Asthma
Asthma triggers
A trigger is anything that irritates the airways and causes the symptoms of asthma, including psychological pressures such as stress. Asthma affects people differently and there may be several or many triggers. An important part of controlling asthma is avoiding triggers. Common triggers include:
- house dust mites
- pets
- animal fur
- animal saliva
- feathers
- perfume
- mould or fungi
- pollen
- pollution or poor air quality
- tobacco smoke
- exercise
- cold air and humid air
- viral infections
Asthma and allergies
A doctor describes the commonest triggers for asthma.
A doctor describes the commonest triggers for asthma.
In terms of, once you have asthma, triggering an attack of asthma then there are very common things such as viral infections. That’s probably the commonest cause of genuine worsening asthma and asthma attacks. On a more short term basis then some people find exercise, breathing cold air, those are the sorts of things that will trigger them, and then of course there are allergens which you can either experience indoors such as house dust mite, cats, or outdoor, such as grass, pollen and fungal spores.
So there’s a range of different things that can do it, both physical and in terms of allergens. But of course on top of that stress, emotion, can act as very potent triggers. On many occasions I’ve had people who will tell me that moments of high emotion, such as funerals will exacerbate an attack.
Can you tell me what, how easy it is to ascertain what the triggers are in people?
That is more difficult. Some people will say to you, this is what it is. ‘I know that if I eat peanuts that I will have an attack of asthma’. In children very often exercise is a classic, very easily recognised trigger. School teachers will say, “He’s not trying at games.” And it’s not that, it’s just they get breathless so, and viral infections clearly, you know, “I had a cold. It went to my chest. My asthma got worse.” Is something that’s fairly easy to recognise.
More difficult are those triggers which you are more hidden, such as perhaps allergens that you’re not aware of. Or maybe even certain chemicals that you’re exposed to at work. Those sorts of things may well be much more difficult to, to understand, except with extensive investigations.
As an adult Eve started getting breathless when walking and was also reacting to a friend’s dog and to cigarette smoke. She’d had hay fever for 20 years but started to realise this was something else. [AUDIO ONLY]
As an adult Eve started getting breathless when walking and was also reacting to a friend’s dog and to cigarette smoke. She’d had hay fever for 20 years but started to realise this was something else. [AUDIO ONLY]
And I had been having troubles with breathing before, I had been troubled, I had recently become allergic to dogs and I was coughing a lot when I was near this friend’s guide dog. And, I thought why, you know, this, with this reaction to the dog and also similar reaction when I was around a couple of people who had been smoking. They weren’t smoking at the time but there was smoke on their clothes. And I was coughing and coughing, and I took my hay fever medication, but that didn’t do it.
Then I had this problem getting up the hill and getting so breathless I couldn’t do it, I couldn’t get up the hill, and I had to stop, literally, wait for everybody else to go back up and then come back down and get me half way, half way there.
I thought wait a second, something’s wrong here. And I said to my GP what the problem was and I said, “This isn’t asthma is it?” Because I’d had hay fever for over twenty years by then, and she said, “Well it kind of sounds like it is.” And she gave me at the time, just a steroid inhaler. She said, take, you know, told me to take it, two puffs in the morning, two at night and see what happened.
And it eased off the symptoms, and the next walk I went on with my friends, I could go all the way. And that sort of told me something [laughs].
Catherine explains how important it is to get to know your own triggers so that you can reduce contact with things that may make your asthma worse.
Catherine explains how important it is to get to know your own triggers so that you can reduce contact with things that may make your asthma worse.
It will induce if I breathe in cold air, it will induce an asthma attack and I’ve got to be aware of that. Whereas I don’t, practicing consultants are always aware of the many, many different things that can set it off.
Asthma rarely troubles David in summer but in winter cold or windy weather will trigger it and he may need extra medication.
Asthma rarely troubles David in summer but in winter cold or windy weather will trigger it and he may need extra medication.
I can generally keep my asthma under control by taking daily inhalers. When I get asthma I can usually keep it down. But there are occasions, particularly if I get a cold or chest infection then none of the normal medication will do anything. So I have to go to the doctors and get steroids. And after two or three weeks it will go back to normal. He also gives me some antibiotics because it’s normally a chesty cold and that is not good for asthma at all.
