Asthma causes chronic inflammation of the airways in the lungs, which is aggravated by asthma triggers that bring on asthma symptoms.

Triggers are substances, weather conditions, or activities that are harmless to most people, but can lead to coughing, wheezing, and shortness of breath in those with asthma. They don't cause asthma, but they can lead to asthma symptoms and flare-ups.

Triggers vary from person to person. They're sometimes seasonal and may even stop affecting kids with asthma as they grow older.

Common asthma triggers include:

• allergens
• irritants and pollutants in the air
• respiratory infections, like colds or flu
• weather conditions
• exercise
• gastroesophageal reflux disease (GERD)

Triggers and Asthma Management

Asthma can't be cured, but it can be managed. The goal of asthma management is to reduce symptoms on a day-to-day basis and to maintain normal activity levels, including the ability to exercise and participate in sports.

One way to do this is by minimizing exposure to triggers. If exposure isn't controlled, triggers can cause severe flare-ups, chronic symptoms between flare-ups, and even reduced lung function.

Because triggers are different for each person, you'll need to work with your doctor to determine your child's specific triggers. The doctor may suggest that you keep an asthma symptoms/trigger diary, using symptoms, peak flow meter readings, and a record of circumstances during which symptoms occurred to help you identify possible triggers. Once triggers are identified, they can be included in the overall asthma action plan you develop with the doctor.

Your child may also need allergy skin testing if the doctor suspects that allergens are triggers. Some kids may need to take allergy medication or have allergy shots. Your doctor will determine if this is necessary.

Allergens and Irritants

Allergens, one of the most common asthma triggers, include:

• mold
• dust mites
• cockroaches
• pollen
• animal dander (tiny flakes of dead skin), saliva, or urine
• feathers

It isn't possible to avoid all allergens, but you can help minimize them in your home. Focus on the rooms where your child sleeps and plays:

• Keep these areas as clean and dust free as possible. This means vacuuming and dusting weekly, eliminating clutter, getting rid of unnecessary stuffed animals, and routinely washing other stuffed animals in hot water.
• Wash sheets weekly in hot water, and get rid of feather pillows and comforters.
• Purchase hypoallergenic covers for the mattress, box spring, and pillows.
• Eliminate rugs and carpeting whenever possible.
• Clean curtains (which should be washable) often.
• Make sure damp areas like bathrooms, basements, and laundry rooms are cleaned often and properly ventilated so that mold and mildew don't form.
• Avoid using humidifiers, and use dehumidifiers in damp parts of your house.
• Check your local mold and pollen count readings and plan indoor activities for windy days, which can lead to high counts.
• Use bait traps or professional extermination to rid your home of cockroaches, and keep your kitchen clean and your house free of stacks of paper.

Irritants are different from allergens. People who don't have allergies or asthma can be affected by irritants, though they're not usually a serious problem. But for kids with asthma, irritants can lead to airway inflammation and flare-ups.

Common irritants include:

• perfumes
• aerosol sprays
• cleaning products
• wood and tobacco smoke
• paint or gas fumes
• air pollution

Even things that may seem harmless, like scented candles or fresh newsprint, are triggers for some kids. Here are some ways to reduce household irritants:

• If you notice that a household product triggers your child's asthma, switch to an unscented or nonaerosol version of it.
• Don't have wood fires in your home.
• Keep your child away from areas where painting or carpentry work is being done.
• If you cook on a gas stove, make sure your kitchen is well ventilated — to the outside, if possible.
• Forbid smoking in your home and car, and make sure your child avoids smoky environments like restaurants and parties.

Weather and External Factors

If outdoor air pollution is a problem, you might want to purchase an air cleaner for your home or run the air conditioning year-round (clean the filter regularly). Also check air quality reports. On days when the quality is especially bad, keep your child indoors with the air conditioning on.

Respiratory infections, such as colds or the flu, are harder to avoid. In fact, viral respiratory infections are among the most common childhood illnesses and may cause breathing problems even in kids who don't have asthma. They usually last several days and cause airway swelling and mucus production. In kids with asthma, breathing problems triggered by colds can last days or even weeks after the cold has gone away.

Teach your child the importance of hand washing, and ask your doctor about an annual flu shot. Health experts now recommend that everyone 6 months of age and older get vaccinated against influenza. This is especially important in people with asthma, who are at greater risk for serious complications if they get the flu. Because respiratory illnesses are an inevitable part of childhood, be sure that your doctor specifies what to do if your child gets a cold or the flu (this information should be in the asthma action plan).

Weather conditions can also play a role, depending on where you live. Windy conditions may stir up pollens and molds. Rain can wash pollen from the air, decreasing the pollen count right after a rainfall. Yet lots of rain can stimulate the trees and grasses to produce more pollen later on in the season.

Extremes of cold or heat can also trigger asthma and so can humidity or very dry air. If you know that certain weather conditions aggravate your child's asthma, keep an eye on the forecast and limit his or her time outdoors on problem days. If cold weather is the trigger, cover your child's nose and mouth with a scarf.

If hot, humid weather triggers symptoms, keep your child in an air-conditioned environment. Guidance for handling weather-related triggers should also be included in the asthma action plan. This may include increasing the dosage of your child's medications.

Exercise

Exercise may be the only trigger for some kids with asthma. Along with allergens, this is one of the more common triggers. In fact, 80%-90% of people with asthma develop symptoms when they exercise. It can be a particular problem in someone whose asthma isn't well managed. But this is one trigger that your child should not avoid because exercise is important for overall health.

Instead of discouraging strenuous play or sports, talk with your doctor about what your child should do before, during, and after exercise. This may include taking medicine prior to working out or playing a sport.

Gastroesophageal reflux (GERD) is when the contents of the stomach flow backward into the esophagus. Some kids also inhale these contents into the lungs, where they can make inflamed airways even more swollen. GERD treatment can lead to improvement in asthma symptoms in these kids.

Your child won't be able to avoid all triggers all the time, and it's unrealistic to expect to do so. But minimizing exposure helps keep asthma symptoms under control.

Just because a child has asthma doesn't mean he or she shouldn't travel, play sports, go to parties, or do any of the things that other kids do. Taking sensible precautions, like following the asthma action plan, carrying rescue medication, and taking allergy medicines before visiting friends with pets can help kids with asthma do everything they enjoy.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: October 2010