It is important to know what triggers your asthma, so that you can avoid that trigger as much as possible. The following are some potential triggers, and advice on how to avoid them.

Pet dander

If animal dander, for example, from a cat or dog, triggers your asthma, experts agree the best thing to do is avoid having a pet in the home.

When visiting friends or relatives, ask that they put the animal in another room and that all furnishings and carpets be vacuumed before you arrive. Note that for some people, reactions will still occur. In this case, visiting that home should be avoided.

Pollen

Allergies to pollens are seasonal: in the spring, the biggest culprit is trees. Summertime is when grass pollinates, and the fall is when ragweed sufferers feel symptoms.

If your asthma is triggered by any of these pollens, you’ll want to do your best to avoid them:

-Stay indoors during high pollen counts: typically in the morning, and on dry, breezy days.
- Keep your windows closed, especially during the day. If it’s hot outside, use an air conditioner instead.
- Don’t hang laundry outside to dry. It will collect pollen.
- Wash your hands and other exposed skin when you come inside, and shower before going to bed to rinse pollen from your skin and hair.
-Invest in a vacuum with a certified HEPA filter, and vacuum often. Also wipe with a damp cloth rather than sweeping.
- If you have a pet, wipe down its fur, which gets laden with pollen, before it comes inside.

See Pollen Allergy

Mold

Molds are a type of fungus that grow in damp, humid areas. Both indoor and outdoor mold can trigger asthma. To avoid mold growing inside your house, keep the humidity in your house between 40 and 45 %, always use bathroom and kitchen fans, and wipe up any spills and fix water leaks immediately.

Outdoor molds can be found in piles of grass or leaves and where there is stagnant water. Remove these from around your home.

See Mold Allergy

Dust mites

Dust mites are microscopic insects that live in our carpets, mattresses, stuffed animals and furniture. Their feces are highly allergenic, and trigger asthma in many people.

While dust mites can never be completely eliminated in your home, there are ways to reduce exposure:

-Dust mites thrive in humid environments, so keep humidity in your home between 40 and 45 per cent.

- Encase your mattress, duvet and pillows in dust mite-proof covers.

-Wash bedding, including fabric mite-blocking covers, weekly in water at least 130 degrees F.

-About every eight weeks, place stuffed animals in the freezer for 24 hours.

- Choose hardwood, tile or vinyl flooring when possible, and minimize plush furnishings.

See Dust Mites Article

Cigarette smoke

Both direct and second hand smoke will trigger asthma in most people. If you have asthma and smoke, now is the time to quit.

If you’re not a smoker, it’s still important to reduce your exposure to cigarette smoke. Don’t allow anybody to smoke in your house or car, and avoid places where people are, or have been smoking. 

Smog

Air pollution and smog can make asthma worse. Smog results when pollution from automobiles, factories and power plants is struck by sunlight. Keep an eye on smog advisories in your area. On smog-alert days, do your best to stay indoors. Experts advise all people to limit outdoor exercise on days with very low air quality.

Perfumes/Fragrance

Scents from perfumes or fragrances in personal care products, such as shampoo, can trigger asthma in some people. If this is the case, avoid products that list “perfume” or “fragrance” in the ingredients.

Viral infections

Asthma is often triggered by viral infections, such as colds. This is particularly true in young children. Frequent hand-washing, as well as avoiding touching your nose and mouth, are recommended.

People with asthma are also encouraged to get the flu shot.

Exercise

While it’s important for people with asthma to exercise, it can also be an asthma trigger. See Exercise and Asthma.

See Also:
Why So Many Allergies Now?
Pet Allergies: A Gander at Dander
Non-Allergic Cat: Soon A Pet To Get

Who Reacts

Even our understanding of the prevalence of pet allergies is fuzzy. Although an estimated 20 to 30 per cent of young adults will react to at least one airborne allergen, studies have shown early exposure to animals (which researchers now suggest can have a protective effect), where you live, and whether you experience asthma, hay fever or both can all influence the development of allergies to animals.

New research from the U.S. National Institutes of Health shows that cats are the single biggest trigger for asthma, causing reactions in 29.3 per cent of asthmatics. A Swedish study, meantime, found 40 per cent of kids with asthma reacted to cats, 34 per cent to dogs, and 28 per cent to horses.

For the kids who got runny noses and itchy eyes, 49 per cent reacted to cats, 33 per cent to dogs, and 37 per cent to horses.

