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An Asthma Story
It's 6 PM and you've just returned home from a hard day at work. Nevertheless, several chores remain before you can relax. You go down to the damp basement to get the laundry from the laundry room. While sorting the clothes, you notice you have a slight wheeze. You think, "I'd better take a few puffs of my albuterol inhaler before things get out of control." After experiencing quick relief, you climb back upstairs to start dinner for your family.

After dinner, your husband lights up a cigar, causing you to start coughing and wheezing again. After a few more puffs from the inhaler, you leave the dinner table and tell your husband to put out his cigar. Then it's time to feed the dog and take him for a walk. During the walk, your asthma kicks in again and you are forced to again use your albuterol inhaler. This time the inhaler only provides partial relief. Nevertheless, by 10 PM your symptoms have returned to normal and you head for the bedroom.

You walk into the bedroom and notice that your cat is curled up on your pillow. After chasing her away, your eyes start to water and the wheezing returns. You change your sheets and pillowcases and throw them on your carpeted floor, but it's too late. You are now in the throes of a severe asthma attack. You take a few last puffs from your albuterol inhaler and call 911.

Asthma Triggers
Unfortunately, the person described in this example does not have a good understanding of her asthma and the triggers that can cause asthma attacks. Triggers from the environment include things you are allergic to (animal fur, molds), irritants (perfume, smoke) or physical changes (cold air, exercise), all of which may precipitate an asthma attack. Recognizing your triggers and taking steps to avoid them can help you control your asthma and reduce the need for medication.

Identify Your Triggers
Answer the following questions to help identify what triggers your asthma attacks:

• Is your asthma worse in certain seasons, especially when associated with nasal congestion and sneezing? (seasonal outdoor pollens and molds).
• Is your asthma worse (wheezing or itchy eyes) when you are around pets? (animal fur or dander [see below]).
• Does your asthma get better when you go away on vacation? (indoor allergens [see below]).
• Do your symptoms get worse when vacuuming or changing the bedding? (dust mites).
• Do your symptoms get worse in the bathroom or basement? (indoor mold).
• Do your symptoms worsen at work and improve when away from work? (occupational asthma).
• Do your symptoms get worse after exposure to cold air or exercise? (physical triggers).
• Do your symptoms get worse after exposure to smoke or perfume? (irritants).
• Does your asthma get worse when you develop a cold or bronchitis? (infection).

Get Tested
Once you have determined your possible triggers for asthma attacks, its time to talk to your doctor. He or she can do confirmatory tests to determine your level of allergy to common indoor and outdoor allergens (a substance that a person is allergic to). This may involve 'skin prick' tests, where small amounts of the offending allergen are injected under the skin, and the response on the skin is measured. Alternatively, a blood test (called a RAST survey) may be used.

Trigger Solutions
Now it's time to put this knowledge into action. The following recommendations may or may not apply to you, depending on your individual trigger(s). It is up to you (with the help of your doctor) to take control of your asthma. Although some of the advice that follows may be impractical, you should prioritize and do as much as you possibly can. You'll be surprised at how your asthma will improve.

House Dust Mites
Dust mites are microscopic insects that feed on human skin. They may be the single most important allergen in the environment. They particularly flourish in the bedroom, where we shed skin on the mattress and pillow during sleep. They also seem to like warm, humid air.

Here are some tips for controlling dust mites:

• Encase your mattress and box spring in a special airtight cover.
• Encase your pillow or wash it once a week.
• Avoid sleeping on upholstered furniture.
• Remove carpets that are laid on concrete.
• Wash your bedding once a week in hot water (130 degrees F).
• Reduce indoor humidity to less than 50%.
• Remove carpets from your bedroom.
• Avoid using a vacuum, or use one with a special bag, wear a special mask, or use a central vacuuming system.

Animal Dander
Animal dander are flakes and other particles from the skin, hair, or feathers of warm-blooded pets including dogs, cats, birds, and mice. There is no such thing as an allergen-free dog or cat. The length of the pet's hair is not important. To control animal dander, it is desirable to:

• Remove the animal from your home.
• If you can't remove the animal, at least keep your pet out of the bedroom.
• Bathe your pet weekly.
• Use a vacuum cleaner fitted with a HEPA filter.

Indoor Molds

• Keep bathrooms and basements well ventilated.
• Clean these areas regularly.
• Avoid humidifiers and use a dehumidifier in damp basements (moisture creates an environment that mold thrives in).

Tobacco Smoke

• Don't smoke and don't allow anyone else to smoke in your home.
• Encourage family members to quit smoking.
• If all else fails, keep smokers out of your bedroom and use an air purifier.

Outdoor Molds

• Stay indoors during midday when pollen counts are high.
• Keep the windows closed and use air conditioning.
• Avoid wet leaves and garden debris.

Infections

• Avoid people with a cold or the flu.
• Talk to your doctor about a flu vaccine.

Cold Weather and Exercise

• Wear a scarf over your mouth and nose in cold weather.
• Develop a medication plan with your physician that helps you exercise without developing asthma symptoms.

Cockroaches: Cockroaches are only a problem in certain cities and climates. Cockroach droppings and body parts can irritate asthma sufferers. Clean up spills immediately and take the garbage out regularly. Do not leave food out uncovered, store food in cabinets and counters in airtight containers. Remove empty boxes and newspapers. Use poison baits and traps instead of chemicals and sprays for pest control.

Chemicals: Avoid contact with perfumed products and chemical inhalants.

Summary
These simple control measures can go a long way in preventing a scenario like the one at the beginning of this discussion. The quicker you start implementing some of these measures, the quicker you can bring your asthma under control. Good luck!