People with asthma also may get hay fever during summer when the pollen count is high. Even hanging out washing in the garden in summer would make them feel wheezy and breathless. Some people may also find it helpful to take antihistamines (particularly if their asthma is allergy based) which provide quick relief for symptoms such as sneezing, runny nose, itchy, watery eyes and itchy throats. Mark also gets hay fever-triggered asthma and finds it difficult to tolerate being outside in summer, especially as he lives close to fields where rapeseed grows.
Alastair’s asthma is triggered by hay fever. He uses a preventive inhaler from May onwards, and it never gets really bad. Exercise can trigger it too.
Alastair’s asthma is triggered by hay fever. He uses a preventive inhaler from May onwards, and it never gets really bad. Exercise can trigger it too.
I’ve never had an asthma attack as such. You hear about people have like a heavy asthma attack and not being able to breathe at all. Mine is just annoying. You know, it will sort of graduate up to the point where it’s just uncomfortable and without an inhaler that uncomfortable feeling lasts, you know, it could be a, you know, a couple of hours. But using the inhaler will stop it and until the next either dawn or dusk when it comes back on again. Or exercise during the summer as well.
Will make it worse?
Yes, but that’s usually a strange one. I’ll exercise for say ten minutes and also running for ten fifteen minutes and I won’t have a problem but as soon as I stop my asthma will kick in and then I have to use the inhaler and then I’ll be able to carry on again.
Julie tries to avoid being near people who have colds. She steps up her medication when she has a cold or chest infection to try to keep her airways clear.
Julie tries to avoid being near people who have colds. She steps up her medication when she has a cold or chest infection to try to keep her airways clear.
I do remember at some phase with the consultant him saying to me, “If you get a cold and you get congestion in your lungs, and you don’t’ get rid of it, you’ve got stuff in there, mucus, then germs will think, ‘Oh lovely environment to get into’ and you’ll get more and it becomes a sort of vicious circle you can’t get out of. So it’s very important to make sure that you clear your lungs at the end of a, a cold or whatever’s caused it”. And that also has worked very well too. I try to make sure that if I’m given any extra medication or I up it that I clear my lungs so that I’m totally not coughing stuff before I, you know, go back to normal medication.
...you know, I suppose I’d been unwell for periods, you know, and instead of just having a cold and you’d recover, I mean, I’m, I always thought I’m just chesty and colds go on. If I do get a, a cold it goes to my chest and it takes me longer because I’m asthmatic to get rid of the mucus and stuff. So it’s a more long drawn out thing.
So I dread getting colds and try to avoid them. And when I was working obviously you’d have to go on working but I didn’t want to go take my germs, you know, I think if everybody stayed at home for the first couple of days and didn’t take it with them a lot of people who suffer from asthma and other things that go on from respiratory infections and things would be…life would be a lot easier.
People don’t, they, particularly now of course people, if you’ve got a job they’re trying to keep it and they’re not going to, you know, stay at home because they’ve got a cold.
Jane’s asthma is affected when she gets a bad cold.
Jane’s asthma is affected when she gets a bad cold.
So I get something like a cold and it goes onto my chest and I get very chesty, I develop a chest infection and then my asthma’s bad. And, and what can happen then is that’s when it can be really difficult to walk say from the chair to the kitchen to make a cup of tea and back again. And my breathing can go from being, when I’m sitting in the chair I can feel absolutely fine. But if I get up to do something my breathing can go in seconds from being as apparently normal as it is now to not being able to catch my breath at all. You know, literally in less than a minute.
It, you know, it just switches. Which is when it gets frightening really. But at that, and that will get better over, so that so... So I might get a cold, it goes onto my chest over a period say two or three days and then over the next week my breathing will be really difficult and I might have four, six of these attacks where I just can’t breathe at all and I have to stop everything and sit down and use my blue inhaler. And in between I’m a bit wheezy and, you know, slow. It’s a bit like, you know, and I was talking about when it started, I felt like my batteries had run out.
So it’s a bit like my batteries are only operating at quarter power. And then over the next three or four weeks it will slowly improve.
Susan has the flu vaccine each year: ‘having flu on top of asthma isn’t much fun’. [AUDIO ONLY]
Susan has the flu vaccine each year: ‘having flu on top of asthma isn’t much fun’. [AUDIO ONLY]
Hmm, is it doing…
...you know, does it make a difference?” But, yeah, having flu was definitely not fun with asthma on top.
And it does seem to work most years.
Mark remembers the first time he had an asthma attack and was taken to hospital.
