Asthma Trigger Hotspots: What Triggers Asthma?

Affecting more than 300 million people worldwide, the prevalence of asthma increases by 50% every decade – so what does the condition actually mean for those who live with it?

Asthma is (typically) a lifelong condition with a high burden.

One million children in the UK are currently receiving treatment for asthma, making it the nation's most common long-term medical condition in young people (1 in 11). Nearly half of these patients have experienced an asthma attack in the past year, and just 25% have a personalised action plan to control their symptoms.

We have produced a series of asthma trigger heat maps to illustrate a day in the life of people with asthma. The purpose is to promote a better understanding of asthma flare-ups and awareness of the surprising scenarios that can trigger asthma attacks.

The research analysed seven common living conditions to reveal the potential hot spots that may exacerbate the symptoms of asthma and trigger an asthma attack. Expert advice is then provided to eliminate risk and remove these triggers from your surroundings.

Think you know what triggers asthma? This revealing study will make you think again.

Ventolin Inhaler & AccuhalerVentolin (blue) inhalers are the most widely used treatment to relieve the symptoms of wheezing and breathlessness associated with asthma.

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What are the most common asthma triggers?

A chronic (meaning long-lasting) lung condition that affects people of all ages, asthma has many burdening symptoms, all of which can vary from mild to severe: wheezing, breathlessness, chest tightness and coughing. People living with asthma experience episodes where symptoms dramatically worsen, this is known as an asthma attack.

Many people learn to live with their asthma and, in some cases, the condition can greatly improve in later life (though it can also come back). Asthma becomes easier to manage and control once the patient has an understanding of the triggers that exacerbate their symptoms.

Typical asthma triggers include infections like colds and flu, as well as common allergies such as hay fever. Though there are many other major triggers you might find surprising:

• Air pollution: including vehicle fumes and tobacco smoke
• Emotional reactions: including laughter, stress, and anxiety
• Medication: including NSAIDs and Beta-Blockers
• Food allergies: and foods containing sulphates
• Weather conditions: including sudden temperature changes
• Mould and damp: particularly when exposed for long periods of time
• Alcohol: with sulphites occurring when wine, beer, and cider is made
• Exercise: strenuous exercise and even sex

There are a range of scenarios, pollutants and particles that can trigger asthma, some being far more surprising than others. So, living with asthma is difficult: your triggers can occur in the most unexpected places and impact your daily life – it’s, for this reason, The Independent Pharmacy has created the Asthma Triggers Heat Map…

Asthma triggers at home

Indoor allergens and irritants are common asthma triggers: you’re more likely to experience poor air quality indoors and many indoor pollutants/particles are typically small enough to get into your lungs, making the home a hotspot for asthma triggers.

How many asthma triggers can you pick out from these typical household scenarios?

Living room

Being the most communal area of the home, the living room is a hotspot for asthma triggers.

Take your sofa, for example, a UNICEF study found the average sofa could be harbouring 12 times the amount of bacteria as a toilet seat: it also collects lots of dust, both in the cushions and the area underneath.

Carpets and rugs are another hidden dust trap. Invisible allergens and dust particles stay hidden deep into the fibres of a carpet, making your living room a thriving environment for dust mites – a tiny creature that can trigger asthma symptoms. The same can be said for television screens, as well as ceilings and walls (dust is hiding everywhere).

Animal dander can be found across the home too, so your beloved family pet might be triggering an allergic reaction that exacerbates your asthma symptoms.

Lots of pets can cause an allergic asthma reaction, including cats and dogs (but also any animal with fur, hair or feathers). While some pets like Portuguese water dogs and Devon rex cats are popular for being hypoallergenic, know that no animal is 100% hypoallergenic: certain breeds simply produce less dander than others.

House plants can also be an asthma trigger, both for being a hiding spot for dust, as well as a place where mould can develop if overwatered. Some plants, however, can help your asthma by filtering toxins from the air (peace lilies are a great example).

Kitchen

The kitchen is home to a myriad of asthma triggers.

Gas stoves, for instance, could be a likely culprit for worsening asthma symptoms. Nitrogen dioxide is an irritant that can affect your eyes, nose, and throat. Long term exposure to nitrogen dioxide is even thought to lead to conditions like chronic bronchitis.

