Asthma Triggers Research Articles

Asthma and exposure to cleaning products - a European Academy of Allergy and Clinical Immunology task force consensus statement

Professional and domestic cleaning is associated with work-related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed.

Synthesis of Fungal Glycolipid Asperamide B and Investigation of Its Ability to Stimulate Natural Killer T Cells

The relationship between mold and asthma has been recognized for decades, but the molecular triggers of asthma generated by molds have not been fully elucidated. A glycolipid generated by Aspergillus species has recently been identified that triggers airway hyperreactivity via natural killer T cell activation. The synthesis of this glycolipid and structural variants designed to allow identification of the features of this glycolipid required for recognition by natural killer T cells is described.

Community-based Participatory Research Intervention to Reduce the Exposure to Environmental Asthma Triggers and Severity of Asthma among Asthmatic Children in H

Background The long-term partnership between state health agencies, local community health centers, and the community is essential to ensure the success of community-based participatory research in...

Perceived triggers of asthma: key to symptom perception and management.

Adequate asthma management depends on an accurate identification of asthma triggers. A review of the literature on trigger perception in asthma shows that individuals vary in their perception of asthma triggers and that the correlation between self-reported asthma triggers and allergy tests is only modest. In this article, we provide an overview of psychological mechanisms involved in the process of asthma triggers identification. We identify sources of errors in trigger identification and targets for behavioural interventions that aim to improve the accuracy of asthma trigger identification and thereby enhance asthma control.

Early-Life Air Pollution and Asthma Risk in Minority Children. The GALA II and SAGE II Studies

Air pollution is a known asthma trigger and has been associated with short-term asthma symptoms, airway inflammation, decreased lung function, and reduced response to asthma rescue medications. To assess a causal relationship between air pollution and childhood asthma using data that address temporality by estimating air pollution exposures before the development of asthma and to establish the generalizability of the association by studying diverse racial/ethnic populations in different geographic regions. This study included Latino (n = 3,343) and African American (n = 977) participants with and without asthma from five urban regions in the mainland United States and Puerto Rico. Residential history and data from local ambient air monitoring stations were used to estimate average annual exposure to five air pollutants: ozone, nitrogen dioxide (NO₂), sulfur dioxide, particulate matter not greater than 10 μm in diameter, and particulate matter not greater than 2.5 μm in diameter. Within each region, we performed logistic regression to determine the relationship between early-life exposure to air pollutants and subsequent asthma diagnosis. A random-effects model was used to combine the region-specific effects and generate summary odds ratios for each pollutant. After adjustment for confounders, a 5-ppb increase in average NO₂ during the first year of life was associated with an odds ratio of 1.17 for physician-diagnosed asthma (95% confidence interval, 1.04-1.31). Early-life NO₂ exposure is associated with childhood asthma in Latinos and African Americans. These results add to a growing body of evidence that traffic-related pollutants may be causally related to childhood asthma.

Environmental control for asthma

To review and interpret recent literature related to the role of environmental control in prevention and treatment of asthma. Environmental control has a clearly established role in the management of asthma, but its role as a primary prevention tool is not supported by recent clinical trials. Although some of the interventions tested in these trials reduced the risk of asthma, the interventions often included dietary modification and those trials intervening only on environmental exposures were largely negative. Environmental interventions that target multiple asthma triggers, such as a laminar airflow device and relocation to high altitude, continue to demonstrate efficacy in asthma. Several studies highlight the efficacy of portable HEPA purifiers in reduction of indoor particulate matter and improving asthma outcomes. Several recently published practice parameters provide evidence-based recommendations for environmental control practices targeting furry pet, rodent, and cockroach allergens. Emerging work highlights the potential impact of spatial-temporal aspects of exposure and the shape of the dose-response relationships on the indoor allergen exposure-asthma relationship. Environmental interventions likely have no effect on the risk of developing atopic disease, but multifaceted interventions are generally of benefit in the management of asthma, particularly in children.

