Allercy and Asthma Health
The Official Publication of AAN - MA

Overcoming Outdoor Barriers for Health and Well Being

by Karen L. Gregory, MS, RRT, FAARC

A prescription for good health should include enjoyment of the great outdoors. Studies reveal physical and mental health benefits are achieved from having regular contact with the outdoor environment. Increased levels of vitamin D are achieved with outdoor exposure, which may protect against bone loss, heart disease, diabetes, and asthma. Despite these health benefits, people with allergies and asthma encounter several barriers by going outdoors. Sneezing, watery-itchy eyes, difficulty breathing, fatigue, and limitations of activity impact the quality of life and are more challenging outdoors.

Asthma affects approximately 22 million Americans, including 6 million children. Half a million annual hospital admissions are attributed to asthma, and an estimated 1.81 million people with asthma annually require treatment in an emergency department. Medical expenses associated with asthma increased nearly $2 billion between 2005 and 2007. Asthma is a chronic inflammatory disease that involves the large and small airways and causes airflow limitation. Asthma is characterized by variable and recurring symptoms, bronchial sensitivity, and underlying inflammation of the airways.

Allergies trigger asthma flare-ups in 60–90% of children and in 50% of adults. Approximately 75–85% of patients with asthma have positive results to allergy skin testing. Airborne allergens in the outdoor environment are associated primarily with pollen grains and mold spores. Exposures are based upon geographic location, season, and weather conditions. Pollen and fungal spore exposures play a contributing factor in acute flare-ups of asthma. Pollen allergens also play a role in allergic rhinitis, which many people have along with asthma. Researchers believe there is a relationship between exposure to pollen and fungal allergens and a flare-up of asthma and are pursuing scientific evidence.

Understanding the role of outdoor allergens can help you overcome the challenges of the great outdoors. Airborne particles containing allergens from wind-pollinated plants, fungi, and animal dander can cause airway sensitivity and the onset of an allergic reaction. The size of particulates in the air ranges from 0.005–100 micrometers (microns). Particles less than 5–7 microns in diameter can get down into your lungs, whereas larger particles become trapped in the upper airway.

In temperate regions, pollen producers include trees, grasses, and weeds. Trees are the earliest pollen producers in the United States, releasing their pollen as early as January in the southern states and as late as May or June in the northern states. In some areas of the United States, tree pollen seasons may begin as early as December or January. However, of the 50,000 different kinds of trees in the United States, less than 100 have been shown to cause allergies.

The wide distribution of wind-pollinated grasses contributes to grass pollen sensitivity being a common cause of allergy symptoms. Grass pollens differ from ragweed pollen in that grasses typically release pollen grains in the afternoon. Weed pollination typically occurs in the last of summer through October in most regions of North America. Ragweed (the the sunflower family) is considered the most important cause of allergenic rhinitis and pollen asthma in North America. Ragweed pollen release normally occurs in midmorning as dew dries and humidity decreases.

About 10% of Americans are allergic to both indoor and outdoor molds, and outdoor mold exposure causes more flare-ups. Asthma flare-ups can be contributed to airborne allergens with high levels of Alternaria mold. Outdoor fungal particle levels usually peak seasonally, particularly in the mid-summer in temperate regions. Fungal spore exposure may increase in the spring, when snow uncovers decaying vegetation, and immediately following rainfall. Alternaria species are more prevalent in dry, warm climates and are usually dispersed by wind as dry spores.

If you suffer from allergies or asthma, it is best to stay indoors as much as possible during peak airborne allergy season. An allergy-free electrostatic air filter that you can insert in your central air conditioning and heating system can be helpful for extracting pollen. Keep windows closed to prevent airborne pollen grains from entering the home or workplace. You can go one step further and caulk the window seals to stop pollen and dust infiltration.

Taking allergy medications as directed by your doctor will be helpful before going outdoors for extended periods of time. Wearing a pollen mask and gloves when working outside and changing your clothes after working outdoors are also good ideas. Keep gardening or other outside clothing out of the home. Bathing and washing your hair in the evening before going to bed prevents pollen exposure in your bedding.

