Asthma Triggers & Their Control

Overview of Asthma in Maine

What is Asthma?

Asthma is a chronic disease that causes swelling and inflammation within the airways as well as increased mucus production and airway constriction. This airway inflammation narrows or reduces the inner diameter of the breathing tubes and makes it difficult to breathe.

There is no cure for asthma. However, asthma can be controlled through a combination of medical treatment and management of environmental triggers.

Who has Asthma in Maine?

Maine has some of the highest rates of asthma in the country:

  • Approximately 10% of Maine adults currently have asthma compared to 7.8% nationally.
  • 10.7% of Maine children have asthma compared to 8.9% nationally.
  • 16.5% of Maine’s non-white population has asthma.
  • New England has the highest rate of adult asthma in the U.S. In 2004, Maine was found to have the highest asthma rate in New England (Asthma Regional Council).
  • Asthma affects about 128,000 people in our state, including 28,000 children. This has a big impact on life in our communities. It is estimated that asthma causes about 65,000 school absences and 37,500 work absences each year in Maine.

(Above data excerpted from: Maine Centers for Disease Control, The Burden of Asthma in Maine, 2008 )

Why does Maine have such high rates?

The exact reason for Maine’s high rates is unknown. However, there may be a number of contributing factors:

  • Maine is geographically located in what is commonly called the “tailpipe” of the United States. Environmental pollutants carried by air patterns lead to high levels of airborne particulate, smog, smoke, and soot.
  • Maine is subject to high levels of summertime ozone.
  • Maine is a densely forested state with high pollen levels.
  • Maine has some of the oldest housing stock in the country.
  • Maine people still rely heavily on burning wood to heat their homes.

Symptoms of Asthma:

People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. Common symptoms of asthma include:

  • Coughing, especially at night
  • Wheezing
  • Shortness of breath
  • Chest tightness, pain, or pressure
  • Feeling tired or weak when exercising
  • Trouble Sleeping

Not every person with asthma has the same symptoms in the same way. Individuals may not have all of these symptoms or may have different symptoms at different times. Asthma symptoms can also vary from one asthma attack to the next, being mild during one asthma attack and severe during another.

What is an Asthma Trigger, and how does managing triggers help asthma?

An asthma trigger is any allergen or irritant that causes a person with asthma to have an asthma attack. Having allergies is NOT the same as having asthma. Asthma triggers vary from person to person. Identifying and attempting to control or eliminate triggers can help reduce asthma symptoms and avoid a potential asthma attack. Individuals with asthma should work with their health care provider to identify their specific triggers and sensitivities. These triggers should be included in a written asthma action plan prepared by you and your doctor. Knowing what your triggers are and how to reduce or remove them in your environment is an effective part of managing asthma.

General Goals for ALL Indoor Environments

Levels of pollutants and irritants can be higher indoors than out of doors. The principles for achieving a healthy and productive indoor environment are simple. The goal is an environment that is:

  • Clean
  • Dry
  • Pollutant and Pest Free
  • Comfortable

The primary best practice methods to achieve these goals are:

  • Prevention or Elimination of Pollutants (source control)
  • Proper Ventilation
  • Thermal and Humidity Control
  • Proper operation and maintenance of the structure by the building owner
  • Proper use of the structure by the building occupants

Adherence to these basic principles will significantly reduce the risk of adverse health effects from indoor pollutants, both for individuals with asthma as well as the general population.

The information that follows identifies some common allergens and irritants (triggers) that may be found in the indoor environment. It also identifies specific strategies for reducing and/or removing them with the goal of minimizing their impact on asthma. These triggers can be found in homes, schools and workplaces.

The Most Common Allergens & Irritants Found in Indoor Environments and How to Control Them:

  1. Dust mites

Dust mites are microscopic and found in household dust. They thrive in fabrics of any kind such as carpets, mattresses, pillow, upholstered furniture, bedding, and stuffed animals. Allergy to dust mites may cause persistent symptoms because of the inability to eliminate dust entirely from homes, work places, and school.

First line measures:

  • Cover mattresses, box springs, and pillows with allergen-proof, zippered covers.
  • Wash all bedding at least once a week in hot water.
  • Remove stuffed animals.
  • Remove upholstered furniture and fabric-covered items from bedroom.
  • Vacuum at least once a week with a good quality vacuum.
  • Improve ventilation.
  • Stop using humidifiers.
  • Place filters over heating vents.