Dr. Jeffrey Davidson, an allergist in San Francisco and a clinical professor at the University of California San Francisco, says it’s fair to expect that as the incidence of allergic disease grows, so does the number of people reacting to animals. And while cat allergies are by far the most prevalent, people can be sensitized to any animals with feathers and fur, including dogs, guinea pigs, mice, birds, and ferrets.

The Symptoms

The range and severity of symptoms is vast, and includes itchy, runny nose and sneezing, irritated, watering eyes, wheezing and shortness of breath, eczema and hives. “Some people say they don’t have a problem unless they touch the pet and touch their eyes,” Davidson said. “And there are other people who walk into a room where there is a cat, or there has been one, and they will have an asthma attack.”

The Allergens

The culprits setting of these reactions are a series of proteins found in concentrated amounts in dander (flakes of dead skin), saliva and oil called sebum that hair follicles secrete to protect fur and skin. In some animals, allergenic proteins that originate in the blood are released through urine. The cat’s most prominent allergenic protein is called Fel d1, and its counterpart in dogs is Can f1.

Dr. James Ransom, an allergist in Topeka, Kansas and clinical instructor at The University of Kansas Medical Center, says cats’ constant grooming and indoor litter boxes mean these allergens are continuously evaporating into indoor air. A pet lover might reason a hairless cat or a short-haired dog should be fine. Not necessarily. Ransom says that, regardless of their fur, pets still emit the allergy-causing proteins from their skin, glands, dander, urine and saliva.

Plan B Solution

Ransom says if a patient has a severe reaction to animals or develops asthma, he’ll advise that the pet has to go. But “getting people to get rid of pets is very difficult.”

His Plan B is to tell the family to minimize the exposure. First, someone not allergic to the animal should wash it once a week. Next, the pet should never be allowed into the allergy sufferer’s bedroom. The pet’s roaming area in the house should be reduced to exclude areas where the allergic person spends much of his or her time. Finally, cloth-covered furniture and carpeting (which Ransom calls the “reservoir of allergens”) must be replaced with leather or vinyl furniture and hard floors such as linoleum or tile.

Although some shampoos and sprays claim to reduce how much allergenic protein your pet totes around, Davidson says washing a pet with water alone is probably just as effective. Wipe down a cat with a damp cloth instead of bathing him, the specialist advises, to avoid “losing your forearms.”

Next Page: The Cat Comes Back

In June of 2005, the smog hanging over downtown Toronto was so thick you couldn’t see the CN Tower from the mid-town restaurant where Sara La Rocque was waiting tables at an outdoor patio. That was when Sara, a 21-year-old creative writing student, quit her job to go home and strip wallpaper.

One day later, she couldn’t breathe properly. Although she had experienced asthma briefly as a child, this was different. It was like breathing through a straw. For most of the rest of the summer, as Ontario lumbered through a record summer of smog advisories, Sara stayed indoors. She was miserable.

It wasn’t until six weeks later that she could even walk around the block with the family’s golden retriever (she is not allergic to dog dander) or the Burmese mountain dog.

Sara’s pretty sure what triggered her condition, and it wasn’t the wallpaper: “My asthma is smog-induced,” she says. “I think that’s what caused it.” A few years ago, most scientists would have doubted her analysis. The common wisdom was that air pollution could only exacerbate symptoms in people already living with asthma.

But now, a handful of mavericks in the scientific world are building a case to prove Sara’s point – that pollution might not just worsen asthma, but cause it. Not that these asthma researchers can yet say how this might happen. That’s still under study.

When it comes to asthma, theories abound as to why it develops, starting with the hygiene hypothesis. This suggests that our urban society is too germ- and virus-free, causing the underworked immune systems of those who inherit the allergic tendency to react to proteins – such as inhaled pollen or dust mites – that should be harmless. The immune system’s over-reaction results in airway inflammation and allergic asthma attacks.

There are also new indications that antibiotics in early life and obesity may be contributing factors. But some scientists keep coming back to the relationship between asthma and air pollution, particularly to that dense layer of smog that blights our cities all too often in the summer.

Somewhere in that haze of pollution, they believe, lies an answer to the mystery of why asthma gets switched on with such frequency in the urban world.

Over the past decade, scientists have found compelling evidence that air pollution irritates the lungs and triggers attacks in those who already have asthma. Some research indicates it can also worsen asthmatic flare-ups to allergens such as pollen, dust mites or pet dander.

“Air pollution remains one of the most under-appreciated contributors to asthma exacerbation,” wrote George Thurston, an associate professor of environmental medicine at New York University School of Medicine, in a 2005 article in the Journal of Allergy and Clinical Immunology.

