Asthma Triggers

Asthma is a chronic inflammatory disorder affecting the lower respiratory tract. The lower respiratory tract includes the muscular tubes that carry air in and out ofthe lungs as well as the tissues in the lungs where gas exchange takes place. The inflammation found in individuals with asthma is usually associated with inflammation of the upper respiratory tract, which includes the nose and the sinuses.

The symptoms of asthma may include a feeling of chest tightness or heaviness in the chest, wheezing (i.e., high-pitched whistling type of noise during breathing), coughing, and/or shortness of breath/difficulty in breathing. The frequency of these symptoms varies depending on the severity of the asthma. The symptoms can be intermittent or persistent. The severity is also classified as either mild, moderate, or severe.

Asthma usually begins in childhood, although it can also be diagnosed for the first time in adulthood. The course of asthma is variable. The symptoms can be mild, moderate, severe, frequent, infrequent, intermittent, and/or persistent at various times throughout one’s life.

The underlying cause for most cases of asthma is a genetic predisposition. However, several factors in the environment play a role in determining the frequency and severity of asthma symptoms. These external factors “trigger” flare-ups or exacerbations of the condition in most individuals.

Common triggers of asthma:

1. Infections: Both upper and lower respiratory infections, especially the ones caused by viruses, are notorious for triggering and aggravating asthma leading individuals to visit emergency departments. In some cases, hospitalizations are required in order to treat the patient effectively. Several viruses such as rhinoviruses, adenoviruses, myxoviruses, and coronaviruses are well-known to exacerbate asthma. Frequent hand washing, avoiding exposure to “sick” people, and timely immunizations to viruses and bacteria (e.g., influenza, coronavirus, respiratory syncytial virus (RSV,) shingles, pneumococcus) can minimize the risk of asthma flare-ups.

2. Allergens: In sensitized individuals, exposure to indoor allergens (i.e., molds, dust mite, animal dander, cockroaches), and outdoor allergens (i.e., tree pollen, grass pollen, weed pollen) could set off more frequent and more severe asthma symptoms. Environmental controls and allergy desensitization with allergen injection therapy (i.e., allergy shots, allergy immunotherapy, allergy hyposensitization) is very helpful to better control and prevent asthma symptoms, as they are effective in 80-85% of the patients that take them.

3. Irritants: Dry air, cold air, excessive humidity, smoke, pollution, chemical aerosol sprays, fragrances, colognes, and other strong odors may irritate the airways of the lungs and result in exacerbations of asthma. As these irritants cannot be “desensitized” by traditional allergy immunotherapy, avoidance is the key to reducing the risks of more severe asthma when irritants are the trigger.

4. Physical Exertion: Exercise can trigger acute attacks of asthma in certain individuals. Proper conditioning, regular use of preventive maintenance medications, and receiving bronchodilator inhaled medications prior to exercise can all help to reduce asthma exacerbations that are caused by physical exertion.

5. Occupational Asthma: Hairstylists, bakers, farmers, welders, seafood processors, textile workers, carpenters, pharmaceutical workers, chemical manufacturers, food processors, animal handlers, metal workers, painters, and adhesive handlers are at increased risk for asthma flare-ups as they may inhale harmful gases, fumes, chemicals, dyes, plastics, metals, enzymes, dust, animal proteins, and/or other particulates. These substances are known to cause wheezing, coughing, and/or shortness of breath in certain occupations, as well as exacerbations in asthmatics in individuals who work there.

The diagnosis and treatment of asthma begins with the allergist performing a comprehensive history and physical examination. The diagnosis is further enhanced by obtaining a pulmonary function test. Occasionally a chest X-ray may be needed to rule out other respiratory diseases. Allergy skin testing or blood testing is often done since both indoor and outdoor aeroallergens are often a trigger in many asthmatics. The treatment of asthma begins with prevention. It is advisable for an asthmatic individual to try to avoid triggers that are known to cause or exacerbate their asthma symptoms. Medications are utilized in the management of asthma in most asthmatics. Every asthma patient should have a short-acting beta2 agonist rescue inhaler rescue medication (e.g., albuterol, ProAir, Proventil, Ventolin, Xopenex, levalbuterol, pirbuterol, Maxair, AirSupra) on hand to use if symptoms develop or to use prophylactically before exposure to a known trigger such as exercise. In addition, many patients will need other medications in order to control their asthma symptoms. Some other medications used to treat asthma may include, inhaled corticosteroids, inhaled long-acting beta2 agonists, oral leukotrienes, oral phosphodiesterase inhibitors, oral beta2 agonists, and biologicals [e.g., Xolair (omalizumab), Nucala (mepolizumab), Fasenra (benralizumab), Dupixent (dupilumab), Tezpire (tezepelumab)]. Allergy injections, as mentioned above may also be beneficial in the treatment of asthma as it helps reduce and prevent allergic triggers such as dust mites, molds, pollens, pets, and cockroaches. It is important to note that the treatment of asthma is individualized as it differs with each individual depending on the patient’s symptoms, frequency of symptoms, severity of symptoms, triggers, medications tried in the past, and the patient’s underlying conditions.

The board certified specialists of Black & Kletz Allergy always strive to keep abreast of new developments in the field of Allergy, Asthma, and Immunology in order to offer new and emerging diagnostic and therapeutic modalities, as soon as they are available. Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at each location. In addition, the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line. The allergy doctors of Black & Kletz Allergy see both children and adults in the Tysons Corner, VA, McLean, VA, and Manassas, VA areas and we have been serving the greater Washington metropolitan area for over 50 decades. Please call one of our convenient offices to make an appointment or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.