Many common cleaning products can also exacerbate asthma symptoms, including bleach, detergents and air fresheners. Cleaning products typically contain strong scents and chemicals that reduce indoor air quality.

The medication box can trigger your asthma symptoms too. Some medicines, over the counter or prescribed, can cause asthma symptoms to flare up: this includes aspirin ibuprofen and beta-blockers. It’s thought somewhere between 10% to 20% of adults with asthma are sensitive to aspirin and NSAIDs.

And if you have an unfortunate pest infestation like rats, mice or cockroaches, you could experience an asthma flare-up too. These creatures produce allergens that exacerbate your asthma through droppings and saliva. Cockroaches, in particular, produce proteins that trigger asthma and allergic reactions in some individuals.The same can be said for mould patches as inhaling mould spores can cause an asthma attack.

Dust is also rife in your kitchen, with the tops of kitchen cabinets, fridges, and light fixtures being key areas where dust can gather.

Bedroom

We spend most of our life in bed, but did you know it could be exacerbating your asthma?

Dust mites thrive in mattresses and pillows as they feed on dead skin cells and enjoy warm, humid conditions: they live in the mattress and rise to the top once people are in bed, this is because body heat increases the overall temperature.

Many asthmatics are allergic to dust mites, making mattresses (especially old or second-hand ones) a major asthma trigger.

Lampshades, under the bed, and any decorative items in your bedroom also collect dust that could affect asthma.

Scented candles are a popular bedroom accessory, but the perfumes typically included in these products are known to make asthma worse. Tea lights are a good alternative that can illuminate your room without reducing indoor air quality.

Asthma triggers away from home

Numerous asthma triggers exist outside of the home, making everyday routines a burden for many asthmatics. Asthma is also the UK’s most common long-term medical condition in children (affecting around 1 in 11 young people), meaning parents are understandably anxious when sending their children to school or allowing them to leave the house away from their supervision.

So, how many asthma triggers do you think exist away from home? Test yourself below.

School

Asthma is a worry for many parents when their children go to school. Why? Because over holidays like summer, routine asthma care can be disturbed, meaning children returning to school are more sensitive to these new asthma triggers. In fact, more children are rushed to hospital for asthma in September than any other time of year.

Infections such as colds and flu are among the most common asthma triggers (75% of asthma patients say getting a cold or flu makes their symptoms worse). With hundreds, if not thousands, of students attending the same school, the spread of infection is common.

Stress and anxiety are asthma triggers too: these strong emotions make asthma patients more likely to react to their triggers. Too much stress can also lead to a panic attack, causing people’s breathing patterns to change and flare up asthma symptoms.

That is why exam season can often exacerbate, with the pressure of exams inducing stress. The pollen count is also high during the summer (when many children take exams), which causes hay fever and triggers asthma.

Exercise-induced asthma is another factor to consider when at school. While exercise can help relieve asthma symptoms, some people find overexerting themselves through exercise can trigger asthma symptoms, making physical education lessons a risk factor.

Office

Occupational asthma is a concern for many working professionals. This type of asthma occurs when people are exposed to irritants in the workplace. Latex, which is commonly found in a healthcare setting, is one such allergen. So is flour dust, which tends to be found in factories.

When it comes to the office environment, there are many potential triggers you might not initially consider. Dust can be found all over the place, including on computer monitors. Your office may also use air fresheners and have the room deep cleaned, all of which can flare up asthma.

A cold air conditioner unit is also bad for people with asthma because cold air tends to irritate bronchial tubes and exacerbate asthma symptoms. Though air conditioners can reduce indoor humidity and remove dust from the environment, a sudden change in temperature can also trigger asthma symptoms.

The smoking area is also a hazard, with second-hand smoke containing more than 7,000 chemicals. If you have asthma and are attending a place of work with a smoking area, be mindful to avoid it.

Aeroplane

If your asthma is well managed, flying is generally safe: this is especially true because most modern planes have fantastic filtering systems to remove particles from the cabin.

However, it’s common to get sick during a flight as you’re in constant close contact with many hundreds of people for a long time.

There are also surprising parts of a plane that may carry lots of dust or bacteria. According to a CBC watchdog series report, headrests and seat pockets are some of the dirtiest parts of a plane – and yeast and mould were detected on a majority of flights.

You can avoid getting sick on a plane by taking precautions such as regularly washing your hands, as well as avoiding touching your eyes, nose and mouth.

