Q.What are “asthma triggers”?
A.Asthma triggers are those substances or situations that set off an asthma attack. The triggers that have been recognised are:

Pollens of different grasses, weeds, shrubs, trees, fungi that grow in abundance in moist air and moderate temperature, both inside and outside the house.
House dust which contains in it the mites (Dermatophagoides pteronyssinus) that grow abundantly in the mattresses, rugs and other furniture in the bed rooms.
Pets like cats and dogs.
Insects in the house, particularly the cockroaches.
Some of the food articles.
Besides the above, mental and physical stress and strain can also precipitate an attack in predisposed people. Viral infections of the upper respiratory tract either precipitate or aggravate an attack of asthma. Some irritants of the respiratory tract such as environmental pollution, tobacco smoke or sudden changes in weather, can also lead to an attack of asthma. Even physical exercise can act as a trigger.

Q.How is a trigger recognized?
A.Through keen observation by the patient over a period of time. Detailed medical history, careful examination of environmental influences and allergy testing are the ways, available to the doctor for discovering triggering factors.

Q.Do the skin tests reveal all that a patient is allergic to?
A.No. Tests only give indications about the things for which the patient has been tested. There may be other things against which the test are not done.

Q.Is it one trigger or more than one, responsible for an asthma attack ?
A.Often a combination of triggers precipitates an attack. That is one reason that asthma seems so unpredictable. At one time in a stressful situation, no asthma is experienced. At another time when stress is experienced, the chest tightens and wheezing begins.

Heavy expossure to any one trigger can also precipitate an attack.

Q.If asthma triggers work so unpredictably, why bother?
A.The reason is to gain better control of the asthma. If the patient or the child and parents are aware of the common triggers and can find ways to minimize their effect, the total impact of asthma can be lessened. One goal of asthma management is to eliminate as many triggers as possible.

Q.How can an asthma patient avoid indoor triggers?
A.House dust, moulds and pet animals occur mostly in indoor environments. In order to avoid house dust and the mites that grow in it, the bed-room of the patient should be as sparingly furnished as possible. It should have no rugs or carpets. The curtains should be light, easily cleaned and washable. The bed should have the mattress cover, pillow cover and the quilt made of cotton- synthetic material which does not generate dust or collect it. Since the mites grow in moderate temperature and humid environment, the mattress should be taken out and spread in the hot sun the whole day so as to kill the mites. Mite-killing spray does a better job. While cleaning is being done in the room, the patient should go out of it or go out of the house.

The houses which are dark and humid, accelerate the growth of the fungi; such houses should be avoided by the patients. The pets, cats and dogs may be removed from the house and in no case should they enter the patient’s room.

Sleeping in an air-conditioned room wherein no outside air circulates, protects the patient from the pollens and other pollutants present in the outside air. HEPA (High Efficiency Particle Arrestor) air filter installed in the room, clears the air of all the particulate matter.

Q.How harmful is cigarette smoke to a child with asthma?
A.Cigarette smoke is very injurious to an asthmatic child. A parent or anybody else who smokes in a house where asthmatic child lives, does him the greatest harm.

Q.How can a patient with asthma avoid outdoor triggers?
A.Outdoor environments contain pollens, moulds and other pollutants. Travelling in the country-sidedirectly exposes the patient to these triggers. If a patient has to travel, the window-panes may be pulled up. If the car is air-conditioned, it protects the patient immensely. Specially designed face masks are helpful in case of those who drive two- wheelers. Working in the garden or even being in the garden, exposes the patient to lot of moulds which grow on and under the rotting leaves; this may be avoided in a season when the patient is known to get the symptoms, or a face mask worn when so exposed.

Q.How to deal with stress triggers?
A.Rather than avoiding stress, one should learn to live comfortably with stress. Learning to relax at will is a useful technique for people whose asthma is triggered in stressful situations. There are many different methods of doing this. Some people are able to control their stress by imagining a soothing and relaxing scene. Others can gain control over stress by doing calm and controlled breathing. Meditation, transcendental, yogic or any other is, very helpful.

Q.How to help a child in an emotional state from getting an attack ?
A.Try to analyze what is going on in the situation. What factors contribute to the situation? In what ways can the situations be dealt with differently? If the problem is recurring and causes disruption for the child and family, consider seeking professional help to learn new ways to cope with emotinally charged situations.

Do not let the possibility of an asthma attack restrict either the child’s fun or need for discipline. If the child knows that discipline will be disregarded when an attack is threatened, the child may learn to respond to discipline with an attack. If the child gets asthma each time she/he gets excited, try to help the child; moderate the excitement and teach the child to relax. Let the child learn her/ hhis own limits, and manage any attacks that do result. If self-management is to become a reality, the child must develop an inner sense of when to tone things down.

Q.How to protect an asthma patient from respirotory viral infectons?
A.The precautions that can be taken include following good, general health practices such as getting plenty of sleep, eating a balanced diet, getting regular physical activity, drinking plenty of fluids, avoiding situations where people may be sick, and promptly taking care of any colds or infections that do occur.

Q.Should an asthma patient participate in physical exertion activities ?

A.All asthma patients should participate in regular physical activity, in spite of the fact that exercise itself can induce an atack. One should start off at a comfortable level and work progressively toward more difficult levels of strength and endurance. When the patient is unwell or in a pollen season or in very cold weather, special precautions may be needed. With the proper medications and understanding of one’s own abilities, there is no reason why asthma should handicap a person’s physical involvement.

Several Olympic athletes have had asthma and have won world class competitions. The key to enjoyment and mastery over physical activities is by gradual learning of your limits and having good medical advice about medication and general asthma management.

Q.Any recommendations about exercise in children with asthma?
A.If the child feels an attack coming on after exercise in the school, she /he should be allowed to stop and rest and to follow other self- management steps. It is importanat for the teacher to understand that “short burst” sports are well tolerrated by children with asthma, while sustained exertion, such as running laps, is potentially dangerous.

Swimming is excellent physical exercise for people with asthma. Any physical activity that a person desires to try, should be tried with the normal precautions and provisions for attack management in case it is needed.