Viral and bacterial infection in acute asthma and chronic obstructive pulmonary disease increases the risk of readmission

Background and objectiveInfection is as an important trigger for acute asthma and chronic obstructive pulmonary disease (COPD). The aim of this article was to determine the prevalence and impact of virus and bacterial infections in acute asthma and COPD.MethodsSubjects were recruited, within 24 h of hospital admission for acute exacerbations of asthma and COPD. Nose/throat swabs and sputum samples were collected and examined by multiplex polymerase chain reaction for respiratory viruses and cultured for bacteria. The primary outcomes were length of stay (LOS) and readmission to hospital within 60 days.ResultsA total of 199 subjects were recruited (96 had asthma and 103 COPD) for 235 events (36 re‐presented). A virus was detected in 79 subjects (40%), bacteria in 41 (21%), and of these, 18 had both. Rhinovirus A was the most frequently isolated virus. A multivariate analysis was performed to control for confounders. It found that detection of a virus, a virus and bacteria, forced expiratory volume in 1 s (FEV1) and a diagnosis of COPD were all independent predictors of prolonged LOS, while risk of readmission within 60 days was increased with virus infection alone, virus and bacterial infection, lower FEV1 and current smoking.ConclusionsVirus infection, especially in the presence of chronic bacterial infection, is an important determinant of more severe acute exacerbations in both asthma and COPD, and patients with co‐infections are more likely to be readmitted to hospital following their exacerbation.

The Devil Is in the Detail

Introduction: The Internet can support people to self-manage their asthma, while overcoming barriers frequently found in primary care. A user-centred design process was utilised to explore the types of asthma information older adults perceived to be beneficial in helping them manage their asthma and the website features they felt were desirable for an asthma education website. Methods: A survey package was mailed to 9,000 adults aged 55 years and over, whose contact details had been obtained from the Australian Electoral Commission. Four focus groups were also conducted covering: asthma management; asthma Internet information; and website features. The Technology Acceptance Model was used as a framework to structure results. Results: Survey respondents indicated that they wanted information about identifying and avoiding asthma triggers, dealing with asthma attacks and the latest information on asthma management. Whilst focus group participants stated that asthma blogs, Internet forums and control assessment quizzes would not be useful to them. However the use of videos was seen as beneficial. Internet forums were the only feature discussed where older adults expressed concerns with their ability to use them effectively. Discussion: While older adults indicated a desire for basic asthma information the individual nature of asthma needs to be taken into consideration when creating website content. Both survey respondents and focus groups participants showed little interest in the use of blogs or forums on asthma. These results have implications for professionals providing self-management education to older adults with asthma and other chronic diseases.

Factors influencing asthma control: results of a real-life prospective observational asthma inhaler treatment (ASIT) study

BackgroundDespite the availability of new pharmacological options and novel combinations of existing drug therapies, the rate of suboptimal asthma control is still high. Therefore, early identification of the clinical and behavioral factors responsible for poor asthma control, and interventions during routine outpatient visits to improve asthma trigger management, are strongly recommended. This study was designed to evaluate the profiles of asthmatic patients and their inhaler treatment devices in relation to asthma control in Turkey.MethodsA total of 572 patients with persistent asthma (mean [standard deviation] age: 42.7 [12.1] years; 76% female) were included in this prospective observational study. A baseline visit (0 month, visit 1) and three follow-up visits (1, 3 and 6 months after enrolment) were conducted to collect data on demographics, past medical and asthma history, and inhaler device use.ResultsAsthma control was identified in 61.5% of patients at visit 1 and increased to 87.3% at visit 4 (P < 0.001), regardless of sociodemographics, asthma duration, body mass index or smoking status. The presence of asthma-related comorbidity had a significantly negative effect on asthma control (P = 0.004). A significant decrease was determined, in the rate of uncontrolled asthma, upon follow-up among patients who were using a variety of fixed dose combination inhalers (P < 0.001 for each). Logistic regression analysis was used to show that the presence of asthma-related comorbidity (odds ratio [OR], 0.602; 95% confidence interval [CI], 0.419; 0.863, P = 0.006) and active smoking (OR, 0.522; 95% CI, 0.330; 0.825, P = 0.005) were significant predictors of asthma control.ConclusionOur findings indicate that, despite ongoing treatment, asthma control rate was 61.5% at visit 1 in adult outpatients with persistent asthma. However, by the final follow-up 6 months later, this had increased to 87.3%, independent of sociodemographic and clinical characteristics. Poor asthma control was associated with asthma-related comorbid diseases, while the efficacy of fixed dose combinations was evident in the achievement of asthma control.