A classic instance: When a strike closed a steel mill in the Utah Valley for the winter during the mid-1980s, researchers found that admissions of children to hospital for asthma and pneumonia were cut in half – and they climbed right back up the following winter after the steel mill had reopened. That’s a vivid example of pollution’s effect on asthma, and there are plenty more.

Next Page: Proof from California

Adrienne Smith has been battling with her asthma since she was diagnosed at the age of 13. For Smith, high school gym class was particulary difficult: she would often get a crushing feeling in her chest when she started to run, and it would take her 25 minutes to recover. “It was humiliating,” she says.

Now, at 30, Smith’s asthma is still a big part of her life. She doesn’t play competitive sports any more, something she used to enjoy. And when she works out, she tends to walk, rather than run. When her asthma is at its worst, it keeps her up at night. During these bouts, she finds ordinary household chores arduous, such as carrying laundry up the stairs.

Still, Smith, who lives in Victoria, B.C., feels she’s doing fairly well. “I haven’t been to the hospital this year,” she says. “So that’s a good sign.” While she finds her limitations frustrating, she accepts them as a part of who she is. “I don’t think I’m sickly. It’s just that sometimes I have these episodes.”

About three million Canadians have asthma – one of the highest incidences in the world – and the majority of those affected share Smith’s conception of the disease.

“They think it’s normal to be short of breath, waking up at night, or not being able to perform exercise,” says Dr. Louis-Philippe Boulet, a respirologist and asthma researcher at Laval University in Quebec City. “I saw a patient recently who had stopped exercising; he started playing chess. He almost couldn’t do anything. But it was normal for him.

“Research shows 28 per cent of Canadians with asthma have symptoms of their disease every day, while 67 per cent have symptoms every week. But the experts agree that this should not be the case; that asthma is completely controllable. In the right environment and with the right medications, even those with severe asthma should have relatively few symptoms.

That’s because the medications available today can prevent the inflammation of the lungs, and the resulting constriction of the bronchial tubes and mucus build-up.

It’s possible to develop an asthma action plan in which, by reducing bronchial inflammation with medication and avoiding asthma triggers, the patient should rarely have to stop to catch a breath. And that blue “rescue” inhaler that many asthmatics depend on to treat frequent symptoms? It should only be used occasionally.

However, this ideal is far from reality. Instead, the majority of Canadian asthmatics are living half-lives. They aren’t exercising, which can lead to a host of other health problems, like obesity, diabetes and heart disease. They are missing school and work, and giving up activities they enjoy.

They see their doctors, but these visits are often marked by poor communication. They end up in the hospital after days of worsening symptoms. They are Canada’s “walking wounded,” and they’re slipping through the cracks of our health-care system. Amazingly, most of them don’t even realize they have a problem.

The statistics show just how bad it is. Six years ago, the Asthma Society of Canada announced that 57 per cent of Canadians with asthma did not have their disease under control. The society’s latest research, released in September 2006, shows no sign of improvement; more than half of asthmatics are still living with symptoms above what are considered acceptable levels.

Earlier findings showed 10 per cent of them had landed in the emergency room at least once in the previous year because of an asthma attack, and 12 per cent reported missing school or work.

In Ontario alone, hospital statistics show that asthmatics made more than 73,000 emergency room visits in the past year. National statistics are not available, but the numbers are known to be uniformly high.

“Certainly for children, we know that it is one of the most common reasons for emergency visits,” says Jan Haffner, vice-president of health initiatives for the Lung Association of Saskatchewan.

Next page: How asthma medication works

Using data accumulated since 1990, scientists in Hamilton, Ontario and London, England have been able to plot the spike on a graph at precisely 17 1/2 days after Labor Day. “If you look at the magnitude of the peak relative to the rest of the year, by 2004 it’s pretty much the same as it was in 1990,” says epidemiologist Neil Johnston, who along with colleagues at St. Joseph’s Healthcare, McMaster University, and Imperial College, has led this research.

The spread of the cold virus is the biggest driver of the spike in students between the ages of 5 and 15, but a number of factors contribute to it. “Kids get back to school and the guy in the next desk or the child they share a school bus ride with has a cold, and maybe they share a drink,” Johnston says.

“But it’s also a period when aero-allergens are at very high levels – ragweed and house dust mite. Then you’ve got the stress of the return to school, allergens in the classroom, and the likelihood that asthma is not as well controlled because kids have been well and their parents haven’t been giving them their [controller] drugs.

“You’ve got a multiple whammy, and that’s what drives the peak.”

