiratory tract is essentially a continuum — or as I like to say, the united airway — treating your nose and sinuses can actually help treat the underlying inflammation that characterizes asthma. In fact, when dealing with serious respiratory diseases such as asthma, doctors increasingly consider it vital to treat the whole patient — not just the patient’s lungs. For more information on dealing with sinusitis and other rhinitis complications, turn to Chapter 13.

Gastroesophageal reflux disease (GERD)

The digestive disorder gastroesophageal reflux disease (GERD) occurs when the valve that separates the esophagus from the stomach doesn’t function properly. As a result, stomach acid and undigested food can wash up into the esophagus (and occasionally, through inhalation, into the respiratory tract) from the stomach in individuals who suffer from GERD. You can see a cross-section of the organs involved in GERD in Figure 5-2.

Patients who suffer from GERD often burp during and after meals, complain of an acid taste in their mouth, and feel a burning sensation in their throat or chest, symptoms that they typically describe as heartburn or indigestion.

Figure 5-2: GERD occurs when stomach contents spill over into the trachea.

GERD is a trigger of asthma symptoms in a large number of asthmatics and is, in particular, a major trigger of adult-onset asthma (see Chapter 2) in patients whose asthma symptoms (coughing, wheezing, shortness of breath) aren’t usually associated with allergic triggers. If you’re asthmatic, the flow of acidic digestive contents into your respiratory airways can make your underlying airway inflammation worse. GERD, with or without inhalation of stomach contents, has also been associated with increased bronchospasm and chronic cough due to irritation of the esophagus. Conversely, when asthma is active, it can also aggravate GERD, and some of the drugs used to treat asthma, such as long-acting beta ₂ -adrenergic bronchodilators and oral theophylline (see Chapter 15 for details on long-term asthma medications), can also worsen GERD symptoms.

If you have frequent heartburn and poorly controlled asthma, particularly with episodes that occur at night and disturb your sleep, your doctor should investigate the possibility that GERD contributes to your asthma symptoms.

To help alleviate the effects of GERD, your doctor may advise the following:

Avoid eating or drinking within three hours of going to bed.

Avoid heavy meals and minimize dietary fat. Also, try to eat several small meals over the course of the day instead of fewer, larger meals.

Eliminate or cut down on the consumption of chocolate, peppermint, alcoholic beverages, coffee, tea, and colas and carbonated beverages.

Avoid or reduce smoking and the use of any tobacco products.

Try elevating the head of your bed, by using 6- to 8-inch blocks, so that your stomach contents are less likely to rise to the point that you can inhale them while sleeping. Adding pillows under your head can also be of some benefit.

To control the digestive problems that result from your GERD symptoms, use appropriate over-the-counter (OTC) products, including Zantac, Tagamet, Axid, Prilosec OTC, and Pepcid AC. Your physician may also prescribe other medications, such as Nexium, Protonix, Aciphex, and Prevacid, which decrease gastric (stomach) acid secretion.

Viral infections

Viral respiratory infections, such as the common cold or flu, can aggravate airway inflammation and trigger asthma symptoms. Asthmatic children under age 10 are particularly prone to asthma symptoms precipitated by rhinovirus infections (upper respiratory infections, usually referred to as the common cold).

Rhinovirus infections cause bronchial hyperreactivity and promote allergic inflammation, leading to increased asthma symptoms. For infants and toddlers, viral infections of all types are the most frequent cause of severe asthma episodes because infants and younger children have smaller airways that are often more susceptible to bronchial obstruction. These infections are also the most frequent cause of episodes in adults, especially those with nonallergic (intrinsic) asthma.

Inform your doctor whenever you experience flu or cold symptoms. As comforting as you may find chicken soup when you’re sniffly and sneezy, you may require early and aggressive medication therapy to keep the virus from adversely affecting your asthma.

Consider the following measures when dealing with viral infections:

If your have persistent asthma, ask your doctor about receiving an annual flu vaccine to reduce the risk of suffering from an influenza respiratory infection that could aggravate your asthma symptoms.

New prescription antiviral medications, such as zanamivir by inhalation (Relenza) and oseltamivir phosphate by oral tablet (Tamiflu), can stop the flu dead in its tracks and get you back on your feet sooner if you take these drugs within the first two days of developing flu symptoms. Common flu symptoms include high fever, muscle aches, fatigue, and increased respiratory symptoms. Using these antiviral products can reduce the respiratory complications that accompany influenza infections, making these medications especially beneficial if you have asthma. However, these medications are only for influenza and aren’t effective against the common cold.

If your young child or infant experiences repeated viral infections that cause coughing and wheezing episodes, and your family medical history includes atopy (the genetic susceptibility for the immune system to produce antibodies to common allergens, which leads to allergy symptoms), make sure your doctor evaluates your child for the possibility of asthma. (See Chapter 18 for more information about asthma and children.)

What to do about the flu

Antiviral medications can help you avoid coming down with influenza even when you’ve had a flu shot. Flu vaccines consist of the World Health Organization’s (WHO) best guess of the viruses from the preceding year that may cause the flu during next year’s winter season. However, the WHO’s predictions aren’t always accurate. As a result, a flu shot may not fully protect you against the viral strains that cause the current year’s flu epidemic, thus making antiviral medications extremely beneficial.