All About Asthma: Top Resources for Children, Adolescents, and Their Families

All About Asthma: Top Resources for Children, Adolescents, and Their Families

Asthma and the Diversity of Fungal Spores in Air

The diversity of fungal spores in air is vast ([1], [2], Figure 1), but research on asthma focuses on a handful of easily identified, culturable species. Ecologists are developing new tools to probe communities and identify the full complement of fungi in habitats. These tools may enable identification of novel asthma triggers, but scientists involved in public health or medicine rarely interact with mycologists focused on ecology. With this primer, my aim is to facilitate communication by providing doctors with a basic, modern guide to spores, by teaching mycologists the essential facts of asthma, and by providing patients with a succinct summary of what is known about spores and asthma. By highlighting the use of emerging metagenomics technologies in ecology, I intend to illustrate how these tools might be used to more thoroughly understand the potential diversity of fungi involved in asthma.

Fel d 1-airway inflammation prevention and treatment by co-immunization vaccine via induction of CD4+CD25-Foxp3+ Treg cells

Pet allergens are major causes for asthma and allergic rhinitis. Fel d 1 protein, a key pet allergen from domestic cat, can sensitize host and trigger asthma attack. In this study, we report that co-immunization with recombinant Fel d 1 protein (rFel d 1) plus plasmid DNA that contains Fe1 d 1 gene was effective in preventing and treating the natural Fel d 1 (nFel d 1) induced allergic airway inflammation in mice. A population of T regulatory cells (iTreg) exhibiting a CD4+CD25-Foxp3+ phenotype and expressing IL-10 and TGF-β was induced by this co-immunization strategy. Furthermore, after adoptive transfers of the iTreg cells, mice that were pre-sensitized and challenged with nFel d 1 exhibited less signs of allergic inflammation, AHR and a reduced allergic immune response. These data indicate that co-immunization with DNA and protein mixture vaccine may be an effective treatment for cat allergy.

Home Asthma Triggers: Barriers to Asthma Control in Chicago Puerto Rican Children

We sought objectively to measure, summarize, and contextualize the asthma triggers found in the homes of urban high-risk Puerto Rican children and adolescents with asthma in Chicago. Data were from the baseline home assessments of Project CURA. Research assistants interviewed caregivers, conducted a home visual inspection, and collected saliva samples for cotinine analysis. A trigger behavior summary score was created. The housing inspected was old with multiple units and obvious structural deficiencies. Many allergic and irritant triggers were observed. Having a controller medicine or private insurance was associated with lower trigger behavior summary scores; caregiver depression, caregiver perceived stress, and child negative life events were associated with high trigger scores. The final multivariate model retained had a controller medicine, private insurance, and caregiver perceived stress. The data from this high-risk cohort identified modifiable areas where environmental interventions could reduce morbidity in Puerto Rican children and adolescents.

The Beat

The Beat

The Contractile Properties of Airway Smooth Muscle: How their Defects can be Linked to Asthmatic Airway Hyperresponsiveness?