There are two other related asthma “peaks”: one in pre-school children, who appear to catch whatever cold brother or sister brings home, since their spike is plotted at 19 to 20 days after Labor Day. For those 16 to 49 with asthma, their peak shows up one week after the big post-Labor Day surge among schoolchildren.

So how do you keep a child from becoming a statistic on Johnston’s graph? He says it begins with awareness and control and making sure asthma medications are up-to-date. Experts remind that your child’s school needs to have a copy of your child’s asthma action plan. If either the plan or the drugs need changes, see a doctor or specialist (respirologist or allergist) promptly. Experts also advise frequent hand-washing to stem the spread of infection.

Next: Mind Those Classroom Triggers

Why should Canadians care about banning smoking in cars carrying children? Because second-hand smoke is more concentrated in a confined space. Within a vehicle, poisons found in smoke can reach high levels in a short amount of time.

A 2006 study in the American Journal of Preventive Medicine found that breathing in smoke from a single cigarette for only five minutes in a car exposes a person to the same amount of smoke as spending the equivalent time in a smoky bar. Babies and children are most vulnerable because they breathe more rapidly and take in more harmful chemicals for their size than adults do. Second-hand smoke affects their developing respiratory, immune and nervous systems.

In the United States, the Surgeon General recently released a report on the profound impact of second-hand smoke on children, revealing that kids exposed to second-hand smoke have an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections such as bronchitis and pneumonia, middle ear infections, more severe asthma, respiratory symptoms and slowed growth of the lungs. The report concludes that there simply is no safe level of exposure to second-hand smoke; even brief exposures can prove harmful.

There is growing evidence as well that kids who are exposed to second-hand smoke in the womb and as infants have more behavioural problems, shorter attention spans, and lower marks than peers who aren’t exposed to smoke.

Since babies and children are powerless to protect themselves from this risk, The Canadian Lung Association is asking Canadians to take a stand with the “Clean Air for Kids” lobby. “This campaign is about protecting Canada’s children from the harmful effects of second-hand smoke,” said Nora Sobolov, president of The Lung Association. “Working together with Canadians, we are confident that action can be taken to ensure kids are not subjected to smoking in cars.”

What can you do? If you want to send a message directly to your provincial or territorial representative, visit The Lung Association.

Related:
• Discussion: Smoking outside “still harms kids”
• The dangers of third-hand smoke
• 15 ways to clean up your home’s air

First published in Breathing Space, a supplement of Allergic Living magazine.

The Lung Association has also asked Air Canada and WestJet to compromise by designating some flights as pet-free. “We’re worried that profit is taking a front seat and public health is taking a back seat,” says Cameron Bishop, director of government affairs for The Lung Association. “We want to help Canadians to express their views on the issue of pet-free flights.”

A poll released by the association found that 80 per cent of Canadians want Canada’s airlines to offer pet-free flights. In addition, 75 per cent of Canadians believe that the federal government has a responsibility to protect the health and safety of passengers and crew.

Bishop hopes the campaign will convince Parliament to hold hearings this fall to review the public health ramifications of the airlines’ policies. “We, of course, recognize the need for service animals or guide dogs to be allowed on flights,” he adds. “We just request that passengers be alerted to their presence.”

The campaign has received the support of thousands of Canadians like Monica Peterson, who has asthma and a severe allergy to cats. She was flying on a WestJet flight from Winnipeg to Victoria last year when her eyes started watering and her airways became congested. “When the plane was unloading, it turned out a cat was under the seat in front of me. Luckily it was a short flight; it was alarming that there wasn’t even a warning that pets were on board.”

When Traveling with Asthma, Pet Allergies or COPD:

• Check with the airline beforehand to try to get on a pet-free flight.
• Take your medications regularly and follow your asthma action plan.
• Use your rescue inhaler 20 minutes before boarding the plane.
• Speak to your doctor before traveling. You may need medications adjusted for the flight.
• Always have your medications with you – never keep them in checked baggage.

From the Fall 2009 issue of Allergic Living magazine.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.

However, a leading Canadian pediatric allergist says acetaminophen – which is the active ingredient in these popular fever-reducing drugs – is safe for children if used properly. “There’s no proof that acetaminophen causes asthma,” says Dr. Allan Becker, a researcher with the Manitoba Institute of Child Health. Even the study authors say acetaminophen remains the medicine of choice for babies with high fevers. But they stress the importance of following the guideline that its use be limited to those cases, and not used casually.

The study reported that children who had been given acetaminophen once a year or more in their first year of life showed a 46 per cent higher risk of asthma symptoms by 6 or 7 years of age compared to those who hadn’t had the drug. The findings also indicate that the asthma risk increased threefold in 6-year-olds and 7-year-olds taking the tablets one or more times a month.

