A written self-management or action plan is useful for asthma patients. The physician prepares the plan detailing the adjustments to patients' medications based on their asthma symptoms and peak flow meter readings. This plan can assist greatly in knowing what to do during an acute increase in symptoms (an acute exacerbation). If there is any doubt about what to do during an acute asthma exacerbation, one should contact the physician. An acute exacerbation can occur over seconds or several days. It can be either mild or life threatening.
The following are risk factors that can lead to death from acute exacerbation of asthma. (It is important to know that absence of these does not exclude the risk of developing a severe exacerbation.)
- history of sudden severe exacerbations
- prior intubation for asthma
- prior admission to an intensive care unit for asthma
- 2 or more hospitalizations for asthma in the past year
- 3 or more emergency care visits for asthma in the past year
- hospitalization or an emergency care visit for asthma within the past month
- use of more than 2 canisters per month of an inhaled short-acting beta2-agonist
- current use of or recent withdrawal from systemic corticosteroids
- difficulty perceiving airflow obstruction or its severity
- comorbidity, such as cardiovascular disease or chronic obstructive pulmonary disease
- low socioeconomic status and urban residence
- illicit drug use
- sensitivity to alternaria
Control of Environmental Factors
An important part of asthma control therapy is the control of contributing environmental factors. Common asthma triggers found in the environment include dust mites, pets, molds, and medications. It often is helpful for the asthma patient to undergo allergy testing for these and other agents before extensive allergen avoidance is prescribed.
The feces (droppings) of dust mites are the most common indoor allergen causing poor asthma control. Dust mites are microscopic organisms that feed on flakes of sloughed-off skin. They exist everywhere. Methods of reducing dust mite exposure in the home include the following:
- Avoiding sleeping or lying on upholstered furniture or on the floor (carpet or rug)
- Desensitization treatment is usually unnecessary, but may be considered
- Dusting and vacuuming frequently
- Encasing mattresses and pillows in an impermeable barrier
- Reducing indoor humidity to less than 50%
- Removing carpets from the bedroom
- Removing carpets covering concrete floors
- Removing stuffed animals from the bedroom
- Using chemical agents to kill mites in rugs and carpeting (Experts do not agree on this.)
- Washing pillowcases and bedding weekly in water above 130° F
Pet dander can be a significant cause of poorly controlled asthma. It is difficult to remove a pet from the house because of strong emotional ties. The minimum effective action is to keep the pet out of the bedroom.
Keep bathrooms clean and dry to reduce molds. Dry freshly laundered clothes promptly. Remove houseplants because molds grow in the soil.
Medications that commonly trigger asthma include aspirin and nonsteroidal anti-inflammatory drugs, and beta blockers, including eye drops for glaucoma.