If you think you may have pollen or mold allergies but you have not been tested, ask your doctor about skin testing to see if it would help you better control your symptoms. Patient education and disease management is essential to controlling asthma worsened by allergy. Airborne allergy treatment, medication therapy including immunotherapy, and avoidance of airborne allergens is the key to achieving control of your allergy symptoms.

Airborne allergens are not the only things that can cause asthma. Humidity, barometric pressure, and sudden temperature changes may worsen asthma. High humidity frequently causes increased complaints of shortness of breath. As humidity increases, the density of the air increases, creating more resistance to airflow in the airway, making it harder to breathe.

Air pollution is a well-recognized health hazard that affects people worldwide. Approximately 2 million premature deaths worldwide per year are contributed to air pollution.  Scientists believe there may be a link between the increase in the prevalence of allergic airway disease and the increase in air pollution. Epithelial cells contribute to the maintenance of an appropriate antioxidant environment in the airway wall. Oxidizing agents, such as ozone, nitrogen oxide, and agents produced by inflammatory cells can cause cell injury. Air pollution is associated with signs of asthma flare-ups, including increased bronchial sensitivity, visits to emergency rooms, hospital admissions, and increased medication use. Ozone causes an immediate decrease in lung function and an increase in airway inflammation.

Outdoor air pollution, largely small particles in ground-level ozone, or smog, is produced by automobile exhaust fumes, smoke, chemicals from industrial units, dust, pollen, and mold spores. Smog is the most prevalent pollutant known to cause serious air pollution problems in many developed countries over the past few decades. It is caused when the sun reacts with pollutants from cars and industrial plants to form ozone at or near the surface of the Earth. The ozone level can be a significant barrier to the outdoors for patients with pulmonary disease such as asthma.

Ozone levels are worse on hot days, especially in the afternoons and early evenings, so remain indoors during high-alert ozone days. The Environmental Protection Agency (EPA) has estimated that 5–20% of the total U.S. population is susceptible to the effects of ozone air pollution. The World Health Organization is working with every country in the world to reach new standards for air quality.

The Air Quality Index (AQI) scale is used for reporting daily air quality. The EPA uses the AQI for five major air pollutants regulated by the Clean Air Act, including ground-level ozone, particulate matter, carbon monoxide, sulfur dioxide, and nitrogen dioxide. For each of these pollutants, the EPA has established national air quality standards to protect against harmful health effects. The AQI is reported on news stations across the country to warn people with respiratory problems to avoid outdoor activities or take precautions on low air quality days, so be aware and protect yourself.

Regular exercise can improve physical endurance and mental health. Although exercise does not improve lung function, muscular strength training can improve endurance and reduce breathlessness. However, outdoor exercising may further pose an increased risk of exacerbation and lower respiratory symptoms due to environmental triggers. Your health care provider can suggest ways to overcome these barriers and improve your quality of life.

Exercise-induced bronchospasm (EIB) is a common complication of many patients with asthma. EIB occurs due to rapid breathing. Administering a beta-2 agonist medication 10–15 minutes before exercise or sports is recommended to prevent EIB. Taking 10–15 minute warm-up and cool-down periods can help reduce complications of EIB. Observing ozone and weather conditions is very important. When exercising in cold air, breathing through a scarf or through the nose helps warm up the airways.

Improved functional status has been linked with social activity and correlates with reduced levels of disability. Talk with your health care provider about the appropriate medication regimens to achieve and maintain control, as well as interventions to promote quality of life. Rapid assessment of the problem, good monitoring, and appropriate response to worsening respiratory symptoms are essential skills for patients with respiratory challenges.

We are dedicated to helping you breathe easier and maintaining your health so you can safely enjoy the many benefits of the great outdoors. Enjoy but stay safe this summer! •

Karen L. Gregory, MS, RRT, FAARC, is a respiratory therapist and pulmonary disease management specialist at the Oklahoma Allergy and Asthma Clinic in Oklahoma City, OK.


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