Researchers gathered the data from children in 73 countries, including Canada, as part of third phase of the International Study of Asthma and Allergies in Children (ISAAC) program. The findings were published in The Lancet, the well-known British medical journal.

This study shows an association between the use of acetaminophen and the definition of asthma in the survey, explains Dr. Becker. In a questionnaire, parents were asked whether their child had experienced wheeze – a whistling noise in the chest – in the past 12 months. “In the two participating Canadian centres, Hamilton and Saskatoon, 20 per cent and 17 per cent respectively answered yes to that question,” says Dr. Becker.

However, a sub-group of these parents was shown a video of a child with asthma wheezing, instead of getting the questionnaire. Only 12 and 10 per cent of this group answered that they had seen ‘wheezing’. “This tells us that many parents who said their child was wheezing really don’t understand what we mean when we say ‘wheezing’,” said Dr. Becker.

Stay tuned. Researchers have called for a large randomized trial to settle the acetaminophen debate once and for all.

First published in Breathing Space, a supplement of Allergic Living magazine.

Proud was able to determine that it is how our immune systems respond to the virus that causes inflammatory symptoms, not the virus itself. He has also investigated an antiviral protein called viperin, which was only recently discovered. It turns out viperin helps to fight the virus. Proud’s team will look at whether it’s possible to boost the body’s natural antivirals as a way to combat rhinovirus.

Research into the cold virus is important for understanding and managing asthma and other conditions. In a healthy lower airway a virus “is not a big deal,” says Proud. But with asthma, “if a virus goes down there and causes more inflammation, it’s problematic.”

His colleague at the University of Calgary, Dr. Richard Leigh, is studying the interplay between asthma and the cold virus. In some children, Leigh believes that it’s possible the structural changes in the airways (that can occur with asthma) may begin with frequent cold viruses – long before the disease is diagnosed.

“We’re beginning to understand that virus plays a big role, perhaps in asthma’s development, certainly in acute attacks,” says Proud.

First published in Allergic Living magazine, Winter 2009 edition.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.

The check-in attendant told the St. John’s resident that WestJet is a pet-friendly airline – small animals are allowed in the cabin in an enclosed kennel. In fact, there were two other cats on the flight. “I told her, ‘I cannot get on that plane. If I do, I could die,’” recalls Callahan.

He was offered a seat near the back. He explained that moving would make no difference since the air is re-circulated: “I can’t get away from a cat at 30,000 feet.” Callahan was told he could have a seat on the next flight, but turned that down since the airline could not guarantee there would be no cats on that plane.

“So I had two options, get on a WestJet plane and put my life in jeopardy or stay behind.” Instead, Callahan bought a last-minute ticket on the next Air Canada flight, which cost him $1,900 one way. Air Canada does not allow animals to travel in the passenger cabin.

“We’ve made the decision as an airline that we will continue to take them (pets) on board,” explains Richard Bartrem, vice-president of culture and communications at WestJet. “While we empathize with this gentleman’s situation, we will continue to offer this service as a benefit to our guests.”

The risk of a severe reaction for passengers with asthma is relatively low with air travel, according to Dr. Antony Ham Pong, an Ottawa allergist. Dander takes time to accumulate, so the level of dander would depend on how long the cat has been on the plane. “The risk is certainly lower than walking into a house where someone lives with a cat,” he says.

The level of reaction would also depend on a person’s asthma control. “If someone has uncontrolled asthma and he or she is sitting beside a cat, it can lead to big-time trouble,” says Dr. Ham Pong. “It could be fatal. But if his or her asthma is under control, it shouldn’t be a big issue. Just don’t sit next to the cat.”

Travelers should check ahead for pet policies on planes, trains and buses to reduce the risk of an asthma attack, the allergist says, adding that they should always carry their asthma and allergy medication on board, just in case.

Callahan is not content with WestJet’s policy, describing the airline’s attitude toward passengers with severe pet allergies as “terrible.” Although WestJet does post its pet-friendly policy on its website, it’s not easy to find. Callahan would like to see it on the homepage, so others with pet allergies will be well warned. However, Bartem says WestJet has no plans to post a warning on its homepage. So unless that policy changes, at least for this airline, it’s “flyer beware.”

To provide feedback, visit www.westjet.com, click on “contact us” and then select “e-mail guest relations”.

First published in Breathing Space, a supplement of Allergic Living magazine.
To contact the Lung Association in your region, click here.