ASTHMA TRIGGER CONTROL PLAN

Because you have asthma, your airways are very sensitive. They may react to things called triggers (stimuli that can cause asthma episodes). Your airways may become swollen, tighten up, and produce excess mucus in the presence of one or more of the triggers below. These triggers may make asthma symptoms worse or keep you from getting better. It's important to find out what your asthma triggers are. Learn ways to avoid them. If you cannot avoid triggers, and your medicine plan does not work as well as you and your doctor think it should, you both should discuss allergy shots (immunotherapy).

-Ask your doctor to help you find out what your triggers are.

-Ask your doctor for help in deciding which actions will help the most to reduce your asthma symptoms.

-Number each action item in order of importance. Carry out these actions first. Once you have completed these actions, move on to actions that are of lesser importance.

- Discuss the results of these efforts with your doctor.

House Dust Mites

These are actions you should take to gain control of dust mites:

- Encase your mattress and box spring in an airtight cover.

- Either encase your pillow or wash it once a week every week.

- Avoid sleeping or lying on upholstered furniture.

- Remove carpets that are laid on concrete.

- Wash your bed covers, clothes, and stuffed toys once a week in hot (130 degree F) water.

These actions will also help you gain control of dust mites but they are not essential:

- Reduce indoor humidity to less than 50 percent. Use a dehumidifier if needed.

- Remove carpets from your bedroom.

- Use chemical agents to kill mites or to change mite antigens in the house.

- Avoid using a vacuum or being in a room while it is being vacuumed.

- If you must vacuum, one or more of the following things can be done to reduce the amount of dust you breathe in.

* Use a dust mask.

* Use a central vacuum cleaner with the collecting bag outside the home.

* Use a vacuum cleaner that has powerful suction.

Cockroach Allergen

        - Use insect sprays; but have someone else spray when you are outside of the home.

- Air out the home for a few hours after spraying.

- Use roach traps.

                - Indoor Molds

- Keep bathrooms, kitchens, and basements well aired.

- Clean bathrooms, kitchens, and basements regularly.

- Do not use humidifiers.

- Use dehumidifiers for damp basement areas, with humidity level set for less than 50 percent but above 25 percent. Empty and clean unit regularly.

Tobacco Smoke

- Do not smoke.

- Do not allow smoking in the home.

- Have household members smoke outside.

- Do not allow any smoking in your bedroom. Encourage family members to quit smoking. Their doctor can help them quit.

- Use an indoor air-cleaning device (for smoke, mold, and dander).

Wood Smoke

- Avoid using a wood burning heat stove to heat your home.

The smoke increases lower respiratory symptoms.

- Avoid using kerosene heaters.

Strong Odors and Sprays

Do not stay in your home when it is being painted. Allow enough time for the paint to dry.

Avoid perfume and perfumed cosmetics such as talcum powder and hair spray.

Do not use room deodorizers.

Use non-perfumed household cleaning products whenever

possible.

- Reduce strong cooking odors (especially frying) by using a fan and opening windows.

- Avoid air pollution by staying indoors on days when the pollution count is high.

Colds and Infections

Exercise

- Work out a medicine plan with your doctor that allows you to exercise without symptoms.

- Wear a scarf over your mouth and nose in cold weather,

- Pull a turtleneck over your nose on windy or cold days.

- Dress warmly in the winter or on windy days.

MORE ABOUT ENVIORNMENTAL CONTROL

ANIMAL DANDER 

Whenever possible, avoidance of animal dander is the treatment of choice because this approach is clearly the most effective. The optimal method is to remove the pet from the home followed by aggressive cleaning measures. In most homes it will take 4 to 6 months to reduce allergen levels in settled dust to levels found in pet-free homes. Removal of residual allergen can be accelerated by improving ventilation and removing large reservoirs of animal allergens, including the carpeting and upholstered furniture. Also, tannic acid have been shown to reduce levels of cat allergen significantly. Steam cleaning has not proven helpful in removing animal allergens, and conventional vacuum cleaners may leak dust and cause increases in airborne allergen levels. Replacing the dust bag with a double-thickness bag and attaching an electrostatic filter over the exhaust reduced leakage of allergen in one study by 98%.

