Asthma is a chronic lung disease characterized by airway obstruction, inflammation, and hyperresponsiveness . Identifying and avoiding asthma "triggers" is essential in preventing asthma flare-ups. Although "triggers" are often thought of as airborne agents that can bring on an attack, there are a variety of exposures that can cause or exacerbate symptoms, including the following categories of stimuli :
- Inhaled allergens
- Respiratory infections
- Inhaled respiratory irritants (including tobacco smoke and cold dry air)
- Hormonal fluctuations
- Physical activity
- Emotional state (eg, anxiety, sudden upsets)
It is recommended that clinicians assess patients for a range of factors that can make asthma worse, including inhalant allergens, tobacco smoke, indoor/outdoor pollutants and irritants, workplace exposures, gastroesophageal reflux and other comorbidities, rhinosinusitis, sulfite sensitivity, and medication intolerances . Such assessment should take into account the amount of exposure, the patient's sensitivity to allergens encountered, and the clinical significance of the exposure/sensitivity in the context of the person's medical history . Exposures at home, daycare, school, work, and regular leisure sites should be reviewed. Questions about work environment are particularly important, as industrial or occupational exposures are responsible for up to 15 percent of cases of adult asthma [2,3].
The recommendations in this topic review are consistent with "The National Asthma Education and Prevention Program: Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma – Full Report 2007" . The full text is available at the website of the National Heart, Lung, and Blood Institute . This document provides a set of questions that can be used to determine which triggers and environmental factors contribute to a patient's asthma (table 1).
After the patient has identified those elements that trigger his or her breathing problems, a plan can be devised to enable the patient to reduce the exposure.