2. Trigger factors Difference between trigger and cause

3. Trigger factors 1. infections 2. house dust mites (HDM) 3. pollen and spores 4. animals 5. exercise 6. cold air 6. Drugs 7. Foods 8. pregnancy and menstruation 9. Emotions 10. Deep inhalation

4. Trigger factors Infections ☞ commonest & important  Respiratory tract infections -acute bronchitis -simple cold -viral infections  Don’t treat infections and forget asthma (incorrect response)

5. Trigger factors House Dust Mite

6. Trigger factors  80% of asthmatic children are sensitive to it  Beddings, carpets, furniture's, soft toys  Present even in most clean houses  You can not eradicate,but can reduce count  Vacuuming, covering mattresses and pillows House Dust Mite

7. Trigger factors Pollen and spores  Grass pollen, plants  Seasons ( late spring and early summer )  Related more to hayfever than asthma

8. Trigger factors Animals  Cats, dogs, horses, small rodents  Birds  Cockroach  Hair, saliva, urine, feaces, shed skin

9. Trigger factors Exercise  Breathlessness during exercise  Asthmatics have narrowing of airways

10. Trigger factors Exercise  Few minutes after exercise stopped →breathlessness

11. Trigger factors Exercise

12. Exercise  Cooling and drying effect of inspired air  Asthmatics tolerate swimming (warm & humid air)

13. Trigger factors Just Going outdoor in cold day can make some people with asthma cough and wheeze Cold air

14. Trigger factors Deep inhalation Any Sharp intake of breath can bring on symptoms for some people with asthma e.g. fit of laughter

15. Trigger factors Drugs  Elderly polypharmacy  B blockers 1) eye drops (timolol) in glaucoma 2) oral (atenolol, metoprolol, propnanolol)  aspirin and NSAIDs (5% of adult onset asthma)

16. Trigger factors Foods  uncommon trigger  more in atopics  milk, eggs, nuts, eggs, fish, Tartrazine, alcohol, sulfur dioxide

17. Trigger factors Pregnancy and menstruation  Role of third  May worsen premenstrual

18. Trigger factors Emotions  Stress  Psychosocial factors  Asthma is worrying disease→aggrevate emotional stress  Controlling symptoms relieve emotional problems

19. Trigger factors Other trigger factors  Smoke  Dust  Fumes  Regurgitation of food (Reflux)

20. Trigger factors How to avoid triggers ?

21. Trigger factors Triggers avoidance Viral infections impossible to avoid action plan (self management )

22. Trigger factors Triggers avoidance - Pollens  Remain indoors when count is high  Close windows

23. Trigger factors Triggers avoidance - HDM  Impossible to eradicate but you can reduce count:  Vacuum cleaner with high efficacy filter (HIPA)  Covering mattress, pillows with protective covers  Changing feather pillows, woolen blankets to synthetic ones  Wash bedding weekly (55 ◦ C)  Vacuum mattress regularly

24. Trigger factors Triggers avoidance - HDM  Impossible to eradicate but you can reduce count:  Replace curtains with blinds or light washables  Replace carpets with vinyl or wooden flooring and rugs which can be shaken outdoors  Place soft toys in freezer (6 hours) – then do vacuum

25. Trigger factors  Commonest allergic disease in clinical practice  80% of asthmatics have association with rhinitis  Rhinitis can trigger asthmatic attack → drip on Throat → cough which trigger asthma Association – Asthma and Rhinitis

26. Trigger factors  Under diagnosed  So … always search for rhinitis in asthmatic patients  Rhinitis treatment will improve asthma control  Treatment: combination of non sedating AH+ topical nasal steroids Association – Asthma and Rhinitis

27. Asthma management across ages Asthma and rhinitis  Treating nasal rhinitis may improve asthma symptoms (Prieto et al,1994)  Oral + inhaled steroids doses should be considered for systemic side effects risk Association – Asthma and Rhinitis