Asthma is a prevalent and sometimes debilitating lung disorder caused by diverse triggers in susceptible individuals. Based on the salutary effect of drugs relaxing airway smooth muscle (ASM) in the treatment of asthma, there is no doubt that airway narrowing elicited by ASM shortening is involved in the development of symptoms. Asthmatic individuals are also commonly hyperresponsive to stimuli acting directly on ASM, such as methacholine; especially when they are not treated optimally. This feature is called airway hypperresponsiveness (AHR) and is thought to contribute importantly to asthma symptoms. This is because the airway response measured in an experimental setting, such as during a methacholine challenge, is a good surrogate of the airway response that would occur in vivo in response to contractile agonists generated endogenously (e.g., leukotriene and histamine) following exposure to asthma triggers. Many muscle and non-muscle factors, as well as their interaction, can contribute to AHR. The present review focuses exclusively on muscle factors. It is important to understand that many contractile properties of ASM may allow narrowing of airways in vivo. These include force, amount and velocity of shortening, stiffness, ability to relax, and ability to tolerate and recover from oscillating stress caused by breathing maneuvers. It is also important to understand that the contractile capacity of ASM can vary in time and in response to external cues (ASM is adaptable). Any permanent and transient defect in any ASM contractile property can be linked to the manifestation of AHR. Evidence supporting these links in asthma is growing. Keywords: Adaptation, breathing, force, relaxation, shortening, stiffness, velocity.

Improving Pediatrician Knowledge About Environmental Triggers of Asthma

Control of environmental triggers (ETs) greatly improves asthma outcomes in children. Disseminating these findings to general pediatricians has not been well established. After delivering a structured and standardized presentation on ET identification and control to pediatricians, we surveyed them about knowledge and practices of ET assessment and management. We analyzed matched responses for pre/post and 3- to 6-month follow-up using McNemar's χ(2) test. Matched data were available for 367 participants, and 3- to 6-month follow-up data were available for 83. There was a significant posttraining increase in intention to ask about ETs and recommend ET management. After 3 to 6 months, all responses remained significantly higher than baseline, except "likely to refer to an asthma specialist." Pediatricians reported a significant improvement in knowledge about ETs of asthma and a willingness to incorporate exposure history questions and remediation recommendations in their routine practice.

Asthma Control and Asthma Triggers

Objective. Little is known about the lifestyle adjustments made by patients with asthma to reduce symptoms and maintain control when exposed to environmental triggers. The objectives of this study were to understand patient perspectives on asthma control, the triggers they identify in their lives, and any lifestyle adjustments they make to control their asthma by avoiding or managing known or perceived triggers. Methods. Focus groups were conducted with patients in the United States who had clinically documented persistent asthma. Participants completed a sociodemographic form and the Asthma Control Test (ACT), on which a score of 19 or lower indicates that asthma may not be well controlled. Results. A total of 19 participants participated in 1 of 2 focus groups. Most participants (n = 14; 74%) reported moderate asthma; 3 (16%) reported mild, and 2 (10%) severe. Mean ACT total score was 16 ± 4; 15 (79%) participants had a score of ≤19, and 4 (21%) participants had a score of ≥20. The most common asthma triggers affecting patients included indoor/outdoor allergens (n = 14; 74%), environmental pollutants/irritants (n = 6; 32%), foods (n = 6; 32%), strong odors (n = 5; 26%), and weather (n = 5; 26%). Additional triggers reported by some patients included exercise, stress, sinusitis/respiratory infections, medications, and strong emotions. Patient-reported behaviors used to maintain asthma control included use of controller medication, use of rescue medication, avoidance of asthma triggers, and relaxation or breathing exercises. Conclusions. Participants perceived themselves to experience symptoms or exacerbations when encountering triggers and to make frequent lifestyle adjustments to cope with triggers encountered.

