Trigger factors Difference between trigger and cause Trigger

Trigger factors Difference between trigger and cause

Trigger factors 1. 2. 3. 4. 5. 6. infections house dust mites (HDM) pollen and spores animals exercise cold air 6. Drugs 7. Foods 8. pregnancy and menstruation 9. Emotions 10. Deep inhalation

Trigger factors Infections ☞commonest & important Ø Respiratory tract infections -acute bronchitis -simple cold -viral infections Ø Don’t treat infections and forget asthma (incorrect response)

Trigger factors House Dust Mite

Trigger factors House Dust Mite Ø 80% of asthmatic children are sensitive to it ØBeddings, carpets, furniture's, soft toys ØPresent even in most clean houses ØYou can not eradicate , but can reduce count ØVacuuming, covering mattresses and pillows

Trigger factors Pollen and spores ØGrass pollen, plants ØSeasons (late spring and early summer) ØRelated more to hayfever than asthma

Trigger factors Animals ØCats, dogs, horses, small rodents ØBirds ØCockroach ØHair, saliva, urine, feaces, shed skin

Trigger factors Exercise Ø Breathlessness during exercise Ø Asthmatics have narrowing of airways

Trigger factors Exercise ØFew minutes after exercise stopped →breathlessness

Trigger factors Exercise

Trigger factors Exercise ØCooling and drying effect of inspired air ØAsthmatics tolerate swimming (warm & humid air)

Trigger factors Cold air Just Going outdoor in cold day can make some people with asthma cough and wheeze

Trigger factors Deep inhalation Any Sharp intake of breath can bring on symptoms for some people with asthma e. g. fit of laughter

Trigger factors Drugs ØElderly polypharmacy ØB blockers 1) eye drops (timolol) in glaucoma 2) oral (atenolol, metoprolol, propnanolol) Øaspirin and NSAIDs (5% of adult onset asthma)

Trigger factors Foods Øuncommon trigger Ømore in atopics Ømilk, eggs, nuts, eggs, fish, Tartrazine, alcohol, sulfur dioxide

Trigger factors Pregnancy and menstruation ØRole of third ØMay worsen premenstrual

Trigger factors Emotions ØStress ØPsychosocial factors ØAsthma is worrying disease→aggrevate emotional stress ØControlling symptoms relieve emotional problems

Trigger factors Other trigger factors ØSmoke ØDust ØFumes ØRegurgitation 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 Ø Remain indoors when count is high Ø Close windows

Trigger factors Triggers avoidance - HDM Ø Impossible to eradicate but you can reduce count: m. Vacuum cleaner with high efficacy filter (HIPA) m. Covering mattress, pillows with protective covers m. Changing feather pillows, woolen blankets to synthetic ones m. Wash bedding weekly (55 ◦ C) m. Vacuum mattress regularly

Trigger factors Triggers avoidance - HDM Ø Impossible to eradicate but you can reduce count: m Replace curtains with blinds or light washables m Replace carpets with vinyl or wooden flooring and rugs which can be shaken outdoors m Place soft toys in freezer (6 hours) – then do vacuum

Trigger factors Association – Asthma and Rhinitis ØCommonest allergic disease in clinical practice Ø 80% of asthmatics have association with rhinitis ØRhinitis can trigger asthmatic attack → drip on Throat → cough which trigger asthma

Trigger factors Association – Asthma and Rhinitis Ø Under diagnosed Ø So … always search for rhinitis in asthmatic patients Ø Rhinitis treatment will improve asthma control Ø Treatment: combination of non sedating AH+ topical nasal steroids

Asthma management across ages Asthma and rhinitis Association – Asthma and Rhinitis ØTreating nasal rhinitis may improve asthma symptoms (Prieto et al, 1994) ØOral + inhaled steroids doses should be considered for systemic side effects risk