Changing air pressure is another potential asthma trigger. Why? Because at high altitudes the amount of oxygen decreases, which puts pressure on the lungs. Some recommend onboard oxygen for severe asthmatics and those who suffer chronic obstructive pulmonary disease (COPD).

If someone has a pet on board, symptoms related to allergens may also be triggered.

And with stress being a key asthma trigger, a fear of flying can also cause asthma symptoms to become more severe. Constant communication with someone you’re flying with may help calm feelings of anxiety. Also, ensure all asthma medications and treatments are up-to-date before travelling.

Outdoor play area

Sharing many of the same asthma triggers as a school like over exhaustion and risk of infection, outdoor play areas (including public parks) expose asthma patients to a myriad of other potential triggers all year round.

Pollen allergies are among the key outdoor asthma triggers: this is because pollen from trees, plants (particularly weeds) and grass blow into your eyes and nose, causing an allergic reaction for many and exacerbating asthma symptoms.

Tree pollen occurs typically from March to mid-May, weeds from April to August, and grass has two peaks lasting from mid-May through to July.

Air pollution and vehicle fumes from nearby roads are also a factor to consider (particularly in urban areas). In fact, vehicle pollution causes 4 million new asthma cases every year. Pollution is quick to irritate airways, with some pollution particles being small enough to get into your lungs.

A sudden change in weather such as a thunderstorm is also a major risk factor for asthma patients. Not only will it cause stress and anxiety, but a thunderstorm can also release airborne allergens that are spread by gusty winds. Research has found emergency room treatments for asthma dramatically increase following a thunderstorm.

What are the symptoms of an asthma attack?

Asthma attacks exhibit the most severe symptoms of asthma: your bronchial tubes narrow when airways contract and become swollen, making it extremely difficult to breathe.

There are three main signs you are having an asthma attack:

1. You have severe shortness of breath and chest tightness or pains
2. Your peak expiratory flow reading (PEF) is low
3. Your symptoms don’t improve with the use of home treatment (inhalers)

Emergency medical treatment is required if you are experiencing severe breathlessness (or wheezing), as well as trouble speaking due to shortness of breath, especially if there is little improvement following the use of an inhaler.

Minor asthma attacks can be eased using home treatment such as a rescue inhaler, while much more severe attacks can be life-threatening. Note that an asthma attack is unlikely to happen if the condition is under control, which is the overall goal of treating asthma.

Controlled asthma occurs when a patient uses their reliever inhaler less than twice a week. A controlled asthmatic will also have no nocturnal symptoms and experience no activity limitation when going about their daily life.

How can you support someone having an asthma attack?

Whether it’s a member a family member, a friend or a complete stranger, it’s important to understand what to do if you see someone having an asthma attack.

Keep calm when you see someone having an asthma attack, you should reassure the person and look to not cause any additional stress or anxiety (this will make breathing even more difficult). Instead, you should do the following:

• Sit the individual in an upright position: to help free airways.
• Remove the trigger: this may be tobacco smoke, pet allergies, dust or a myriad of other possible triggers (see the heat map for more information).
• Understand their treatment: communicate with the individual (or someone with them) and follow their asthma plan. The plan will inform whether you help them use a rescue inhaler or immediately contact emergency services when symptoms worsen.

While following these steps, you also need to evaluate the severity of the attack. Blueish lips and tight skin that looks sucked in between the ribs are classic signs of a severe asthma attack – this means the individual is struggling to get any air into the lungs. You should also pick up on whether the person is having trouble speaking or isn’t responding to medication.

If you feel someone is having a severe asthma attack, call the emergency services. (999 in the UK, 911 in the US).

Summary: don’t let asthma ruin your day (get a plan)

Despite there being many asthma triggers in your environment, don’t let asthma ruin your day or cause anxiety.

The best way to prevent asthma flareups is to keep your condition well under control. You can do this by ensuring you have an up to date asthma action plan: this is a tailored guide to treating your asthma, typically filled in alongside a GP.

Your asthma action plan outlines the medication you take (preventers and relievers), how to act when your symptoms get worse, and what to do if emergency action is required. For peace of mind, share your asthma plan with others (family, friends, and coworkers), so they know what to do if you have an asthma attack.

Once your asthma is controlled, you should have little worry about your daily routine, and your environment won’t feel like a hotspot any longer.