Second line measures:

  • Remove carpets, particularly in bedrooms and basements.
  • Dehumidify if damp.
  • Add air cleaners. (Do not use an ozone-generating unit. See MIAQC fact sheet on Portable Air Cleaners.)
  1. Animal allergens: cats, dogs, guinea pigs, mice, rabbits, birds

Animals produce strong allergens (found in their skin flakes and saliva) that can remain in carpets and furnishings. There are no true hypo-allergenic dogs or cats. About 6% of the population is allergic to cat dander. Allergists recommend removing furred or feathered animals from the home for those who are allergic.

First line measure:

  • Remove pets from the home (and school) if possible.
  • Keep pets out of bedrooms.
  • Restrict pets to non-carpeted areas.
  • Remove carpeting and upholstered furniture, especially in bedrooms.
  • Keep bedroom doors shut.
  • Provide good ventilation.
  • Use an air cleaner. (Do not use an ozone-generating unit. See MIAQC fact sheet on Portable Air Cleaners.)
  • Wash pet regularly.
  • Allergic persons should avoid certain activities such as grooming and brushing pets.
  1. Molds

Molds and fungi are naturally occurring organisms that can be found everywhere, both indoors and out. Humans do not live in a mold-free environment, nor would we want to. Molds are a necessary part of our natural environment.

Problems occur, however, when conditions indoors allow for mold growth. The primary culprit for mold growth is excess moisture. No excess moisture = no mold growth. Maintain your home or building to prevent excess moisture and properly fix moisture problems when they do occur. Proper moisture management not only minimizes impact of mold on those with asthma, it also prevents long-term structural damage in the building.

For more information about mold (what it is, how it grows, recommendations for remediation): see MIAQC Fact Sheet on Mold.

Common indoor sources for molds are basements, bathrooms, kitchens, food storage units, old foam in furniture or pillows, houseplants, and poorly maintained humidifiers, vaporizers and air conditioners. Outdoor sources are soil, fallen leaves, moist debris, and damp surfaces.

Indoor first line measures:

  • Maintain a relative humidity between 30-50%.
  • Use kitchen and bath fans.
  • Fix all leaks promptly (roof, plumbing, etc.) to prevent mold growth.
  • Clean humidifiers, air conditioners, and vaporizers frequently.
  • Remove localized sources: houseplants (dried flowers and Christmas trees may carry mold as well), foam pillows, carpets in bathrooms, kitchens, and basements.
  • Clean surface mold on walls or windows. Bleach is generally not recommended.

Outdoor first line measures:

  • Avoid or limit activities such as cutting grass and raking leaves which disperse molds.
  • Avoid farm plowing and barns containing hay.
  • Wear a mask outdoors if needed.
  • Install and maintain proper drainage (gutters, downspouts, subsurface drainage) around the building perimeter so that water flows down, out and away from the building.
  • Keep fallen leaves and compost a good distance away or remove from the property.
  • Clean leaves out of gutters.
  1. Tobacco Smoke

Tobacco smoke comes from the burning end of a cigarette, cigar or pipe as well as the exhaled smoke from smokers themselves (exhaled smoke is also often referred to as secondhand smoke or environmental tobacco smoke). Tobacco smoke can trigger asthma and increase the severity of attacks. Tobacco smoke contains more than 4,000 substances, including several compounds that are known to cause cancer.

First Line Measures:

  1. Cockroaches (and other pests)

Cockroaches are widely dispersed around the world. In the U.S. they are most common in urban areas and most prevalent in the south. The source of cockroach allergen seems to be in the body parts, feces or cockroach secretions. Cockroach allergy is a major trigger for asthma and may also contribute to hay fever (rhinitis).

First line measures:

  • Aggressive extermination.
  • Thoroughly clean after extermination to rid the building of dead roaches and their debris.
  • Block openings into building to prevent roaches and other pests from entering the building.
  • Place foods in airtight containers.
  • Restrict meals and snacks to one or two areas of the home.
  • Clean the kitchen (dishes, open foods…) soon after food preparation is completed.
  • Keep trash in tightly covered containers.
  • Do not leave pet foods out.
  • Eliminate free water sources that attract roaches and other pests. Examples: leaky pipes and faucets (roaches like moist places.)

6. Pollens

Pollens are released by plants to as part of their natural reproductive cycle. Allergies to pollen from Maine trees, grasses, weeds and other plants is seasonal. (This differs from allergies due to dust mites or mold which can continue year-round.) It is difficult to control how, when, or where pollens move outdoors, so people with pollen allergies should try to reduce the amount of pollen that gets indoors, so that the indoor environment can become a safe haven during times of heavy outdoor pollen.

Different pollens peak at different times in the U.S.

Below is the general time frame for peak pollen in the Northeast:

  • Trees: from April through the first of June.
  • Grasses: from early May through the end of July.
  • Weeds: from mid-August through mid-October.

