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This article first appeared in the American Association
for Respiratory Care's monthly magazine, AARC Times. The magazine, for
respiratory therapists, also contains information we all can use. Tom
Kallstrom, the author, has studied indoor asthma triggers for years
and offers this information to help you control asthma in your home.
strategies for patients begin with knowing the allergy and asthma triggers.
The management of asthma and allergy triggers continues to be of major importance to patients with asthma who are susceptible to them. Interestingly, it is in our own homes that we encounter many of the triggers that can initiate or worsen an asthma condition. There are only about five major categories of offenders that patients with asthma and allergies should be educated about as they relate to self-management. Knowledge of these triggers and methods to eradicate or reduce them affords the bedside respiratory therapist an opportunity to provide valuable information that could potentially reduce the number of exposures that a patient may encounter.
The five most common triggers are secondhand smoke, animal danders, molds and mildew, dust mites, and cockroaches. Some patients may be sensitive to more than one of these, so it may take a little detective work by the clinician to discover a likely cause and effect, to devise an intervention, and most importantly, to teach the patient what they need to know. Patients who experience persistent symptoms when exposed to allergens should ask their physician about an allergen skin test. This is especially pertinent for atopic patients.
Common trigger No. 1
Secondhand smoke can exacerbate the asthmatic condition. Being exposed to the airborne particulates can initiate this, and so can exposure to particles that have settled onto the smoker’s clothing. Of course, the most important message here is to inform the patient that by the act of smoking they are putting a loved one at an increased risk for an untimely exacerbation. Today there are numerous patches, gums, and pills that offer a nicotine replacement option that allows the smoker to wean off of this effective narcotic. Smoking-cessation programs are readily available in most communities. In fact, this is a domain in which the respiratory therapist really should be taking the lead, especially with hospitalized patients. Along with this, there must be a level of determination on the part of the smoker to actually stop.
Common trigger No. 2
We love our dogs and cats in this country, but it is these domestic animals that can actually trigger an asthma episode in a sensitized and allergic patient. Options here are to remove the pet from the home or to relegate the animal to a particular area of the home — preferably one that is away from the patient. The most important strategy with controlling this trigger is never to allow the dog or cat into the bedroom. The door should remain closed at all times. Other options include washing the dog or cat once or twice a month.
Common trigger No. 3
Mold spores are invisible to the eye, but the damage they cause can be picked up by the other senses. Mold contamination can be seen as it forms on objects and, in many instances, can be smelled as well. The cardinal rule with mold is to immediately clean it up, dry the area, and correct the cause of the water leak. It is often found in humid areas of the home such as the shower, kitchen, and basements, but can also be found outdoors. Use of a dehumidifier and/or an air conditioning unit can also help to lower the humidity levels, which in turn will decrease mold growth. Another strategy is to open a window or operate an exhaust fan in the bathroom or kitchen when showering or cooking.
Common trigger No. 4
Dust mites are invisible to the naked eye but can be a significant trigger for a sensitive asthmatic. Dust mites are in all areas of the Unites States in large numbers but are less dense in upper levels of the Rocky Mountains and in the desert Southwest. The dust mite requires a warm humid environment; therefore, it is important to control humidity levels by lowering them to less then 50% relative humidity. Again, this can be achieved with dehumidifiers and air conditioning units. Another successful intervention is to wash the bedding once a week in hot water (over 120° F). Children should not be allowed to keep stuffed animals exposed to the air but rather to keep them isolated in a container so that they will not collect dust when not in use. It is also advisable that the patient not lie directly on carpeting or upholstered furniture as those areas potentially house large numbers of dust mites. Instead, the patient should lay down a protective barrier (e.g., a blanket) to reduce direct exposure.
Common trigger No. 5
Finally, cockroaches are a significant trigger usually seen in the inner city and southern portions of the United States, but certainly can be found anywhere. Children under the age of two are most at risk because it is at this age that a child may develop a life-long sensitivity. The best way to control roaches is to practice keeping an environment that will be inhospitable to roaches. This means not allowing food to be kept out or within easy access of a roach. Garbage should be taken outside and not kept in the home. There are also effective chemical agents that can help control the infestation. Boric acid is deadly to the roach and can be purchased inexpensively. Poison baits are also effective in attracting the roach and then creating a route into the nest where the roach that consumed the poison will actually contaminate and kill the other roaches.
While there are many domestic triggers, there are also options that
the respiratory therapist can and should impart to patients to help
them control their environment. Once these simple interventions are
taught and the patient understands them, implementation will likely
result in reeducation or perhaps an elimination of the offending trigger.
If we don’t teach our patients, who will?
About the Author
Thomas J. Kallstrom, BS, RRT, AE-C, FAARC, is associate executive director and chief operating officer of the AARC. He is also a member of the NAEPP Coordinating Committee and is a certified asthma educator.