Mark remembers the first time he had an asthma attack and was taken to hospital.
Can you remember the first time that you really noticed that you had it, that you really noticed you were wheezing?
Yeah. My, my eyes really watered and also my eyes were swollen up. And I was, I could not breathe and they had to call an ambulance. And that is one of the first times that I was aware that, you know, some, something wasn’t really right.
Pollution, especially from traffic, is increasingly recognised as making asthma worse. Alice and Jane both said that traffic fumes and waiting in train stations could set off their asthma. Chemical irritants such as cleaning products, shoe polish, nail varnish and perfume can be triggers for some people. Often people talked about how they avoided using certain cleaning products and how they had adapted their house to keep it as dust-free as possible.
Smoking or being exposed to a smoky atmosphere can irritate the lungs and bring on asthma symptoms. Exposure to tobacco smoke in childhood, or if your mother smoked during pregnancy may increase your likelihood of getting asthma. Belinda’s parents both smoked at home in the 1960s when she was a child; she thinks passive smoking contributed to her asthma. When Gail stopped smoking her symptoms disappeared almost completely. Esther used to smoke when she was younger but is now very sensitive to being in a smoky atmosphere. Some people said that the smoking ban in public places has enabled them to go out and socialise more.
David was told his asthma was triggered by and made worse by smoking. His doctor strongly advised him to give up smoking
David was told his asthma was triggered by and made worse by smoking. His doctor strongly advised him to give up smoking
I don’t smoke now of course, because I’d be dead if I did. But yes, my asthma really developed. If I hadn’t smoked and I gave up cigarettes an awful long while ago, but then I went onto cigars and that really ruined my lungs completely.
Right.
You know, I’m quite happy to admit that now. But I didn’t realise it at the time of course.
And did you quit smoking after or before being diagnosed or… around that time?
About the same time. I suppose it was about a year or so later.
Okay. And was that the... What was your motivation to quit smoking? Was it…?
Well because the doctor told me I’d be dead in two years if I didn’t.
In some people certain foods can trigger asthma. People talked about a variety of things that could set off their asthma including dairy products, fizzy drinks, certain wines and beers. Charles said that white wine in particular can make him feel wheezy. Even a small amount of alcohol such as in sherry trifle can make Jenny’s asthma flare up.
Faisil finds that certain foods trigger his asthma and has tried to cut them from his diet to avoid getting symptoms.
Faisil finds that certain foods trigger his asthma and has tried to cut them from his diet to avoid getting symptoms.
Do you avoid them completely or would you kind of do it in moderation and see how it goes?
I did sort of cut out milk for a long time. But I think I ended up with a calcium deficiency, so and I think eventually, when I started it just bothered my stomach than my breathing. So then you’ve got that lactose free in the alternatives so I started using that more, because I started going basically with the calcium deficiencies and stuff. So it’s not as much of a problem.
But the rest for example, avoiding, yes, I mean I can avoid having frozen stuff because it always ends to be stuff that’s not good for you in the winter time, so I can sort of live without that. Fizzy drinks I find hard work, because I don’t drink alcohol and I do find that it tends to, I just seem to always have an unsettled stomach anyway for some reason. Fizzy drinks help that in one case but it causes the problem the other way, so it balance… I can be quite annoyed.
Asthma can be triggered by stress or emotion. Some people’s asthma got worse when they felt anxious or stressed. Christine’s first asthma attack came in childhood when her mother was seriously ill and she was very anxious. Several people said that it could be difficult to control stress levels in the midst of an asthma attack. People spoke of a ‘vicious circle’ because the more stressed you become, the harder it is to control.
Jenny, said that if she worried about her asthma the stress and anxiety could make things worse.
Jenny, said that if she worried about her asthma the stress and anxiety could make things worse.
One thing I did want to say about asthma and is the, the mental implications and the, and the, how to put it, the effect the brain can have on your asthma.
There’s so much… people don’t realise the... I don’t know how to put it... the, like the stress, anxiety, the psychological, that’s it, the psychological impact or the impact of psychology on your asthma.
So your emotional state?
Yes.
Yeah.
Yeah, if you get stressed… you know, stressed at work, you can do anxious for something, you know, if you’re upset about something, anything like that can set you asthma off. And so many people don’t realise it, and, and then when your asthma’s not so good or your breathing generally, you know, if you’re breathless and then you start panicking, worrying and… getting anxious about it, it just spirals, and I now know that anxiety and stress are one of my big triggers, psychological thing. You know, if I think I’m going to get ill, then I can, I can almost make it, make it happen, almost self -fulfilling because you think, “Oh, I’ve sneezed, I’ve got a cold I’m going to be ill”.