Impact of LEED-Certified Affordable Housing on Asthma in the South Bronx

Green housing reduces energy costs and may mitigate indoor allergens and pollutants, improving asthma morbidity. High asthma burden is seen in low-income neighborhoods. Past studies show improvements in respiratory symptoms when living in green homes. Develop partnership with Blue Sea Development Company to determine impacts of living in Melrose Commons V (MCV), a Leadership in Energy and Environmental Design (LEED) Platinum-certified affordable housing complex, on asthma in the South Bronx. Participants completed a home-based respiratory health questionnaire before moving into MCV. Follow-up occurred at 6, 12, and 18 months post-move. A home-based educational module was delivered on indoor environmental interventions to avoid asthma triggers. A pretest was given before the module and a posttest was given 9 months later, including an evaluation of behavioral practice changes. Outcomes included decreases in continuous daily respiratory symptoms (p < .001), asthma symptoms disrupting sleep in the past month (p = .028), and urgent visits to a healthcare professional for asthma in the past 3 months (p = .038). Clinically relevant outcomes included fewer days with asthma symptoms; asthma episodes; days of work, school, or daycare missed; and emergency department visits. Education changes from pretest to posttest included increased knowledge about dust mites, roaches, mold, and chemical irritants (p = .007). Common behavioral changes included using hypoallergenic mattress covers, using green cleaning products, and eliminating bedroom carpets. Findings support the beneficial effect of LEED Platinum-certified buildings on respiratory health. Trends may be clinically and economically relevant. Advocacy efforts should promote the expansion of green housing and emphasize the development of healthy communities.

The Effect of Educational and Modifying Intervention on Asthma Control among Adolescents: a Randomized Clinical Trial.

Controlling over allergens and environmental irritants is one of the essential elements of controlling asthma. Asthma control in adolescents is a challenge. The current study was performed with the goal of investigating the effect of an educational and modifying intervention about asthma triggers on asthma control among adolescents. The current study was a randomized clinical trial. 60 adolescents of 12-18 years of age participated in this study. The participants were randomly divided into the two control and experimental groups. The Juniper's Asthma Control Questionnaire was completed by the adolescents before and 5 weeks after the intervention. Training sessions, planning for modification of asthma triggers and telephone follow-up were performed in the experimental group. There was a significant difference between the asthma control score before and after the intervention in the control and experimental groups. The asthma control status improved in the experimental group. In other words, the educational interventions to modify asthma triggers were effective in improving asthma control. Since this intervention method can improve the asthma control in adolescents, it is recommended that adolescents directly participate in such programs about asthma triggers and the education become less parent-centred. Moreover, the necessity of such an intervention in clinics and outpatient clinics is emphasized.

Younger Cosmetology Workers and Environmental and Occupational Asthma Triggers at Training Sites and in Salons

Secondary school students in career, technical, and vocational education (CTE) programs include minors aged ≤17 years. These students enter the workforce starting at age 18 as young adults, and specifically in cosmetology after completing the State of New Jersey mandated 2-part licensing exam (theory and practical). The New Jersey Safe Schools Task Force 2010-2012 focused on potential safety and health (S&amp;H) risks encountered by minors training in cosmetology. We conducted a stakeholder-driven participatory process with relevant state and federal agencies, private sector partners, teachers, administrators, and students from 1-in-3 of 21 county CTE school districts. We developed and disseminated Web pages ( http://www.njsafeschools.org/Cosmetology.htm ) with science-based information, materials such as “Right to Know” brochures in multiple languages (English, Spanish), and student-designed educational posters. Resources highlight S&amp;H issues such as chemical exposures, including known environmental and occupational asthma triggers and respiratory irritants, for example, formaldehyde and volatile organic compounds. Asthma education professionals working in clinical management of chronic respiratory diseases can increase self-awareness of S&amp;H in cosmetology. They can then help inform younger patients/workers with asthma, teachers, older employees, and managers/owners of hair, nail, and skin care salons of potential asthma triggers. The goal is to minimize exposures (S&amp;H risks) among these professionals and their clients (general public).