ASTHMA TRIGGERS:

Less known but no less potent!

When you have asthma, you know that certain things are powerful triggers for wheeing.  A short exposure is enough to give you chest tightness, throat tightening, and soon, you’ll be wheezing.  Having your rescue inhaler at your fingertips can tamp this wheezing down, but figuring out what this triggers are and where you encounter them is a hugely important approach to preventing wheezing.  

Once you identify the trigger, we can go to work to block it’s effect, assuming you can’t just avoid it (which can be really hard to do).

Common Triggers

You already know about dust, smoke, animal dander and how they set you off.  Using an antihistamine daily is a good way to block these triggers. In some cases, a special medicine (monteleukast) is even more effective because it directly blocks of the trigger effect.  If you think you could get better control with it, let’s talk.

Less Well Recognized Triggers

Environmental triggers are usually a problem for all patients with asthma.  There are a few trigger conditions that are uniquely problematic and when identified, can be controlled with the right strategy.

• Reflux
• Sleep Apnea
• Allergic Rhinitis

Let’s run through these and if you have a history of any of them or think you have one that is not better managed, let’s talk.

Reflux

Reflux generally describes the splashing of acidic stomach fluid into the esophagus at either the lower or upper end.  This occurs when the valve at the top of the stomach doesn’t clinch down tightly during digestive action.  When this acidic fluid hits the lining of the esophagus (at any level), it can trigger bronchial spasm, wheezing, and a full-blown asthma attack.  When this problem is discovered, we can control with:

• Lifestyle
• Acid Blockers
• Gastric “raft”

Lifestyle intervention consists of:

1. avoiding foods that promote reflux due to their oily, greasy, high-fat content;

2. avoiding eating and then laying down, which allows stomach contents to easily move through a leaky valve into the esophagus; and,

3. avoiding large meals, which put pressure on a leaky valve, challenging its ability to stop stomach contents from entering the esophagus.

Acid blockers (famotadine, omeprazole) work to decrease the acid production in the stomach so that if contents do get into the esophagus, they aren’t able to trigger the usual bronchial spasm.  Acid neutralizers like Milk of Magnesia and calcium carbonate decrease the acid content of stomach contents to prevent the bronchial effect when stomach contents leak into the esophagus.

A gastric raft refers to an oral alginate available as either pill or gel forms that is taken after a meal to mix with stomach contacts making them thick and less prone to escape up a leaky valve.  Alginates are derived from seaweed and can be remarkably effective at controlling reflux triggers.

Sleep Anea

Sleep apnea, usually caused by obstruction of the upper airway, causes carbon dioxide levels to increase in the blood stream and this can be a powerful driver of wheezing.  Excess weight is a common cause for obstructive sleep apnea so weight loss is the most effective intervention.  Fortunately, new medicines like tirzepatide and semaglutide are very helpful for weight loss and have been shown to be particularly helpful in reducing obstructive sleep apnea.  I treat patients with both of these medicines so we should talk about how you might benefit.

Allergic Rhinitis

Though most asthma sufferers have wheezing when exposed to pollen, dust, smoke and dander, sometimes you’ll have a runny nose and post-nasal drip even when you haven’t been exposed to such triggers, and as you know, these symptoms can trigger your wheezing as well.  Sometimes an allergic cause can be identified and for that reason, we always order an allergy test.  Many times, we can find an allergic cause.  Even so, medicines that bolster the lining of the nose and upper airway can be helpful.  Such medications include: fluticasone nasal spray, loratidine, cetirizine, and monteleukast.  If you have never had allergy testing and you experience post-nasal drip, stuffy nose, or puffy eyes, you might benefit from testing and one of these medications.

Our Goal?

Better Breathing!

That means:

• Fewer asthma attacks
• Better symptom control
• Less need for steroids overall
• Fewer trips to urgent care or the ER

What Should You Do Next?

At Asthmaniac.com, I offer online visits to help you achieve the best strategies for better breathing.  And when we decide on what medications might be best, I can get them prescribed online for a quick start to Better Breathing! 

🎯 No waiting rooms. No confusion. Just better breathing. Your Back-pocket-asthma-doc!