Asthma Triggers

By editor | July 4, 2007

Anything that affects the airways of a child with asthma is called a trigger. It is often something your child is allergic to, such as pollen or dust mites (tiny “bugs” that live in carpet or fabrics), as well as irritants like cigarette smoke. Exposure to a trigger even in very small amounts can set off a flare or sudden worsening of asthma symptoms.

Asthma flares are also commonly triggered by colds, exercise, or exposure to cold, dry air, as on a winter day. Respiratory infections are the most common triggers for flares in children. Usually these are common viruses that are “only a cold” in other children who don’t have asthma. For them, the cough is not the same, and they don’t develop the other features of asthma described previously.

Upper respiratory tract infections (common colds) caused by viruses usually produce a runny nose before coughing or other symptoms begin. But not all of the time. If you watch carefully, you will find that not every runny nose and respiratory infection will cause an asthma flare. Thank goodness! A child who is only triggered by viral infections will recover completely between asthma flares.

Unfortunately, viral infections can occur frequently. A child might get a new one even before completely recovering from an asthma flare. When this happens, it seems as if the child continues being sick for an unusually long time. A cold usually should last a week or less, but if the cold triggers an asthma flare, the cough may hang on longer. Before you know it, the child catches another cold. Tracking nighttime cough or other symptoms will help you sort out what is really happening. When night symptoms appear, disappear, and then return again, a second flare is quite likely.

When a child’s asthma is triggered only by respiratory infections, a typical pattern of symptoms appears over the course of a year. First there is a flare, then complete recovery, and later additional flares at random intervals. During the winter months, a child may have many flares, but if there is time to recover, all asthma symptoms will disappear between the attacks.

This has important implications for treatment. If your child has no symptoms for a long time and no flares, it might seem correct not to give medicines every day. You are right! But if the flares come often, perhaps every week or two, your child may need daily medicine to help prevent frequent flares.

Allergy triggers can be found indoors and out. A child may be continually exposed to allergy triggers, including dust mites or animal dander from pets in your home. (Dander refers to flakes of skin or dried saliva from animals with fur or feathers.) If a child is sensitive to pollens, she may be exposed to them not only when she’s outdoors but also indoors if the windows are kept open and especially if window fans are used.

Children may have intermittent exposure to allergy triggers too. A child who is allergic or “sensitized” to animal dander, for example, may be exposed only while visiting a friend’s home where a furry pet lives.

Brief exposure-just a few hours-to a trigger can cause symptoms and even a flare if a child is very sensitive. But allergy-triggered flares will be shorter than an attack brought on by a virus, which typically lasts about a week or longer.

Important fact: Daily exposure to allergy triggers inside a home will cause increased airway inflammation. If the exposure continues for months, the inflammation builds, and so do the symptoms. Problems like seasonal pollen exposure can also create prolonged symptoms. These seasonal patterns last only as long as the pollen season lasts, of course.

When a child is exposed to allergy triggers daily throughout the year, it is called a perennial problem. The greater the number of significant triggers, the more likely there will be constant or repeated exposure. And increased exposures mean increased risk for chronic inflammation in the lungs. As exposures increase, so does airway inflammation. And daily symptoms follow close behind.

It’s important to understand that all exposures-both allergy triggers and infections-pile up on one another. While the presence of one trigger alone may not produce obvious symptoms, several combined triggers may do so. A child who has lots of triggers and persistent symptoms will have a more difficult time when a viral infection sparks a new flare that may be more severe and take longer to abate.

Constant inflammation in the lungs caused by allergy exposures makes it easier for viral infections to bring on flares. For example:

Katie is allergic to cats, but her family doesn’t want to give away their cat. They try to keep it away from Katie, and it sleeps in her brother’s room. But Katie has more virus-triggered asthma attacks than her friend Sandy, another cat-allergic child, who isn’t frequently inhaling cat dander.

Irritants are a common problem. Exposures may be intermittent or ongoing, almost every day. Tobacco smoke is the classic culprit in this category. Even if parents step outdoors to smoke, they bring tobacco fumes into the home on their clothing. This passive or indirect exposure can cause problems for infants and children of all ages. You may think that’s unlikely or far-fetched, but the by-products of tobacco smoke can be detected in a child’s bloodstream, which proves that the transfer occurs even when tobacco is smoked out-of-doors. Children with high levels of tobacco chemicals in their blood have been proven to have much greater problems with asthma.

Other types of smoke-from fireplaces, wood-burning stoves, candles, or incense-and fumes from cleaning products or perfumes are also irritants. They’re worse during the winter. When doors and windows are closed, it’s difficult for a child to escape these irritants. Long term exposure to large amounts of irritants and can create more inflammation in a child’s lungs. As the number of irritants increases, the inflammation and symptoms build. And flares occur more often.

Certain medicines may also trigger asthma symptoms in a susceptible patient, hut this does not happen often. Examples are drugs used to treat high blood pressure (angiotensin converting enzyme inhibitors) or migraine (beta-blockers), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs, like ibuprofen).

When a child is evaluated for asthma, physicians and nurse practitioners will carefully consider all the triggers that increase the inflammation level in the lungs as well as other conditions that can complicate asthma.

By decreasing your child’s exposure to triggers, you can do a great deal to reduce the number and severity of flares. This isn’t always easy, some triggers can be eliminated or reduced very simply. Others may take more effort. But with each step you take to remove or reduce triggers, you’ll see benefits-an improvement in your child’s symptoms, and fewer medicines will be needed to control them.


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