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Over the past 20 years, self-reported cases of asthma have increased by 74 percent. In that same time, the number of asthma-related office visits has doubled and the number of asthma-related deaths has increased by 61 percent. With more than 31 million adults and children who have asthma in the United States alone, the need to educate the public in ways to prevent attacks is critical. Learning what triggers your asthma attacks and asthma-proofing your home are the key to maintaining control over this life-long condition.
Understanding Your Triggers
At age 8, Teri Estes was diagnosed with asthma, an illness of the respiratory system characterized by coughing, wheezing, chest tightness and difficulty breathing. After a couple of years, she thought she had grown out of it. But after a severe bout of pneumonia 10 years ago, her asthma returned. Estes has since been able to live with her asthma with relative ease — until this year, when she moved into a new home. Her asthma attacks became worse than ever before.
“This is the first year I have ever had to go to the emergency room,” Estes says. “My asthma has been getting worse, especially at night. I've even had to use an inhaler in the middle of the night, something I've never had to do before.”
Estes began to wonder if there was something in her new home that could be to blame. She sought help from the University of Michigan (U-M) Health System to help her identify what might be causing her increasingly severe attacks.
Paying close attention to when an attack is triggered and what appears to be the most likely cause can help physicians make recommendations about how to asthma-proof your home.“In the home, there are a number of different irritants and allergens that can actually stimulate an asthma reaction,” says William F. Bria II, M.D., medical co-director of the U-M Health System's Asthma Airways Program. “Asthma is an excellent detector. It is as if your respiratory tract becomes an alarm, letting you know what is not right in your microenvironment, inside and outside the home.”
Patients who seek help, like Estes, should discuss in depth with their physician their home environment. “Asking questions, being extremely specific about your home environment can help us identify triggers,” explains Bria. “We like to methodically eliminate or include possible problems from a comprehensive list to help identify areas where the environment can be improved.”
The Environmental Protection Agency suggests developing a written asthma management plan with your physician that includes triggers and how to manage them. Paying close attention to when an attack is triggered and what appears to be the most likely cause can help physicians make recommendations about how to asthma-proof your home.
According to the American Lung Association, the top five areas where you can make the most difference in controlling what triggers an attack include:
- Prohibiting smoking in the home
- Asthma-proofing the bedroom
- Choosing the right flooring and cleaning it properly
- Reducing dust
- Preventing infestation by cockroaches and dust mites.
Smoking: The No. 1 Concern
It's important that people with asthma understand that smoking or being exposed to secondhand smoke is one of the biggest triggers for an asthmatic. “Individuals that smoke often wonder why their asthma is so hard to control,” Bria says. “They think of every other reason besides the obvious.”
Smoking also poses a particular risk to children with asthma. Even the smell of smoke on clothes can trigger an attack in children with sensitive airways. Smoking in the home of a child with asthma is very serious, even life-threatening.
Smoking in the bathroom with the window open, smoking with a vent fan on — any type of smoking in the home is dangerous. If you can't quit, smoke outside — not in the home or car where children can be exposed. Talk to your physician about a smoking cessation program and other ways to help you quit.
In addition to addressing the issue of smoking, one of the most effective ways to get in control of your asthma triggers is by having a thorough home inspection that begins in the bedroom.
Bedrooms Are a Top Priority
Because the bedroom is the room where people spend most of their time, adults and children with asthma need to take extra care when asthma-proofing their bedrooms. Debby Fugitt, R.N., B.S.N., of the U-M Health System's Michigan Visiting Nurses, spent an afternoon with Estes going from room-to-room to help her identify the possible causes for her increased asthma attacks.In the bedroom, Fugitt advised Estes to wash her bedding once a week and to make sure there are no feather pillows or feather mattresses. “One of the biggest concerns in the bedroom is the bed itself. Make sure the mattresses and pillows are enclosed in airtight plastic materials,” she says.