First line measures:

  • Keep windows and doors shut at all times. (Pollens come in with air!)
  • Use air conditioners to cool the air and also filter out pollens. (The same advice applies to your car; keep windows rolled up and the air conditioner on.)
  • If you have severe allergies, wear a dust mask outdoors for protection when the pollen is high.
  • Know your pollens: some pollens peak at mid-morning and others in the afternoon.
  • Do not dry clothes outside where pollen can stick to them.
  • Shower in the evening to reduce pollens on hair and body and to reduce night-time allergy symptoms.
  • Stay inside on dry windy days when pollen is high.
  • Wearing sunglasses may reduce pollen contact to eyes.
  1. Irritants and VOCs (volatile organic compounds)

All the irritants listed below may produce physical side effects. Many of the listed items may increase asthma symptoms. It is recommended that people with asthma avoid or reduce exposure to the following:

  • Tobacco smoke.
  • Combustion Pollutants from oil or gas burning appliances.
  • Smoke from wood stoves.
  • Personal scents (scented perfume, deodorant, powders).
  • Smoke or soot from burning candles, oil lamps and incense.
  • Dust and particulates from lumber and building materials.
  • Smoke from burning wood or leaves.

VOC Sources: Avoid exposure to household products including paints, paint strippers and other solvents; wood preservatives; aerosol sprays; cleansers and disinfectants; moth repellents and air fresheners; stored fuels and automotive products; hobby supplies; dry-cleaned clothing.

Health Effects of VOC Exposure: Eye, nose, and throat irritation; headaches, loss of coordination, nausea; damage to liver, kidney, and central nervous system. Some VOCs can cause cancer in animals; some are suspected or known to cause cancer in humans.

Levels in Homes: Studies have found that levels of several VOCs average 2 to 5 times higher indoors than outdoors. During and for several hours immediately after certain activities, such as paint stripping, levels may be 1,000 times background outdoor levels.

Steps to Reduce Exposure:

  • Use household products according to manufacturer’s directions.
  • Make sure you provide plenty of fresh air when using these products.
  • Throw away unused or little-used containers safely; buy in quantities that you will use soon.
  • Keep out of reach of children and pets.
  • Never mix household care products unless directed on the label.
  • Seek out alternative products with fewer VOCs.

VOCs are widely used as ingredients in household products. Paints, varnishes, and wax all contain VOCs as solvents, as do many cleaning, disinfecting, cosmetic, degreasing, and hobby products. Fuels are also made up of VOCs All of these products can release volatile organic compounds while you are using them, and, to some degree, when they are stored.

  1. Outdoor air as an indoor pollutant

The quality of the outdoor air can increase asthma symptoms. High levels of ozone and fine airborne particles are of particular concern in Maine. Homes and other buildings can draw in outdoor pollutants through heating and ventilation systems, open windows, and minor air pathways in the building.

First line measures:

  • Monitor daily air quality forecasts. (The Maine Department of Environmental Protection publishes daily forecasts.)
  • Stay indoors when air quality index is high.
  • Keep windows and doors shut as much as possible during times of the day when outdoor pollutants peak (such as the afternoon and evening.)
  • Do not dry clothes outside where pollens and other fine particles can stick to them.
  • Shower in the evening to reduce outdoor contaminants on your hair and body and minimize nighttime exposure.
  1. Work-Related Triggers

There are many substances found in workplaces that can trigger asthma or increase the severity of asthma attacks. These substances include chemicals, animals, plant matter, and particles, and are too numerous to be listed in this fact sheet. If you suspect that your workplace environment is affecting your asthma or your overall health, visit the Work-Related Asthma Q & A page found on the Maine Asthma Prevention & Control website. You should further consult with your regular physician to determine a particular asthma management plan that works best for you.

Web Resources

Maine Asthma Prevention & Control Program

The Maine Asthma Control & Prevention Program website contains extensive information about asthma, asthma management, and asthma prevention. The site contains links to:

  • Data and reports on asthma prevalence, hospitalizations, and the impact/burden of asthma in Maine
  • Sample Action Management Plans
  • Basic Fact Sheets
  • Information and links to programs for asthma management in homes, schools and workplaces
  • Links to regional partners

U.S. Environmental Protection Agency

The U.S. EPA has an extensive website containing both basic information about asthma in a variety of languages, as well as links to extensive research on asthma and asthma management and prevention.

Asthma Regional Council of New England

In addition to links to basic information about asthma in New England and around the country, this site contains information on design, construction and maintenance of asthma-healthy homes and schools, as well as regional policy supporting healthy communities.

Smoke-Free Housing Coalition

Has smoke-free pledge forms as well as a smoke-free housing registry for renters looking for smoke-free rental properties.