Start to panic.
Yeah, you start to panic and it’s just one thing after another. So you have to learn a lot of relaxation and calming techniques.
Eileen’s diagnosis came at a time when she was under a lot of emotional stress. Over time she has been able to recognise her triggers more easily.
Eileen’s diagnosis came at a time when she was under a lot of emotional stress. Over time she has been able to recognise her triggers more easily.
I went to the doctor and she said, “You’ve got asthma." “Why? How?” You know, I just couldn’t understand why I suddenly had asthma. I’d had nothing before.
But I was going through a very stressful part of my life and it, she said that it was, in the main, stress-related.
But gradually over time I’ve looked at it I’ve analysed where my problems are because everybody has a different trigger. I know that certain types of stress will bring it on. I also know that if I have a really bad cold my nose gets stuffed up, my breathing then becomes difficult. I know the kinds of foods that make me worse.
Jane has had asthma for many years, but only found out via the internet that hormonal changes triggered her asthma when she was a teenager.
Jane has had asthma for many years, but only found out via the internet that hormonal changes triggered her asthma when she was a teenager.
And I went to the doctor and they all agreed it was something it was called catamenia asthma and he was really quite distraught that he hadn’t thought of it himself. He said he’d never heard of it. And apparently it’s quite common. More commonly known in America than it is here but the consultant I’ve got here is really very good and he referred me to a gynaecologist who said, “Well the only thing they can do is give you a hysterectomy, and probably it’s not worth it yet, you know, now because of your age.” So I thought well when, when I stop, when I stop having my periods it’ll get a lot better and it did, but it didn’t go away altogether and apparently because your hormones never go away, but it’s a lot, lot better.
Jenny has severe brittle asthma and has many different triggers for her asthma. Sometimes people are surprised that she can have a pet dog.
Jenny has severe brittle asthma and has many different triggers for her asthma. Sometimes people are surprised that she can have a pet dog.
So, my grandmother had popped down to the shop and I was hunting round her house trying to find the bleach ‘where is it?’
And it was in the – in her en-suite and, you know, so I had to flush the loo and get rid of it and then I was fine. But you’d have thought I was mad for a minute, going round the house sniffing, ‘where’s the bleach?’ But I was getting tighter and tighter and I knew that if I could get rid of the bleach, use my inhaler, I’d be fine but if I left it there, I’d have just got worse and worse and could have ended up in hospital.
Belinda says it’s important to recognise that different things are triggers for different people. [AUDIO ONLY]
Belinda says it’s important to recognise that different things are triggers for different people. [AUDIO ONLY]
He was stressed…
…Yes.
Yeah.
It wasn’t the dog at all.
Tim is allergic to some cats, but not all. ‘For a while I tried to avoid cats and staying in people’s houses who have cats but strangely enough they don’t always affect me’.
Tim is allergic to some cats, but not all. ‘For a while I tried to avoid cats and staying in people’s houses who have cats but strangely enough they don’t always affect me’.
I was tested actually for it, cats and house dust. But then I don’t like cats much, so they couldn’t find an allergy to dogs, because I like dogs. So I don’t know really how widely it is. I’m sure pollen is also a factor because at certain times of year; presumably cats and house dust are there all the time. So, it must be pollen too.
Are you able to avoid the triggers, the things that set your asthma off? Is that something that you try to do or…?
I try, well for a while I tried to avoid cats [laughs] and staying in people’s houses who have cats but strangely enough they don’t always affect me. We spent some weeks living in a neighbour’s house just across the road here while we were having these extensions done, and they have two cats with whom I got on extremely well and they thought I was God’s gift, and they, as far as I know never affected me at all. Whereas other people’s places I can’t go in. There’s a place I visit regularly every, a friend’s house, I visit for a meeting every few months, and his place never fails to set me off, and they’ve got half a dozen long haired cats. So some do, some don’t.
(Also see ‘Asthma in the workplace’, ‘Exercise, diet, weight and other lifestyle issues’, ‘Managing asthma – reviews and action plans’ and ‘Finding information about asthma’).
Last reviewed August 2017.
Last updated August 2017.
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