Mattresses, box springs and pillows should be enclosed in allergy-free covers that can be easily washed. Bedding should be washed in hot water that is at least 130 degrees. This will help prevent dust mite infestation, a potential trigger for asthma sufferers.
“Carpeting is a concern, especially in the bedroom. Hardwood or tile floors are ideal, but if that is not possible, carpet should be made of a nylon-type material with no wool blend at all,” Fugitt says. The carpet should also be low pile.
Choosing appropriate flooring in the bedroom and throughout the home can help decrease the amount of dust. Floors should be cleaned or vacuumed early in the day, and frequently, to allow dust to settle, especially before a child's naptime.
Children with asthma are at risk for increased attacks if they have stuffed animals. “Especially in children's bedrooms, you want to keep toys to a minimum,” explains Fugitt. “A great trick to relieve dust mites and molds in stuffed animals is to put them in a freezer once a week. This takes care of all the little critters,” she says.
Common Area Concerns
Pets are another area of particular concern, according to the EPA. Pets should be kept out of the bedroom, and preferably out of the home entirely. A pet's hair, dandruff, saliva and urine can be particularly nasty allergens, especially for children.Stuffed furniture, wall surfaces, rugs, drapes and the heating and cooling systems, which easily capture pet allergens, should be cleaned at least once per month, and thoroughly after a pet has been removed since these allergens can remain in the home for months.
Reducing dust throughout the home is critical to controlling triggers. Just as carpets and flooring should be cleaned frequently to decrease dust, so should blinds, drapes, furniture and knickknacks.Reducing the amount of dust-catching items in the home, such as hard-to-clean knickknacks is ideal.
“Upholstery and other furniture should be vacuumed at least once a week. This will help keep the dust mites down,” advises Fugitt. “Also, asthmatics should remember not to sleep on upholstered furniture, because they do hold a lot of mites.”
Silk flowers, knick-knacks, picture frames, Venetian blinds and other dust catchers should be cleaned at least once per month. However, reducing the amount of dust-catching items in the home, such as hard-to-clean knickknacks is ideal.
Kitchens
When Fugitt inspected Estes' kitchen, she noticed that Estes had house plants, a potential problem for an asthmatic. “The soil in house plants can harbor mites and molds, both potential triggers,” she explained.Another item to consider in the kitchen is ventilation. “On the stove, whenever you're frying, make sure you have a well-ventilated fan and that the window is open whenever possible,” Fugit says. “You'll also want to know that you can have candles as decorations, but be sure not to light them because candle flames are a big asthma trigger.”
Cleaning products are another big trigger, explains Fugitt. “It's best to avoid aerosols and just damp wipe your counters with a rag in stead of using sprays," she says.
Cockroach infestations can be addressed in the kitchen. “Cockroaches can be attracted to food and can happen in any type of home, regardless of cleanliness,” says Fugitt. “The excrement and decay of the cockroaches are the biggest triggers.”
A simple way to prevent cockroach infestation is not to leave food or garbage out. Cleaning up messes and spills right away and storing food in airtight containers is an easy way to prevent an infestation.
Basements
Other possible triggers include dampness and mold in the basement. Regulating the humidity in your home and preventing mold are good ways to combat asthma triggers. “Humidity should be kept at a level between 30 percent and 50 percent,” Fugitt explains.
Asthmatics should be on the lookout for black mold in particular, which can grow in the dampness of basements, ceilings and wall tiles. This is a particularly dangerous mold for asthmatics.
Self Management is Key
Asthmatics should learn and understand what causes their attacks. Patients should pay close attention to and discuss with their physicians the impact of dust, animals, heating and cooling systems and filtration, the use of fireplaces, the age of the home, use of aerosols, damp areas in the home and how these affect their asthma.“If asthmatics are not aware of how to modify their risk profile so that they are less likely to have an attack, their asthma starts to get out of control,” explains Bria. “So rather than can a patient get involved with their asthma management and improve things, they must get involved in order to have adequate control over this life-long condition.”