If patients are unwilling to remove a pet from the home, some degree of avoidance may still be possible. Limiting the pet's access to patient's rooms and closing forced-air ventilation ducts may help reduce the allergen content in those rooms. One study combined multiple modalities, including monthly washing of cats, use of a high-efficiency particulate air filter, and removal of carpeting and upholstered furniture. This combination substantially reduced cat allergen levels Air filters may be helpful in this situation because cat allergen is bound to particles that remain suspended for long periods of time, making them available for filtration

Indoor molds

A.vpergillus and Penicillium species are the two most common indoor fungi, which occur most commonly in areas of water damage. Patients should be instructed to identify areas of water leakage beneath carpeting or above the ceiling and have it fixed promptly. Other areas that may harbor mildew include damp basements and closets, cupboards beneath sinks, and bathroom floors and tiles.

Outdoor allergens

Avoidance of outdoor aeroallergens may be assisted by staying indoors, with windows closed, in an air conditioned environment. Because grass and ragweed poliens reach their peak concentrations during the middday, and A lternaria spores are highest during the late afternoon, sensitized patients may benefit from reducing their time out of doors during these hours In general, however, it is difficult to appreciably reduce exposure to most common poliens and outdoor mold allergens.

Dust mites

House dust mites are extremely common indoor allergens that can be found throughout the world. Dust mite numbers within homes are most strongly related to temperature and relative humidity., with optimal conditions for growth consisting of 75% to 80% relative humidity and 25 degreeC to 30 degreeC. Mite numbers often increase during the summer months, and are correlated with higher humidity levels Other important factors associated with increased concentrations of mites include poor building ventilation , old buildings, old mattresses, and first floor rooms. Highest levels of mite allergens are found in dust from mattresses, carpets, upholstered furniture, pillows, and bed covers. It has been suggested that feathers and goosedown promote higher mite numbers.

Several studies from the past 20 years have demonstrated that effective control of dust mite allergen levels can decrease symptoms of asthma. However, these measures must be quite stringent to achieve significant improvement. Recently investigators have focused on the ability of several individual techniques to reduce the mite allergen load. These methods have included 1) use of air control systems (air conditioners, ventilation systems, air purifiers, and ionizers 2) alterations in bedding (washing linens, mattress. and pillow covers); 3) vacuum cleaning; and 4) use of acaricidal and denaturing agents.

A variety of air Control systems have had variable success in reducing mite allergen levels or improving asthma symptoms, Air conditioners have lowered mite allergen concentrations in house dust by up to 80% during the peak summer months by reducing relative humidity and air temperature. In new, "tightly built" homes, mechanical exhaust and supply ventilation systems also reduced relative humidity and lowered mite allergen levels significantly better than did low-flow, natural ventilation. High efficiency particulate air filters have demonstrated clinical benefits in some studies Conversely, controlled studies of electrostatic air filters have demonstrated that these machines had no more effect than a placebo. Negative ionizers were shown in one study to reduce airborne mite allergen concentrations, but there were no beneficial effects on any clinical parameters of asthma . Positive ionizers have not proven helpful and appear to have caused an irritant effect on the airways of some asthmatic patients.

Alterations in bedding have been shown to effectively reduce mite allergen levels. Washing of bedding and soft furnishings in hot water (> 58 degreeC) effectively kills dust mites, whereas cold water washing does not. Because regular washing of heavy blankets or comforters is difficult, dry cleaning (using perchloroethylene) serves as a convenient

alternative and has been shown to physically remove 98% of mite allergens . Barrier covers for pillows, mattresses, and box springs, once made from vinyl or plastic, are now constructed of a microporous fabric that allows the passage of water vapor but excludes mites and their allergen.