TRIGGERS AND ENVIRONMENTAL CONTROL

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TRIGGERS AND ENVIRONMENTAL CONTROL

• By Marcia Magann
• MSN, RN, CPNP, AE-C

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This session will cover

• Factors that contribute to asthma severity
• Allergens, irritants
• Tobacco smoke
• Viral illnesses

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• For successful long-term asthma management, it is
  essential to identify and reduce exposures to
  allergens and irritants and to control other
  factors that have been shown to cause an increase
  in asthma symptoms.

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Allergens

• A substance that causes a person to have an
  allergic reaction.
• Exposure in a person who is sensitive increases
  airway inflammation and symptoms.
• IgE mediated
• Affects only those sensitized to the allergen
• Not usually dose-dependent

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Allergen examples

• Tree pollen (spring)
• Grass pollen (summer)
• Weed pollen (fall)
• House dust mite (perennial)
• Furred animals (perennial)
• Fungi/mold (perennial)
• Cockroach allergens

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IRRITANTS

• A substance that irritate the lungs and when
  exposed to them, will cause an increase in asthma
  symptoms or limits airflow.
• Not mediated through IgE
• Dose dependent response, will affect everyone at
  a high enough dose

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EXAMPLES OF IRRITANTS

• Tobacco smoke-active, passive, or second hand
• Environmental smoke- stoves, fireplaces, kerosene
  heaters
• Ozone
• Exhaust fumes/diesel
• Perfumes
• Aerosol sprays, odors, incense, potpourri

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VIRAL ILLNESSES

• Viral respiratory infections can exacerbate
  asthma in children. It is the most common
  precipitant of asthma exacerbation among children
  5 years of age or younger.
• The exacerbations caused by viral respiratory
  infections may be intermittent yet severe.

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ENVIRONMENTAL ASSESSMENT

• There may be multiple environments to assess such
  as
• Home kitchen, bathroom, basement, bedroom
• School, Daycare, Car, activities such as scouts
• Workplace
• Outdoors
• Vacations airplane, ships, hotels

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• Always Ask
• Have you noticed anything in those environments
  that makes your asthma worse?
• EXERCISE-May be the only trigger for some people
  usually occurring during or minutes after
  vigorous activity, peaks 5-10min. after stopping,
  and may resolve in another 20-30min.

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REDUCING EXPOSURE TO TRIGGERS

• Smoke
• Permit no smoking around asthmatics
• Help parents and caregivers stop smoking
• Eliminate use of wood stoves and fireplaces
• VIRAL UPPER RESPIRATORY INFECTIONS, FLU
• Flu shots for children with persistent asthma

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• Dust mites
• Encase the childs mattress and box springs in an
  allergen-impermeable cover as well as the pillow.
• Remove carpets if possible
• Avoid sleeping or lying on upholstered furniture
• Minimize stuffed toys and wash weekly
  (recc.130degrees/AAP recc. 120degrees),may also
  place in bag in freezer for 24 hrs.
• Reduce indoor humidity

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• ANIMAL DANDER
• There is no such thing as a non-allergic animal.
  Remove pet from home, is this is not possible,
  keep the pet out of the childs bedroom and the
  door closed.
• Remove any products made with feathers
• Keep pet off of upholstered furniture and carpets
• Use a filter on air ducts in the bedroom
• May wash pet weekly to decrease the amount of
  dander, urine, and dried saliva

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• INDOOR MOLD
• Fix leaky faucet, pipes
• Avoid vaporizers/bedside humidifiers
• Reduce indoor humidity to lt50
• Keep windows closed and use air conditioning when
  pollen, smog, and humidity levels are high

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• COCKROACH ALLERGENS
• The proteins found in cockroach feces and saliva
  can cause allergic reactions or trigger asthma in
  some individuals
• Reduce indoor humidity to lt50
• Use boric acid traps (avoid poisons around very
  young children)

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• EIA
• Use short-acting inhaled beta 2 agonist shortly
  before exercise will prevent 80, (15-20min
  before)
• Lengthy warm-up period
• Long-term control therapy if appropriate
• Cromolyn and Nedocromil taken shortly before
  exercise
• Teachers and Coaches need to be aware of
• EIA.

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